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151. Vitamin K antagonists in heart disease: Current status and perspectives (Section III). Position Paper of the ESC Working Group on Thrombosis - Task Force on Anticoagulants in Heart Disease

Author

Caterina, R. de, Husted, S., Wallentin, L., Andreotti, F., Arnesen, H., Bachmann, F., Baigent, C., Huber, K., Jespersen, J., Kristensen, S.D., Lip, G.Y., Morais, J., Rasmussen, L.H., Siegbahn, A., Verheugt, F.W.A., Weitz, J.I., Caterina, R. de, Husted, S., Wallentin, L., Andreotti, F., Arnesen, H., Bachmann, F., Baigent, C., Huber, K., Jespersen, J., Kristensen, S.D., Lip, G.Y., Morais, J., Rasmussen, L.H., Siegbahn, A., Verheugt, F.W.A., and Weitz, J.I.

Abstract

Contains fulltext : 126210.pdf (publisher's version ) (Closed access), Oral anticoagulants are a mainstay of cardiovascular therapy, and for over 60 years vitamin K antagonists (VKAs) were the only available agents for long-term use. VKAs interfere with the cyclic inter-conversion of vitamin K and its 2,3 epoxide, thus inhibiting gamma-carboxylation of glutamate residues at the amino-termini of vitamin K-dependent proteins, including the coagulation factors (F) II (prothrombin), VII, IX and X, as well as of the anticoagulant proteins C, S and Z. The overall effect of such interference is a dose-dependent anticoagulant effect, which has been therapeutically exploited in heart disease since the early 1950s. In this position paper, we review the mechanisms of action, pharmacological properties and side effects of VKAs, which are used in the management of cardiovascular diseases, including coronary heart disease (where their use is limited), stroke prevention in atrial fibrillation, heart valves and/or chronic heart failure. Using an evidence-based approach, we describe the results of completed clinical trials, highlight areas of uncertainty, and recommend therapeutic options for specific disorders. Although VKAs are being increasingly replaced in most patients with non-valvular atrial fibrillation by the new oral anticoagulants, which target either thrombin or FXa, the VKAs remain the agents of choice for patients with atrial fibrillation in the setting of rheumatic valvular disease and for those with mechanical heart valves.

Published
2013

152. Safety and efficacy outcomes of first and second generation durable polymer drug eluting stents and biodegradable polymer biolimus eluting stents in clinical practice: Comprehensive network meta-analysis.

Author

Aprami T.M., Kedhi E., Birgelen C., Pasquale G.D., Navarese E., Tandjung K., Claessen B., Andreotti F., Kowalewski M., Kandzari D., Kereiakes D., Waksman R., Mauri L., Meredith I., Finn A., Kim H.-S., Kubica J., Suryapranata H., Aprami T.M., Kedhi E., Birgelen C., Pasquale G.D., Navarese E., Tandjung K., Claessen B., Andreotti F., Kowalewski M., Kandzari D., Kereiakes D., Waksman R., Mauri L., Meredith I., Finn A., Kim H.-S., Kubica J., and Suryapranata H.

Abstract

Objectives: To investigate the safety and efficacy of durable polymer drug eluting stents (DES) and biodegradable polymer biolimus eluting stents (biolimus-ES). Design(s): Network meta-analysis of randomised controlled trials. Data sources and study selection: Medline, Google Scholar, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) database search for randomised controlled trials comparing at least two of durable polymer sirolimus eluting stents (sirolimus-ES) and paclitaxel eluting stents (paclitaxel-ES), newer durable polymer everolimus eluting stents (everolimus-ES), Endeavor and Resolute zotarolimus eluting stents (zotarolimus-ES), and biodegradable polymer biolimus-ES. Primary outcomes: Safety (death, myocardial infarction, definite or probable stent thrombosis) and efficacy (target lesion and target vessel revascularisation) assessed at up to one year and beyond. Result(s): 60 randomised controlled trials were compared involving 63 242 patients with stable coronary artery disease or acute coronary syndrome treated with a DES. At one year, there were no differences in mortality among devices. Resolute and Endeavor zotarolimus-ES, everolimus-ES, and sirolimus-ES, but not biodegradable polymer biolimus-ES, were associated with significantly reduced odds of myocardial infarction (by 29-34%) compared with paclitaxel-ES. Compared with everolimus-ES, biodegradable polymer biolimus-ES were associated with significantly increased odds of myocardial infarction (by 29%), while Endeavor zotarolimus-ES and paclitaxel-ES were associated with significantly increased odds of stent thrombosis. All investigated DES were similar with regards to efficacy endpoints, except for Endeavor zotarolimus-ES and paclitaxel-ES, which were associated with significantly increased the odds of target lesion and target vessel revascularisations compared with other devices. Direction of results beyond one year did not diverge from the findings for up to one year follow-up. B

