Author: "Giancarlo, Piovaccari" / Topic: internal medicine - Searchworks@Jio Institute Digital Library Search Results

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1. Impact of the COVID-19 pandemic on coronary invasive procedures at two Italian high-volume referral centers

Author: Luca Fileti, Andrea Rubboli, Sabine Vecchio, Alessandra Reggi, Andrea Santarelli, Matteo Aquilina, Carolina Moretti, Giancarlo Piovaccari, Marco Balducelli, and Daniele Grosseto
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Delayed Diagnosis, Coronavirus disease 2019 (COVID-19), Referral, medicine.medical_treatment, Pneumonia, Viral, Myocardial Infarction, 030204 cardiovascular system & hematology, Time-to-Treatment, Betacoronavirus, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, Pandemic, medicine, Humans, Hospital Mortality, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Pandemics, Cardiac catheterization, Infection Control, SARS-CoV-2, business.industry, COVID-19, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Hospitalization, Outcome and Process Assessment, Health Care, Italy, Cardiology, Female, Coronavirus Infections, Cardiology and Cardiovascular Medicine, Early phase, business
Abstract: Aims The purpose of this study was to verify the impact on the number and characteristics of coronary invasive procedures for acute coronary syndrome (ACS) of two hub centers with cardiac catheterization facilities, during the first month of lockdown following the COVID-19 pandemic. Materials and methods Procedural data of ACS patients admitted between 10 March and 10 April 2020 were compared with those of the same period of 2019. Results We observed a 23.4% reduction in ACS admissions during 2020, with a decrease for both ST-elevation myocardial infarction (STEMI) (-5.6%) and non-ST-elevation myocardial infarction (-34.5%), albeit not statistically significant (P = 0.2). During the first 15 days of the examined periods, the reduction in ACS admissions reached 52.5% (-25% for STEMI and -70.3% for non-ST-elevation myocardial infarction, P = 0.04). Among STEMI patients, the rate of those with a time delay from symptoms onset longer than 180 min was significantly higher during the lockdown period (P = 0.01). Radiograph exposure (P = 0.01) was higher in STEMI patients treated in 2020 with a slightly higher amount of contrast medium (P = 0.1) and number of stents implanted (P = 0.1), whereas the number of treated vessels was reduced (P = 0.03). Percutaneous coronary intervention procedural success and in-hospital mortality were not different between the two groups and in STEMI patients (P NS for all). Conclusion During the early phase, the COVID-19 outbreak was associated with a lower rate of admissions for ACS, with a substantial impact on the time delay presentation of STEMI patients, but apparently without affecting the in-hospital outcomes.
Published: 2020

2. Electrocardiographic features of 431 consecutive, critically ill COVID-19 patients: an insight into the mechanisms of cardiac involvement

Author: Biagio Sassone, Paolo Ortolani, Luca Rossi, Gabriele Guardigli, Michele Malagù, Carlo Alberto Volta, Gianni Casella, Giancarlo Piovaccari, Paolo Cimaglia, Andrea Rubboli, Ottavio Zucchetti, Daniela Aschieri, Alessandro Navazio, Claudio Rapezzi, Francesco Vitali, Matteo Bertini, Alessandro Corzani, Emanuele D'Aniello, Roberto Ferrari, Marcello Galvani, and Gianfranco Tortorici
Subjects: Male, medicine.medical_specialty, Critical Illness, medicine.medical_treatment, Critically ill COVID-19, NO, Critically ill COVID-19, ECG, Right ventricular pressure overload, Electrocardiography, QRS complex, Clinical Research, Physiology (medical), Internal medicine, Troponin I, Humans, Medicine, Repolarization, AcademicSubjects/MED00200, Right ventricular pressure overload, cardiovascular diseases, Myocardial infarction, Pandemics, Aged, Retrospective Studies, Aged, 80 and over, Mechanical ventilation, SARS-CoV-2, ECG, business.industry, COVID-19, Arrhythmias, Cardiac, Atrial fibrillation, Middle Aged, Right bundle branch block, medicine.disease, Respiration, Artificial, Hospitalization, Cross-Sectional Studies, Italy, Ventricular pressure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract: Aims Our aim was to describe the electrocardiographic features of critical COVID-19 patients. Methods and results We carried out a multicentric, cross-sectional, retrospective analysis of 431 consecutive COVID-19 patients hospitalized between 10 March and 14 April 2020 who died or were treated with invasive mechanical ventilation. This project is registered on ClinicalTrials.gov (identifier: NCT04367129). Standard ECG was recorded at hospital admission. ECG was abnormal in 93% of the patients. Atrial fibrillation/flutter was detected in 22% of the patients. ECG signs suggesting acute right ventricular pressure overload (RVPO) were detected in 30% of the patients. In particular, 43 (10%) patients had the S1Q3T3 pattern, 38 (9%) had incomplete right bundle branch block (RBBB), and 49 (11%) had complete RBBB. ECG signs of acute RVPO were not statistically different between patients with (n = 104) or without (n=327) invasive mechanical ventilation during ECG recording (36% vs. 28%, P = 0.10). Non-specific repolarization abnormalities and low QRS voltage in peripheral leads were present in 176 (41%) and 23 (5%), respectively. In four patients showing ST-segment elevation, acute myocardial infarction was confirmed with coronary angiography. No ST-T abnormalities suggestive of acute myocarditis were detected. In the subgroup of 110 patients where high-sensitivity troponin I was available, ECG features were not statistically different when stratified for above or below the 5 times upper reference limit value. Conclusions The ECG is abnormal in almost all critically ill COVID-19 patients and shows a large spectrum of abnormalities, with signs of acute RVPO in 30% of the patients. Rapid and simple identification of these cases with ECG at hospital admission can facilitate classification of the patients and provide pathophysiological insights.
Published: 2020

3. Prevalence Of familial hypercholeSTerolaemia (FH) in Italian Patients with coronary artERy disease: The POSTER study

Author: Federico Ariel Sanchez, Poster Investigators, Furio Colivicchi, Marzia De Biasio, Donata Lucci, Alberico L. Catapano, Fabio Mangiacapra, V. Zampoleri, Maurizio Giuseppe Abrignani, Manuela Casula, Marco Marini, Maurizio Averna, Gianna Fabbri, Aldo P. Maggioni, Giancarlo Piovaccari, Laura Montagna, Claudio Bilato, Michele Massimo Gulizia, Gulizia M.M., Maggioni A.P., Abrignani M.G., Bilato C., Mangiacapra F., Sanchez F.A., Piovaccari G., Montagna L., Marini M., De Biasio M., Averna M., Casula M., Colivicchi F., Fabbri G., Lucci D., Zampoleri V., and Catapano A.L.
Subjects: Male, 0301 basic medicine, Acute coronary syndrome, medicine.medical_specialty, Settore MED/09 - Medicina Interna, Familial hypercholesterolemia, 030204 cardiovascular system & hematology, Coronary revascularization, Coronary artery disease, Hyperlipoproteinemia Type II, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, Risk Factors, Internal medicine, Prevalence, medicine, Humans, Low-density lipoprotein cholesterol, Myocardial infarction, Risk factor, Aged, High prevalence, business.industry, Cholesterol, LDL, Middle Aged, medicine.disease, 030104 developmental biology, Italy, Dutch lipid clinic network, Cardiology and Cardiovascular Medicine, business
Abstract: Background and aims: Familial hypercholesterolaemia (FH) is a powerful risk factor for cardiovascular (CV) events. High levels of low-density lipoprotein cholesterol (LDL-C) since birth are linked to the early onset of atherosclerotic disease. A genetic mutation determining FH is present in about one subject out of 250; FH should be more represented among subjects with a documented diagnosis of coronary artery disease (CAD). The POSTER Study evaluated the prevalence of FH in Italian patients with a recent CAD event. Methods: Eighty-two cardiology centres enrolled patients with a documented CAD event; CV risk profile, drug therapy and biochemical parameters were collected. Dutch Lipid Clinic Network (DLCN) criteria were used to define patients with a potential FH diagnosis (score ≥6); these patients underwent molecular testing for genetic diagnosis of FH. Results: Overall, 5415 patients were enrolled and the main index events were myocardial infarction with ST-elevation, non ST-elevation acute coronary syndrome (ACS), or a recent coronary revascularization (34.8%, 37.2%, and 28% respectively). Mean age was 66 ± 11 years, men were 78%; about 40% were already treated with statins, proportion that increased after the acute event (96.5%). Based on the DLCN score, the prevalence of potential FH was 5.1%, 0.9% of them had a diagnosis of definite FH (score >8). These patients were younger than patients with a score 190 mg/dL. FH was genetically confirmed in 42 subjects (15.9%); genetic diagnosis was defined as not conclusive for FH in 63 patients (23.9%). Finally, in 159 subjects (60.2%) no pathogenic mutations in the tested genes were identified, defining them as negative for monogenic familial hypercholesterolemia. Conclusions: Results underscore a relatively high prevalence of potential FH in patients with a recent CAD event. Therefore, an early identification of these subjects may help improve the management of their high CV risk and, by cascade screening, identify possible FH relatives.
Published: 2020

4. Early switch to oral anticoagulation in patients with acute intermediate-risk pulmonary embolism (PEITHO-2) : a multinational, multicentre, single-arm, phase 4 trial

Author: Frederikus A Klok, Gerrit Toenges, Anna C Mavromanoli, Stefano Barco, Walter Ageno, Hélène Bouvaist, Marianne Brodmann, Claudio Cuccia, Francis Couturaud, Claudia Dellas, Konstantinos Dimopoulos, Daniel Duerschmied, Klaus Empen, Pompilio Faggiano, Emile Ferrari, Nazzareno Galiè, Marcello Galvani, Alexandre Ghuysen, George Giannakoulas, Menno V Huisman, David Jiménez, Matija Kozak, Irene Marthe Lang, Mareike Lankeit, Nicolas Meneveau, Thomas Münzel, Massimiliano Palazzini, Antoniu Octavian Petris, Giancarlo Piovaccari, Aldo Salvi, Sebastian Schellong, Kai-Helge Schmidt, Franck Verschuren, Irene Schmidtmann, Guy Meyer, Stavros V Konstantinides, Jaime Antonio, Abelaira Freire, Ibrahim Akin, Toni Anusic, Dorothea Becker, Laurent Bertoletti, Giuseppe Bettoni, Harald Binder, Regina Carels, Giuseppe Di Pasquale, Daniel Dürschmied, Iolanda Enea, Joachim Ficker, Sabine Genth-Zotz, Philippe Girard, Stanislav Gorbulev, Matthias Held, Lukas Hobohm, Menno V. Huisman, Frederikus A. Klok, Stavros V. Konstantinides, Kai Kronfeld, Walter Lehmacher, Concepcion Patricia Lopez Miguel, Nadine Martin, Anna Mavromanoli, Roman Pareznik, Kurt Quitzau, Irinel Raluca Parepa, Purificacion Ramirez Martin, Marc Righini, Silviu Bogdan Todea, Adam Torbicki, Luca Valerio, Thomas Vanassche, Luminita Animarie Vida-Simiti, Anamaria Wolf-Pütz, Klok, Frederikus A., Toenges, Gerrit, Mavromanoli, Anna C., Barco, Stefano, Ageno, Walter, Bouvaist, Hélène, Brodmann, Marianne, Cuccia, Claudio, Couturaud, Franci, Dellas, Claudia, Dimopoulos, Konstantino, Duerschmied, Daniel, Empen, Klau, Faggiano, Pompilio, Ferrari, Emile, Galiè, Nazzareno, Galvani, Marcello, Ghuysen, Alexandre, Giannakoulas, George, Huisman, Menno V., Jiménez, David, Kozak, Matija, Lang, Irene Marthe, Lankeit, Mareike, Meneveau, Nicola, Münzel, Thoma, Palazzini, Massimiliano, Petris, Antoniu Octavian, Piovaccari, Giancarlo, Salvi, Aldo, Schellong, Sebastian, Schmidt, Kai-Helge, Verschuren, Franck, Schmidtmann, Irene, Meyer, Guy, and Konstantinides, Stavros V.
Subjects: Male, medicine.medical_specialty, Population, Administration, Oral, Hemorrhage, 030204 cardiovascular system & hematology, Drug Administration Schedule, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, education, Aged, Aged, 80 and over, education.field_of_study, RIGHT-VENTRICULAR DYSFUNCTION VENOUS THROMBOEMBOLISM DABIGATRAN MANAGEMENT WARFARIN HOSPITALIZATION RATIONALE HEPARIN DESIGN, Heparin, business.industry, Anticoagulants, Venous Thromboembolism, Hematology, Guideline, Middle Aged, Interim analysis, medicine.disease, Thrombosis, 3. Good health, Pulmonary embolism, Clinical trial, Treatment Outcome, Female, Pulmonary Embolism, business, Follow-Up Studies, medicine.drug
Abstract: BACKGROUND: Current guidelines recommend a risk-adjusted treatment strategy for the management of acute pulmonary embolism. This is a particular patient category for whom optimal treatment (anticoagulant treatment, reperfusion strategies, and duration of hospitalisation) is currently unknown. We investigated whether treatment of acute intermediate-risk pulmonary embolism with parenteral anticoagulation for a short period of 72 h, followed by a switch to a direct oral anticoagulant (dabigatran), is effective and safe. METHODS: We did a multinational, multicentre, single-arm, phase 4 trial at 42 hospitals in Austria, Belgium, France, Germany, Italy, Netherlands, Romania, Slovenia, and Spain. Adult patients (aged ≥18 years) with symptomatic intermediate-risk pulmonary embolism, with or without deep-vein thrombosis, were enrolled. Patients received parenteral low-molecular-weight or unfractionated heparin for 72 h after diagnosis of pulmonary embolism before switching to oral dabigatran 150 mg twice per day following a standard clinical assessment. The primary outcome was recurrent symptomatic venous thromboembolism or pulmonary embolism-related death within 6 months. The primary and safety outcomes were assessed in the intention-to-treat population. The study was terminated early, as advised by the data safety and monitoring board, following sample size adaptation after the predefined interim analysis on Dec 18, 2018. This trial is registered with the EU Clinical Trials Register (EudraCT 2015-001830-12) and ClinicalTrials.gov (NCT02596555). FINDINGS: Between Jan 1, 2016, and July 31, 2019, 1418 patients with pulmonary embolism were screened, of whom 402 were enrolled and were included in the intention-to-treat analysis (median age was 69·5 years [IQR 60·0-78·0); 192 [48%] were women and 210 [52%] were men). Median follow-up was 217 days (IQR 210-224) and 370 (92%) patients adhered to the protocol. The primary outcome occurred in seven (2% [upper bound of right-sided 95% CI 3]; p
Published: 2021

5. Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol

Author: Gregory G. Schwartz, Michael Szarek, Vera A. Bittner, Rafael Diaz, Shaun G. Goodman, J. Wouter Jukema, Ulf Landmesser, Patricio López-Jaramillo, Garen Manvelian, Robert Pordy, Michel Scemama, Peter R. Sinnaeve, Harvey D. White, Ph Gabriel Steg, P.h. Gabriel Steg, Deepak L. Bhatt, Robert A. Harrington, Andreas M. Zeiher, Pierluigi Tricoci, Matthew T. Roe, Kenneth W. Mahaffey, Jay M. Edelberg, Corinne Hanotin, Guillaume Lecorps, Angèle Moryusef, William J. Sasiela, Jean-François Tamby, Philip E. Aylward, Heinz Drexel, Peter Sinnaeve, Mirza Dilic, Renato D. Lopes, Nina N. Gotcheva, Juan-Carlos Prieto, Huo Yong, Ivan Pećin, Zeljko Reiner, Petr Ostadal, Steen Hvitfeldt Poulsen, Margus Viigimaa, Markku S. Nieminen, Nicolas Danchin, Vakhtang Chumburidze, Nikolaus Marx, Evangelos Liberopoulos, Pablo Carlos Montenegro Valdovinos, Hung-Fat Tse, Robert Gabor Kiss, Denis Xavier, Doron Zahger, Marco Valgimigli, Takeshi Kimura, Hyo Soo Kim, Sang-Hyun Kim, Andrejs Erglis, Aleksandras Laucevicius, Sasko Kedev, Khalid Yusoff, Gabriel Arturo Ramos López, Marco Alings, Sigrun Halvorsen, Roger M. Correa Flores, Rody G. Sy, Andrzej Budaj, Joao Morais, Maria Dorobantu, Yuri Karpov, Arsen D. Ristic, Terrance Chua, Jan Murin, Zlatko Fras, Anthony J. Dalby, José Tuñón, H. Asita de Silva, Emil Hagström, Christian Müller, Chern-En Chiang, Piyamitr Sritara, Sema Guneri, Alexander Parkhomenko, Kausik K. Ray, Patrick M. Moriarty, Robert Vogel, Bernard Chaitman, Sheryl F. Kelsey, Anders G. Olsson, Jean-Lucien Rouleau, Maarten L. Simoons, Karen Alexander, Chiara Meloni, Robert Rosenson, Eric J.G. Sijbrands, John H. Alexander, Luciana Armaganijan, Akshay Bagai, Maria Cecilia Bahit, J. Matthew Brennan, Shaun Clifton, Adam D. DeVore, Shalonda Deloatch, Sheila Dickey, Keith Dombrowski, Grégory Ducrocq, Zubin Eapen, Patricia Endsley, Arleen Eppinger, Robert W. Harrison, Connie Ng Hess, Mark A. Hlatky, Joseph Dedrick Jordan, Joshua W. Knowles, Bradley J. Kolls, David F. Kong, Sergio Leonardi, Linda Lillis, David J. Maron, Jill Marcus, Robin Mathews, Rajendra H. Mehta, Robert J. Mentz, Humberto Graner Moreira, Chetan B. Patel, Sabrina Bernardez Pereira, Lynn Perkins, Thomas J. Povsic, Etienne Puymirat, William Schuyler Jones, Bimal R. Shah, Matthew W. Sherwood, Kenya Stringfellow, Darin Sujjavanich, Mustafa Toma, Charlene Trotter, Sean F.P. van Diepen, Matthew D. Wilson, Andrew Tze-Kay Yan, Lilia B. Schiavi, Marcelo Garrido, Andrés F. Alvarisqueta, Sonia A. Sassone, Anselmo P. Bordonava, Alberto E. Alves De Lima, Jorge M. Schmidberg, Ernesto A. Duronto, Orlando C. Caruso, Leonardo P. Novaretto, Miguel Angel Hominal, Oscar R. Montaña, Alberto Caccavo, Oscar A. Gomez Vilamajo, Alberto J. Lorenzatti, Luis R. Cartasegna, Gustavo A. Paterlini, Ignacio J. Mackinnon, Guillermo D. Caime, Marcos Amuchastegui, Oscar Salomone, Oscar R. Codutti, Horacio O. Jure, Julio O.E. Bono, Adrian D. Hrabar, Julio A. Vallejos, Rodolfo A. Ahuad Guerrero, Federico Novoa, Cristian A. Patocchi, Cesar J. Zaidman, Maria E. Giuliano, Ricardo D. Dran, Marisa L. Vico, Gabriela S. Carnero, Pablo N. Guzman, Juan C. Medrano Allende, Daniela F. Garcia Brasca, Miguel H. Bustamante Labarta, Sebastian Nani, Eduardo D.S. Blumberg, Hugo R. Colombo, Alberto Liberman, Victorino Fuentealba, Hector L. Luciardi, Gabriel D. Waisman, Mario A. Berli, Ruben O. Garcia Duran, Horacio G. Cestari, Hugo A. Luquez, Jorge A. Giordano, Silvia S. Saavedra, Gerardo Zapata, Osvaldo Costamagna, Susana Llois, Jonathon H. Waites, Nicholas Collins, Allan Soward, Chris L.S. Hii, James Shaw, Margaret A. Arstall, John Horowitz, Daniel Ninio, James F. Rogers, David Colquhoun, Romulo E. Oqueli Flores, Philip Roberts-Thomson, Owen Raffel, Sam J. Lehman, Constantine Aroney, Steven G.M. Coverdale, Paul J. Garrahy, Gregory Starmer, Mark Sader, Patrick A. Carroll, Ronald Dick, Robert Zweiker, Uta Hoppe, Kurt Huber, Rudolf Berger, Georg Delle-Karth, Bernhard Frey, Dirk Faes, Kurt Hermans, Bruno Pirenne, Attilio Leone, Etienne Hoffer, Mathias C.M. Vrolix, Luc De Wolf, Bart Wollaert, Marc Castadot, Karl Dujardin, Christophe Beauloye, Geert Vervoort, Harry Striekwold, Carl Convens, John Roosen, Emanuele Barbato, Marc Claeys, Frank Cools, Ibrahim Terzic, Fahir Barakovic, Zlatko Midzic, Belma Pojskic, Emir Fazlibegovic, Azra Durak-Nalbantic, Mehmed Kulić, Dusko Vulic, Adis Muslibegovic, Boris Goronja, Gilmar Reis, Luciano Sousa, Jose C. Nicolau, Flavio E. Giorgeto, Ricardo P. Silva, Lilia Nigro Maia, Rafael Rech, Paulo R.F. Rossi, Maria José A.G. Cerqueira, Norberto Duda, Renato Kalil, Adrian Kormann, José Antonio M. Abrantes, Pedro Pimentel Filho, Ana Priscila Soggia, Mayler O.N. de Santos, Fernando Neuenschwander, Luiz C. Bodanese, Yorghos L. Michalaros, Freddy G. Eliaschewitz, Maria H. Vidotti, Paulo E. Leaes, Roberto V. Botelho, Sergio Kaiser, Euler Roberto F. Fernandes Manenti, Dalton B. Precoma, Jose C. Moura Jorge, Pedro Silva, Jose A. Silveira, Wladmir Saporito, Jose A. Marin Neto, Gilson S. Feitosa, Luiz Eduardo F. Ritt, Juliana A. de Souza, Fernando Costa, Weimar K.S.B. Souza, Helder J.L. Reis, Leandro Machado, José Carlos Aidar Ayoub, Georgi V. Todorov, Fedya P. Nikolov, Elena S. Velcheva, Maria L. Tzekova, Haralambi O. Benov, Stanislav L. Petranov, Haralin S. Tumbev, Nina S. Shehova-Yankova, Dimitar T. Markov, Dimitar H. Raev, Mihail N. Mollov, Kostadin N. Kichukov, Katya A. Ilieva-Pandeva, Raya Ivanova, Maryana Gospodinov, Valentina M. Mincheva, Petar V. Lazov, Bojidar I. Dimov, Manohara Senaratne, James Stone, Jan Kornder, Stephen Pearce, Danielle Dion, Daniel Savard, Yves Pesant, Amritanshu Pandey, Simon Robinson, Gilbert Gosselin, Saul Vizel, Gordon Hoag, Ronald Bourgeois, Anne Morisset, Eric Sabbah, Bruce Sussex, Simon Kouz, Paul MacDonald, Ariel Diaz, Nicolas Michaud, David Fell, Raymond Leung, Tycho Vuurmans, Christopher Lai, Frank Nigro, Richard Davies, Gustavo Nogareda, Ram Vijayaraghavan, John Ducas, Serge Lepage, Shamir Mehta, James Cha, Robert Dupuis, Peter Fong, Sohrab Lutchmedial, Josep Rodes-Cabau, Hussein Fadlallah, David Cleveland, Thao Huynh, Iqbal Bata, Adnan Hameed, Cristian Pincetti, Sergio Potthoff, Juan C. Prieto, Monica Acevedo, Arnoldo Aguirre, Margarita Vejar, Mario Yañez, Guillermo Araneda, Mauricio Fernandez, Luis Perez, Paola Varleta, Fernando Florenzano, Laura Huidobro, Carlos A. Raffo, Claudia Olivares, Leonardo Nahuelpan, Humberto Montecinos, Jiyan Chen, Yugang Dong, Weijian Huang, Jianzhong Wang, Shi'An Huang, Zhuhua Yao, Xiang Li, Lan Cui, Wenhua Lin, Yuemin Sun, Jingfeng Wang, Jianping Li, Xuelian Zhang, Hong Zhu, Dandan Chen, Lan Huang, Shaohong Dong, Guohai Su, Biao Xu, Xi Su, Xiaoshu Cheng, Jinxiu Lin, Wenxia Zong, Huanming Li, Yi Feng, Dingli Xu, Xinchun Yang, Yuannan Ke, Xuefeng Lin, Zheng Zhang, Zeqi Zheng, Zhurong Luo, Yundai Chen, Chunhua Ding, Yi Zhong, Yang Zheng, Xiaodong Li, Daoquan Peng, Shuiping Zhao, Ying Li, Xuebo Liu, Meng Wei, Shaowen Liu, Yihua Yu, Baiming Qu, Weihong Jiang, Yujie Zhou, Xingsheng Zhao, Zuyi Yuan, Ying Guo, Xiping Xu, Xubo Shi, Junbo Ge, Guosheng Fu, Feng Bai, Weiyi Fang, Xiling Shou, Xiangjun Yang, Jian'An Wang, Meixiang Xiang, Yingxian Sun, Qinghua Lu, Ruiyan Zhang, Jianhua Zhu, Yizhou Xu, Zhongcai Fan, Tianchang Li, Chun Wu, Nicolas Jaramillo, Gregorio Sanchez Vallejo, Diana C. Luna Botia, Rodrigo Botero Lopez, Dora I. Molina De Salazar, Alberto J. Cadena Bonfanti, Carlos Cotes Aroca, Juan Diego Higuera, Marco Blanquicett, Sandra I. Barrera Silva, Henry J. Garcia Lozada, Julian A. Coronel Arroyo, Jose L. Accini Mendoza, Ricardo L. Fernandez Ruiz, Alvaro M. Quintero Ossa, Fernando G. Manzur Jatin, Aristides Sotomayor Herazo, Jeffrey Castellanos Parada, Rafael Suarez Arambula, Miguel A. Urina Triana, Angela M. Fernandez Trujillo, Maja Strozzi, Siniša Car, Melita Jerić, Davor Miličić, Martina Lovrić Benčić, Hrvoje Pintarić, Đeiti Prvulović, Jozica Šikić, Viktor Peršić, Dean Mileta, Kresimir Štambuk, Zdravko Babić, Vjekoslav Tomulic, Josip Lukenda, Stanka Mejic-Krstulovic, Boris Starcevic, Jindrich Spinar, David Horak, Zdenek Velicka, Josef Stasek, David Alan, Vilma Machova, Ales Linhart, Vojtech Novotny, Vladimir Kaucak, Richard Rokyta, Robert Naplava, Zdenek Coufal, Vera Adamkova, Ivo Podpera, Jiri Zizka, Zuzana Motovska, Ivana Marusincova, Premysl Svab, Petr Heinc, Jiri Kuchar, Petr Povolny, Jiri Matuska, Steen H. Poulsen, Bent Raungaard, Peter Clemmensen, Lia E. Bang, Ole May, Morten Bøttcher, Jens D. Hove, Lars Frost, Gunnar Gislason, John Larsen, Peter Betton Johansen, Flemming Hald, Peter Johansen, Jørgen Jeppesen, Tonny Nielsen, Kjeld S. Kristensen, Piotr Maria Walichiewicz, Jens D. Lomholdt, Ib C. Klausen, Peter Kaiser Nielsen, Flemming Davidsen, Lars Videbaek, Mai Soots, Veiko Vahula, Anu Hedman, Üllar Soopõld, Kaja Märtsin, Tiina Jurgenson, Arved Kristjan, Heikki Huikuri, Juhani Airaksinen Pierre Coste, Emile Ferrari, Olivier Morel, Gilles Montalescot, Jacques Machecourt, Gilles Barone-Rochette, Jacques Mansourati, Yves Cottin, Florence Leclercq, Abdelkader Belhassane, Nicolas Delarche, Franck Boccara, Franck Paganelli, Jérôme Clerc, Francois Schiele, Victor Aboyans, Vincent Probst, Jacques Berland, Thierry Lefèvre, Bernard Citron, Irakli Khintibidze, Tamaz Shaburishvili, Zurab Pagava, Ramaz Ghlonti, Zaza Lominadze, George Khabeishvili, Rayyan Hemetsberger, Kemala Edward, Ursula Rauch-Kröhnert, Matthias Stratmann, Karl-Friedrich Appel, Ekkehard Schmidt, Heyder Omran, Christoph Stellbrink, Thomas Dorsel, Emmanouil Lianopoulos, Hans Friedrich Vöhringer, Roger Marx, Andreas Zirlik, Detlev Schellenberg, Thomas Heitzer, Ulrich Laufs, Christian Werner, Stephan Gielen, Sebastian Nuding, Bernhard Winkelmann, Steffen Behrens, Karsten Sydow, Mahir Karakas, Gregor Simonis, Thomas Muenzel, Nikos Werner, Stefan Leggewie, Dirk Böcker, Rüdiger Braun-Dullaeus, Nicole Toursarkissian, Michael Jeserich, Matthias Weißbrodt, Tim Schaeufele, Joachim Weil, Heinz Völler, Johannes Waltenberger, Mohammed Natour, Susanne Schmitt, Dirk Müller-Wieland, Stephan Steiner, Lothar Heidenreich, Elmar Offers, Uwe Gremmler, Holger Killat, Werner Rieker, Sotiris Patsilinakos, Athanasios Kartalis, Athanassios Manolis, Dimitrios Sionis, Geargios Chachalis, Ioannis Skoumas, Vasilios Athyros, Panagiotis Vardas, Frangkiskos Parthenakis, John Lekakis, Apostolos Hatzitolios, Sergio R. Fausto Ovando, Juan L. Arango Benecke, Edgar R. Rodriguez De Leon, Bryan P.Y. Yan, David C.W. Siu, Tibor Turi, Bela Merkely, Imre Ungi, Geza Lupkovics, Lajos Nagy, András Katona, István Édes, Gábor Müller, Iván Horvath, Tibor Kapin, Zsolt Szigeti, József Faluközy, Mukund Kumbla, Manjinder Sandhu, Sharath Annam, Naveen Reddy Proddutur, Reddy Regella, Rajendra K. Premchand, Ajaykumar Mahajan, Sudhir Pawar, Atul D. Abhyanakar, Prafulla Kerkar, Ravishankar A. Govinda, Abraham Oomman, Dhurjati Sinha, Sachin N. Patil, Dhiman Kahali, Jitendra Sawhney, Abhijeet B. Joshi, Sanjeev Chaudhary, Pankaj Harkut, Santanu Guha, Sanjay Porwal, Srimannarayana Jujjuru, Ramesh B. Pothineni, Minguel R. Monteiro, Aziz Khan, Shamanna S. Iyengar, Jasprakash Singh Grewal, Manoj Chopda, Mahesh C. Fulwani, Aparna Patange, Patil Sachin, Vijay K. Chopra, Naresh K. Goyal, Rituparna Shinde, Gajendra V. Manakshe, Nitin Patki, Sumeet Sethi, Vengatesh Munusamy, Sunil Karnaand Sunil Thanvi, Srilakshmi Adhyapak, Chandrakant Patil, Ulhas Pandurangi, Rishabh Mathur, Jugal Gupta, Suhas Kalashetti, Ajit Bhagwat, Bagirath Raghuraman, Shiv Kumar Yerra, Prasant Bhansali, Rohidas Borse, Patil Rahul, Srihari Das, Vinay Kumar, Jabir Abdullakutty, Shireesh Saathe, Priya Palimkar, Jabir Abdullkutty, Shireesh Sathe, Shaul Atar, Michael Shechter, Morris Mosseri, Yaron Arbel, Chorin Ehud, Havakuk Ofer, Chaim Lotan, Uri Rosenschein, Amos Katz, Yaakov Henkin, Adi Francis, Marc Klutstein, Eugenia Nikolsky, Robert Zukermann, Yoav Turgeman, Majdi Halabi, Alon Marmor, Ran Kornowski, Michael Jonas, Offer Amir, Yonathan Hasin, Yoseph Rozenman, Shmuel Fuchs, Vered Zvi, Osamah Hussein, Dov Gavish, Zvi Vered, Yoseph Caraco, Mazen Elias, Naveh Tov, Efrat Wolfovitz, Michael Lishner, Nizar Elias, Giancarlo Piovaccari, Annamaria De Pellegrin, Raffaella Garbelotto, Gabriele Guardigli, Valgimigli Marco, Giovanni Licciardello, Carla Auguadro, Filippo Scalise, Claudio Cuccia, Alessandro Salvioni, Giuseppe Musumeci, Michelle Senni, Paolo Calabrò, Salvatore Novo, Pompilio Faggiano, Marco Metra, Nicoletta B. De Cesare, Sergio Berti, Claudio Cavallini, Enrico Puccioni, Marcello Galvani, Maurizio Tespili, Piermarco Piatti, Michela Palvarini, Giuseppe De Luca, Roberto Violini, Alessandro De Leo, Zoran Olivari, Pasquale Perrone Filardi, Maurizio Ferratini, Vittorio Racca, Kazuoki Dai, Yuji Shimatani, Haruo Kamiya, Kenji Ando, Yoshihiro Takeda, Yoshihiro Morino, Yoshiki Hata, Kazuo Kimura, Koichi Kishi, Ichiro Michishita, Hiroki Uehara, Toshinori Higashikata, Atsushi Hirayama, Keiji Hirooka, Yasuji Doi, Satoru Sakagami, Shuichi Taguchi, Akihiro Koike, Hiroyuki Fujinaga, Shinji Koba, Ken Kozuma, Tomohiro Kawasaki, Yujiro Ono, Masatoshi Shimizu, Yousuke Katsuda, Atsuyuki Wada, Toshiro Shinke, Junya Ako, Kenshi Fujii, Toshiyuki Takahashi, Tomohiro Sakamoto, Koichi Nakao, Yutaka Furukawa, Hiroshi Sugino, Ritsu Tamura, Toshiaki Mano, Masaaki Uematsu, Noriaki Utsu, Kashima Ito, Takuya Haraguchi, Katsuhiko Sato, Yasunori Ueda, Akira Nishibe, Kazuteru Fujimoto, Motomaru Masutani, Jung Han Yoon, Hack-Lyoung Kim, Hun Sik Park, In-Ho Chae, Moo Hyun Kim, Myung Ho Jeong, Seungwoon Rha, Chongjin Kim, Hae Young Kim, Taekjong Hong, Seung-Jea Tahk, Youngkwon Kim, Arija Busmane, Natalija Pontaga, Aldis Strelnieks, Iveta Mintale, Iveta Sime, Zaneta Petrulioniene, Roma Kavaliauskiene, Ruta Jurgaitiene, Gintare Sakalyte, Rimvydas Slapikas, Sigute Norkiene, Nerijus Misonis, Aleksandras Kibarskis, Raimondas Kubilius, Stojko Bojovski, Nensi Lozance, Aleksandar Kjovkaroski, Snezana Doncovska, Tiong Kiam Ong, Sazzli Kasim, Oteh Maskon, Balachandran Kandasamy, Houng B. Liew, Wan Mohd Izani Wan Mohamed, Armando García Castillo, Jorge Carrillo Calvillo, Pedro Fajardo Campos, Juan Carlos Núñez Fragoso, Edmundo Alfredo Bayram Llamas, Marco Antonio Alcocer Gamba, Jaime Carranza Madrigal, Luis Gerardo González Salas, Enrique López Rosas, Belinda González Díaz, Eduardo Salcido Vázquez, Alfredo Nacoud Ackar, Guillermo Antonio Llamas Esperón, Carlos Rodolfo Martínez Sánchez, María Guerrero De Leon, Rodrigo Suarez Otero, Guillermo Fanghänel Salmón, Jesús Antonio Pérez Ríos, José Angel Garza Ruíz, Robert W. Breedveld, Margriet Feenema-Aardema, Alida Borger-Van Der Burg, Pieter A.M. Hoogslag, Harry Suryapranata, Antonius Oomen, Paulus Van Haelst, Margriet Feenema-Aradema, Jacobijne J. Wiersma, Dirk Basart, Ruud M.A. Van Der Wal, Peter Zwart, Pascalle Monraats, Henricus Van Kesteren, Ioannis Karalis, Johan Jukema, Gerardus J.E. Verdel, Bart R.G. Brueren, Roland PTh Troquay, Eric P. Viergever, Nadea Y.Y. Al-Windy, Gerard L. Bartels, Jan H. Cornel, Walter R.M. Hermans, Johannes P.R. Herrman, Robert J. Bos, Reginald G.E.J. Groutars, Coenraad C. Van Der Zwaan, Refik Kaplan, Raymond Lionarons, Eelko Ronner, Bjorn E. Groenemeijer, Patrick N.A. Bronzwaer, Anho A.H. Liem, Bernard J.W.M. Rensing, Marcel J.J.A. Bokern, Remco Nijmeijer, Ferry M.R.J. Hersbach, Frank F. Willems, Antonius T.M. Gosselink, Saman Rasoul, John Elliott, Gerard Wilkins, Raewyn Fisher, Douglas Scott, Hamish Hart, Ralph Stewart, Scott Harding, Ian Ternouth, Nicholas Fisher, Samuel Wilson, Denise Aitken, Russell Anscombe, Laura Davidson, Tadeusz Tomala, Ottar Nygård, Jon Arne Sparby, Kjell Andersen, Lars Gullestad, Jarle Jortveit, Peter S. Munk, Erlend gyllensten Singsaas, Ulf Hurtig, Jorge R. Calderon Ticona, Julio R. Durand Velasquez, Sandra A. Negron Miguel, Enrique S. Sanabria Perez, Jesus M. Carrion Chambilla, Carlos A. Chavez Ayala, Reynaldo P. Castillo Leon, Rolando J. Vargas Gonzales, Jose D. Hernandez Zuniga, Luis A. Camacho Cosavalente, Jorge E. Bravo Mannucci, Javier Heredia Landeo, Nassip C. Llerena Navarro, Yudy M. Roldan Concha, Víctor E. Rodriguez Chavez, Henry A. Anchante Hernandez, Carlos A. Zea Nunez, Walter Mogrovejo Ramos, Arthur Ferrolino, Rosa Allyn G. Sy, Louie Tirador, Generoso Matiga, Raul Martin Coching, Alisa Bernan, Gregorio Rogelio, Dante D. Morales, Edgar Tan, Dennis Jose Sulit, Adrian Wlodarczak, Krystyna Jaworska, Grzegorz Skonieczny, Lidia Pawlowicz, Pawel Wojewoda, Benita Busz-Papiez, Janusz Bednarski, Aleksander Goch, Pawel Staneta, Elzbieta Dulak, Krzysztof Saminski, Wlodzimierz Krasowski, Wanda Sudnik, Aleksander Zurakowski, Marcin Skorski, Roman Lysek, Beata Miklaszewicz, Jacek Kubica, Jan Andrzej Lipko, Edyta Kostarska-Srokosz, Marek Piepiorka, Anna Drzewiecka, Ryszard Sciborski, Arkadiusz Stasiewski, Tomasz Blicharski, Leszek Bystryk, Michal Szpajer, Marek Korol, Tomasz Czerski, Ewa Mirek-Bryniarska, Jacek Gniot, Andrzej Lubinski, Jerzy Gorny, Edward Franek, Grzegorz Raczak, Hanna Szwed, Pedro Monteiro, Jose Mesquita Bastos, Helder H. Pereira, Dinis Martins, Filipe Seixo, Carlos Mendonça, Ana Botelho, Francisca Caetano, Bogdan Minescu, Octavian Istratoaie, Dan N. Tesloianu, Gabriel Cristian, Silviu Dumitrescu, Cristian G.C. Podoleanu, Mircea C.A. Constantinescu, Cristina M. Bengus, Constantin Militaru, Doina Rosu, Irinel R. Parepa, Adrian V. Matei, Tom M. Alexandru, Mihaela Malis, Ioan Coman, Rodica Stanescu-Cioranu, Doina Dimulescu, Yury Shvarts, Olga Orlikova, Zhanna Kobalava, Olga L. Barbarash, Valentin Markov, Nadezhda Lyamina, Alexander Gordienko, Konstantin Zrazhevsky, Alexander Y. Vishnevsky, Victor Gurevich, Raisa Stryuk, Nikita V. Lomakin, Igor Bokarev, Tatiana Khlevchuk, Sergey Shalaev, Larisa Khaisheva, Petr Chizhov, Inna Viktorova, Natalya Osokina, Vladimir Shchekotov, Evgenia Akatova, Galina Chumakova, Igor Libov, Mikhail I. Voevoda, Tatyana V. Tretyakova, Evgeny Baranov, Sergey Shustov, Sergey Yakushin, Ivan Gordeev, Niiaz Khasanov, Olga Reshetko, Tatiana Sotnikova, Olga Molchanova, Konstantin Nikolaev, Liudmila Gapon, Elena Baranova, Zaur Shogenov, Elena Kosmachova, Yuriy Karpov, Anton Povzun, Liudmila Egorova, Vadim V. Tyrenko, Igor G. Ivanov, Masterov Ilya, Sergey Kanorsky, Dragan Simic, Nikola Ivanovic, Goran Davidovic, Nebojsa Tasic, Milika R. Asanin, Stevo Stojic, Svetlana R. Apostolovic, Stevan Ilic, Biljana Putnikovic Tosic, Aleksandar Stankovic, Aleksandra Arandjelovic, Slavica Radovanovic, Branislava Todic, Jovan Balinovac, Dragan V. Dincic, Petar Seferovic, Ana Karadzic, Slobodan Dodic, Sinisa Dimkovic, Tamara Jakimov, Kian-Keong Poh, Hean Yee Ong, Justin Tang I-Shing, Karol Micko, Jan Nociar, Daniel Pella, Peter Fulop, Marian Hranai, Juraj Palka, Juraj Mazur, Ivan Majercák, Andrej Dzupina, František Fazekas, Jozef Gonsorcik, Viliam Bugan, Juraj Selecky, Gabriel Kamensky, Jaroslava Strbova, Rudolf Smik, Andrej Dukat, Peter Olexa, Ivan Žuran, Janez Poklukar, Nataša Černič Šuligoj, Matija Cevc, Henry P. Cyster, Naresh Ranjith, Clive Corbett, Junaid Bayat, Ellen Makoali Makotoko, Hendrik du Toit Theron, Ilse E. Kapp, Matthys M. de V Basson, Hanlie Lottering, Dina Van Aswegen, Louis J. Van Zyl, Peter J. Sebastian, Thayabran Pillay, Jan A. Saaiman, Patrick J. Commerford, Soraya Cassimjee, Garda Riaz, Iftikhar O. Ebrahim, Mahomed Sarvan, Joseph H. Mynhardt, Helmuth Reuter, Rajendran Moodley, Manuel Vida, Angel R. Cequier Fillat, Vicente Bodí Peris, Francisco Fuentes Jimenez, Francisco Marín, Jose M. Cruz Fernández, Rafael Jesus Hidalgo Urbano, Blas Gil-Extremera, Pablo Toledo, Fernando Worner Diz, David Garcia-Dorado, Andres Iñiguez, José Tuñón Fernández, Jose R. Gonzalez-Juanatey, Javier Fernandez Portales, Fernando Civeira Murillo, Laia Matas Pericas, Jose Luis Zamorano, Manuel De Mora Martin, Jordi Bruguera Cortada, Joaquin J. Alonso Martin, Jose Maria Serrano Antolin, José R. De Berrazueta Fernández, José Antonio Vázquez de Prada, Jose Francisco Díaz Fernández, José Alberto García Lledó, Juan Cosín Sales, Javier Botas Rodriguez, Gabriel Gusi Tragant, Amparo Benedicto, Carlos Gonzalez-Juanatey, Mercedes Camprubí Potau, Ignacio Plaza Perez, César Morís De La Tassa, Pablo Loma-Osorio Rincon, Javier Balaguer Recena, Juan M. Escudier, Antonio Coca Payeras, Norberto Alonso Orcajo, Pedro Valdivielso, Godwin Constantine, Ruvaiz Haniffa, Nirmali Tissera, Stanley Amarasekera, Chandrike Ponnamperuma, Nimali Fernando, Kaputella Fernando, Jayanthimala Jayawardena, Santharaj Wijeyasingam, Gotabhaya Ranasinghe, Ruvan Ekanayaka, Sepalika Mendis, Vajira Senaratne, Gnanamoorthy Mayurathan, Ajantha Rajapaksha, Thilak Sirisena, Jagath I. Herath, Naomali Amarasena, Stefan Berglund, Gundars Rasmanis, Ola Vedin, Nils Witt, Georgios Mourtzinis, Peter Nicol, Ole Hansen, Stefano Romeo, Steen Agergaard Jensen, Ingemar Torstensson, Ulf Ahremark, Torbjörn Sundelin, Tiziano Moccetti, Francois Mach, Ronald Binde, Oliver Gämperli, Wei-Chuan Tsai, Kwo-Chang Ueng, Wen-Ter Lai, Ming-En Liu, Juey-Jen Hwang, Wei-Hsian Yin, I-Chang Hsieh, Ming-Jer Hsieh, Wei Hsiang Lin, Jen-Yuan Kuo, Tsuei-Yuan Huang, Chih-Yuan Fang, Pinij Kaewsuwanna, Wasant Soonfuang, Woravut Jintapakorn, Apichard Sukonthasarn, Nattawut Wongpraparut, Krisada Sastravaha, Nakarin Sansanayudh, Wirash Kehasukcharoen, Dilok Piyayotai, Paiboon Chotnoparatpat, Ahmet Camsari, Hakan Kultursay, Bulent Mutlu, Murat Ersanli, Mustafa Demirtas, Cevat Kirma, Ertan Ural, Lale Koldas, Oleksandr Karpenko, Alexander Prokhorov, Ihor Vakaluyk, Halyna Myshanych, Dmytro Reshotko, Valeriy Batushkin, Leonid Rudenko, Ihor Kovalskyi, Mykola Kushnir, Vira Tseluyko, Yuriy Mostovoy, Mykola Stanislavchuk, Yulian Kyiak, Yuriy Karpenko, Yaroslav Malynovsky, Andriy Klantsa, Oles Kutniy, Ekaterina Amosova, Viktor Tashchuk, Oleh Leshchuk, Mykola Rishko, Mykola Kopytsya, Andriy Yagensky, Mykola Vatutin, Andriy Bagriy, Olga M. Barna, Olexiy Ushakov, Georgiy Dzyak, Borys Goloborodko, Anatolii Rudenko, Volodymyr Zheleznyy, Jasper Trevelyan, Azfar Zaman, Kaeng Lee, Andrew Moriarty, Rajesh K. Aggarwal, Piers Clifford, Yuk-Ki Wong, Syed M.R. Iqbal, Eduardas Subkovas, Denise Braganza, David Sarkar, Robert Storey, Huw Griffiths, Sam Mcclure, Rangasamy Muthusamy, Simon Smith, John Kurian, Terry Levy, Craig Barr, Honer Kadr, Robert Gerber, Audrius Simaitis, Handrean Soran, Anthony Mathur, Adrian Brodison, Mohammad Ayaz, Muhammad Cheema, Richard Oliver, Simon Thackray, Telal Mudawi, Gohar Rahman, Ayyaz Sultan, Timothy Reynolds, David Sharman, null david Sprigings, Rob Butler, Peter Wilkinson, Gregory Y.H. Lip, Julian Halcox, Sean Gallagher, Nicholas Ossei-Gerning, Gil Vardi, Duccio Baldari, David Brabham, Charles Treasure, Charles Dahl, Bruce Palmer, Alan Wiseman, Abul Khan, Sanjeev Puri, Ann Elizabeth Mohart, Carlos Ince, Enrique Flores, Scott Wright, Shi-Chi Cheng, Michael Rosenberg, William Rogers, Edward Kosinski, Les Forgosh, Jonathan Waltman, Misal Khan, Mohammad Shoukfeh, Georges Dagher, Patrick Cambier, Ira Lieber, Priya Kumar, Cara East, Perry Krichmar, Mian Hasan, Lindsey White, Thomas Knickelbine, Thomas Haldis, Eve Gillespie, Thomas Amidon, David Suh, Imran Arif, Mouhamad Abdallah, Faiq Akhter, Eric Carlson, Michael D'Urso, Fadi El-Ahdab, William Nelson, Katie Moriarty, Barry Harris, Steven Cohen, Luther Carter, Daniel Doty, Kenneth Sabatino, Tariq Haddad, Amir Malik, Sunder Rao, Angel Mulkay, Ion Jovin, Kim Klancke, Vinay Malhotra, Sai K. Devarapalli, Michael Koren, Harish Chandna, George Dodds, Tauqir Goraya, James Bengston, Matthew Janik, Joseph Moran, Andrew Sumner, John Kobayashi, William Davis, Shahram Yazdani, John Pasquini, Maitreya Thakkar, Amarnath Vedere, Wayne Leimbach, James Rider, Sarah fenton, Narendra Singh, Anil V. Shah, Denise Janosik, Carl Pepine, Brett Berman, Joseph Gelormini, Christopher Daniels, Kerensky Richard, Friederike Keating, Nicholas I. Kondo, Sanjay Shetty, Howard Levite, Winfried Waider, Theodore Takata, Mazen Abu-Fadel, Vipul Shah, Rahul Aggarwal, Mark Izzo, Anil Kumar, Brack Hattler, Rose Do, Chad Link, Anna Bortnick, George Kinzfogl, Arnold Ghitis, John Larry, Edward Teufel, Peter Kuhlman, Brent Mclaurin, Wenwu Zhang, Stephen Thew, Jalal Abbas, Matthew White, Othman Islam, Sumeet Subherwal, Nandkishore Ranadive, Babak Vakili, Christian Gring, David Henderson, Timothy Schuchard, Naim Farhat, Geoffrey Kline, Sharan Mahal, Jack Whitaker, Shawn Speirs, Rolf Andersen, Nizar Daboul, Phillip Horwitz, Firas Zahr, George Ponce, Zubair Jafar, Joseph Mcgarvey, Vipul Panchal, Stephen Voyce, Thomas Blok, William Sheldon, Masoud M. Azizad, Carsten Schmalfuss, Mark Picone, Robert Pederson, William Herzog, Keith Friedman, Jason Lindsey, Rosemary Nowins, Eichenlaub Timothy, Parilak Leonard, Norman Lepor, Mahfouz El Shahawy, Howard Weintraub, Anand Irimpen, Alvaro Alonso, Wade May, Daniels Christopher, Thomas Galski, Alan Chu, Freny Mody, Ebrahimi Ramin, Zachary Hodes, Joseph Rossi, Gregory Rose, James Fairlamb, Charles Lambert, Ajit Raisinghani, Antonio Abbate, George Vetrovec, Marilyn King, Charles Carey, Jaime Gerber, Liwa Younis, Hyeun Park, Mladen Vidovich, Thomas Knutson, Dennis Friedman, Fred Chaleff, Arthur Loussararian, Phillip Rozeman, Carey Kimmelstiel, Jeffrey Kuvin, Kevin Silver, Malcolm Foster, Glen Tonnessen, Andrey Espinoza, Mohamadali Amlani, Andreas Wali, Christopher Malozzi, Geert T. Jong, Clara Massey, Keattiyoat Wattanakit, Philip J. O'Donnell, Dinesh Singal, Naseem Jaffrani, Sridhar Banuru, Daniel Fisher, Mark Xenakis, Neal Perlmutter, Ravi Bhagwat, James Strader, Ronald Blonder, Ayim Akyea-Djamson, Ajay Labroo, Kwan Lee, H. John Marais, Edmund Claxton, Robert Weiss, Rohr Kathryn, Martin Berk, Peter Rossi, Parag Joshi, Amit Khera, Ajit S. Khaira, Greg Kumkumian, Steven Lupovitch, Joshua Purow, Stephen Welka, David Hoffman, Stuart Fischer, Eugene Soroka, Donald Eagerton, Samir Pancholy, Michael Ray, Norman Erenrich, Michael Farrar, Stewart Pollock, William J. French, Steve Diamantis, Douglas Guy, Lawrence Gimple, Mark Neustel, Steven Schwartz, Edward Pereira, Seals Albert, Douglas Spriggs, Janet Strain, Suneet Mittal, Anthony Vo, Majed Chane, Jason Hall, Nampalli Vijay, Kapildeo Lotun, F. Martin Lester, Ahed Nahhas, Theodore Pope, Paul Nager, Rakesh Vohra, Mukesh Sharma, Riyaz Bashir, Hinan Ahmed, Michael Berlowitz, Robert Fishberg, Robert Barrucco, Eric Yang, Michael Radin, Daniel Sporn, Dwight Stapleton, Steven Eisenberg, Joel Landzberg, Martin Mcgough, Samir Turk, Michael Schwartz, P. Sandy Sundram, Diwakar Jain, Mark Zainea, Carlos Bayron, Ronald Karlsberg, Suhail Dohad, Henry Lui, William Keen, Donald Westerhausen, Sandeep Khurana, Himanshu Agarwal, Jessica Birchem, William Penny, Mark Chang, Sherrill Murphy, John Henry, Branislav Schifferdecker, John M Gilbert, Gopal Chalavarya, Charles Eaton, John F. Schmedtje, Stuart Christenson, Imran Dotani, Douglas Denham, Alexander Macdonell, Paul Gibson, Aref Rahman, Tammam Al Joundi, Nizar Assi, Gary Conrad, Purushotham Kotha, Michael Love, Gregory Giesler, Howard Rubenstein, Dawood Gamil, Laura Akright, Justine Krawczyk, Joanne Cobler, Terry Wells, James Welker, Robert Foster, Richard Gilmore, Jay Anderson, Douglas Jacoby, Bill Harris, Geraldine Gardner, Ramprasad Dandillaya, Kishor Vora, John Kostis, John Hunter, David Laxson, Eric Ball, Flavia Egydio, Anelise Kawakami, Janaina Oliveira, Julianna Wozniak, Alexander Matthews, Caroline Ratky, Janine Valiris, Lisa Berdan, Anita Hepditch, Kirby Quintero, Tyrus Rorick, Melissa Westbrook, Andrea Pascual, Carla Rovito, Madeleine Bezault, Elodie Drouet, Tabassome Simon, Caroline Alsweiler, Anne Luyten, Julie Butters, Liddy Griffith, Michelle Shaw, Lena Grunberg, Shahidul Islam, Marie-France Brégeault, Nathalie Bougon, Douglas Faustino, Sylvie Fontecave, Judith Murphy, Melanie Verrier, null Veronique Agnetti, Dorthe Andersen, Emmy Badreddine, Mhamed Bekkouche, Cecile Bouancheau, Imane Brigui, Maddy Brocklehurst, Joseph Cianciarulo, Dawn Devaul, Szilvia Domokos, Cecile Gache, Caroline Gobillot, Severine Guillou, Jan Healy, Megan Heath, Gayatri Jaiwal, Carine Javierre, Julien Labeirie, Myriam Monier, Ulises Morales, Asmaa Mrabti, Bicky Mthombeni, Betim Okan, Lucile Smith, Jennifer Sheller, Sebastien Sopena, Valerie Pellan, Fadela Benbernou, Nafissa Bengrait, Maud Lamoureux, Katarina Kralova, Raphael Bejuit, Anthony Coulange, Christelle Berthou, Jérôme Repincay, Christelle Lorenzato, Alexis Etienne, Valerie Gouet, Virginie Loizeau, Mickael Normand, Anne Ourliac, Christelle Rondel, Antony Adamo, Pascale Beltran, Pauline Barraud, Helene Dubois-Gache, Benjamin Halle, Lamia Metwally, Maxime Mourgues, Marc Sotty, Marion Vincendet, Raluca Cotruta, Zhu Chengyue, Dominique Fournie-Lloret, Christine Morrello, Aurelie Perthuis, Patrick Picault, Isabelle Zobouyan, Helen M. Colhoun, Michael A. Dempsey, Mark A. McClanahan, Masira, and Laucevičius, Aleksandras
Subjects: Male, Acute coronary syndrome, medicine.medical_specialty, Cardiac & Cardiovascular Systems, Randomization, PCSK9 inhibitor, LOW-DENSITY-LIPOPROTEIN, Antibodies, Monoclonal, Humanized, acute coronary syndrom, Placebo, Gastroenterology, lipoprotein(a), Internal medicine, medicine, Humans, Low-density lipoprotein cholesterol, Aged, Alirocumab, RISK, low-density lipoprotein cholesterol, Science & Technology, biology, business.industry, PCSK9, PCSK9 Inhibitors, Hazard ratio, ALIROCUMAB, acute coronary syndrome, Cholesterol, LDL, Lipoprotein(a), Middle Aged, EFFICACY, medicine.disease, Cardiovascular Diseases, CARDIOVASCULAR-DISEASE, SAFETY, Cardiovascular System & Cardiology, biology.protein, Female, lipids (amino acids, peptides, and proteins), STATIN, low-density lipoprotein, cholesterol PCSK9 inhibitor, CORONARY, Cardiology and Cardiovascular Medicine, business, Life Sciences & Biomedicine, Mace
Abstract: Digital, Background Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. Objectives In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. Methods ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was 13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. Conclusions In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402), Ciencias Médicas y de la Salud
Published: 2021

