Giorgio Baldereschi

Azienda Ospedaliero Universitaria Careggi, Firenzuola, Tuscany, Italy

Are you Giorgio Baldereschi?

Claim your profile

Publications (29)138.25 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims: To compare the effects of two thrombus aspiration devices, the manual catheter Export® and the more complex and expensive mechanical Angiojet®, on several indices of reperfusion in acute ST-elevation myocardial infarction (STEMI). Methods and results: Clinical, hemodynamic and procedural characteristics of 185 STEMI patients, randomized to treatment with Export (n=95) or Angiojet (n=90) during primary percutaneous coronary intervention (PPCI) were analyzed. The primary endpoint was ST-segment elevation reduction 90min after culprit vessel re-opening. Secondary endpoints included variations in some angiographic parameters (TIMI Flow, TIMI Frame Count and Myocardial Blush Grade) and Infarct Size and Severity at myocardial scintigraphy. A significant reduction in ST-elevation was observed in both groups after PPCI without significant differences between the two groups. No significant difference between Angiojet vs. Export was observed in ST-segment resolution >50% and ≥70%, in TIMI Flow, TIMI Frame Count and Myocardial Blush Grade before vs. after PPCI and in Infarct Size and Severity. Conclusions: PPCI with thrombus aspiration was effective in both groups of patients, without differences in myocardial reperfusion and necrosis indices. These results could support the routine use of manual devices during PPCI, reserving the more expensive Angiojet in case of manual device failure and persistent or massive intracoronary thrombosis, with favorable implications in terms of cost containment.
    No preview · Article · Mar 2015 · International Journal of Cardiology

  • No preview · Article · Feb 2015 · Journal of the American College of Cardiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The effect : of thrombus aspiration on mortality is still controversial, with results which are often inconsistent in different randomized trials, real world registries and different follow-up duration. AIM: : The aim of this analysis was to assess the effect on 30-day and 1-year mortality of thrombus aspiration during primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) compared with conventional PCI. Methods: We used data from all the consecutive STEMI patients treated either with conventional PCI or thrombus aspiration between January 1, 2004 and January 1, 2012. Propensity matching score was calculated on the basis of several baseline and procedural characteristics in order to predict the probability for each patient of having been treated with thrombus aspiration. This propensity score analysis was used in order to select a cohort of patients treated with thrombus aspiration matched one-to-one with patients treated with conventional PCI. Results: In total 744 (53.1%) patients out of the 1400 enrolled were treated with thrombus aspiration. In the matched cohort at 30-day follow-up 6.3% of patients in the conventional PCI group had died compared to 4.7% in the thrombus aspiration group. The unadjusted hazard ratio for 30-day mortality was 1.01 (95% CI 0.33-3.14, p=0.985). In the same cohort 10.7% of patients had died at 1-year in the conventional PCI group compared to 5.2% in the thrombus aspiration group. The 1-year unadjusted hazard ratio for mortality was 0.47 (95% CI 0.25-0.90, p=0.025). The hazard ratio changed and was no longer significant after adjustment for differences in the use of glycoprotein IIb/IIIa inhibitors, lesion pre-dilatation and pre-procedural TIMI flow: 0.71 (95% CI 0.36-1.39, p=0.322). Conclusions: Thrombus aspiration does not influence 30-day mortality while is associated with 1-year survival benefit. Glycoprotein IIb/IIIa inhibitors and thrombus aspiration may have an important synergistic role in leading to this long-term benefit.
    Full-text · Article · Sep 2014 · Cardiology journal
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although several studies reported that drug-eluting stents (DES) are able to reduce restenosis incidence without increasing mortality, concerns still exist about their safety in ST-segment elevation myocardial infarction (STEMI) patients mainly for a possible higher rate of in-stent thrombosis. Recent evidence suggests a better safety profile of second-generation DES, but data on their outcome in STEMI are still poor. In this study we evaluated the impact on mortality and target lesion revascularization (TLR) of DES or bare metal stent (BMS) implantation in STEMI patients submitted to primary angioplasty. We analyzed mortality and TLR in 1150 STEMI patients during a mean 43-month follow-up after DES (44.6%) or BMS (55.4%) implantation. A propensity score method was used to minimize bias. During follow-up, 223 deaths occurred. Unadjusted for potential confounders, DES implantation was associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.40; 95%CI 0.30-0.54] and TLR (HR 0.55; 95%CI 0.36-0.86); this latter was confirmed after propensity score analysis (HR 0.39; 95%CI 0.21-0.67). Second- (n=179) vs. first- (n=337) generation DES showed a further reduction in TLR (HR 0.17; 95%CI 0.05-0.57). Adjusted analyses showed a significant reduction in the combined end-point of all-cause mortality or TLR after both first- and second-generation DES vs. BMS implantation with a trend to a lower risk for second- vs. first-generation DES. DES implantation in STEMI patients showed a significant reduction in TLR and in the combined endpoint of TLR or mortality. Second-generation DES showed a more protective effect on the combined endpoint, suggesting that they would be preferred in this setting.
    Full-text · Article · Dec 2013 · Journal of Cardiology
  • Source