Published
2013

153. Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy

Author

Agewall, S., Cattaneo, M., Collet, J.P., Andreotti, F., Lip, G.Y., Verheugt, F.W.A., Huber, K., Grove, E.L., Morais, J., Husted, S., Wassmann, S., Rosano, G., Atar, D., Pathak, A., Kjeldsen, K., Storey, R.F., Pharmacology, E.S.C.W.G.o.C., Drug, T., Thrombosis, E.S.C.W.G.o., Agewall, S., Cattaneo, M., Collet, J.P., Andreotti, F., Lip, G.Y., Verheugt, F.W.A., Huber, K., Grove, E.L., Morais, J., Husted, S., Wassmann, S., Rosano, G., Atar, D., Pathak, A., Kjeldsen, K., Storey, R.F., Pharmacology, E.S.C.W.G.o.C., Drug, T., and Thrombosis, E.S.C.W.G.o.

Abstract

Item does not contain fulltext

Published
2013

155. New oral anticoagulants in atrial fibrillation and acute coronary syndromes: ESC Working Group on Thrombosis-Task Force on Anticoagulants in Heart Disease position paper.

Author

Caterina, R. de, Husted, S., Wallentin, L., Andreotti, F., Arnesen, H., Bachmann, F., Baigent, C., Huber, K., Jespersen, J., Kristensen, S.D., Lip, G.Y., Morais, J., Rasmussen, L.H., Siegbahn, A., Verheugt, F.W.A., Weitz, J.I., Caterina, R. de, Husted, S., Wallentin, L., Andreotti, F., Arnesen, H., Bachmann, F., Baigent, C., Huber, K., Jespersen, J., Kristensen, S.D., Lip, G.Y., Morais, J., Rasmussen, L.H., Siegbahn, A., Verheugt, F.W.A., and Weitz, J.I.

Abstract

Item does not contain fulltext, Until recently, vitamin K antagonists were the only available oral anticoagulants, but with numerous limitations that prompted the introduction of new oral anticoagulants targeting the single coagulation enzymes thrombin (dabigatran) or factor Xa (apixaban, rivaroxaban, and edoxaban) and given in fixed doses without coagulation monitoring. Here we review the pharmacology and the results of clinical trials with these new agents in stroke prevention in atrial fibrillation and secondary prevention after acute coronary syndromes, providing perspectives on their future incorporation into clinical practice. In phase III trials in atrial fibrillation, compared with warfarin, dabigatran etexilate 150 mg B.I.D. reduced the rates of stroke/systemic embolism without any difference in major bleeding; dabigatran etexilate 110 mg B.I.D. had similar efficacy with decreased bleeding; apixaban 5 mg B.I.D. reduced stroke, systemic embolism, and mortality as well as major bleeding; and rivaroxaban 20 mg Q.D. was noninferior to warfarin for stroke and systemic embolism without a difference in major bleeding. All these agents reduced intracranial hemorrhage. Edoxaban is currently being evaluated in a further large phase III trial. Apixaban and rivaroxaban were evaluated in phase III trials for prevention of recurrent ischemia in patients with acute coronary syndromes who were mostly receiving dual antiplatelet therapy, with conflicting results on efficacy but consistent results for increased major bleeding. Overall, the new oral anticoagulants are poised to replace vitamin K antagonists for many patients with atrial fibrillation and may have a role after acute coronary syndromes. Although convenient to administer and manage, they present challenges that need to be addressed.

Published
2012

156. Ticlopidine and aspirin fail to suppress the increased platelet aggregability that follows percutaneous coronary interventions

Author

Fischetti, D., Sciahbasi, A., Leone, A. M., Giampaolo NICCOLI, Schiavoni, G., Trani, C., Mazzari, M. A., and Andreotti, F.