6. Procedures for chronic total occlusion: when are they recommended and when not

Author: Mila Menozzi and Giancarlo Piovaccari
Subjects: medicine.medical_specialty, Percutaneous, medicine.medical_treatment, OMT (optimal medical treatment), law.invention, Angina, Coronary artery bypass surgery, Randomized controlled trial, law, Internal medicine, Medicine, AcademicSubjects/MED00200, Myocardial infarction, cardiovascular diseases, Reversible ischaemia, business.industry, Percutaneous coronary intervention, Articles, Chronic total occlusion (CTO), medicine.disease, Viable myocardium, Conventional PCI, Cardiology, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: Coronary chronic total occlusion (CTO) produces an important clinical problem, often treated with medical therapy or coronary artery bypass grafting. Recent clinical studies, both registries and randomized trials, demonstrated that percutaneous coronary interventions (PCI), could provide a valid therapeutic option. Nonetheless, significant reduction in all-cause mortality, cardiac mortality, myocardial infarction, MACE, and MACCE has not been demonstrated in the subgroups analysis of randomized trials. These analyses suggest that PCI for CTO should be reserved for patients with angina or with large areas of the myocardium with reversible ischaemia. Large randomized studies should search for a personalized approach, considering the risks and complexity of PCI in CTO, which should mainly consider the extension of the ischaemia and the viability of the myocardium.
Published: 2020

7. In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study

Author: Nazzareno Galiè, Giuseppe Boriani, Stefano Tondi, Gabriele Guardigli, AMI-Co investigators, Elena Berti, Giuseppe Di Pasquale, Marcello Galvani, Giancarlo Piovaccari, Massimo Piepoli, Diego Ardissino, Rubboli A, Daniela Fortuna, Rossana De Palma, Gianluca Campo, Federico Banchelli, Alessandro Navazio, Gianni Casella, Andrea Santarelli, Campo, Gianluca, Fortuna, Daniela, Berti, Elena, De Palma, Rossana, Pasquale, Giuseppe Di, Galvani, Marcello, Navazio, Alessandro, Piovaccari, Giancarlo, Rubboli, Andrea, Guardigli, Gabriele, Galiè, Nazzareno, Boriani, Giuseppe, Tondi, Stefano, Ardissino, Diego, Piepoli, Massimo, Banchelli, Federico, Santarelli, Andrea, and Casella, Gianni
Subjects: Out of hospital, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Health Policy, INTERVENTION REPERFUSION IMPACT COVID 19, Population based, Cardiac mortality, medicine.disease, NO, Oncology, Internal medicine, Concomitant, Pandemic, Internal Medicine, medicine, Observational study, Myocardial infarction, Public aspects of medicine, RA1-1270, business, Research Paper
Abstract: BACKGROUND: The COVID-19 pandemic has put several healthcare systems under severe pressure. The present analysis investigates how the first wave of the COVID-19 pandemic affected the myocardial infarction (MI) network of Emilia-Romagna (Italy). METHODS: Based on Emilia-Romagna mortality registry and administrative data from all the hospitals from January 2017 to June 2020, we analysed: i) temporal trend in MI hospital admissions; ii) characteristics, management, and 30-day mortality of MI patients; iii) out-of-hospital mortality for cardiac cause. FINDINGS: Admissions for MI declined on February 22, 2020 (IRR -19.5%, 95%CI from -8.4% to -29.3%, p=0.001), and further on March 5, 2020 (IRR -21.6%, 95%CI from -9.0% to -32.5%, p=0.001). The return to pre-COVID-19 MI-related admission levels was observed from May 13, 2020 (IRR 34.3%, 95%CI 20.0%-50.2%, p
Published: 2021

8. A Simple Multiparametric Score System to Predict In-Hospital Mortality of COVID-19 Patients

Author: Gianfranco Tortorici, Paolo Ortolani, Gabriele Guardigli, Francesco Vitali, Gibiino F, Gianni Casella, Alessandro Corzani, Emanuele D'Aniello, Mezzanotte R, Cimaglia P, Michele Malagù, Giancarlo Piovaccari, Luca Rossi, Ienno Ld, Andrea Rubboli, Navazio A, Marcello Galvani, Daniela Aschieri, Manfrini M, Claudio Rapezzi, Matteo Bertini, Roberto Ferrari, Biagio Sassone, and Ottavio Zucchetti
Subjects: medicine.medical_specialty, In hospital mortality, Coronavirus disease 2019 (COVID-19), business.industry, Ethics committee, Multicenter study, Internal medicine, medicine, Clinical endpoint, Delirium, Observational study, medicine.symptom, Risk assessment, business
Abstract: Background: Several clinical, laboratory and instrumental prognostic indicators for coronavirus disease 2019 (COVID-19) have been found. Combining all the different predictors in a score would make easier and more accurate the risk assessment of COVID-19 patients. To this purpose, we examined a large number of COVID-19 patients. First, we identified the best predictors of in-hospital mortality at admission. Then, we calculated a score system to capture the contribution of the various prognostic indicators. Methods: Prospective multicenter study (ELCOVID) referring to central-northern Italy. This project is registered on ClinicalTrials.gov (identifier: NCT04367129). COVID-19 patients admitted to the hospital in the period May-September 2020 were enrolled. Clinical, laboratory and electrocardiographic (ECG) records were collected at admission. Patients were followed-up and in-hospital mortality constituted the primary endpoint. A risk scoring system to predict prognosis was derived by independent predictors of in-hospital mortality. Findings: A total of 1014 patients fulfilled inclusion criteria. Demographic, clinical, laboratories and ECG characteristics were collected. Median age was 74 (IQR 64-82) years, and most patients were male (61%). During a median follow-up of 12 (IQR 7-22) days, 359 (35%) patients died. Age (HR 2.25, 95%CIs 1.72-2.94, p < 0.001), delirium (HR 2.03, 95%CIs 2.14-3.61, p = 0.012), platelets count (HR 0.91, 95%CIs 0.83-0.98, p = 0.018), D-dimer (HR 1.18, 95%CIs 1.01-1.31, p = 0.002), S1Q3T3 pattern and/or RBBB (HR 1.47, 95%CIs 1.02-2.13, p = 0.039) and ECG signs of previous myocardial necrosis (HR 2.28, 95%CIs 1.23-4.21, p = 0.009) were independently associated to in-hospital mortality. The risk scoring system derived had a moderate discriminatory capability and good calibration. A score value ≥4 had a sensitivity of 78,4% and specificity of 65,2% to predict in-hospital mortality. Interpretation: This score system stratifies prognosis and may be important for the management of COVID-19 patients admitted to the hospital. Trial Registration: ClinicalTrials.gov (identifier: NCT04367129). Funding Statement: None. Declaration of Interests: None declared. Ethics Approval Statement: ELCOVID is a prospective observational study approved by the local Ethics Committee and involves 15 hospitals in the Emilia Romagna and Lazio, two regions in northern and central Italy heavily affected by the pandemic.
Published: 2021

9. Comparison of Reduced-Dose Prasugrel and Standard-Dose Clopidogrel in Elderly Patients With Acute Coronary Syndromes Undergoing Early Percutaneous Revascularization

Author: Stefano Savonitto, Luca A. Ferri, Luigi Piatti, Daniele Grosseto, Giancarlo Piovaccari, Nuccia Morici, Irene Bossi, Paolo Sganzerla, Giovanni Tortorella, Michele Cacucci, Maurizio Ferrario, Ernesto Murena, Girolamo Sibilio, Stefano Tondi, Anna Toso, Sergio Bongioanni, Amelia Ravera, Elena Corrada, Matteo Mariani, Leonardo Di Ascenzo, A. Sonia Petronio, Claudio Cavallini, Giancarlo Vitrella, Renata Rogacka, Roberto Antonicelli, Bruno M. Cesana, Leonardo De Luca, Filippo Ottani, Giuseppe De Luca, Federico Piscione, Nadia Moffa, Stefano De Servi, Leonardo Bolognese, Francesco Bovenzi, Giuseppe Steffenino, Ignazio Santilli, Giorgio Bassanelli, Alice Sacco, Federico Canziani, Marco Ferri, Emilia Lo Jacono, Umberto Canosi, Giuseppe Fornaro, Mario Leoncini, Maria Rosa Conte, Rosario Farina, Catia Stefanin, Francesco Di Pede, Piersilvio Chella, M. Chiara Nardoni, Paola Tamburrini, Bruno Trimarco, Gennaro Galasso, Raffaele Elia, Simone Grotti, Lucia Borrelli, Corrado Tamburino, Piera Capranzano, Bruno Francaviglia, Carlo Campana, Roberto Bonatti, Alessandro Martinoni, Fabio Abate, Sebastian Coscarelli, Paolo Rubartelli, Giovanni Q. Villani, and Roberta Rossini
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Prasugrel, medicine.medical_treatment, Myocardial Infarction, Hemorrhage, antiplatelet drugs, 030204 cardiovascular system & hematology, elderly, percutaneous coronary interventions, Disease-Free Survival, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Physiology (medical), Internal medicine, medicine, Humans, acute coronary syndromes, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Aged, Aged, 80 and over, Maintenance dose, business.industry, Hazard ratio, Percutaneous coronary intervention, Clopidogrel, medicine.disease, Survival Rate, Cardiology, Platelet aggregation inhibitor, Female, Cardiology and Cardiovascular Medicine, business, Prasugrel Hydrochloride, medicine.drug
Abstract: Background: Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome and display higher on-clopidogrel platelet reactivity compared with younger patients. Prasugrel 5 mg provides more predictable platelet inhibition compared with clopidogrel in the elderly, suggesting the possibility of reducing ischemic events without increasing bleeding. Methods: In a multicenter, randomized, open-label, blinded end point trial, we compared a once-daily maintenance dose of prasugrel 5 mg with the standard clopidogrel 75 mg in patients >74 years of age with acute coronary syndrome undergoing percutaneous coronary intervention. The primary end point was the composite of mortality, myocardial infarction, disabling stroke, and rehospitalization for cardiovascular causes or bleeding within 1 year. The study was designed to demonstrate superiority of prasugrel 5 mg over clopidogrel 75 mg. Results: Enrollment was interrupted, according to prespecified criteria, after a planned interim analysis, when 1443 patients (40% women; mean age, 80 years) had been enrolled with a median follow-up of 12 months, because of futility for efficacy. The primary end point occurred in 121 patients (17%) with prasugrel and 121 (16.6%) with clopidogrel (hazard ratio, 1.007; 95% confidence interval, 0.78–1.30; P =0.955). Definite/probable stent thrombosis rates were 0.7% with prasugrel versus 1.9% with clopidogrel (odds ratio, 0.36; 95% confidence interval, 0.13–1.00; P =0.06). Bleeding Academic Research Consortium types 2 and greater rates were 4.1% with prasugrel versus 2.7% with clopidogrel (odds ratio, 1.52; 95% confidence interval, 0.85–3.16; P =0.18). Conclusions: The present study in elderly patients with acute coronary syndromes showed no difference in the primary end point between reduced-dose prasugrel and standard-dose clopidogrel. However, the study should be interpreted in light of the premature termination of the trial. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01777503.
Published: 2018

10. Twelve-month outcome of patients with an established indication for oral anticoagulation undergoing coronary artery stenting and stratified by the baseline risk of bleeding

Author: Giacomo Piccalò, Francesco Saia, Michele Dallago, Paolo Magnavacchi, Stefano Mameli, Giancarlo Piovaccari, Alessandro Sciahbasi, Paolo Calabrò, Antonio Maria Leone, Annamaria Nicolino, Luigi Steffanon, Stefano Maggiolini, Andrea Rubboli, Maria Letizia Bacchi-Reggiani, Barbara Bordoni, Luigi Vignali, Nicoletta Franco, Cataldo Palmieri, and Giuseppe Di Pasquale
Subjects: Aspirin, medicine.medical_specialty, business.industry, medicine.medical_treatment, Warfarin, Percutaneous coronary intervention, Atrial fibrillation, General Medicine, 030204 cardiovascular system & hematology, Clopidogrel, medicine.disease, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Coronary stent, medicine, Cardiology, cardiovascular diseases, 030212 general & internal medicine, Ticlopidine, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Purpose To evaluate the outcome of patients with an established indication for oral anticoagulation (OAC) undergoing coronary stent implantation (PCI-S) and stratified by the baseline risk of bleeding. Material and methods The database of the prospective, multicentre, observational WAR-STENT registry ( ClinicalTrials.gov identifier NCT00722319 ) was analyzed and patients with atrial fibrillation and CHA 2 DS 2 -VASc score ≥2, mechanical heart valve, prior cardiac embolism, intra-cardiac thrombus and recent venous thromboembolism who were treated with either triple (warfarin, aspirin and clopidogrel) or dual (warfarin and clopidogrel) or dual antiplatelet (aspirin and clopidogrel) therapy, identified. Patients were then sorted into two groups at non-low and low risk of bleeding, as defined by an ATRIA score >3 and ≤3 respectively, and compared regarding major adverse cardiac and vascular events (MACVE) and bleeding. Results At 12-month follow up, MACVE were comparable in the two groups, whereas total, major and minor bleeding, as well as combined MACVE and total bleeding, were significantly more frequent in the non-low bleeding risk group. Upon Cox univariate and multivariable analysis, non-low bleeding risk category confirmed as an independent predictor of major bleeding. The choice of antithrombotic therapy however, appeared not to be influenced by the bleeding risk category at baseline. Conclusions In patients with an established indication for OAC undergoing PCI-S, non-low bleeding risk category is the most potent independent predictor of major bleeding. Stratification of the bleeding risk at baseline should therefore be regarded as an indispensable process to be carried out before selection of the antithrombotic therapy.
Published: 2017

11. Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes: a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial

Author: Kausik K Ray, Helen M Colhoun, Michael Szarek, Marie Baccara-Dinet, Deepak L Bhatt, Vera A Bittner, Andrzej J Budaj, Rafael Diaz, Shaun G Goodman, Corinne Hanotin, Robert A Harrington, J Wouter Jukema, Virginie Loizeau, Renato D Lopes, Angèle Moryusef, Jan Murin, Robert Pordy, Arsen D Ristic, Matthew T Roe, José Tuñón, Harvey D White, Andreas M Zeiher, Gregory G Schwartz, Philippe Gabriel Steg, Gregory G. Schwartz, Ph. Gabriel Steg, Deepak L. Bhatt, Vera A. Bittner, Shaun G. Goodman, Robert A. Harrington, J. Wouter Jukema, Harvey D. White, Andreas M. Zeiher, Pierluigi Tricoci, Matthew T. Roe, Kenneth W. Mahaffey, Jay M. Edelberg, Guillaume Lecorps, William J. Sasiela, Jean-François Tamby, Philip E. Aylward, Heinz Drexel, Peter Sinnaeve, Mirza Dilic, Renato D. Lopes, Nina N. Gotcheva, Juan-Carlos Prieto, Huo Yong, Patricio López-Jaramillo, Ivan Pećin, Zeljko Reiner, Petr Ostadal, Margus Viigimaa, Markku S. Nieminen, Vakhtang Chumburidze, Nikolaus Marx, Nicolas Danchin, Evangelos Liberopoulos, Pablo Carlos Montenegro Valdovinos, Hung-Fat Tse, Robert Gabor Kiss, Denis Xavier, Doron Zahger, Marco Valgimigli, Takeshi Kimura, Hyo Soo Kim, Sang-Hyun Kim, Andrejs Erglis, Aleksandras Laucevicius, Sasko Kedev, Khalid Yusoff, Gabriel Arturo Ramos López, Marco Alings, Sigrun Halvorsen, Roger M. Correa Flores, Andrzej Budaj, Joao Morais, Maria Dorobantu, Yuri Karpov, Arsen D. Ristic, Terrance Chua, Zlatko Fras, Anthony J. Dalby, H. Asita de Silva, Emil Hagström, Ulf Landmesser, Chern-En Chiang, Piyamitr Sritara, Sema Guneri, Alexander Parkhomenko, Kausik K. Ray, Patrick M. Moriarty, Robert Vogel, Bernard Chaitman, Sheryl F. Kelsey, Anders G. Olsson, Jean-Lucien Rouleau, Maarten L. Simoons, Karen Alexander, Chiara Meloni, Robert Rosenson, Eric J.G. Sijbrands, John H. Alexander, Luciana Armaganijan, Akshay Bagai, Maria Cecilia Bahit, J. Matthew Brennan, Shaun Clifton, Adam D. DeVore, Shalonda Deloatch, Sheila Dickey, Keith Dombrowski, Grégory Ducrocq, Zubin Eapen, Patricia Endsley, Arleen Eppinger, Robert W. Harrison, Connie Ng Hess, Mark A. Hlatky, Joseph Dedrick Jordan, Joshua W. Knowles, Bradley J. Kolls, David F. Kong, Sergio Leonardi, Linda Lillis, David J. Maron, Jill Marcus, Robin Mathews, Rajendra H. Mehta, Robert J. Mentz, Humberto Graner Moreira, Chetan B. Patel, Sabrina Bernardez-Pereira, Lynn Perkins, Thomas J. Povsic, Etienne Puymirat, William Schuyler Jones, Bimal R. Shah, Matthew W. Sherwood, Kenya Stringfellow, Darin Sujjavanich, Mustafa Toma, Charlene Trotter, Sean Van Diepen, Matthew D. Wilson, Andrew T. Yan, Lilia B. Schiavi, Marcelo Garrido, Andrés F. Alvarisqueta, Sonia A. Sassone, Anselmo P. Bordonava, Alberto E. Alves De Lima, Jorge M. Schmidberg, Ernesto A. Duronto, Orlando C. Caruso, Leonardo P. Novaretto, Miguel Angel Hominal, Oscar R. Montaña, Alberto Caccavo, Oscar A. Gomez Vilamajo, Alberto J. Lorenzatti, Luis R. Cartasegna, Gustavo A. Paterlini, Ignacio J. Mackinnon, Guillermo D. Caime, Marcos Amuchastegui, Oscar Salomone, Oscar R. Codutti, Horacio O. Jure, Julio OE Bono, Adrian D. Hrabar, Julio A. Vallejos, Rodolfo A. Ahuad Guerrero, Federico Novoa, Cristian A. Patocchi, Cesar J. Zaidman, Maria E. Giuliano, Ricardo D. Dran, Marisa L. Vico, Gabriela S. Carnero, Pablo N. Guzman, Juan C. Medrano Allende, Daniela F. Garcia Brasca, Miguel H Bustamante Labarta, Sebastian Nani, Eduardo DS Blumberg, Hugo R Colombo, Alberto Liberman, Victorino Fuentealba, Hector L Luciardi, Gabriel D Waisman, Mario A Berli, Ruben O Garcia Duran, Horacio G Cestari, Hugo A Luquez, Jorge A Giordano, Silvia S Saavedra, Gerardo Zapata, Osvaldo Costamagna, Susana Llois, Jonathon H Waites, Nicholas Collins, Allan Soward, Chris LS Hii, James Shaw, Margaret A Arstall, John Horowitz, Daniel Ninio, James F Rogers, David Colquhoun, Romulo E Oqueli Flores, Philip Roberts-Thomson, Owen Raffel, Sam J Lehman, Constantine Aroney, Steven GM Coverdale, Paul J Garrahy, Gregory Starmer, Mark Sader, Patrick A Carroll, Ronald Dick, Robert Zweiker, Uta Hoppe, Kurt Huber, Rudolf Berger, Georg Delle-Karth, Bernhard Frey, Franz Weidinger, Dirk Faes, Kurt Hermans, Bruno Pirenne, Attilio Leone, Etienne Hoffer, Mathias CM Vrolix, Luc De Wolf, Bart Wollaert, Marc Castadot, Karl Dujardin, Christophe Beauloye, Geert Vervoort, Harry Striekwold, Carl Convens, John Roosen, Emanuele Barbato, Marc Claeys, Frank Cools, Ibrahim Terzic, Fahir Barakovic, Zlatko Midzic, Belma Pojskic, Emir Fazlibegovic, Mehmed Kulić, Azra Durak-Nalbantic, Dusko Vulic, Adis Muslibegovic, Boris Goronja, Gilmar Reis, Luciano Sousa, Jose C Nicolau, Flavio E Giorgeto, Ricardo P Silva, Lilia Nigro Maia, Rafael Rech, Paulo RF Rossi, Maria José AG Cerqueira, Norberto Duda, Renato Kalil, Adrian Kormann, José Antonio M Abrantes, Pedro Pimentel Filho, Ana Priscila Soggia, Mayler ON de Santos, Fernando Neuenschwander, Luiz C Bodanese, Yorghos L Michalaros, Freddy G Eliaschewitz, Maria H Vidotti, Paulo E Leaes, Roberto V Botelho, Sergio Kaiser, Euler Roberto Fernandes Manenti, Dalton B Precoma, Jose C Moura Jorge, Pedro G de B Silva, Jose A Silveira, Wladmir Saporito, Jose A Marin-Neto, Gilson S Feitosa, Luiz Eduardo F Ritt, Juliana A de Souza, Fernando Costa, Weimar KSB Souza, Helder JL Reis, Leandro Machado, José Carlos Aidar Ayoub, Georgi V Todorov, Fedya P Nikolov, Elena S Velcheva, Maria L Tzekova, Haralambi O Benov, Stanislav L Petranov, Haralin S Tumbev, Nina S Shehova-Yankova, Dimitar T Markov, Dimitar H Raev, Mihail N Mollov, Kostadin N Kichukov, Katya A Ilieva-Pandeva, Raya Ivanova, Maryana Gospodinov, Valentina M Mincheva, Petar V Lazov, Bojidar I Dimov, Manohara Senaratne, James Stone, Jan Kornder, Stephen Pearce, Danielle Dion, Daniel Savard, Yves Pesant, Amritanshu Pandey, Simon Robinson, Gilbert Gosselin, Saul Vizel, Gordon Hoag, Ronald Bourgeois, Anne Morisset, Eric Sabbah, Bruce Sussex, Simon Kouz, Paul MacDonald, Ariel Diaz, Nicolas Michaud, David Fell, Raymond Leung, Tycho Vuurmans, Christopher Lai, Frank Nigro, Richard Davies, Gustavo Nogareda, Ram Vijayaraghavan, John Ducas, Serge Lepage, Shamir Mehta, James Cha, Robert Dupuis, Peter Fong, Sohrab Lutchmedial, Josep Rodes-Cabau, Hussein Fadlallah, David Cleveland, Thao Huynh, Iqbal Bata, Adnan Hameed, Cristian Pincetti, Sergio Potthoff, Juan C Prieto, Monica Acevedo, Arnoldo Aguirre, Margarita Vejar, Mario Yañez, Guillermo Araneda, Mauricio Fernandez, Luis Perez, Paola Varleta, Fernando Florenzano, Laura Huidobro, Carlos A Raffo, Claudia Olivares, Leonardo Nahuelpan, Humberto Montecinos, Jiyan Chen, Yugang Dong, Weijian Huang, Jianzhong Wang, Shi'An Huang, Zhuhua Yao, Xiang Li, Lan Cui, Wenhua Lin, Yuemin Sun, Jingfeng Wang, Jianping Li, Xuelian Zhang, Hong Zhu, Dandan Chen, Lan Huang, Shaohong Dong, Guohai Su, Biao Xu, Xi Su, Xiaoshu Cheng, Jinxiu Lin, Wenxia Zong, Huanming Li, Yi Feng, Dingli Xu, Xinchun Yang, Yuannan Ke, Xuefeng Lin, Zheng Zhang, Zeqi Zheng, Zhurong Luo, Yundai Chen, Chunhua Ding, Yi Zhong, Yang Zheng, Xiaodong Li, Daoquan Peng, Shuiping Zhao, Ying Li, Xuebo Liu, Meng Wei, Shaowen Liu, Yihua Yu, Baiming Qu, Weihong Jiang, Yujie Zhou, Xingsheng Zhao, Zuyi Yuan, Ying Guo, Xiping Xu, Xubo Shi, Junbo Ge, Guosheng Fu, Feng Bai, Weiyi Fang, Xiling Shou, Xiangjun Yang, Jian'An Wang, Meixiang Xiang, Yingxian Sun, Qinghua Lu, Ruiyan Zhang, Jianhua Zhu, Yizhou Xu, Zhongcai Fan, Tianchang Li, Chun Wu, Nicolas Jaramillo, Gregorio Sanchez Vallejo, Diana C Luna Botia, Rodrigo Botero Lopez, Dora I Molina De Salazar, Alberto J Cadena Bonfanti, Carlos Cotes Aroca, Juan Diego Higuera, Marco Blanquicett, Sandra I Barrera Silva, Henry J Garcia Lozada, Julian A Coronel Arroyo, Jose L Accini Mendoza, Ricardo L Fernandez Ruiz, Alvaro M. Quintero Ossa, Fernando G Manzur Jatin, Aristides Sotomayor Herazo, Jeffrey Castellanos Parada, Rafael Suarez Arambula, Miguel A Urina Triana, Angela M Fernandez Trujillo, Maja Strozzi, Siniša Car, Melita Jerić, Davor Miličić, Martina Lovrić Benčić, Hrvoje Pintarić, Đeiti Prvulović, Jozica Šikić, Viktor Peršić, Dean Mileta, Kresimir Štambuk, Zdravko Babić, Vjekoslav Tomulic, Josip Lukenda, Stanka Mejic-Krstulovic, Boris Starcevic, Jindrich Spinar, David Horak, Zdenek Velicka, Josef Stasek, David Alan, Vilma Machova, Ales Linhart, Vojtech Novotny, Vladimir Kaucak, Richard Rokyta, Robert Naplava, Zdenek Coufal, Vera Adamkova, Ivo Podpera, Jiri Zizka, Zuzana Motovska, Ivana Marusincova, Premysl Svab, Petr Heinc, Jiri Kuchar, Petr Povolny, Jiri Matuska, Steen H Poulsen, Bent Raungaard, Peter Clemmensen, Lia E Bang, Ole May, Morten Bøttcher, Jens D Hove, Lars Frost, Gunnar Gislason, John Larsen, Peter Betton Johansen, Flemming Hald, Peter Johansen, Jørgen Jeppesen, Tonny Nielsen, Kjeld S Kristensen, Piotr Maria Walichiewicz, Jens D Lomholdt, Ib C Klausen, Peter Kaiser Nielsen, Flemming Davidsen, Lars Videbaek, Mai Soots, Veiko Vahula, Anu Hedman, Üllar Soopõld, Kaja Märtsin, Tiina Jurgenson, Arved Kristjan, Juhani K Helsinki, Saila Vikman, Heikki Huikuri, Juhani Airaksinen, Pierre Coste, Emile Ferrari, Olivier Morel, Gilles Montalescot, Jacques Machecourt, Gilles Barone-Rochette, Jacques Mansourati, Yves Cottin, Florence Leclercq, Abdelkader Belhassane, Nicolas Delarche, Franck Boccara, Franck Paganelli, Jérôme Clerc, Francois Schiele, Victor Aboyans, Vincent Probst, Jacques Berland, Thierry Lefèvre, Bernard Citron, Irakli Khintibidze, Tamaz Shaburishvili, Zurab Pagava, Ramaz Ghlonti, Zaza Lominadze, George Khabeishvili, Rayyan Hemetsberger, Kemala Edward, Ursula Rauch-Kröhnert, Matthias Stratmann, Karl-Friedrich Appel, Ekkehard Schmidt, Heyder Omran, Christoph Stellbrink, Thomas Dorsel, Emmanouil Lianopoulos, Hans Friedrich Vöhringer, Roger Marx, Andreas Zirlik, Detlev Schellenberg, Thomas Heitzer, Ulrich Laufs, Christian Werner, Stephan Gielen, Sebastian Nuding, Bernhard Winkelmann, Steffen Behrens, Karsten Sydow, Mahir Karakas, Gregor Simonis, Thomas Muenzel, Nikos Werner, Stefan Leggewie, Dirk Böcker, Rüdiger Braun-Dullaeus, Nicole Toursarkissian, Michael Jeserich, Matthias Weißbrodt, Tim Schaeufele, Joachim Weil, Heinz Völler, Johannes Waltenberger, Mohammed Natour, Susanne Schmitt, Dirk Müller-Wieland, Stephan Steiner, Lothar Heidenreich, Elmar Offers, Uwe Gremmler, Holger Killat, Werner Rieker, Sotiris Patsilinakos, Athanasios Kartalis, Athanassios Manolis, Dimitrios Sionis, Geargios Chachalis, Ioannis Skoumas, Vasilios Athyros, Panagiotis Vardas, Frangkiskos Parthenakis, Dimitrios Alexopoulos, Georgios Hahalis, John Lekakis, Apostolos Hatzitolios, Sergio R Fausto Ovando, Juan L Arango Benecke, Edgar R Rodriguez De Leon, Bryan PY Yan, David CW Siu, Tibor Turi, Bela Merkely, Imre Ungi, Geza Lupkovics, Lajos Nagy, András Katona, István Édes, Gábor Müller, Iván Horvath, Tibor Kapin, Zsolt Szigeti, József Faluközy, Mukund Kumbla, Manjinder Sandhu, Sharath Annam, Naveen Reddy Proddutur, Reddy Regella, Rajendra K Premchand, Ajaykumar Mahajan, Sudhir Pawar, Atul D Abhyanakar, Prafulla Kerkar, Ravishankar A Govinda, Abraham Oomman, Dhurjati Sinha, Sachin N Patil, Dhiman Kahali, Jitendra Sawhney, Abhijeet B Joshi, Sanjeev Chaudhary, Pankaj Harkut, Santanu Guha, Sanjay Porwal, Srimannarayana Jujjuru, Ramesh B Pothineni, Minguel R Monteiro, Aziz Khan, Shamanna S Iyengar, Jasprakash Singh Grewal, Manoj Chopda, Mahesh C Fulwani, Aparna Patange, Patil Sachin, Vijay K Chopra, Naresh K Goyal, Rituparna Shinde, Gajendra V Manakshe, Nitin Patki, Sumeet Sethi, Vengatesh Munusamy, Sunil Karna, Sunil Thanvi, Srilakshmi Adhyapak, Chandrakant Patil, Ulhas Pandurangi, Rishabh Mathur, Jugal Gupta, Suhas Kalashetti, Ajit Bhagwat, Bagirath Raghuraman, Shiv Kumar Yerra, Prasant Bhansali, Rohidas Borse, Patil Rahul, Srihari Das, Vinay Kumar, Jabir Abdullakutty, Shireesh Saathe, Priya Palimkar, Shireesh Sathe, Shaul Atar, Michael Shechter, Morris Mosseri, Yaron Arbel, Chorin Ehud, Havakuk Ofer, Chaim Lotan, Uri Rosenschein, Amos Katz, Yaakov Henkin, Adi Francis, Marc Klutstein, Eugenia Nikolsky, Robert Zukermann, Yoav Turgeman, Majdi Halabi, Alon Marmor, Ran Kornowski, Michael Jonas, Offer Amir, Yonathan Hasin, Yoseph Rozenman, Shmuel Fuchs, Vered Zvi, Osamah Hussein, Dov Gavish, Zvi Vered, Yoseph Caraco, Mazen Elias, Naveh Tov, Efrat Wolfovitz, Michael Lishner, Nizar Elias, Giancarlo Piovaccari, Annamaria De Pellegrin, Raffaella Garbelotto, Gabriele Guardigli, Valgimigli Marco, Giovanni Licciardello, Carla Auguadro, Filippo Scalise, Claudio Cuccia, Alessandro Salvioni, Giuseppe Musumeci, Michelle Senni, Paolo Calabrò, Salvatore Novo, Pompilio Faggiano, Marco Metra, Nicoletta B De Cesare, Sergio Berti, Claudio Cavallini, Enrico Puccioni, Marcello Galvani, Maurizio Tespili, Piermarco Piatti, Michela Palvarini, Giuseppe De 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Palmer, B, Wiseman, A, Puri, S, Mohart, A, Ince, C, Flores, E, Wright, S, Cheng, S, Rosenberg, M, Rogers, W, Kosinski, E, Forgosh, L, Waltman, J, Khan, M, Shoukfeh, M, Dagher, G, Cambier, P, Lieber, I, Kumar, P, East, C, Krichmar, P, Hasan, M, White, L, Knickelbine, T, Haldis, T, Gillespie, E, Amidon, T, Suh, D, Arif, I, Abdallah, M, Akhter, F, Carlson, E, D'Urso, M, El-Ahdab, F, Nelson, W, Moriarty, K, Harris, B, Cohen, S, Carter, L, Doty, D, Sabatino, K, Haddad, T, Malik, A, Rao, S, Mulkay, A, Jovin, I, Klancke, K, Malhotra, V, Devarapalli, S, Koren, M, Chandna, H, Dodds III, G, Goraya, T, Bengston, J, Janik, M, Moran, J, Sumner, A, Kobayashi, J, Davis, W, Yazdani, S, Pasquini, J, Thakkar, M, Vedere, A, Leimbach, W, Rider, J, Fenton, S, Singh, N, Shah, A, Janosik, D, Pepine, C, Berman, B, Gelormini, J, Daniels, C, Richard, K, Keating, F, Kondo, N, Shetty, S, Levite, H, Waider, W, Takata, T, Abu-Fadel, M, Shah, V, Izzo, M, Kumar, A, Hattler, B, Do, R, Link, C, Bortnick, A, Kinzfogl III, G, Ghitis, A, Larry, J, Teufel, E, Kuhlman, P, Mclaurin, B, Zhang, W, Thew, S, Abbas, J, White, M, Islam, O, Subherwal, S, Ranadive, N, Vakili, B, Gring, C, Henderson, D, Schuchard, T, Farhat, N, Kline, G, Mahal, S, Whitaker, J, Speirs, S, Andersen, R, Daboul, N, Horwitz, P, Zahr, F, Ponce, G, Jafar, Z, Mcgarvey, J, Panchal, V, Voyce, S, Blok, T, Sheldon, W, Azizad, M, Schmalfuss, C, Picone, M, Pederson, R, Herzog, W, Friedman, K, Lindsey, J, Nowins, R, Timothy, E, Leonard, P, Lepor, N, El Shahawy, M, Weintraub, H, Irimpen, A, Alonso, A, May, W, Christopher, D, Galski, T, Chu, A, Mody, F, Ramin, E, Hodes, Z, Rossi, J, Rose, G, Fairlamb, J, Lambert, C, Raisinghani, A, Abbate, A, Vetrovec, G, King, M, Carey, C, Gerber, J, Younis, L, Vidovich, M, Knutson, T, Friedman, D, Chaleff, F, Loussararian, A, Rozeman, P, Kimmelstiel, C, Kuvin, J, Silver, K, Foster, M, Tonnessen, G, Espinoza, A, Amlani, M, Wali, A, Malozzi, C, Jong, G, Massey, C, Wattanakit, K, O'Donnell, P, Singal, D, Jaffrani, N, Banuru, S, Fisher, D, Xenakis, M, Perlmutter, N, Bhagwat, R, Strader, J, Blonder, R, Akyea-Djamson, A, Labroo, A, Marais, H, Claxton, E, Weiss, R, Kathryn, R, Berk, M, Joshi, P, Khera, A, Khaira, A, Kumkumian, G, Lupovitch, S, Purow, J, Welka, S, Hoffman, D, Fischer, S, Soroka, E, Eagerton, D, Pancholy, S, Ray, M, Erenrich, N, Farrar, M, Pollock, S, French, W, Diamantis, S, Guy, D, Gimple, L, Neustel, M, Schwartz, S, Pereira, E, Albert, S, Spriggs, D, Strain, J, Mittal, S, Vo, A, Chane, M, Hall, J, Vijay, N, Lotun, K, Lester, F, Nahhas, A, Pope, T, Nager, P, Vohra, R, Sharma, M, Bashir, R, Ahmed, H, Berlowitz, M, Fishberg, R, Barrucco, R, Yang, E, Radin, M, Sporn, D, Stapleton, D, Eisenberg, S, Landzberg, J, Mcgough, M, Turk, S, Schwartz, M, Sundram, P, Jain, D, Zainea, M, Bayron, C, Karlsberg, R, Dohad, S, Lui, H, Keen, W, Westerhausen, D, Khurana, S, Agarwal, H, Birchem, J, Penny, W, Chang, M, Murphy, S, Henry, J, Schifferdecker, B, Gilbert, J, Chalavarya, G, Eaton, C, Schmedtje, J, Christenson, S, Dotani, I, Denham, D, Macdonell, A, Gibson, P, Rahman, A, Al Joundi, T, Assi, N, Conrad, G, Kotha, P, Love, M, Giesler, G, Rubenstein, H, Gamil, D, Akright, L, Krawczyk, J, Cobler, J, Wells, T, Welker, J, Foster, R, Gilmore, R, Anderson, J, Jacoby, D, Gardner, G, Dandillaya, R, Vora, K, Kostis, J, Hunter, J, Laxson, D, Ball, E, Egydio, F, Kawakami, A, Oliveira, J, Wozniak, J, Matthews, A, Ratky, C, Valiris, J, Berdan, L, Hepditch, A, Quintero, K, Rorick, T, Westbrook, M, Pascual, A, Rovito, C, Bezault, M, Drouet, E, Simon, T, Alsweiler, C, Luyten, A, Butters, J, Griffith, L, Shaw, M, Grunberg, L, Islam, S, Bregeault, M, Bougon, N, Faustino, D, Fontecave, S, Murphy, J, Verrier, M, Agnetti, V, Andersen, D, Badreddine, E, Bekkouche, M, Bouancheau, C, Brigui, I, Brocklehurst, M, Cianciarulo, J, Devaul, D, Domokos, S, Gache, C, Gobillot, C, Guillou, S, Healy, J, Heath, M, Jaiwal, G, Javierre, C, Labeirie, J, Monier, M, Morales, U, Mrabti, A, Mthombeni, B, Okan, B, Smith, L, Sheller, J, Sopena, S, Pellan, V, Benbernou, F, Bengrait, N, Lamoureux, M, Kralova, K, Scemama, M, Bejuit, R, Coulange, A, Berthou, C, Repincay, J, Lorenzato, C, Etienne, A, Gouet, V, Normand, M, Ourliac, A, Rondel, C, Adamo, A, Beltran, P, Barraud, P, Dubois-Gache, H, Halle, B, Metwally, L, Mourgues, M, Sotty, M, Vincendet, M, Cotruta, R, Chengyue, Z, Fournie-Lloret, D, Morrello, C, Perthuis, A, Picault, P, Zobouyan, I, Dempsey, M, Mcclanahan, M, ODYSSEY OUTCOMES Comm Investigato, and Ege Üniversitesi
Subjects: Male, BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences, STATIN THERAPY, blood-glucose, Endocrinology, Diabetes and Metabolism, GUIDELINES, PCSK9, 0302 clinical medicine, Endocrinology, GENETIC-VARIANTS, Cardiovascular Disease, Diabetes Complication, Aged Antibodies, Monoclonal, Humanized / therapeutic use* Cardiovascular Diseases / blood Cardiovascular Diseases / prevention & control* Diabetes Complications / blood Diabetes Complications / prevention & control* Female Humans Male Middle Aged Substances, Clinical endpoint, Medicine, guidelines, 030212 general & internal medicine, Prediabetes, Myocardial infarction, myocardial-infarction, genetic-variants, statin therapy, risk, pcsk9, association, liraglutide, evolocumab, RISK, BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti, BLOOD-GLUCOSE, ASSOCIATION, Middle Aged, Cardiovascular Diseases, Female, Life Sciences & Biomedicine, Human, medicine.medical_specialty, Acute coronary syndrome, PCSK9 inhibitor, acute coronary syndrome, lipoprotein(a), low-density lipoprotein cholesterol, 030209 endocrinology & metabolism, Antibodies, Monoclonal, Humanized, Diabetes Complications, Endocrinology & Metabolism, 03 medical and health sciences, Diabetes mellitus, Internal medicine, Internal Medicine, Humans, Aged, Alirocumab, diabetes, PCSK9, hyperlipidemia, Science & Technology, ODYSSEY OUTCOMES Committees and Investigators, business.industry, Unstable angina, EVOLOCUMAB, medicine.disease, MYOCARDIAL-INFARCTION, LIRAGLUTIDE, Human medicine, business
Abstract: Doi, Yasuji/0000-0002-8368-0827; galvani, marcello/0000-0001-5897-667X; Gislason, Gunnar H/0000-0002-0548-402X; Taskinen, Marja-Riitta/0000-0002-6229-3588; Sherwood, Matthew/0000-0002-4305-5883; Malynovsky, Yaroslav V/0000-0002-9118-1104; Viktorova, vic-inna@mail.ru I.A./0000-0001-8728-2722; bastos, jose/0000-0002-9526-3123; Yang, Eric H/0000-0003-4889-7454; Rudenko, Anatoliy Viktorovich/0000-0003-1099-1613; Novotny, Vojtech/0000-0003-3521-9945; Nikolaev, Konstantin/0000-0003-4601-6203; Reshetko, Olga/0000-0003-3107-7636; Leonardi, Sergio/0000-0002-4800-6132; Muenzel, Thomas/0000-0001-5503-4150; Ushakov, Alexei V/0000-0002-7020-4442; Tse, Hung Fat/0000-0002-9578-7808; Podoleanu, Cristian/0000-0001-9987-2519; Raffel, Owen C/0000-0001-5470-7050; Khasanov, Niiaz/0000-0002-7760-0763; Chumakova, Galina A/0000-0002-2810-6531; Ersanli, Murat/0000-0003-1847-3087; cornel, jan hein/0000-0002-1006-2112; Abbate, Antonio/0000-0002-1930-785X; Racca, Vittorio/0000-0002-4465-3789; Urina-Triana, Miguel A/0000-0001-6003-4622; Rasputina, Lesia/0000-0003-1230-4039; Racca, Vittorio/0000-0002-4465-3789; Reis, Gilmar/0000-0002-4847-1034; Sandhu, Manjinder/0000-0003-2538-2079; Keskin, Kudret/0000-0002-9049-1530; PAREPA, IRINEL/0000-0002-7571-9015; Manakshe, Gajendra/0000-0002-4983-4271; Nicolau, Jose C/0000-0002-9680-3689; Strelnieks, Aldis/0000-0003-3493-2562; Budaj, Andrzej/0000-0002-6395-2098; Marin, Francisco/0000-0001-7246-7708; Wongpraparut, Nattawut/0000-0002-1541-3313; Yuan, Zuyi/0000-0002-4141-0298; Jeong, Myung Ho/0000-0003-2424-810X; Mostovoy, Yuriy/0000-0002-7041-1230; Pepine, Carl/0000-0002-6011-681X; Lopez-Jaramillo, Patricio/0000-0002-9122-8742; Garcia-Lledo, Alberto/0000-0002-8986-2584; Tesloianu, Nicolae-Dan/0000-0002-1007-3022; Kosmacheva, Elena/0000-0001-8600-0199; Kunz Sebba Barroso Souza, Weimar/0000-0002-1265-1930; Katz, Amos/0000-0003-0422-934X; Tunon, Jose/0000-0002-1373-0999; Acevedo, Monica/0000-0002-7989-6633; Hove, Jens/0000-0002-5600-5623; Yakushin, Sergey/0000-0001-7202-742X; Gonzalez Juanatey, Jose Ramon/0000-0001-9681-3388; Lyamina, Nadezhda/0000-0001-6939-3234; Aylward, Philip/0000-0002-5358-8552; Apostolovic, Svetlana/0000-0001-9015-297X; Airaksinen, Juhani/0000-0002-0193-568X; Nahhas, Prof. Dr. Ahmed/0000-0002-2887-8187; Barbarash, Olga/0000-0002-4642-3610, WOS: 000475553300016, PubMed: 31272931, Background After acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1.4-1.8 mmol/L with ezetimibe or statins reduces cardiovascular events in patients with an acute coronary syndrome and diabetes. However, the efficacy and safety of further reduction in LDL cholesterol with an inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) after acute coronary syndrome is unknown. We aimed to explore this issue in a prespecified analysis of the ODYSSEY OUTCOMES trial of the PCSK9 inhibitor alirocumab, assessing its effects on cardiovascular outcomes by baseline glycaemic status, while also assessing its effects on glycaemic measures including risk of new-onset diabetes. Methods ODYSSEY OUTCOMES was a randomised, double-blind, placebo-controlled trial, done at 1315 sites in 57 countries, that compared alirocumab with placebo in patients who had been admitted to hospital with an acute coronary syndrome (myocardial infarction or unstable angina) 1-12 months before randomisation and who had raised concentrations of atherogenic lipoproteins despite use of high-intensity statins. Patients were randomly assigned (1: 1) to receive alirocumab or placebo every 2 weeks; randomisation was stratified by country and was done centrally with an interactive voice-response or web-response system. Alirocumab was titrated to target LDL cholesterol concentrations of 0.65-1.30 mmol/L. in this prespecified analysis, we investigated the effect of alirocumab on cardiovascular events by glycaemic status at baseline (diabetes, prediabetes, or normoglycaemia)-defined on the basis of patient history, review of medical records, or baseline HbA(1c) or fasting serum glucose-and risk of new-onset diabetes among those without diabetes at baseline. the primary endpoint was a composite of death from coronary heart disease, non-fatal myocardial infarction, fatal or non-fatal ischaemic stroke, or unstable angina requiring hospital admission. ODYSSEY OUTCOMES is registered with ClinicalTrials. gov, number NCT01663402. Findings At study baseline, 5444 patients (28.8%) had diabetes, 8246 (43.6%) had prediabetes, and 5234 (27.7%) had normoglycaemia. There were no significant differences across glycaemic categories in median LDL cholesterol at baseline (2.20-2.28 mmol/L), after 4 months' treatment with alirocumab (0.80 mmol/L), or after 4 months' treatment with placebo (2.25-2.28 mmol/L). in the placebo group, the incidence of the primary endpoint over a median of 2.8 years was greater in patients with diabetes (16.4%) than in those with prediabetes (9.2%) or normoglycaemia (8.5%); hazard ratio (HR) for diabetes versus normoglycaemia 2.09 (95% CI 1.78-2.46, p, Sanofi; Regeneron Pharmaceuticals, Sanofi and Regeneron Pharmaceuticals.
Published: 2019