    Preview · Article · Oct 2013 · Journal of the American College of Cardiology
  • Source
    E. Beccastrini · G. Baldereschi · M. M. D’Elios · L. Emmi
    [Show abstract] [Hide abstract]
    ABSTRACT: A large number of diseases can mimic a vasculitis. The diagnosis can be challenging due to the similarity with several diseases that have a different pathogenesis. As reported in the literature, incontinentia pigmenti (IP), a rare genetic disorder, can present vascular alterations on eye, brain and lung. We report a case of peripheral arterial disease in a patient with IP, suggesting further vascular localizations of the disease.
    Preview · Article · Aug 2013 · Autoimmunity Highlights
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Few studies are available on the hemody- namic changes acutely determined by Primary Per- cutaneous Coronary Intervention (PCI) in ST-Eleva- tion Myocardial Infarction (STEMI) patients, proba- bly for the difficult evaluation of hemodynamic vari- ables in this acute setting. Therefore, the paper is to evaluate the variations of several hemodynamic pa-rameters determined by PCI using PRAM (Pressure Recording Analytical Method), minimally invasive hemodynamic monitoring. Methods: We analyzed in 20 STEMI patients submitted to PCI several hemody- namic variables, assessed with PRAM from radial/ femoral artery, 3-minute before PCI and at endpro- cedure. Variables measures were: systolic, diastolic, dicrotic and mean arterial pressures; heart rate (HR); stroke volume (SV); systemic vascular resistance (SVR); dP/dtmax; cardiac cycle efficiency (CCE). Re- sults: In our patients HR, SVR and dP/dtmax de- creased significantly (85 ± 6.3 to 77 ± 4.5, p = 0.002; 1738 ± 241 to 1450 ± 253, p = 0.022; 1.22 ± 0.11 to 1.11 ± 0.12, p = 0.007, respectively) while CCE and SV increased significantly (−0.25 ± 0.23 to −0.01 ± 0.12, p < 0.001; 53 ± 8.4 to 65 ± 11.2, p < 0.001, respectively). Conclusions: Hemodynamic monitoring with PRAM seems feasible during primary PCI and can provide further notions regarding the acute effects deter-mined on cardiovascular system by the culprit artery revascularization. The most significant hemodynamic changes acutely observed in our study should be mainly ascribed to the reduction in sympathetic ac- tivity after PCI with a rapid improvement of the car- diovascular system efficiency.
    Full-text · Article · May 2013 · World Journal of Cardiovascular Diseases
  • Source