Subjects
Male, Ticlopidine, Aspirin, Platelet Aggregation, Coronary angioplasty, Angioplasty, Middle Aged, Coronary Angiography, Angina Pectoris, Drug Therapy, Combination, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Chronic stable angina, Drug Evaluation, Humans, Drug Therapy, Combination, Female, Blood Coagulation Tests, Platelet aggregability, Angioplasty, Balloon, Balloon, Aged
Abstract

Previous studies indicate that percutaneous transluminal coronary angioplasty (PTCA) is associated with platelet activation. It is not well-established whether enhanced platelet aggregability after PTCA is prevented by the association of ticlopidine with aspirin. The aim of this study was to evaluate whole blood platelet aggregability before and after elective PTCA in patients with chronic stable angina receiving ticlopidine and aspirin. We studied 16 patients referred for elective PTCA, treated foror = 72 hours with oral aspirin and ticlopidine (group 1), and 10 patients referred for diagnostic coronary angiography, treated with oral aspirin alone (group 2). An intravenous bolus of heparin was administered at the start of PTCA. In both groups, platelet aggregability was assessed at baseline and 24 hours after the procedure, using the PFA 100(R) system. This method measures the time required for flowing whole blood to occlude a collagen and adenosine diphosphate (ADP)-coated ring, shorter times indicating greater aggregability. In both groups, platelet aggregability after the procedure was significantly increased compared with baseline: 104+/-30 seconds before versus 88+/-24 seconds at 24 hours in group 1 (p=0.03) and 84+/-16 seconds before versus 69+/-14 seconds at 24 hours in group 2 (p=0.004). Group 1 patients, compared with group 2, showed a trend toward reduced aggregability at baseline (p=0.06) and significantly lower aggregability 24 hours after the procedure (p=0.03). Ticlopidine and aspirin reduce whole-blood platelet aggregability compared with aspirin alone but fail to suppress the increased aggregability that occurs 24 hours after PTCA.

Published
2000

158. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology

Author

Steg, P.G., Huber, K., Andreotti, F., Arnesen, H., Atar, D., Badimon, L., Bassand, J.P., De Caterina, R., Eikelboom, J.A., Gulba, D., Hamon, M., Helft, G., Fox, K.A., Kristensen, S.D., Rao, S.V., Verheugt, F.W.A., Widimsky, P., Zeymer, U., Collet, J.P., Steg, P.G., Huber, K., Andreotti, F., Arnesen, H., Atar, D., Badimon, L., Bassand, J.P., De Caterina, R., Eikelboom, J.A., Gulba, D., Hamon, M., Helft, G., Fox, K.A., Kristensen, S.D., Rao, S.V., Verheugt, F.W.A., Widimsky, P., Zeymer, U., and Collet, J.P.

Abstract

Item does not contain fulltext, Bleeding has recently emerged as an important outcome in the management of acute coronary syndromes (ACS), which is relatively frequent compared with ischaemic outcomes and has important implications in terms of prognosis, outcomes, and costs. In particular, there is evidence that patients experiencing major bleeding in the acute phase are at higher risk for death in the following months, although the causal nature of this relation is still debated. This position paper aims to summarize current knowledge regarding the epidemiology of bleeding in ACS and percutaneous coronary intervention, including measurement and definitions of bleeding, with emphasis on the recent consensus Bleeding Academic Research Consortium (BARC) definitions. It also provides an European perspective on management strategies to minimize the rate, extent, and consequences of bleeding. Finally, the research implications of bleeding (measuring and reporting bleeding in trials, the importance of bleeding as an outcome measure, and bleeding as a subject for future research) are also discussed.

Published
2011

160. Baseline von Willebrand factor plasma levels and no-reflow phenomenon after primary percutaneous coronary intervention for ST segment elevation myocardial infarction

Author

Sgueglia, Ga, Niccoli, Giampaolo, Spaziani, Cristina, Cosentino, N, Russo, E, Andreotti, F, Lanza, Ga, Landolfi, Raffaele, Crea, F., Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), Landolfi, Raffaele (ORCID:0000-0002-7913-8576), Sgueglia, Ga, Niccoli, Giampaolo, Spaziani, Cristina, Cosentino, N, Russo, E, Andreotti, F, Lanza, Ga, Landolfi, Raffaele, Crea, F., Niccoli, Giampaolo (ORCID:0000-0002-3187-6262), and Landolfi, Raffaele (ORCID:0000-0002-7913-8576)

Abstract

No-reflow phenomenon is associated with a poor prognosis and its underlying mechanisms are still poorly understood. von Willebrand Factor (vWF) is a central molecule in haemostasis which plays an important role in acute coronary syndromes. However its possible role in no-reflow has not been assessed prior to this study. Quantitative baseline vWF plasma antigen was measured by immunoturbidometric assay in 54 consecutive patients with a first ST segment elevation acute myocardial infarction, treated by primary percutaneous coronary intervention within 12 h of symptom onset. Definitions of no-reflow were (1) angiographic: final TIMI flow ≤2 or final TIMI flow 3 with a myocardial blush grade <2; (2) electrocardiographic: lack of ST segment resolution (≤50% reduction of ST segment elevation at 90 min). Angiographic and electrocardiographic no-reflow was observed in 32 (59%) and 30 (56%) patients, respectively (only 9 patients had both type of no-reflow). Plasma levels of vWF were significantly higher in patients with angiographic no-reflow but not in those with electrocardiographic no-reflow. Also, vWF was the most powerful independent predictors of angiographic no-reflow (OR 3.8, 95% CI 1.1-12.9, p=0.033). Our results provide new insights into no-reflow pathophysiology with appealing therapeutic implications.