12. Zofenopril and Ramipril in Combination with Acetyl Salicylic Acid in Postmyocardial Infarction Patients with Left Ventricular Systolic Dysfunction: A Retrospective Analysis of the SMILE-4 Randomized, Double-Blind Study in Diabetic Patients

Author: BORGHI, CLAUDIO, AMBROSIONI, ETTORE, Omboni, Stefano, Novo, Salvatore, Vinereanu, Dragos, Ambrosio, Giuseppe, Dimitrios, Alexopolulus, Ioannis, Nanas, Marco, Agrusta, Antonio, Barsotti, Serena, Bergerone, Luigi, Caliendo, Pio, Caso, Antonio, Castello, Domenico, Cianflone, Tommaso, Cipolla, Gaetano, De Ferrari, Giuseppe, De Nittis, Livio, Dei Cas, Paolo, Di Pasquale, Rosario, Evola, Luciano, Fattore, Raffaele, Ferrante, Antonio, Fiscella, Achille, Gaspardone, Giuseppe, Ielasi, Niccoló, Marchionni, Giancarlo, Marenzi, Filippo, Marte, Federico, Miccoli, Patrizia, Noussan, Mario, Orlandi, Giancarlo, Piovaccari, Maurizio, Porcu, Patrizia, Presbitero, Antonio, Raviele, Emiliano, Renaldini, Jorge, Salerno Uriarte, Giovanni, Storti, Corrado, Tamburino, Pierfranco, Terrosu, Roberto, Testa, Rita, Trinchero, Bernardino, Tuccillo, Ludovico, Vasquez, Quinto, Villani Giovanni, Garcia, Alvés Mario, Aurora, Andrade, Silva, Cardoso, Ilidio, Moreira Joseà, Catalina, Arsenescu Georgescu, Mircea, Cinteza, Maria, Dorobantu, Dominic, Ionescu, Ioan, Manitiu, Florin, Ortan, Calin, Pop, Mariana, Radoi, Yuriy, Alexandrovich Vasyuk, Victor, Avenirovitch Kostenko, Yuriy, Borisovich Karpov, Vira, Iosifovna Tseluiko, Abram, Lvovich Syrkin, Boris, Mikhailovich Goloschekin, Evgeniy, Mikhaylovich Nifontov, Sergey, Nikolaevich Tereschenko, Natalia, Nikolaevna Burova, Konstantin, Nikolayevich Zrazhevsky, Grigory, Pavlovich Arutuynov, Valentin, Sergeevich Moiseev, Leonid, Victorovich Rudenko, Alexander, Yurievich Vishnevsky, Diaz, D. L. Y. De La Yera, Fernández, Romero, Cevat, Kirma, Kayikcioglu, Meral, Abdurrahman, Oğuzhan, Dilek, Ural Komsuoglu, Olena, Ankindinovna Koval, Alexan, Nikolaevich Parkhomenko, Igor, Petrovich Vakalyuk, Mykola, Tihonovich Vatutin, Valerii, Vladimirovich Batushkin, Borghi, Claudio, Omboni, Stefano, Novo, Salvatore, Vinereanu, Drago, Ambrosio, Giuseppe, Ambrosioni, Ettore, Dimitrios, Alexopolulu, Ioannis, Nana, Marco, Agrusta, Antonio, Barsotti, Serena, Bergerone, Luigi, Caliendo, Pio, Caso, Antonio, Castello, Domenico, Cianflone, Tommaso, Cipolla, Gaetano, De Ferrari, Giuseppe, De Nitti, Livio, Dei Ca, Paolo, Di Pasquale, Rosario, Evola, Luciano, Fattore, Raffaele, Ferrante, Antonio, Fiscella, Achille, Gaspardone, Giuseppe, Ielasi, Niccoló, Marchionni, Giancarlo, Marenzi, Filippo, Marte, Federico, Miccoli, Patrizia, Noussan, Mario, Orlandi, Giancarlo, Piovaccari, Maurizio, Porcu, Patrizia, Presbitero, Antonio, Raviele, Emiliano, Renaldini, Jorge, Salerno Uriarte, Giovanni, Storti, Corrado, Tamburino, Pierfranco, Terrosu, Roberto, Testa, Rita, Trinchero, Bernardino, Tuccillo, Ludovico, Vasquez, Quinto, Villani Giovanni, Garcia, Alvés Mario, Aurora, Andrade, Silva, Cardoso, Ilidio, Moreira Joseà, Catalina, Arsenescu Georgescu, Mircea, Cinteza, Maria, Dorobantu, Dominic, Ionescu, Ioan, Manitiu, Florin, Ortan, Calin, Pop, Mariana, Radoi, Yuriy, Alexandrovich Vasyuk, Victor, Avenirovitch Kostenko, Yuriy, Borisovich Karpov, Vira, Iosifovna Tseluiko, Abram, Lvovich Syrkin, Boris, Mikhailovich Goloschekin, Evgeniy, Mikhaylovich Nifontov, Sergey, Nikolaevich Tereschenko, Natalia, Nikolaevna Burova, Konstantin, Nikolayevich Zrazhevsky, Grigory, Pavlovich Arutuynov, Valentin, Sergeevich Moiseev, Leonid, Victorovich Rudenko, Alexander, Yurievich Vishnevsky, Diaz, D.L.Y.De La Yera, Fernández, Romero, Cevat, Kirma, Kayikcioglu, Meral, Abdurrahman, Oğuzhan, Dilek, Ural Komsuoglu, Olena, Ankindinovna Koval, Alexan, Nikolaevich Parkhomenko, Igor, Petrovich Vakalyuk, Mykola, Tihonovich Vatutin, Valerii, Vladimirovich Batushkin, on behalf of the SMILE-4 Working, Party, and Cianflone, Domenico
Subjects: Male, Captopril, Diabetic Cardiomyopathies, Myocardial Infarction, Infarction, Angiotensin-Converting Enzyme Inhibitors, 030204 cardiovascular system & hematology, chemistry.chemical_compound, Ventricular Dysfunction, Left, 0302 clinical medicine, Diabetes mellitus, Ramipril, Retrospective Studie, Cardiovascular Disease, Medicine, Pharmacology (medical), 030212 general & internal medicine, Myocardial infarction, Diabetic Cardiomyopathie, Randomized Controlled Trials as Topic, Aspirin, Left ventricular dysfunction, General Medicine, Acetyl salicylic acid, Acute myocardial infarction, Angiotensin-converting enzyme inhibitors, Zofenopril, Cardiology and Cardiovascular Medicine, Pharmacology, Middle Aged, Cardiovascular Diseases, Cardiology, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, medicine.drug, Human, medicine.medical_specialty, Diabetes mellitu, Systole, 03 medical and health sciences, Internal medicine, Humans, Aged, Retrospective Studies, business.industry, Platelet Aggregation Inhibitor, Angiotensin-Converting Enzyme Inhibitor, medicine.disease, chemistry, Angiotensin-converting enzyme inhibitor, business, Mace, Platelet Aggregation Inhibitors
Abstract: Summary Objective In the SMILE-4 study, zofenopril + acetyl salicylic acid (ASA) was more effective than ramipril + ASA on 1-year prevention of major cardiovascular events (MACE) in patients with acute myocardial infarction complicated by left ventricular dysfunction. In this retrospective analysis, we evaluated drug efficacy in subgroups of patients, according to a history of diabetes mellitus. Methods The primary study endpoint was 1-year combined occurrence of death or hospitalization for cardiovascular causes. Diabetes was defined according to medical history (previous known diagnosis). Results A total of 562 of 693 (81.0%) patients were classified as nondiabetics and 131 (18.9%) as diabetics. The adjusted rate of MACE was lower under zofenopril than under ramipril in both nondiabetics [27.9% vs. 34.9% ramipril; odds ratio, OR and 95% confidence interval: 0.55 (0.35, 0.86)] and diabetics [30.9% vs. 41.3%; 0.56 (0.18, 1.73)], although the difference was statistically significant only for the nondiabetic group (P = 0.013). Zofenopril was superior to ramipril as regards to the primary study endpoint in the subgroup of 157 patients with uncontrolled blood glucose (≥126 mg/dL), regardless of a previous diagnosis of diabetes [0.31 (0.10, 0.90), P = 0.030]. Zofenopril significantly reduced the risk of hospitalization for cardiovascular causes in both nondiabetics [0.64 (0.43, 0.96), P = 0.030] and diabetics [0.38 (0.15, 0.95), P = 0.038], whereas it was not better than ramipril in terms of prevention of cardiovascular deaths. Conclusions This retrospective analysis of the SMILE-4 study confirmed the good efficacy of zofenopril plus ASA in the prevention of long-term MACE also in the subgroup of patients with diabetes mellitus.
Published: 2016

13. The adult patient with congenital heart disease

Author: Arpes Mainardi, Giancarlo Piovaccari, and Paola Testa
Subjects: Adult, Heart Defects, Congenital, medicine.medical_specialty, Heart disease, business.industry, Disease Management, General Medicine, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Text mining, Pregnancy, Internal medicine, Cardiology, Medicine, Humans, Female, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Intensive care medicine, Sports
Published: 2017

14. Tako-tsubo cardiomyopaty after femur fracture

Author: Jonathan Montomoli, Luca Morolli, Davide Lazzarini, Cesare Cangiotti, Giorgio Ioli, Giancarlo Piovaccari, Sante Morelli, and Paola Venturi
Subjects: Acute coronary syndrome, medicine.medical_specialty, Femur fracture, business.industry, Cardiomyopathy, Warfarin, medicine.disease, Chest pain, Broken heart syndrome, Surgery, Internal medicine, Orthopedic surgery, medicine, Cardiology, medicine.symptom, Differential diagnosis, business, medicine.drug
Abstract: We present the case of an 86-year-old woman referred to us from Orthopaedics Division after surgical treatment for femur fracture without personal or family history of ischemic cardiopathy. During hospitalization the patient had stomach-ache and the electrocardiogram demonstrated ST-segment elevation in anterior leads. The coronarography showed haziness, but no critical stenosis; ventricolography revealed apical ballooning of the left ventricle with severe systolic dysfunction. She was treated with dopamine in renal dose, beta-blockers and warfarin. When she was in fairly good condition, she started physiotherapy for endoprosthesis for the femur fracture. Clinicians should consider takotsubo cardiomyopathy in the differential diagnosis of patients presenting with chest pain, especially in women with a recent history of physical stress.
Published: 2012

15. Long-term clinical outcomes after drug eluting stent implantation in women with de novo coronary lesions

Author: Francesco Passerini, Rosario Rossi, Antonio Manari, Gianni Casella, Rossana De Palma, Paolo Ortolani, Giancarlo Piovaccari, Antonio Marzocchi, Emilia Solinas, Roberto Grilli, Marco Balducelli, Luigi Vignali, Stefano Tondi, Paolo Guastaroba, Gianfranco Percoco, and Fabio Tarantino
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Incidence (epidemiology), medicine.disease, Surgery, Restenosis, Drug-eluting stent, Angioplasty, Internal medicine, Propensity score matching, Conventional PCI, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: Background The long-term effectiveness of drug eluting stents (DESs) in a real-world setting of female patients is currently unclear. Methods and results We analyzed long-term follow-up (up to 3 years) data from all female patients with de novo lesions enrolled in a prospective web-based multicenter registry (REAL Registry; study period, July 2002–June 2006) including all 15 hospitals performing PCI in the Emilia-Romagna region of Italy. Among the 3549 women without ST elevation myocardial infarction, 2434 were treated with BMSs alone and 1115 with DESs alone. At 3 years, use of DESs was associated with a lower propensity score adjusted incidence of MACE [cardiac mortality, non-fatal myocardial infarction and target vessel revascularization (TVR); 19.5% vs. 24.4%; HR 0.75, p =0.006)] and TVR (11.6% vs. 15.6%; HR 0.68, p =0.004) compared with BMSs. No difference was apparent in terms of adjusted 3-year cardiac mortality or myocardial infarction. Nevertheless, after the first 6months of follow-up, a non significantly increased risk of myocardial infarction and stent thrombosis was found in the DES group. Conclusions In this real-world female registry, the use of DESs was associated with a 3-year reduction of TVR and MACE in comparison with the use of BMSs. However, the observed (non-significant) increment of late AMI makes performing larger studies to clarify the long-term safety of DESs mandatory.
Published: 2011

16. Long-Term Outcomes With Drug-Eluting Stents Versus Bare Metal Stents in the Treatment of Saphenous Vein Graft Disease (Results from the REgistro Regionale AngiopLastiche Emilia-Romagna Registry)