    Full-text · Article · Apr 2013 · International journal of cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stent thrombosis (ST) is a new, rare, cause of STEMI. Few data are available about incidence and clinical impact of shock complicating acute myocardial infarction due to ST (st-STEMI). From January 2004 to March 2007, 92 st-STEMI patients were observed: 14 (15.2%) of them presented with cardiogenic shock and were evaluated in the present analysis. In particular, clinical and angiographic characteristics of survivors and non-survivors to PCI were compared. St-STEMI was related to left main or multivessels stent thrombosis in 35.7% of cases; whereas in 93% of cases st-STEMI occurred in a territory with previous myocardial infarction. All patients underwent IABP implantation immediately before coronary angiography, whereas Impella LP 2.5 pump was used in 21% of cases when persistent cardiac low-output signs were recorded. PCI was successful in 80% of cases. In-hospital survival was 28.6%. Death occurred within the first 48 h in the majority of patients. At six-months all patients survived to the acute phase were alive. Survivors had significantly lower thrombus grade after wire passage (p=0.03) and, albeit not significant, they showed a higher rate of very late ST, longer times from symptoms onset to revascularization, and higher TIMI flow grade either before and after PCI. The incidence of cardiogenic shock in st-STEMI is high, particulary it seems to be two times higher than the rate reported during myocardial infarction. One third of cases is related to left main or multiple vessels ST. Shock in st-STEMI represents a dramatic event with very low in-hospital and early survival.
    No preview · Article · May 2011 · International journal of cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: We compared left ventricular (LV) remodeling following a first time acute anterior ST-elevation myocardial infarction (aSTEMI) treated with primary coronary intervention (pPCI) in different age groups. A total of 116 patients, 61 aged <65 and 55 aged >or=65 years, who survived after a recent aSTEMI treated with pPCI, underwent dobutamine stress-echocardiography (DSE) and non-invasive measurement of left anterior descending coronary artery flow reserve (CFR) during intravenous adenosine infusion. Baseline LV dimensions and systolic function were similar between the two groups; wall motion score indices during all DSE stages and CFR were also similar. In both groups, the LV ejection fraction was positively affected by the presence of viability in the necrosis area and by a higher CFR, but negatively influenced by viability in a remote area, an indirect sign of an extensive infarction size. This study demonstrates that PCI in the geriatric population with aSTEMI is as equally effective as in younger subjects, in terms of LV remodeling and function.
    No preview · Article · Aug 2010 · Internal and Emergency Medicine
  • Francesco Cappelli · Simone Vignini · Giorgio Jacopo Baldereschi
    [Show abstract] [Hide abstract]
    ABSTRACT: Percutaneous placement of an inferior vena cava (IVC) filter is indicated in patients affected by pulmonary embolism or proximal deep venous thrombosis when anticoagulation therapy is contraindicated or there is evidence of thromboembolic recurrence during anticoagulation. Several complications have been reported using IVC filters. Migration is a rare but known and potentially lethal complication of IVC filter placement. In this patient, an ALN IVC filter (ALN Implants Chirurgicaux Ghisonaccia, France) proximal migration occurred from the inferior cava vein to a zone just below the right atrium; it was associated with a complete 180 degrees rotation, and we describe here the procedure employed to successfully remove this filter.
    No preview · Article · Aug 2010 · The Journal of invasive cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: One of the major predictors of late stent malapposition (LSM) is primary stenting in acute myocardial infarction. However, mechanisms of LSM are still under debate. Patients with ST-elevation myocardial infarction (STEMI) and enrolled in the SELECTION trial (38 patients in the paclitaxel-eluting stent, PES, and 35 in the bare metal stent, BMS, cohort) were retrospectively analyzed to evaluate LSM, by means of intravascular ultrasound (IVUS) data recorded at the index and 7-month follow-up procedures. Stent malapposition was documented in 21 lesions in 21 patients (28.8%): in 8 of these 21 patients (38.1%) it was LSM. Although statistical significance was not reached, LSM was more frequent after PES than BMS implantation (15.8% vs. 5.7%). LSM was mainly located within the body of the stent (62.5% of the cases). At the LSM segment, a significant increase of vessel area (19.2 +/- 3.3 mm(2) vs. 21.9 +/- 5.3 mm(2), P = 0.04) and a reduction of plaque area (12.6 +/- 4.6 mm(2) vs. 9.1 +/- 3.9 mm(2), P = 0.04) were observed at IVUS between the index and follow-up procedure. After primary stenting for STEMI, LSM seems to be more frequent after PES rather than BMS implantation. In the STEMI setting, possible mechanisms leading to LSM include positive remodeling and plaque mass decrease.