Published
2010

161. Daily life ischaemia in chronic stable angina is related to platelet activation induced by increased cytokine plasma levels

Author

Emanuel V. Economou, Andreotti F, Christos Pitsavos, Petros Nihoyannopoulos, C. Stefanadis, I. Ikonomidia, and P.K. Toutouzas

Subjects
Cytokine, business.industry, Anesthesia, medicine.medical_treatment, Ischemia, medicine, Platelet activation, Plasma levels, medicine.disease, business, Cardiology and Cardiovascular Medicine, Chronic stable angina
Published
1998
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162. Increased cytokine levels and thrombin generation in stable angina are reduced by aspirin. A randomised, controlled, cross-over trial

Author

Petros Nihoyannopoulos, Andreotti F, C. Stefanadia, P. Toulouzas, Emanuel V. Economou, I. Ikonomidia, and C. Pitaavos

Subjects
Aspirin, Cytokine, business.industry, medicine.medical_treatment, Medicine, Pharmacology, business, Cardiology and Cardiovascular Medicine, Crossover study, Thrombin generation, Stable angina, medicine.drug
Published
1998
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163. Safety and efficacy outcomes of first and second generation durable polymer drug eluting stents and biodegradable polymer biolimus eluting stents in clinical practice: comprehensive network meta-analysis

Author

Navarese, E. P., primary, Tandjung, K., additional, Claessen, B., additional, Andreotti, F., additional, Kowalewski, M., additional, Kandzari, D. E., additional, Kereiakes, D. J., additional, Waksman, R., additional, Mauri, L., additional, Meredith, I. T., additional, Finn, A. V., additional, Kim, H.-S., additional, Kubica, J., additional, Suryapranata, H., additional, Aprami, T. M., additional, Di Pasquale, G., additional, von Birgelen, C., additional, and Kedhi, E., additional

Published
2013
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166. Glycoprotein la C807T qene polymorphism and increased risk of recurrent acute coronary syndromes: A five year follow up

Author

Leone, Antonio Maria, De Stefano, Valerio, Burzotta, Francesco, Chiusolo, Patrizia, Casorelli, I., Paciaroni, Katia, Rossi, Elena, Sciahbasi, A., Testa, L., Leone, Maria Grazia, Crea, Filippo, Andreotti, Felicita, Leone A. M. (ORCID:0000-0002-1276-9883), De Stefano V. (ORCID:0000-0002-5178-5827), Burzotta F. (ORCID:0000-0002-6569-9401), Chiusolo P. (ORCID:0000-0002-1355-1587), Paciaroni K., Rossi E. (ORCID:0000-0002-7572-9379), Leone G., Crea F. (ORCID:0000-0001-9404-8846), Andreotti F. (ORCID:0000-0002-1456-6430), Leone, Antonio Maria, De Stefano, Valerio, Burzotta, Francesco, Chiusolo, Patrizia, Casorelli, I., Paciaroni, Katia, Rossi, Elena, Sciahbasi, A., Testa, L., Leone, Maria Grazia, Crea, Filippo, Andreotti, Felicita, Leone A. M. (ORCID:0000-0002-1276-9883), De Stefano V. (ORCID:0000-0002-5178-5827), Burzotta F. (ORCID:0000-0002-6569-9401), Chiusolo P. (ORCID:0000-0002-1355-1587), Paciaroni K., Rossi E. (ORCID:0000-0002-7572-9379), Leone G., Crea F. (ORCID:0000-0001-9404-8846), and Andreotti F. (ORCID:0000-0002-1456-6430)

Abstract

N/A

Published
2004

167. G20210A Prothrombin gene polymorphism and coronary ischaemic syndromes: A phenotype-specific meta-analysis of 12 034 subjects