Author: Andrea Santarelli, Giancarlo Piovaccari, Paolo Marzaroli, Paolo Guastaroba, Gianfranco Percoco, Elisabetta Varani, Francesco Saia, Alberto Benassi, Alberto Menozzi, Antonio Marzocchi, Guido Rusticali, Antonio Manari, Luigi Vignali, Roberto Grilli, Aleardo Maresta, and Rubboli A
Subjects: Male, medicine.medical_specialty, Time Factors, Percutaneous, medicine.medical_treatment, Coronary Artery Disease, Revascularization, Coronary artery disease, Restenosis, Internal medicine, medicine, Humans, Saphenous Vein, Registries, Angioplasty, Balloon, Coronary, Aged, business.industry, Incidence, Cardiogenic shock, Graft Occlusion, Vascular, Percutaneous coronary intervention, Drug-Eluting Stents, Middle Aged, medicine.disease, Surgery, Stenosis, Treatment Outcome, Drug-eluting stent, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business
Abstract: Percutaneous revascularization of saphenous vein grafts (SVGs) remains a challenging task. Drug-eluting stents (DESs) have been shown to decrease the incidence of restenosis in de novo native coronary artery lesions. However, their clinical value in SVGs remains to be established. We compared long-term clinical outcomes of percutaneous coronary intervention with DESs and bare metal stents (BMSs) for de novo lesions in SVGs. In a large prospective, multicenter registry, 360 patients underwent stenting of a de novo lesion in SVGs using BMSs (288 patients) or DESs (72 patients). Incidence of major adverse cardiac events (MACEs), including all-cause mortality, reinfarction, and target vessel revascularization, was recorded at a 12-month follow-up. Compared with the DES group, patients receiving BMSs were more likely to be men, to have chronic renal insufficiency or higher Charlson scores, but less likely to have undergone previous percutaneous coronary intervention. Incidence of MACEs at 12-month follow-up was similar in the 2 groups (17.8% in DES group vs 20.3% in BMS group, respectively, p = 0.460). Cox regression analysis identified age, chronic renal failure, cardiogenic shock at presentation, and ostial location of stenosis as independent predictors of long-term MACEs. In conclusion, our data suggest that rates of 12-month MACEs associated with the use of DESs and BMSs are similar in patients undergoing treatment of de novo lesions in SVGs.
Published: 2008

17. Clinical Outcomes for Sirolimus-Eluting Stents and Polymer-Coated Paclitaxel-Eluting Stents in Daily Practice

Author: Fabio Tarantino, Giuseppe Geraci, Paolo Guastaroba, Francesco Saia, Giancarlo Piovaccari, Andrea Santarelli, Antonio Marzocchi, Giuseppe Vecchi, Roberto Grilli, Pietro Sangiorgio, Alberto Benassi, Enrico Aurier, and Antonio Manari
Subjects: medicine.medical_specialty, education.field_of_study, business.industry, medicine.medical_treatment, Hazard ratio, Population, medicine.disease, Confidence interval, Surgery, Drug-eluting stent, Internal medicine, medicine, Cardiology, Cumulative incidence, Myocardial infarction, Cardiology and Cardiovascular Medicine, Prospective cohort study, education, business, Mace
Abstract: OBJECTIVES We compared the clinical outcome of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in a real-world scenario. BACKGROUND In selected patients, SES has been associated with lower late luminal loss than PES. Whether this emerging biological difference could translate into different clinical efficacy in daily practice is presently unknown. METHODS This analysis included 1,676 consecutive patients with de novo coronary lesions treated solely with drug-eluting stents (SES = 992; PES = 684). All patients were enrolled in a dynamic prospective registry comprising 13 hospitals. We assessed the cumulative incidence of major adverse cardiac events (MACE), defined as death, myocardial infarction (MI), and target vessel revascularization (TVR) during follow-up. RESULTS Overall, 29% of the patients had diabetes, 23% had prior MI, and 9% had poor left ventricular function. ST-segment elevation MI was diagnosed at admission in 12%. Multivessel intervention was performed in 16%. At 1-year follow-up, SES was associated with a reduced incidence of MACE (9.2% SES vs. 14.1% PES; p = 0.007) and TVR (5.0% SES vs. 10.0% PES; p = 0.0008) compared to PES. A propensity analysis with many clinical and angiographic variables was carried out to adjust for baseline differences. In this analysis, SES was associated with a 44% risk reduction of MACE (hazard ratio 0.56, 95% confidence interval 0.39 to 0.78) and a 55% reduction of TVR (hazard ratio 0.45, 95% confidence interval 0.29 to 0.70). This result was consistent across most subgroups tested. Similar rates of death and MI were observed in the 2 treatment groups. CONCLUSIONS In this large real-world population, SES improved 1-year clinical results as compared to PES.
Published: 2006

18. Comparison of Effectiveness of Sirolimus-Eluting Stents Versus Bare Metal Stents for Percutaneous Coronary Intervention in Patients at High Risk for Coronary Restenosis or Clinical Adverse Events

Author: Antonio Marzocchi, Antonio Manari, Gianni Casella, Andrea Santarelli, Aleardo Maresta, Francesco Saia, Roberto Grilli, Giancarlo Piovaccari, Paolo Guastaroba, Alberto Benassi, Enrico Aurier, and Elisabetta Varani
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Coronary Angiography, Prosthesis Design, Coronary Restenosis, Coated Materials, Biocompatible, Restenosis, Risk Factors, Internal medicine, Angioplasty, Humans, Multicenter Studies as Topic, Medicine, Prospective Studies, Myocardial infarction, Angioplasty, Balloon, Coronary, Adverse effect, Aged, Proportional Hazards Models, Randomized Controlled Trials as Topic, Sirolimus, business.industry, Incidence, Hazard ratio, Percutaneous coronary intervention, Stent, Middle Aged, medicine.disease, Confidence interval, Survival Rate, Treatment Outcome, Metals, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, Immunosuppressive Agents, Follow-Up Studies
Abstract: We evaluated the clinical effect of selective use of sirolimus-eluting stents (SESs) in real-world, high-risk patients. A total of 4,237 consecutive patients who underwent percutaneous coronary intervention (SES, n = 872, bare metal stents [BMSs], n = 3,365) was enrolled in a prospective regional survey. A prespecified high-risk subset of patients was selected on the basis of clinical and angiographic characteristics. A propensity score analysis was performed to compare patients who received SESs with those who received BMSs. Patients in the SES group more often had diabetes and more frequently had previous myocardial infarction or coronary revascularization, type C lesions, and multivessel procedures. Patients who presented with acute myocardial infarction were treated more often with BMSs. At 9 months, the use of SESs was associated with fewer major adverse cardiac events (death, myocardial infarction, or target lesion revascularization; hazard ratio 0.56, 95% confidence interval 0.37 to 0.85) and target lesion revascularizations (hazard ratio 0.43, 95% confidence interval 0.20 to 0.91). This decrease was more evident in a prespecified high-risk subgroup of patients (major adverse cardiac events, 8.0% SES vs 15.6% BMS, hazard ratio 0.45, 95% confidence interval 0.29 to 0.72). We conclude that selective SES use in real-world patients who have high-risk clinical and angiographic characteristics is associated with significant decreases in major adverse cardiac events and repeat revascularizations compared with BMS use.
Published: 2005

19. Combined Abciximab REteplase Stent Study in acute myocardial infarction (CARESS in AMI)

Author: Vanessa Belpomme, Dariusz Dudek, Philippe Gabriel Steg, Giampiero Patrizi, Ciro Indolfi, Leonardo Bolognese, Giuseppe Steffenino, Rita Panzarasa, Flavio Airoldi, Carlo Di Mario, Luc Maillard, Giancarlo Piovaccari, Agnes Ricard Hibon, Zoran Olivari, Giampaolo Gambarati, Krzysztof Zmudka, Marcus Flather, Antonio Manari, Vincenzo Guiducci, and Luigi Cesare Rusconi
Subjects: Emergency Medical Services, medicine.medical_specialty, Abciximab, Cost-Benefit Analysis, medicine.medical_treatment, Myocardial Infarction, Reteplase, Platelet Glycoprotein GPIIb-IIIa Complex, Immunoglobulin Fab Fragments, Plasminogen Activators, Recurrence, Internal medicine, Angioplasty, medicine, Humans, Thrombolytic Therapy, Prospective Studies, cardiovascular diseases, Myocardial infarction, Stroke, business.industry, Antibodies, Monoclonal, Percutaneous coronary intervention, Stent, Thrombolysis, medicine.disease, Recombinant Proteins, Treatment Outcome, Tissue Plasminogen Activator, Cardiology, Drug Therapy, Combination, Stents, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background Most patients with acute myocardial infarction (AMI) are admitted to hospitals without percutaneous transluminal coronary angioplasty (PTCA) facilities or are initially managed in a prehospital mobile unit. Thrombolysis remains the most readily available reperfusion treatment in those settings, but the optimal subsequent strategy in those patients is unclear. If a mechanical recanalization is likely to be performed in an emergency, it is probably desirable that the patient receives abciximab, the glycoprotein IIb/IIIa antagonist with the strongest evidence of benefit for angioplasty in AMI. Objective The aim of this trial is to compare the effects on clinical outcome and cost-effectiveness of 2 strategies after immediate treatment with abciximab and half-dose reteplase for ST-elevation AMI: to manage the patients conservatively (referring them for rescue PTCA only if needed) or to immediately send all patients for emergency coronary angioplasty. Methods The Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction (CARESS in AMI) is an open, prospective, randomized, multicenter clinical trial conducted in patients with high-risk ST-segment elevation AMI treated within 12 hours from symptom onset in hospitals without PTCA facilities or in a prehospital mobile intensive care unit. Apart from contraindications to thrombolysis, the main exclusion criteria are age ≥75 years and a past history of CABG surgery or a percutaneous coronary intervention procedure involving the infarct-related artery. Enrollment will be performed in hospitals without PTCA facilities or directly in the ambulance if a dedicated system is in place for prehospital diagnosis and treatment of AMI. Patients will receive half-dose reteplase and full-dose abciximab and will subsequently be randomized to conventional medical therapy (with referral for emergency rescue PTCA allowed in selected cases) or emergency angioplasty. The primary end point is the 30-day combined incidence of mortality, reinfarction, and refractory ischemia. In order to obtain a 95% power (2-sided) to detect a 42% reduction in the primary end point, 900 patients are required in each arm of the study. Secondary end points include the 1-year composite end point of mortality, reinfarction, refractory ischemia, and hospital readmission because of heart failure; resource use at 30 days and 1 year; and the incidence of inhospital stroke and bleeding complications in the 2 groups. Results Seventy-four patients have been randomized (as of March 10, 2004); results are expected in June 2005. Conclusion This study will establish whether angioplasty must be started as soon as possible in all patients who receive combined pharmacologic reperfusion with the glycoprotein IIb/IIIa inhibitor abciximab and half-dose thrombolysis or whether it can be postponed or skipped in patients with signs of successful reperfusion, with obvious organizational advantages.
Published: 2004

20. Zofenopril and ramipril and acetylsalicylic acid in postmyocardial infarction patients with left ventricular systolic dysfunction: a retrospective analysis in hypertensive patients of the SMILE-4 study

Author: Borghi, Claudio, Ambrosioni, Ettore, Omboni, Stefano, Cicero, Arrigo F. G., Bacchelli, Stefano, Esposti, Daniela D., Vinereanu, Dragos, Ambrosio, Giuseppe, Zava, Dario, SMILE-4 Working Party: Dimitrios Alexopolulus, Mario Garcia Alvés, Aurora Andrade, Marco Agrusta, Antonio Barsotti, Serena Bergerone, Luigi Caliendo, Pio Caso, Antonio Castello, Domenico Cianflone, Tommaso Cipolla, Gaetano De Ferrari, Giuseppe De Nittis, Livio Dei Cas, Paolo Di Pasquale, Rosario Evola, Luciano Fattore, Raffaele Ferrante, Antonio Fiscella, Achille Gaspardone, Giuseppe Ielasi, Niccol ‘o Marchionni, Giancarlo Marenzi, Filippo Marte, Federico Miccoli, Patrizia Noussan, Ioannis Nanas, Salvatore Novo, Mario Orlandi, Giancarlo Piovaccari, Maurizio Porcu, Patrizia Presbitero, Antonio Raviele, Emiliano Renaldini, Jorge Uriarte Salerno, Giovanni Storti, Corrado Tamburino, Pierfranco Terrosu, Roberto Testa, Rita Trinchero, Bernardino Tuccillo, Ludovico Vasquez, Giovanni Quinto Villani, Claudio, Borghi, Ettore, Ambrosioni, Stefano, Omboni, Arrigo F. G., Cicero, Stefano, Bacchelli, Daniela D., Esposti, Dragos, Vinereanu, Giuseppe, Ambrosio, Dario, Zava, Working Party: Dimitrios Alexopolulus, SMILE-4, Garcia Alvés, Mario, Andrade, Aurora, Agrusta, Marco, Barsotti, Antonio, Bergerone, Serena, Caliendo, Luigi, Caso, Pio, Castello, Antonio, Cianflone, Domenico, Cipolla, Tommaso, De Ferrari, Gaetano, De Nittis, Giuseppe, Dei Cas, Livio, Di Pasquale, Paolo, Evola, Rosario, Fattore, Luciano, Ferrante, Raffaele, Fiscella, Antonio, Gaspardone, Achille, Ielasi, Giuseppe, ‘o Marchionni, Niccol, Marenzi, Giancarlo, Marte, Filippo, Miccoli, Federico, Noussan, Patrizia, Nanas, Ioanni, Novo, Salvatore, Orlandi, Mario, Piovaccari, Giancarlo, Porcu, Maurizio, Presbitero, Patrizia, Raviele, Antonio, Renaldini, Emiliano, Uriarte Salerno, Jorge, Storti, Giovanni, Tamburino, Corrado, Terrosu, Pierfranco, Testa, Roberto, Trinchero, Rita, Tuccillo, Bernardino, Vasquez, Ludovico, Quinto Villani, Giovanni, Claudio Borghi, Ettore Ambrosioni, Stefano Omboni, Arrigo F.G. Cicero, Stefano Bacchelli, Daniela D. Esposti, Dragos Vinereanu, Giuseppe Ambrosio, Dario Zava, and on behalf of the SMILE-4 Working Party
Subjects: Male, Captopril, Physiology, Myocardial Infarction, Infarction, Blood Pressure, law.invention, chemistry.chemical_compound, Ventricular Dysfunction, Left, Randomized controlled trial, Ramipril, Retrospective Studie, law, Retrospective analysis, zofenopril, Myocardial infarction, Randomized Controlled Trials as Topic, left ventricular dysfunction, Middle Aged, humanities, Zofenopril, Europe, Antihypertensive Agent, angiotensin-converting enzyme inhibitor, Hypertension, Cardiology, Female, Cardiology and Cardiovascular Medicine, Human, medicine.drug, arterial hypertension, medicine.medical_specialty, acute myocardial infarction, Internal medicine, Internal Medicine, medicine, Humans, cardiovascular diseases, Risk factor, Antihypertensive Agents, Aged, Retrospective Studies, Aspirin, business.industry, Platelet Aggregation Inhibitor, Retrospective cohort study, acetylsalicylic acid, medicine.disease, chemistry, business, Platelet Aggregation Inhibitors
Abstract: BACKGROUND: Antecedent hypertension represents a risk factor for adverse outcomes in survivors of acute myocardial infarction (AMI). Prognosis of such patients might be greatly improved by drugs enhancing blood pressure control. In the present retrospective analysis of the randomized, double-blind, parallel-group, SMILE-4 study we compared the efficacy of zofenopril 60 mg and acetylsalicylic acid (ASA) 100 mg versus ramipril 10 mg and ASA in patients with AMI complicated by left ventricular dysfunction, classified according to a history of hypertension. METHODS: The primary study end-point was 1-year combined occurrence of death or hospitalization for cardiovascular causes. Hypertension was defined according to medical history and current blood pressure values at entry and could be determined in 682 of 716 patients of the intention-to-treat analysis. RESULTS: One hundred and fifty-seven patients (23%) were normotensives and 525 (77%) hypertensives. In the normotensive population the primary end-point occurred in 19 of 76 zofenopril-treated patients (25%) and in 23 of 81 ramipril-treated patients (28%) [odds ratio (95% confidence interval): 0.84 (0.41-1.71), P = 0.631]. In the hypertensive population, major cardiovascular outcomes were reported in 84 of 273 zofenopril-treated patients (31%) and in 99 of 252 ramipril-treated patients (39%), with a 31% significantly (P = 0.041) lower risk with zofenopril [0.69 (0.48-0.99)]. The superiority of zofenopril versus ramipril was particularly evident in patients with isolated systolic hypertension [n = 131, 0.48 (0.23-0.99), P = 0.045]. CONCLUSION: This retrospective analysis of the SMILE-4 study confirmed the good efficacy of zofenopril and ASA in the prevention of long-term cardiovascular outcomes also in the subgroup of patients with hypertension.
Published: 2013

21. Causes of death in patients ≥75 years of age with non-ST-segment elevation acute coronary syndrome

Author: Giuseppe Steffenino, Corrado Tamburino, Giuseppe Ambrosio, Alessandro Fontanelli, Mila Menozzi, Nuccia Morici, Stefano Savonitto, Federico Piscione, Anna Sonia Petronio, Claudio Cavallini, Leonardo Bolognese, Daniele Tucci, Stefano De Servi, Giancarlo Piovaccari, Roberto Antonicelli, and Ernesto Murena
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, Electrocardiography, Interquartile range, Predictive Value of Tests, Risk Factors, Internal medicine, Cause of Death, medicine, ST segment, Humans, Registries, Acute Coronary Syndrome, Cause of death, Aged, Aged, 80 and over, Ejection fraction, Chi-Square Distribution, medicine.diagnostic_test, business.industry, Hazard ratio, medicine.disease, Confidence interval, Surgery, Logistic Models, Italy, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Follow-Up Studies
Abstract: The causes of death within 1 year of hospital admission in patients with non-ST-segment elevation acute coronary syndromes are ill defined, particularly in patients aged ≥75 years. From January 2008 through May 2010, we enrolled 645 patients aged ≥75 years with non-ST-segment elevation acute coronary syndromes: 313 in a randomized trial comparing an early aggressive versus an initially conservative approach, and 332, excluded from the trial for specific reasons, in a parallel registry. Each death occurring during 1 year of follow-up was adjudicated by an independent committee. The mean age was 82 years in both study cohorts, and 53% were men. By the end of the follow-up period (median 369 days, interquartile range 345 to 391), 120 patients (18.6%) had died. The mortality was significantly greater in the registry (23.8% vs 13.1%, p = 0.001). The deaths were classified as cardiac in 94% of the cases during the index admission and 68% of the cases during the follow-up period. Eighty-six percent of the cardiac deaths were of ischemic origin. In a multivariate logistic regression model that included the variables present on admission in the whole study population, the ejection fraction (hazard ratio 0.95, 95% confidence interval 0.94 to 0.97; p0.001), hemoglobin level (hazard ratio 0.85, 95% confidence interval 0.76 to 0.94; p = 0.001), older age (hazard ratio 1.05, 95% confidence interval 1.01 to 1.10, p = 0.010), and creatinine clearance (hazard ratio 0.99, 95% confidence interval 0.97 to 0.99; p = 0.030) were the independent predictors of all-cause death at 1 year. In conclusion, within 1 year after admission for non-ST-segment elevation acute coronary syndromes, most deaths in patients aged ≥75 years have a cardiac origin, mostly owing to myocardial ischemia.
Published: 2013

22. Relevance of gender in patients with acute myocardial infarction undergoing coronary interventions

Author: Piera Angelica Merlini, Antonio Marzocchi, Emilia Solinas, Massimiliano Marino, Filippo Ottani, Rossana De Palma, Elisabetta Varani, Giancarlo Piovaccari, Gianni Casella, Diego Ardissino, Gianluca Campo, Antonio Manari, Caterina Caminiti, Paolo Ortolani, and Paolo Guastaroba
Subjects: Male, medicine.medical_specialty, Time Factors, Population, Myocardial Infarction, Kaplan-Meier Estimate, NO, Percutaneous Coronary Intervention, Sex Factors, Risk Factors, Internal medicine, gender, medicine, Risk of mortality, Humans, cardiovascular diseases, Myocardial infarction, Registries, coronary percutaneous angioplasty, education, Propensity Score, Stroke, Aged, Proportional Hazards Models, Retrospective Studies, Aged, 80 and over, education.field_of_study, Chi-Square Distribution, business.industry, Unstable angina, Hazard ratio, Age Factors, General Medicine, Health Status Disparities, Middle Aged, medicine.disease, Logistic Models, Treatment Outcome, Italy, coronary percutaneous angioplasty, gender, myocardial infarction, registries, Conventional PCI, Propensity score matching, Multivariate Analysis, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: AIMS To evaluate whether gender differences in terms of up to 4-year outcome still persist within patients with acute myocardial infarction (AMI) who uniformly underwent coronary revascularization, we performed a gender comparison in a large contemporary multicentre percutaneous intervention (PCI) registry. MATERIALS AND METHODS We retrospectively analyzed data from 18,351 patients with AMI, who underwent percutaneous coronary interventions (5093 women and 13,258 men) in the Emilia Romagna region of Italy between July 2002 and December 2007. Median follow-up was 1174 days. RESULTS After propensity score adjustment, differences in gender-related mortality were not temporarily homogeneous: 30-day adjusted mortality was higher in women than in men [hazard ratio (HR): 1.40, P < 0.0001], whereas thereafter female gender showed a significantly lower mortality risk (HR: 0.84, P = 0.01). Notably, younger women (
Published: 2012

23. Comparison of 2-year clinical outcomes with sirolimus and paclitaxel-eluting stents for patients with diabetes: Results of the REgistro regionale AngiopLastiche Emilia-Romagna registry

Author: Stefano Tondi, Pietro Sangiorgio, Aleardo Maresta, Antonio Manari, Paolo Ortolani, Roberto Grilli, Giancarlo Piovaccari, Marco Balducelli, Fabio Tarantino, Paolo Guastaroba, Alberto Menozzi, Francesco Passerini, Paolo Marzaroli, Antonio Marzocchi, and Rosario Rossi
Subjects: Male, medicine.medical_specialty, Paclitaxel, Population, Coronary, Coronary Artery Disease, Coronary Angiography, Coronary artery disease, Diabetes mellitus, Restenosis, Internal medicine, Nuclear Medicine and Imaging, medicine, Diabetes Mellitus, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Myocardial infarction, Registries, Angioplasty, Balloon, Coronary, education, Propensity Score, Aged, Retrospective Studies, Sirolimus, education.field_of_study, Internet, Drug-eluting-stents, business.industry, Angioplasty, Retrospective cohort study, Drug-Eluting Stents, General Medicine, Middle Aged, medicine.disease, Female, Immunosuppressive Agents, Radiology, Nuclear Medicine and Imaging, Cardiology and Cardiovascular Medicine, Conventional PCI, Propensity score matching, Cardiology, business, Radiology, Mace, Balloon
Abstract: Background: Long-term outcomes of percutaneous coronary interventions (PCI) with sirolimus-eluting stents (SES) compared to paclitaxel-eluting-stents (PES) in unselected diabetics in routine practice is still debated. Objective: This study compared the 2-year incidence of MACE (all-cause mortality, nonfatal myocardial infarction and target vessel revascularization) of SES and PES in a real-world setting of patients with diabetes. Design: Observational, multicenter, nonrandomized study. Setting: Prospective web-based registry (REAL Registry; study period, 2002–2005) comprising all 13 hospitals performing PCI. Patients: Among the 945 eligible patients treated with either SES alone (n = 606) or PES alone (n = 339), 29% were insulin-requiring, 72% had multivessel coronary disease, 26% had prior myocardial infarction and 10% had poor left ventricular function. Measurements: Unadjusted and propensity score-adjusted 2-year clinical outcome. Results: After propensity score adjustment, 2-year MACE incidence in the SES and PES groups was equivalent (23.3% vs. 23.7%, HR 1.01, 95%CI 0.72–1.42, P = 0.96). Adjusted 2-year angiographic stent thrombosis occurred in 1.1% of the SES patients versus 2.6% of the PES patients (P = 0.15). In this large, real-world, diabetic population treated with DES, there was no difference in outcome between SES and PES. Further studies are needed to demonstrate the long-term safety of different types of DES in patients with diabetes. © 2009 Wiley-Liss, Inc.
Published: 2010