    No preview · Article · May 2009 · Journal of Interventional Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to compare the feasibility of dobutamine stress echocardiography (DSE) and exercise stress test (EST) between patients in different age groups and to evaluate their proportional prognostic value in a population with established coronary artery disease (CAD). The study sample included 323 subjects, subdivided in group 1 (G1), comprising 246 patients aged <75 years, and group 2 (G2), with 77 subjects aged >or=75 years. DSE and EST were performed before enrollment in a cardiac rehabilitation program; for prognostic assessment, end points were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction). During DSE, G2 patients showed worse wall motion score index (WMSI), but the test was stopped for complications in a comparable proportion of cases (54 G1 and 19 G2 patients, P = NS). EST was inconclusive in similarly high proportion of patients in both groups (76% in G1 vs. 84% in G2, P = NS); G2 patients reached a significantly lower total workload (6 +/- 1.6 METs in G1 vs. 5 +/- 1.2 METs in G2, P < 0.001). At multivariate analysis, a lower peak exercise capacity (HR 0.566, CI 0.351-0.914, P = 0.020) was associated with higher mortality, while a high-dose WMSI >2 (HR 5.123, CI 1.559-16.833, P = 0.007), viability (HR 3.354, CI 1.162-9.678, P = 0.025), and nonprescription of beta-blockers (HR 0.328, CI 0.114-0.945, P = 0.039) predicted hard cardiac events. In patients with known CAD, EST and DSE maintain a significant prognostic role in terms of peak exercise capacity for EST and of presence of viability and an extensive wall motion abnormalities at peak DSE.
    No preview · Article · Nov 2008 · Echocardiography
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this retrospective study was to compare clinical and angiographic outcomes between patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) and de novo coronary thrombosis. There are limited data for procedural and mid-term outcomes of patients with ST presenting with STEMI. From January 2004 to March 2007, 115 definite ST patients were observed: 92 (80%) of them presented as STEMI and were compared with a consecutive group of 98 patients with de novo STEMI. All patients underwent primary percutaneous coronary intervention. Primary end points were successful angiographic reperfusion and distal embolization. Major adverse cardiovascular and cerebrovascular events (MACCE), evaluated at 6-month follow-up, were defined as death, nonfatal myocardial reinfarction, target vessel revascularization, and cerebrovascular accident. Successful reperfusion rate was lower in patients with ST (p < 0.0001), whereas distal embolization rate was higher (p = 0.01) in comparison with patients with de novo STEMI. Stent thrombosis proved to be an independent predictor of unsuccessful reperfusion at propensity-adjusted binary logistic regression (odds ratio 6.8, p = 0.004). In-hospital MACCE rate was higher in patients with ST (p = 0.003), whereas no differences were observed at 6-month follow-up among hospital survivors between the 2 groups (p = 0.7). Stent thrombosis identifies a subgroup of patients with STEMI with poor angiographic and early clinical outcomes, suggesting that the management of these patients should be improved.
    Preview · Article · Jun 2008 · Journal of the American College of Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Florence Acute Myocardial Infarction registry was a population-based, prospective study aimed at identifying the determinants of coronary reperfusion therapy [CRT, by primary coronary intervention (PCI) in more than 95% of cases] utilization and of prognosis in patients with ST-segment elevation myocardial infarction (STEMI). The registry involved one teaching hospital with, and five district hospitals without PCI facilities. Overall, as many as 45.6% of 930 cases of STEMI did not receive any form of CRT. In multivariable analysis, the direct admission to the teaching hospital was the strongest positive predictor, whereas the time delay, older age, and chronic comorbid conditions were negative predictors of CRT utilization. Compared to conservative therapy, CRT was associated with a remarkably reduced 12-month mortality, after adjusting for age, chronic comorbidities and Killip class, which also were significantly associated with long-term prognosis. The higher crude mortality observed in women was accounted for by older age and other age-related factors. The improvement in prognosis with CRT was larger in older patients and/or in those with a greater burden of chronic comorbidity, who less frequently received CRT. These results suggest the need for interdisciplinary reassessing the adherence to therapeutic guidelines and the criteria adopted in the real clinical world to select patients for CRT during STEMI.
    No preview · Article · May 2008 · Internal and Emergency Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the superiority of the paclitaxel-eluting stent (PES) in reducing neointimal hyperplasia (NIH) over its corresponding bare metal stent (BMS) during primary percutaneous coronary intervention (PCI). Primary PCI with stent implantation is the repercussion strategy of choice for ST-elevation myocardial infarction (STEMI); nonetheless restenosis rate is still high. Drug-eluting stents have been proven to reduce restenosis rate in many settings, but their use during primary PCI is still controversial. Consecutive patients with STEMI <12 hours were randomized to receive PES or BMS. The primary end-point was the percentage of the stent volume obstructed by neointimal proliferation (NIH) measured by intravascular ultrasound (IVUS) at a 7-month angiographic follow-up. Secondary end-points were binary restenosis rate and major adverse cardiac events (MACE, i.e., death, nonfatal myocardial infarction, and target lesion revascularization). Eighty patients with STEMI were randomized into the PES or BMS group. Patients were well matched for baseline characteristics and the index procedure was always successful. In-hospital and 1-month MACE were 2.5% per group. NIH at 7 months was 4.6% versus 20% (P< 0.01), late lumen loss 0.1 versus 1.01 mm (P = 0.01). MACE were 7.5% versus 42.5% (P = 0.001) with no difference in death and recurrent myocardial infarction rates. Late-acquired incomplete stent apposition (ISA) rate was 5.1% versus 2.7% (P = 0.65). One subacute stent thrombosis was reported in each group. PES was superior to its corresponding BMS in reducing NIH in the STEMI setting without any increase in early and long-term clinical adverse events.
    No preview · Article · Aug 2007 · Journal of Interventional Cardiology
  • Source
    F Innocenti · C. Agresti · G.J. Baldereschi · N Marchionni · R Pini