24. Twenty-four months clinical outcomes of sirolimus-eluting stents for the treatment of small coronary arteries: the long-term SES-SMART clinical study

Author: Diego Ardissino, Claudio Cavallini, Alessandra Repetto, Paolo Ortolani, Piera Angelica Merlini, Antonio Manari, Luigi Vignali, Emilia Solinas, Erminio Bonizzoni, Alberto Menozzi, Enrico Magagnini, Francesco Saia, and Giancarlo Piovaccari
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Kaplan-Meier Estimate, Revascularization, Coronary Restenosis, Restenosis, Risk Factors, Internal medicine, medicine, Clinical endpoint, Myocardial Revascularization, Humans, Single-Blind Method, Myocardial infarction, Prospective Studies, Antibacterial agent, Aged, Sirolimus, business.industry, Stent, Drug-Eluting Stents, Middle Aged, medicine.disease, Tubulin Modulators, Surgery, Coronary arteries, Cerebrovascular Disorders, medicine.anatomical_structure, Death, Sudden, Cardiac, Treatment Outcome, Drug-eluting stent, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Aims It has been demonstrated that, in comparison with bare-metal stents (BMS), sirolimus-eluting stents (SES) reduce restenosis after the percutaneus revascularization of small coronary arteries, but the long-term clinical outcomes of this treatment have not yet been investigated. Methods and results The long-term SES-SMART clinical study was a multicentre, prospective, randomized, single-blind study of 257 patients receiving a SES or BMS in a small coronary artery, who were evaluated at discharge, 30 days, 8 and 24 months after stenting. The clinical endpoint of the study was a 24 months composite of major adverse cardiac and cerebrovascular events, which included death, non-fatal myocardial infarction, ischaemia-driven target lesion revascularization (TLR), and cerebrovascular accident. The 24 months follow-up was completed by 254 patients (98.8%). The use of SES was associated with a significantly lower incidence of the clinical endpoint (12.6% vs . 33.1%; HR 0.30, 95% CI: 0.17–0.55; P < 0.0001), which was not only due to a reduction in TLR (7.9% vs . 29.9%; HR 0.30, 95% CI: 0.16–0.59; P < 0.0001), but also to a reduction in myocardial infarction (1.6% vs . 10.2%; HR 0.09, 95% CI: 0.01–0.66; P = 0.018). Conclusion In comparison with BMS, the use of SES in the percutaneous revascularization of small coronary arteries is associated with improved clinical outcomes after 2 years follow-up.
Published: 2009

25. Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease? Insights from a multicentre registry

Author: Giuseppe Sangiorgi, Angelo Ramondo, Cataldo Palmieri, Antonio L. Bartorelli, Luigi Inglese, Corrado Tamburino, Anna Sonia Petronio, Davide Capodanno, Diego Ardissino, Imad Sheiban, Leonardo Bolognese, Aleardo Maresta, Fabio Barlocco, Aldo Patti, Francesco Di Pede, Maria Elena Di Salvo, Carlo Briguori, Massimo Margheri, Antonio Marzocchi, Alberto Benassi, Stefano De Servi, and Giancarlo Piovaccari
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Population, Coronary Artery Disease, Coronary Restenosis, Left coronary artery, Restenosis, Drug-eluting stent, Unprotected left main, medicine.artery, Internal medicine, 80 and over, Medicine, Humans, Registries, education, Survival rate, Aged, Aged, 80 and over, education.field_of_study, Coronary Vessels, Drug-Eluting Stents, Epidemiologic Methods, Female, Italy, Metals, Middle Aged, Stents, Treatment Outcome, business.industry, Percutaneous coronary intervention, Stent, medicine.disease, Surgery, Ostium, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract: Aims 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. Methods and results 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). Conclusion 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.
Published: 2009

26. Long-term clinical benefit of drug-eluting stents over bare-metal stents in diabetic patients with de novo left main coronary artery disease: results from a real-world multicenter registry

Author: Giuseppe Vecchi, Maria Elena Di Salvo, Stefano De Servi, Anna Sonia Petronio, Francesco Di Pede, Vincenzo Filippone, Massimo Margheri, Giancarlo Piovaccari, Giuseppe Sangiorgi, Cataldo Palmieri, Davide Capodanno, Leonardo Bolognese, Diego Ardissino, Alberto Benassi, Luigi Inglese, Antonio L. Bartorelli, Tullio Palmerini, Angelo Ramondo, Imad Sheiban, Corrado Tamburino, and Carlo Briguori
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Context (language use), Coronary Artery Disease, Statistics, Nonparametric, Coronary artery disease, Aged, Chi-Square Distribution, Diabetes Mellitus, Drug-Eluting Stents, Female, Follow-Up Studies, Humans, Proportional Hazards Models, Registries, Retrospective Studies, Statistics, Nonparametric, Stents, Survival Analysis, Treatment Outcome, Diabetes mellitus, Internal medicine, Medicine, Radiology, Nuclear Medicine and imaging, Myocardial infarction, unprotected left main, business.industry, Stent, Percutaneous coronary intervention, General Medicine, medicine.disease, Drug-eluting stent, diabetes mellitus, Conventional PCI, Cardiology, drug eluting stent, Cardiology and Cardiovascular Medicine, business
Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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. © 2009 Wiley-Liss, Inc.
Published: 2009

27. Response to Letters Regarding Article, 'Two-Year Clinical Outcomes With Drug-Eluting Stents for Diabetic Patients With De Novo Coronary Lesions: Results From a Real-World Multicenter Registry'

Author: Stefano Tondi, Francesco Saia, Robin M. T. Cooke, Roberto Grilli, Marco Balducelli, Pietro Sangiorgio, Paolo Marzaroli, Antonio Marzocchi, Giancarlo Piovaccari, Aleardo Maresta, Paolo Guastaroba, Vincenzo Guiducci, Alberto Menozzi, Fabio Tarantino, Giuseppe Geraci, Fausto Castriota, and Paolo Ortolani
Subjects: Drug, medicine.medical_specialty, business.industry, media_common.quotation_subject, Regression analysis, Regression, Surgery, Physiology (medical), Internal medicine, Covariate, Propensity score matching, medicine, Population study, Cardiology and Cardiovascular Medicine, business, media_common, Balance (ability)
Abstract: We thank Barlis and colleagues for their legitimate1 query about the ability of the propensity score regression technique to balance covariates between the somewhat heterogeneous groups. Our decision to report the results of a propensity score regression analysis conducted across the overall study population was based on a number of considerations. Nevertheless, application of propensity score matching (as suggested by Barlis and colleagues) in 2 well-balanced but smaller groups (253 patients each) substantially confirms the main results. Indeed, the result for the main …
Published: 2008

28. Randomized comparison between tirofiban and abciximab to promote complete ST-resolution in primary angioplasty: results of the facilitated angioplasty with tirofiban or abciximab (FATA) in ST-elevation myocardial infarction trial

Author: Antonio, Marzocchi, Antonio, Manari, Giancarlo, Piovaccari, Cinzia, Marrozzini, Sebastiano, Marra, Paolo, Magnavacchi, Pietro, Sangiorgio, Lucia, Marinucci, Nevio, Taglieri, Giovanni, Gordini, Nicola, Binetti, Vincenzo, Guiducci, Nicoletta, Franco, Maria Letizia-Bacchi, Reggiani, Francesco, Saia, Paolo, Guastaroba, Marzocchi A., Manari A., Piovaccari G., Marrozzini C., Marra S., Magnavacchi P., Sangiorgio P., Marinucci L., Taglieri N., Gordini G., Binetti G., Guiducci V., Franco N., Bacchi Reggiani M.L., Saia F., and FATA investigators
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Abciximab, Myocardial Infarction, Myocardial Reperfusion, Coronary Angiography, Electrocardiography, Immunoglobulin Fab Fragments, Internal medicine, Angioplasty, medicine, Humans, Myocardial infarction, Prospective Studies, Angioplasty, Balloon, Coronary, Dose-Response Relationship, Drug, business.industry, ST elevation, Percutaneous coronary intervention, Antibodies, Monoclonal, Drug-Eluting Stents, Tirofiban, Middle Aged, medicine.disease, Treatment Outcome, Glycoprotein IIb/IIIa inhibitors, Anesthesia, Cardiology, Platelet aggregation inhibitor, Tyrosine, Female, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract: Aims To test the equivalence of high-dose bolus (HDB) tirofiban vs. abciximab during primary percutaneous coronary intervention (PPCI) in terms of ST-segment resolution (STR). Methods and results The FATA trial (Facilitated Angioplasty with Tirofiban or Abciximab) was a prospective, multicentre, open-label trial that enrolled 692 patients with ST-segment elevation myocardial infarction (STEMI) undergoing PPCI. Patients were randomized 1:1 to receive abciximab ( n = 341) or HDB tirofiban ( n = 351). Primary endpoint was the rate of complete (≥70%) STR 90 min after first balloon inflation. Thirty-day incidence of major bleedings, death, re-infarction and new revascularizations was also evaluated. Baseline characteristics of the two groups were well-balanced, with the exception of previous MI rates (tirofiban 6% vs. abciximab 2.6%, P = 0.03). The procedure was successful in 96.7% of the abciximab and in 96.6% of the tirofiban cohort ( P = 0.94). Complete STR was obtained in 67.05% of the tirofiban and 70.45% of the abciximab group (Δ −3.4%, 95% confidence interval −10.35 to +3.56), which falls beyond the predefined Δ ± 10% equivalence boundaries. Rates of secondary endpoints were similar between the two groups. Conclusion This study failed to show the equivalence of HBD of tirofiban and abciximab as adjunctive therapy to PPCI.
Published: 2008

29. Left ventricular function after ST-elevation myocardial infarction in patients treated with primary percutaneous coronary intervention and abciximab or tirofiban (from the Facilitated Angioplasty with Tirofiban or Abciximab [FATA] Trial)

Author: Nevio, Taglieri, Francesco, Saia, Vincenzo, Guiducci, Stefano, Tondi, Federico, Conrotto, Cinzia, Marrozzini, Guido, Rocchi, Elena, Biagini, Maria Letizia Bacchi, Reggiani, Paola, Giacometti, Giancarlo, Piovaccari, Antonio, Manari, Antonio, Marzocchi, Paolo, Guastaroba, Taglieri N., Saia F., Guiducci V., Tondi S., Conrotto F., Marrozzini C., Rocchi G., Biagini E., Bacchi Reggiani M.L., Giacometti P., Piovaccari G., Manari A., and Marzocchi A.
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Abciximab, Myocardial Infarction, Ventricular Function, Left, Electrocardiography, Immunoglobulin Fab Fragments, Internal medicine, medicine, Humans, cardiovascular diseases, Myocardial infarction, Angioplasty, Balloon, Coronary, Aged, business.industry, ST elevation, Percutaneous coronary intervention, Antibodies, Monoclonal, Thrombolysis, Tirofiban, Middle Aged, medicine.disease, Combined Modality Therapy, Treatment Outcome, Conventional PCI, Cardiology, Tyrosine, Female, Myocardial infarction diagnosis, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract: Abciximab therapy during primary percutaneous coronary intervention (PCI) has shown to ameliorate left ventricular (LV) function recovery in patients with ST elevated myocardial infarction. High-dose bolus tirofiban has similar effect on platelet inhibition. Whether this is associated with comparable efficacy on LV function recovery remains unclear. We sought to evaluate the impact on LV function of high-dose bolus tirofiban or abciximab in patients undergoing primary PCI with the predictors of favorable (or = 50%) LV ejection fraction (EF) and LV function recovery at 30 days. We studied 314 patients (abciximab n = 154; tirofiban n = 160) undergoing primary PCI in the randomized Facilitated Angioplasty with Tirofiban or Abciximab (FATA) Trial. LVEF was assessed within 48 hours and at 30 days after primary PCI. In patients with systolic dysfunction at baseline, LV function recovery was defined by either increase of LVEFor = 10% compared with baseline or LVEFor = 50%. Similar LVEF was observed in the 2 groups postprocedure (abciximab 49.7 +/- 10.1% vs tirofiban 49.3 +/- 10.1%, p = 0.9) and at 30 days (abciximab 53.1 +/- 9.8% vs tirofiban 52.5 +/- 10.2%, p = 0.6). Independent predictors of 30-day LVEFor = 50% were preprocedure Thrombolysis In Myocardial Infarction flow class0 (odds ratio = 2.4, 95% confidence interval 1.32 to 4.34), anterior location (odds ratio = 0.25, 95% confidence interval 0.15 to 0.42), and age (odds ratio = 0.97, 95% confidence interval 0.95 to 0.99). Preprocedure Thrombolysis In Myocardial Infarction flow grade0 was the only predictor of LV function recovery (odds ratio = 6.73, 95% confidence interval 2.69 to 16.88). In conclusion, this study showed no difference in LV function recovery in patients undergoing primary PCI treated either with abciximab or high-dose bolus tirofiban. Preprocedure Thrombolysis In Myocardial Infarction flow grade0 seems to be the most important predictor of favorable LVEF and LV function recovery at 30 days.
Published: 2008

30. A comparison between coronary artery bypass grafting surgery and drug eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients (agedor =75 years)

Author: Germano Di Credico, Elisa Baldini, Roberto Di Bartolomeo, Laura Alessi, Andrea Santarelli, Stefano De Servi, Carlo Savini, Antonio Marzocchi, Giancarlo Piovaccari, Angelo Branzi, Fabio Barlocco, Michele Ruffini, Tullio Palmerini, Letizia Bacchi-Reggiani, Palmerini T, Barlocco F, Santarelli A, Bacchi-Reggiani L, Savini C, Baldini E, Alessi L, Ruffini M, Di Credico G, Piovaccari G, Di Bartolomeo R, Marzocchi A, Branzi A, and De Servi S
Subjects: Male, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Revascularization, Coronary artery bypass surgery, Left coronary artery, Internal medicine, Angioplasty, medicine.artery, medicine, Humans, cardiovascular diseases, Myocardial infarction, Angioplasty, Balloon, Coronary, Coronary Artery Bypass, Aged, Aged, 80 and over, business.industry, Coronary Stenosis, Stent, Drug-Eluting Stents, medicine.disease, Survival Analysis, Surgery, surgical procedures, operative, Treatment Outcome, Drug-eluting stent, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Aims In this study, we compared the clinical outcomes of elderly patients with unprotected left main coronary artery (ULMCA) stenosis treated with either coronary artery bypass grafting (CABG) or drug-eluting stent (DES). Methods and results From January 2003 to April 2006, 259 patients with ULMCA stenosis and age ≥75 years underwent coronary revascularization with either CABG or DES. One hundred and sixty-one patients were treated with CABG and 98 with DES. The cumulative unadjusted rates of 2-year mortality were 17% in CABG-treated patients and 18% in those treated with DES ( P = 0.71). The adjusted rates of 2-year survival were 85% for CABG-treated patients and 87% for DES-treated patients ( P = 0.74). The incidence of 2-year myocardial infarction was 6% in CABG-treated patients and 4% in DES-treated patients ( P = 0.11). The incidence of target lesion revascularization (TLR) was 3% in CABG-treated patients and 25% in DES-treated patients ( P < 0.0001). In the multivariable analysis, peripheral vascular disease, left ventricular ejection fraction and acute coronary syndrome were independent predictors of 2-year mortality. Conclusion In this study, we could not demonstrate a difference in mortality between CABG-treated patients and those treated with DES. However, the rate of TLR was higher in the DES group.
Published: 2007

31. Comparison of two antiplatelet regimens (aspirin alone versus aspirin+ticlopidine or clopidogrel) after intracoronary implantation of a carbofilm-coated stent

Author: Roberto Serdoz, Alfredo R. Galassi, Antonio L. Bartorelli, Carlo Di Mario, Marco Zimarino, Daniela Trabattoni, Imad Sheiban, Alberto Benassi, Corrado Tamburino, Giancarlo Piovaccari, Sergio Chierchia, Bernhard Reimers, and Pietro Sangiorgio
Subjects: Male, Reoperation, medicine.medical_specialty, Ticlopidine, Thienopyridine, medicine.medical_treatment, Myocardial Infarction, Coronary Disease, Postoperative Hemorrhage, Coronary Restenosis, Coated Materials, Biocompatible, Coronary thrombosis, Cause of Death, Internal medicine, medicine, Humans, Prospective Studies, Myocardial infarction, Aspirin, business.industry, Coronary Thrombosis, Stent, Equipment Design, Middle Aged, medicine.disease, Clopidogrel, Carbon, Surgery, Drug Combinations, Treatment Outcome, Cardiology, Platelet aggregation inhibitor, Female, Stents, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Follow-Up Studies, medicine.drug
Abstract: Stent thrombosis (ST) is an infrequent (0.5% to 1.5%) complication of intracoronary stenting, with severe clinical consequences. This multicenter, randomized study evaluated the clinical outcome in 479 patients (598 lesions treated) who underwent elective coronary stenting with a Carbofilm-coated stent (CarboStent) who met prespecified eligibility criteria and were randomly assigned to receive aspirin alone (n = 235) or aspirin plus a thienopyridine antiplatelet regimen (n = 244). Clinical, angiographic, and procedural characteristics were similar between groups. The primary end point was the incidence of 30-day ST; secondary end points included major vascular or bleeding complications within 30 days and death, acute myocardial infarction, and target vessel revascularization at 6 months. ST occurred in 4 patients (1.4%) in the aspirin-only group and in 1 patient (0.3%) in the aspirin-plus-thienopyridine group (relative risk 0.23, 95% confidence interval 0.03 to 2.08, p = NS). After careful review of cases, 89 patients (19%) with protocol deviations were identified. When they were excluded from the analysis, no ST was observed in either group. Secondary end points were reached by 4% of the aspirin-alone group and 8% of the aspirin-plus-thienopyridine group (relative risk 2.35, 95% confidence interval 0.94 to 5.85, p = NS). In conclusion, after optimal intracoronary implantation of the CarboStent, antiplatelet therapy with aspirin alone was safe and provided efficacy comparable to aspirin plus a thienopyridine in the prevention of ST.
Published: 2007

32. SAFETY AND LONG-TERM EFFICACY OF SYROLIMUS ELUTING STENT IN ST-ELEVATION ACUTE MYOCARDIAL INFARCTION: THE REAL (REGISTRO REGIONALE ANGIOPLASTICHE EMILIA-ROMAGNA) REGISTRY

Author: Giuseppe Geraci, Giancarlo Piovaccari, Gianluca Campo, Monica Naldi, Francesco Passerini, Paolo Guastaroba, Gianfranco Percoco, Antonio Marzocchi, Francesco Saia, Pietro Sangiorgio, Vincenzo Guiducci, Enrico Aurier, and Antonio Manari
Subjects: Male, Bare-metal stent, medicine.medical_specialty, medicine.medical_treatment, Myocardial Infarction, Drug Delivery Systems, Internal medicine, Angioplasty, Secondary Prevention, Humans, Medicine, Pharmacology (medical), Registries, cardiovascular diseases, Myocardial infarction, Angioplasty, Balloon, Coronary, Aged, Retrospective Studies, Sirolimus, Pharmacology, business.industry, ST elevation, Stent, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Italy, Cardiovascular Diseases, Conventional PCI, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: Background: Limited data are available for sirolimus eluting stent (SES) implantation in patients with ST-segment elevation myocardial infarction (STEMI). Aim: to confirm the safety and effectiveness of SES in patients with STEMI in a real-world scenario (multicentric registry). Methods: From July 2002 to June 2004, clinical and angiographic data of 1617 patients with STEMI treated with primary percutaneous coronary intervention (PCI) have been collected. Patients were prospectively followed for the occurrence of major adverse cardiac events (MACE): death, reinfarction and target vessel revascularization (TVR). Results: Overall, 205 patients received SES (12.5%, SES group) and 1412 received bare metal stent (87.5%, BMS group) in the infarct related artery. Compared with the BMS group, SES patients were younger, had more often diabetes mellitus, anterior localization and less cardiogenic shock at admission. The angiographic characteristics in the SES group showed longer lesions and smaller diameter of vessels. After a median follow-up of 396 days, there was no significant difference in the rate of stent thrombosis (1% in the SES group vs 1.5% in the BMS group, p=ns). The incidence of MACE was significantly lower in the SES group compared to BMS group (HR 0.62 [95% CI: 0.4–0.95]; p=0.03), principally due to the lower rate of TVR (HR 0.41 [95% CI: 0.2–0.85]; p=0.01). Conclusions: Utilization of SES in the setting of primary PCI for STEMI, in our “real world” registry, was safe and improved the 1-year clinical outcome compared to BMS reducing the need of TVR.
Published: 2006

33. Cardiac Resynchronization Therapy: What Device Data Do We Need for Optimal Patient Treatment?

Author: M. Marconi, S. Sermasi, M. Mezzetti, G. Corbucci, and Giancarlo Piovaccari
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Continuous monitoring, Cardiac resynchronization therapy, Hemodynamics, Atrial fibrillation, medicine.disease, Pressure sensor, medicine.anatomical_structure, Ventricle, Internal medicine, Heart failure, Cardiology, medicine, Heart rate variability, business
Abstract: The long experience of rate-responsive (RR) pacing and the technological advances in implantable devices form the basis for significant improvement of diagnostics for the treatment of atrial fibrillation (AF) or heart failure (HF) or both. In the past, the development of sensors for RR pacing gave the chance to investigate not only the effectiveness of physiological and mechanical sensors, but also long-term reliability and stability. Many sensors failed to demonstrate their long-term reliability and stability after implantation. For example, pressure sensors implanted in the right ventricle (RV) were totally surrounded by fibrosis after some months, making their membrane unreliable in detecting the true pressure. Similar problems were reported for oxygen saturation and pH sensors. Recently, pressure sensors for the RV have been proposed again for continuous monitoring of the hemodynamics of patients with HF: probably improvements in their technology have increased their long-term reliability. The strong competition for RR pacing in clinical practice has left in the market only the stable and reliable ones.
Published: 2004

34. Recurrent Tako-Tsubo cardiomyopathy with similar clinical and instrumental signs

Author: Daniele Grosseto, Giancarlo Piovaccari, Federica Baldazzi, Samuela Carigi, Domenico Santoro, and Andrea Santarelli
Subjects: medicine.medical_specialty, Mitral regurgitation, Ejection fraction, business.industry, Cardiogenic shock, Cardiomyopathy, Chest pain, medicine.disease, medicine.anatomical_structure, Internal medicine, Heart failure, Mitral valve, medicine, Cardiology, Ventricular outflow tract, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Tako-tsubo syndrome is a clinical entity of transient left ventricular apical ballooning, frequently precipitated by a stressful event. The syndrome can be complicated by left ventricular outflow tract (LVOT) obstruction and can be recurrent. Herewe describe a case of a 64 years old female who had two episodes of tako-tsubo syndrome characterized by a similar stressful event and similar clinical and instrumental characteristics. Apical ballooning syndrome (or Tako-tsubo cardiomyopathy) is a clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction. Recurrence of Tako-stubo syndrome is not frequent as well as LVOT obstruction, mitral regurgitation and shock. We describe a case of recurrent tako-tsubo cardiomyopathy with recurrence of LVOT obstruction and mitral regurgitation and complicated by cardiogenic shock. A 64 years old female with hypertension and chronic obstructive pulmonary disease (COPD) was admitted to the hospital in June 2005 with an acute recurrent chest pain. The patient was on cortisone from 24 h before because of an asthma exacerbation and she reported having also vomit and fright. The clinical symptom started in the morning but she had the first medical contact only in the evening. At the admission in intensive care unit (ICU) the patients was asymptomatic, the electrocardiogram (ECG) showed a 1.5 mm ST elevation from V3 to V6, DI, DII and aVL. Systolic blood pressure was 90 mm Hg, and an echocardiography exam showed an apical ballooning of the left ventricle with moderate mitral regurgitation secondary to left ventricular outflow tract (LVOT) obstruction (Fig. 1). Promptly, glycoprotein inhibitors and heparine were started and coronary angiography was performed the day after. Ventriculography confirmed the apical ballooning and normal coronary artery. Left ventricular ejection fraction (LVEF) was 35% (Fig. 2). The peak of plasma MB-creatinine kinase and of troponin I was 28.5 ng/mL and 6.9 ng/mL respectively. The systolic pressure remained stable at 90 mm Hg for four days with gradually recover until 110 mm Hg. The patient had no signs of congestive heart failure and was discharged after six days. Complete normalization of LVEF was documented at the follow-up. In December 2009 the woman was admitted in hospital for an exacerbation of her COPD. She was treated for eight days with cortisone, ipratropium, salmeterol and antibiotics with a good clinical response. During her stay she presented chest pain and the ECG showed a 2.5 mm STelevation fromV3 to V6, DI and aVL. The coronary angiography showed no obstructive coronary lesions and an apical ballooning aspect at the ventriculogram (Fig. 3). In ICU the patient developed a cardiogenic shock (initial systolic blood pressure of 90 mm Hg with rapid deterioration until 60 mm Hg). An urgent echocardiogram showed the apical ballooning with the concomitance of LVOT obstruction, systolic anterior motion of mitral valve and severe mitral regurgitation (Figs. 3 and 4). Peak dynamic intraventricular pressure gradient detected by echocardiography was 80 mm Hg. The LVEF was 25%. Urgently an intra-aortic balloon pump (IABP) was placed and then she was treated with low-dose beta-blockers until restoration of good pressure and initial recovery of LVEF. After a period of seven days the IABP was removed: the LVEF was 35% and the peak dynamic pressure gradient was lower (12 mm Hg). The peak of plasma MB-creatinine kinase and troponin T was 18.07 μg/L and 0.55 μg/L respectively. She was discharged after other eight days with a good pressure, no sign of congestive heart failure, a LVEF of 48% and absence of sign of LVOT obstruction and mitral regurgitation. Normalization of LVEF was after documented. Tako-tsubo syndrome, which is also called stress cardiomyopathy or transient left ventricular apical ballooning syndrome, is a clinical entity frequently precipitated by a stressful event. Initially, the syndrome was described in Japanese and afterwards an increasing number of cases has been reported also in Caucasian [1,2]. The main features are the absence of coronary atherosclerosis disease and the reversibility of left ventricular dysfunction. Recurrence of Tako-tsubo syndrome is not frequent. The yearly recurrence rate is 2.9% over the first few years, subsequently decreasing to 1.3% per year [3,4]. The syndrome can be also complicated by LVOT obstruction as previously described [5]. The report described is a rare case of recurrent Tako-Tsubo syndrome with recurrence of similar clinical and instrumental signs. In both episodes the main common findings were hypotension and an echocardiographic aspect of LVOT obstruction, systolic anterior motion and secondary mitral regurgitation. The recurrent episode was much more severe with a cardiogenic shock requiring the IABP positioning. Furthermore the patients experienced in both cases the same physical stressful event.
Published: 2011

35. Coronary stenting for unstable angina: predictors of 30-day and long-term clinical outcome

Author: Antonio Marzocchi, Cinzia Marrozzini, Giancarlo Piovaccari, Angelo Branzi, Lucia Marinucci, Francesco Saia, Maria Letizia Bacchi Reggiani, Paolo Ortolani, Bruno Magnani, Tullio Palmerini, and Giampiero Nobile
Subjects: Adult, Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Revascularization, Coronary Angiography, Coronary artery disease, Angioplasty, Internal medicine, medicine, Humans, cardiovascular diseases, Myocardial infarction, Angina, Unstable, Angioplasty, Balloon, Coronary, Aged, Retrospective Studies, Aged, 80 and over, Unstable angina, business.industry, Cardiogenic shock, Anticoagulant, Stent, General Medicine, Middle Aged, medicine.disease, Survival Rate, Treatment Outcome, Cardiology, Female, Stents, business, Cardiology and Cardiovascular Medicine, Follow-Up Studies
Abstract: BACKGROUND Unstable angina is usually caused by acute thrombosis superimposed on a fissured plaque. Coronary artery stenting has been shown to improve short- and long-term results of coronary angioplasty in mainly stable patients with one-vessel disease, but it is uncertain whether its use in an unstable clinical setting can be safe and useful. This study sought to evaluate the results of coronary stenting in unstable angina and to determine patient, lesion and procedure-related predictors of 30-day and long-term ischemic events. METHODS We studied 266 consecutive patients (mean age 62 +/- 9 years) with unstable angina who underwent coronary artery stenting. The procedure was performed electively in 24%, in bailout situations in 11% and for a suboptimal result of conventional angioplasty in 65%. After stent implantation, patients were treated with anticoagulation (61) on combined antiplatelet therapy (200). Multivariate logistic regression analyses were performed to determine 30-day and long-term predictive factors of ischemic complications. RESULTS Procedural success was obtained in 261 patients (98.1%). During the first 30 days after stenting, one patient died from cardiogenic shock (0.3%) and six (22%) suffered a non-fatal Q-wave myocardial infarction. Patients with combined antiplatelet therapy had a significantly lower stent thrombosis rate (1.5% versus 11.4%, P = 0.002) than those treated with anticoagulant regimen. At long-term follow-up (17.7 +/- 9.4 months) cardiac mortality myocardial infarction and target-vessel revascularization rates were 0.4%, 1.5% and 9.3%, respectively. In multivessel and diabetic patients, a worse long-term event-free survival was observed. Logistic multivariate analysis revealed bailout stenting, anticoagulant therapy, implantation of stents longer than 15 mm as predictors of 30-day ischemic events. In addition, multivessel coronary artery disease and stent application with balloon size of less than 3 mm were predictive of long-term ischemic events. CONCLUSIONS This study demonstrates that, either electively or after failure of conventional angioplasty, coronary stenting represents an effective therapy for patients with unstable angina. In the same clinical setting, combined antiplatelet therapy is associated with a lower 30-day stent thrombosis rate than anticoagulant therapy. Bailout stenting, anticoagulant therapy, implantation of stents longer than 15 mm were shown to be predictors of 30-day ischemic events, whereas multivessel coronary artery disease and stent application with small balloon size were predictive of long-term ischemic events.
Published: 1999

36. Results of coronary stenting for unstable versus stable angina pectoris

Author: Paolo Ortolani, Bruno Magnani, Tullio Palmerini, Angelo Branzi, Giancarlo Piovaccari, Antonio Marzocchi, and Cinzia Marrozzini
Subjects: Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Angina Pectoris, Internal medicine, Angioplasty, medicine, Humans, cardiovascular diseases, Myocardial infarction, Angina, Unstable, Angioplasty, Balloon, Coronary, Aged, Retrospective Studies, Unstable angina, business.industry, Incidence (epidemiology), Anticoagulant, Anticoagulants, Thrombosis, Middle Aged, medicine.disease, Combined Modality Therapy, Surgery, Regimen, medicine.anatomical_structure, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Artery, Follow-Up Studies
Abstract: Coronary artery stenting has been shown to improve the short- and long-term results of coronary angioplasty in mainly stable patients with 1-vessel disease, but it is uncertain whether its use in an unstable clinical setting may be safe and useful. To evaluate the stenting efficacy in patients with unstable angina, we retrospectively examined our experience with the Palmaz-Schatz balloon expandable stent in 231 consecutive patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent implantation: group U (132 patients) had unstable angina, and group S (99 patients) had stable angina. After stent insertion, patients were treated with anticoagulant or combined antiplatelet therapy. Baseline characteristics of the 2 groups were comparable with the exception of age (higher in the unstable group) and angiographic characteristics of the target lesions (more unfavorable in unstable patients). In both groups, coronary stenting presented a high procedural success rate. Major in-hospital complications occurred in 9 unstable (6.8%) and in 2 stable (2%) patients (p = NS) and were mainly related to subacute stent thrombosis. In both groups, subacute stent thrombosis mostly occurred in patients treated with anticoagulant therapy (7 of 9 unstable patients, 2 of 2 stable patients). At 6-month follow-up, unstable and stable patients had a similar incidence of death (0%), Q-wave myocardial infarction (0%), and need of coronary artery bypass graft (3.2% vs 4%, p = NS), but coronary angioplasty repetition (4.8% vs 14%, p = 0.027) and target vessel revascularization (6.3% vs 17%, p = 0.019) rates were lower in the unstable group. In conclusion, stent insertion increases the short- and midterm coronary angioplasty effectiveness in unstable angina, making it possible to achieve outcomes quite comparable to stable angina. Compared with conventional anticoagulant regimen, combined antiplatelet therapy after placement of coronary stents seems to reduce the incidence of subacute thrombosis also in this clinical setting.
Published: 1997

37. Takotsubo cardiomiopathy: incidence, clinical features and prognosis in all comers patients referred for acute coronary syndrome

Author: Andrea Santarelli, Federica Baldazzi, Daniele Grosseto, S. Carigi, Giancarlo Piovaccari, Nicoletta Franco, L. Marinelli, M. Marconi, D. Santoro, and S. Amati
Subjects: Brachial Plexus Neuritis, medicine.medical_specialty, Acute coronary syndrome, Ejection fraction, business.industry, Incidence (epidemiology), Signs and symptoms, Chest pain, medicine.disease, Comorbidity, Internal medicine, medicine, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Killip class
Published: 2013

38. Dynamic planar myocardial perfusion imaging in patients with one-vessel disease with intracoronary injection of technetium 99m teboroxime during papaverine-induced coronary hyperemia

Author: Tartagni F, Bruno Magnani, Abdulmassih S. Iskandrian, Nino Monetti, Jaekyeong Heo, Romano Zannoli, Antonio Marzocchi, C. Corbelli, Giancarlo Piovaccari, Angelo Branzi, and Francesco Fallani
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Vasodilator Agents, chemistry.chemical_element, Coronary Disease, Hyperemia, Injections, Intralesional, Technetium, Ventricular tachycardia, Scintigraphy, Myocardial perfusion imaging, Angioplasty, Internal medicine, Papaverine, Oximes, medicine, Image Processing, Computer-Assisted, Humans, Angioplasty, Balloon, Coronary, Radionuclide Imaging, Aged, medicine.diagnostic_test, business.industry, Myocardium, Heart, Organotechnetium Compounds, Middle Aged, medicine.disease, medicine.anatomical_structure, chemistry, Injections, Intra-Arterial, Cardiology, Feasibility Studies, Cardiology and Cardiovascular Medicine, business, Perfusion, Artery, medicine.drug
Abstract: This study examined the imaging results and kinetics of technetium 99m teboroxime after its intracoronary injection during papaverine-induced coronary hyperemia in patients with one-vessel disease before and after coronary angioplasty. Thirteen patients withor = 90% diameter stenosis of either the left anterior descending or the left circumflex coronary artery were included. Two patients were excluded because of ventricular tachycardia during papaverine injection in one patient and unsuccessful angioplasty in the second patient. One mCi of technetium 99m teboroxime was injected into the left main coronary artery during coronary hyperemia induced by intracoronary injection of papaverine. Dynamic acquisition in a frame mode (20 sec/frame) was performed for 5 minutes in the left anterior oblique projection with a multicrystal gamma camera before and after successful angioplasty. Ischemic:normal count ratio increased from 0.75 +/- 0.4 before to 1.00 +/- 0.50 after angioplasty (p0.1). The T 1/2 of teboroxime was 6.5 +/- 1.5 min in the normal zone and 7.2 +/- 1.9 min in the ischemic zone (p, NS). Perfusion defects were visible in the territory of the stenosed coronary artery in 9 of 11 patients before angioplasty and in 7 of 11 patients after angioplasty. The image quality was excellent in all studies. Thus this study shows that performing dynamic imaging with intracoronary injection of technetium 99m teboroxime is feasible. This technique may be useful to study the impact of angioplasty on coronary flow and tracer kinetics.
Published: 1996

39. Cardiac disease after chest irradiation for Hodgkin's disease: incidence in 108 patients with long follow-up

Author: Milva Gobbi, Francesco Prati, Bruno Magnani, Luciano Caravita, Giancarlo Piovaccari, Angelo Branzi, Anna Maria Traini, and Rossella M. Ferretti
Subjects: Constrictive pericarditis, Adult, Male, medicine.medical_specialty, Heart disease, medicine.medical_treatment, Angina, Coronary artery disease, Cohort Studies, Internal medicine, medicine, Humans, Myocardial infarction, Pericardiectomy, Radiation Injuries, Cardiac catheterization, Aged, business.industry, Middle Aged, Thorax, medicine.disease, Prognosis, Hodgkin Disease, Surgery, Cardiovascular Diseases, Echocardiography, Heart failure, cardiovascular system, Cardiology, Exercise Test, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract: Occult or overt but delayed cardiac disease after thoracic radiotherapy for Hodgkin's disease may be common. Detailed cardiac evaluation was performed in 108 patients, mean age 46 ± 6.2 years, with Hodgkin's disease at 175 ±43 months after irradiation. The study protocol included clinical examination, graded treadmill exercise test and echocardiography. Some patients with angina pectoris, previous myocardial infarction and an abnormal ECG were studied by thallium-201 scintigraphy, cardiac catheterization and coronary angiography. Cardiac disease was found in 12 patients (11%). Three patients had angina pectoris, one patient had myocardial infarction, two complained of dyspnea on effort and two had congestive heart failure. At catheterization, constrictive pericarditis was diagnosed in four patients; in two additional patients an occult constrictive pericarditis was found. One patient had both mitral and tricuspidal regurgitation and one had mitral regurgitation alone. Eight patients (7.4%) had severe coronary artery disease; four of these had associated constrictive pericarditis. Four patients had a pericardiectomy and another four had undergone coronary artery by-pass graft. Two patients died after operation from persistant pericardial constriction. It is concluded that the incidence of delayed cardiac disease after radiotherapy is relatively high; chronic pericardial disorders and coronary artery disease are the most frequent manifestations of this disease. Standard surgical treatment may be beneficial because of the relative youth of these patients.
Published: 1995

40. Is transseptal left heart catheterization for bioprosthetic mitral valve evaluation really necessary?

Author: Marco Zimarino, Antonio Barsotti, Giancarlo Piovaccari, and Angelo Branzi
Subjects: Bioprosthesis, Cardiac Catheterization, medicine.medical_specialty, business.industry, Left heart catheterization, General Medicine, Ventricular Function, Left, Postoperative Complications, Treatment Outcome, medicine.anatomical_structure, Heart Valve Prosthesis, Internal medicine, Mitral valve, Cardiology, medicine, Humans, Mitral Valve Stenosis, Radiology, Nuclear Medicine and imaging, Pulmonary Wedge Pressure, Cardiology and Cardiovascular Medicine, business
Published: 1999

41. Haemodynamic effects of short term intravenous amiodarone for hypertrophic cardiomyopathy

Author: M. Bacchi, Romano Zannoli, Bruno Magnani, Giancarlo Piovaccari, Angelo Branzi, P. M. Benenati, R Roncuzzi, Claudio Rapezzi, and Binetti G
Subjects: Adult, Male, medicine.medical_specialty, Diastole, Cardiac index, Amiodarone, Afterload, Internal medicine, medicine, Humans, Pulmonary wedge pressure, Infusions, Intravenous, business.industry, Hypertrophic cardiomyopathy, Hemodynamics, Stroke volume, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, medicine.anatomical_structure, Anesthesia, Vascular resistance, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug, Research Article
Abstract: The haemodynamic effects of an intravenous amiodarone infusion (5 mg/kg for 10 minutes) were measured in ten patients with hypertrophic cardiomyopathy (two with a left ventricular outflow gradient at rest) five, 15, and 30 minutes after drug administration. Mean (SD) pulmonary capillary wedge pressure rose significantly at five and 15 minutes (from 12.3 (6.2) mm Hg to 17.6 (9.2) and to 16.2 (8.6] with a subsequent tendency to fall to control values at 30 minutes. Mean right atrial and right ventricular end diastolic pressures increased from 3.6 (1.8) mm Hg to 7.3 (3.1) and from 6.3 (2.4) to 9.8 (3.2) mm Hg respectively at 30 minutes. The increase in filling pressures was paralleled by a decrease of left ventricular max dP/dt from 1522 (414) to 1372 (327) to 1316 (338) and to 1326 (379) five, 15, and 30 minutes after infusion. Despite this slight negative inotropic effect, cardiac index and stroke volume index were unchanged or slightly increased, possibly because of the decrease in systemic vascular resistance (from 1326 (330) dyn s cm-5/m2 to 1152 (285]. In both patients with outflow gradient the pressure gradient at rest decreased (from 110 to 65 and from 85 to 65 mm Hg) through a reduction of left ventricular systolic pressure. Thus short term intravenous infusion of amiodarone is safe in patients with hypertrophic cardiomyopathy. The main changes were a mild depression of ventricular contractility, which was well tolerated and adequately compensated for by a decrease in afterload.
Published: 1988

42. Echocardiographic evaluation of the response to afterload stress test in young asymptomatic patients with chronic severe aortic regurgitation: Sensitivity of the left ventricular end-systolic pressure-volume relationship

Author: Salvatore Specchia, Claudio Rapezzi, Bruno Magnani, Romano Zannoli, Binetti G, Cinzia Lolli, Giancarlo Piovaccari, and Angelo Branzi
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Systole, Heart Ventricles, Aortic Valve Insufficiency, Hemodynamics, Blood Pressure, Regurgitation (circulation), Asymptomatic, Contractility, Afterload, Physiology (medical), Internal medicine, Medicine, Humans, Cardiac Output, business.industry, Angiotensin II, Stroke Volume, Stroke volume, Middle Aged, Myocardial Contraction, Echocardiography, Chronic Disease, Cardiology, Exercise Test, End-diastolic volume, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: The detection of myocardial depression is an important goal in the management of patients with chronic severe aortic regurgitation but may be quite difficult at an early stage by the conventional basal measures of contractility. The response to afterload stress determined by angiotensin challenge and the end-systolic pressure-volume relationship was evaluated echocardiographically in 16 asymptomatic or mildly symptomatic patients with chronic severe aortic regurgitation, ages 15 to 56 years (mean 32 +/- 12). Nine normal subjects, ages 25 to 41 years (mean 31 +/- 5), served as a control group. In the group with aortic regurgitation, end-systolic dimensions were greater than 55 mm in five of 16 patients and fractional shortening was 25% or less in two of 16. In the control group angiotensin caused a decrease of stroke volume index in six out of nine patients (15% at the most) and a mild increase in three. In the group with aortic regurgitation stroke volume index decreased by 15% or more of the basal value in nine of 16 patients and increased or decreased by less than 15% in seven of 16. Ejection fraction decreased in both groups, from 61 +/- 6% to 52 +/- 7% in the control group and from 56 +/- 6% to 45 +/- 5% in the group with aortic regurgitation. Ventricular function curves were derived by relating end-diastolic volume index to stroke work index; seven of 16 patients had abnormal responses reflecting an afterload mismatch.(ABSTRACT TRUNCATED AT 250 WORDS)

43. Severe subpulmonary obstruction caused by an aneurysmal tissue tag complicating an infundibular perimembranous ventricular septal defect

Author: F M Picchio, Bonvicini M, and Giancarlo Piovaccari
Subjects: Adult, Heart Septal Defects, Ventricular, Male, congenital, hereditary, and neonatal diseases and abnormalities, Heart septal defect, medicine.medical_specialty, business.industry, Perimembranous ventricular septal defect, medicine.disease, Pulmonary Valve Insufficiency, medicine.anatomical_structure, Aneurysm, Ventricle, Internal medicine, cardiovascular system, medicine, Cardiology, Humans, cardiovascular diseases, Heart Aneurysm, Cardiology and Cardiovascular Medicine, business, Research Article
Abstract: A case of severe right ventricular obstruction caused by a huge aneurysmal tissue tag is described associated with a perimembranous ventricular septal defect with an infundibular extension. Angiograms and surgical inspection clearly showed that the ventricular septal defect extended into the outlet septum. The distinctive features of this case was the severity of the gradient related to the peculiar position of the aneurysmal tissue in the outlet portion of the ventricle. We presume that such an aneurysm, however small it is, developing in association with a ventricular septal defect with an infundibular extension may be a potential cause of severe obstruction and should therefore be carefully followed in the ensuing years.

44. Patient selection to enhance the long-term benefit of first generation drug-eluting stents for coronary revascularisation procedures. Insights from a large multicentre registry

Author: Antonio Marzocchi, Luigi Vignali, Paolo Guastaroba, Rossana De Palma, Fabio Tarantino, Armando Liso, Elisabetta Varani, Gianluca Campo, Andrea Santarelli, Antonio Manari, Giancarlo Piovaccari, Stefano Tondi, Alberto Benassi, and Francesco Saia
Subjects: Male, medicine.medical_specialty, Time Factors, Heart Diseases, medicine.medical_treatment, Myocardial Infarction, Coronary Artery Disease, Coronary Angiography, Prosthesis Design, Risk Assessment, Coronary Restenosis, Coronary artery disease, Restenosis, Coronary thrombosis, Internal medicine, Angioplasty, Drug-eluting stent, Registries, Thrombosis, medicine, Humans, Prospective Studies, Myocardial infarction, Angioplasty, Balloon, Coronary, Prospective cohort study, Aged, Proportional Hazards Models, Aged, 80 and over, business.industry, Coronary Thrombosis, Incidence, Patient Selection, Drug-Eluting Stents, Middle Aged, medicine.disease, Treatment Outcome, Italy, Metals, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: AIMS: To evaluate the long-term clinical outcome after drug-eluting stents (DES) implantation, and to test if patient selection could enhance their net clinical benefit. METHODS AND RESULTS: We assessed the incidence of major adverse cardiac events (MACE=death, acute myocardial infarction, and target vessel revascularisation, TVR) and angiographic stent thrombosis (ST) during 3-year follow-up in a prospective multicentre registry. Propensity-score analysis to adjust for different clinical, angiographic and procedural characteristics was performed. Overall, 14,115 patients enrolled in the registry received solely BMS (n=9,565) or DES (n=4,550). The incidence of definite ST was 0.6% for BMS and 1.3% for DES (p=0.003). The propensity-score adjusted incidence of cardiac death and myocardial infarction was similar between the two groups (DES 11.9% vs. BMS 12.1%, HR 0.90, 95% CI 0.77-1.04), whereas DES were associated with lower rates of TVR (DES 11.6% vs. BMS 15.2%, HR 0.67, 95% CI 0.59-0.76). The efficacy of DES in reducing TVR increased with increasing likelihood of TVR at baseline. CONCLUSIONS: The beneficial effect of DES in reducing new revascularisations compared to BMS extends out to three years without a significantly worse overall safety profile. The benefit seems more evident in patients with the highest baseline risk of clinical restenosis.

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