    Full-text · Article · Dec 2006 · European Heart Journal – Cardiovascular Imaging
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Observational studies suggest that open visiting policies are preferred by most patients and visitors in intensive care units (ICUs), but no randomized trial has compared the safety and health outcomes of unrestrictive (UVP) and restrictive (RVP) visiting policies. The aim of this pilot, randomized trial was to compare the complications associated with UVP (single visitor with frequency and duration chosen by patient) and RVP (single visitor for 30 minutes twice a day). Two-month sequences of the 2 visiting policies were randomly alternated for 2 years in a 6-bed ICU, with 226 patients enrolled (RVP/UVP, n=115/111). Environmental microbial contamination, septic and cardiovascular complications, emotional profile, and stress hormones response were systematically assessed. Patients admitted during the randomly scheduled periods of UVP received more frequent (3.2+/-0.2 versus 2.0+/-0.0 visits per day, mean+/-SEM) and longer (2.6+/-0.2 versus 1.0+/-0.0 h/d) visits (P<0.001 for both comparisons). Despite significantly higher environmental microbial contamination during the UVP periods, septic complications were similar in the 2 periods. The risk of cardiocirculatory complications was 2-fold (odds ratio 2.0; 95% CI, 1.1 to 3.5; P=0.03) in the RVP periods, which were also associated with a nonsignificantly higher mortality rate (5.2% versus 1.8%; P=0.28). The UVP was associated with a greater reduction in anxiety score and a significantly lower increase in thyroid stimulating hormone from admission to discharge. Despite greater environmental microbial contamination, liberalizing visiting hours in ICUs does not increase septic complications, whereas it might reduce cardiovascular complications, possibly through reduced anxiety and more favorable hormonal profile.
    Full-text · Article · Feb 2006 · Circulation
  • Source

    Full-text · Article · Jan 2006
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this short review, we examine the most peculiar diagnostic, pathophysiological and therapeutical issues which characterize chronic heart failure (CHF) in older persons. A frequently atypical clinical presentation - possibly leading to underdiagnosis -, together with the uncertainty on the prognostic significance of and the optimal therapeutic approach to diastolic CHF, the impact of somatic and emotional comorbidities, and substantial differences between the characteristics of patients enrolled in clinical trials and those commonly encountered in the clinical practice, are all factors that may contribute to a remarkable undertreatment of CHF in older patients.
    No preview · Article · Feb 2005

Publication Stats

406 Citations
138.25 Total Impact Points

Institutions

  • 2008-2015
    • Azienda Ospedaliero Universitaria Careggi
      • • Department of Heart and Vessels
      • • Department of Cardiology and Geriatric Medicine
      Firenzuola, Tuscany, Italy
  • 2001-2013
    • University of Florence
      • Dipartimento di Chirurgia e Medicina Traslazionale (DCMT)
      Florens, Tuscany, Italy