Author

Burzotta, Francesco, Paciaroni, K., De Stefano, Valerio, Crea, Filippo, Maseri, A., Leone, Maria Grazia, Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), De Stefano V. (ORCID:0000-0002-5178-5827), Crea F. (ORCID:0000-0001-9404-8846), Leone G., Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta, Francesco, Paciaroni, K., De Stefano, Valerio, Crea, Filippo, Maseri, A., Leone, Maria Grazia, Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), De Stefano V. (ORCID:0000-0002-5178-5827), Crea F. (ORCID:0000-0001-9404-8846), Leone G., and Andreotti F. (ORCID:0000-0002-1456-6430)

Abstract

Objective: To investigate the possible link between the G20210A prothrombin gene variant and different forms of ischaemic heart disease. Design: Phenotype-specific meta-analysis of 19 studies published within March 2002, globally including 4944 patients and 7090 controls. Sample size, inclusion criteria, geographical location, clinical presentation, age, cardiovascular risk factors, and angiographic extent of disease were extracted from each study. Analyses were done according to Mantel-Haenszel. Results: Overall, the odds ratio (OR) for unspecified ischaemic heart disease associated with the 20210A allele was 1.21 (95% confidence interval (Cl) 0.99 to 1.59, n = 12 034). Similar findings were seen for acute coronary syndromes (unstable angina and myocardial infarction) and for myocardial infarction without age limits (OR 1.24, 95% Cl 0.98 to 1.63, n = 10 240; and OR 1.19, 95% Cl 0.93 to 1.58, n = 9765). The effects were similar in male and female subjects. In the 1931 subjects < 55 years of age, the OR for myocardial infarction increased to 1.77 (95% Cl 1.16 to 3.42) and in the 1359 subjects < 45 years to 2.30 (95% Cl 1.27 to 4.59). No significant association was found between the 20210A allele and the presence of angiographically documented coronary disease (OR 1.08, 95% Cl 0.70 to 1.64, n = 3444). However, patients with 0/1 vessel disease at angiography showed a greater prevalence of the A allele than those with multivessel disease (relative risk 2.0, 95% Cl 1.2 to 3.1, n = 2376). Conclusions: G20210A prothrombin gene polymorphism may represent a modest but significant risk factor for myocardial infarction at yaung ages and favour the expression of ischaemic heart disease among individuals who have a limited extent of coronary atherosclerosis at angiography.

Published
2004

168. Early spontaneous intermittent myocardial reperfusion during acute myocardial infarction is associated with augmented thrombogenic activity and less myocardial damage

Author

Haider, A.W., Andreotti, F., Hackett, D.R., Tousoulis, D., Kluft, C., Maseri, A., Davies, G.J., and Gaubius Instituut TNO

Subjects
Male, angiocardiography, Time Factors, Heart Ventricles, oral drug administration, Myocardial Infarction, Myocardial Reperfusion Injury, heparin, heart ventriculography, thrombogenesis, Coronary Angiography, Statistics, Nonparametric, Coronary Circulation, coronary artery thrombosis, Humans, controlled study, Thrombolytic Therapy, fibrin, human, alteplase, Biology, Creatine Kinase, Analysis of Variance, Hemostasis, tissue plasminogen activator, Chi-Square Distribution, controlled clinical trial, adult, Coronary Thrombosis, diltiazem, article, heart muscle injury, clinical trial, acetylsalicylic acid, Middle Aged, major clinical study, reperfusion, intravenous drug administration, Isoenzymes, acute heart infarction, aged, female, creatine kinase mb, priority journal, Electrocardiography, Ambulatory, Enzyme Tests, c reactive protein
Abstract

Objectives. This study investigated the influence of early spontaneous intermittent reperfusion on the extent of myocardial damage and its relation to endogenous hemostatic activity, Background. In the early phase of acute myocardial infarction coronary occlusion is often intermittent, even before thrombolytic therapy is administered. The relation between this phenomenon, myocardial damage and hemostatic activity is unknown. Methods. Holter ST segment recording and pretreatment plasma tissue type plasminogen activator (t-PA) antigen, plasminogen activator inhibitor-1 (PAI-1) antigen, prothrombin fragment F1+2 and soluble fibrin levels were measured in 57 patients with acute evolving myocardial infarction. Spontaneous intermittent myocardial reperfusion, defined as two or more episodes of transient resolution of ST segment elevation to within 0.05 mV of baseline, lasting ≥1 min, before the start of recombinant t-PA (rt-PA) treatment was present in 28 patients (group 1) and absent in 29 (group 2). Left ventriculography and coronary angiography were performed 90 min after intravenous rt-PA administration. Plasma creatine kinase-MB fraction (CK-MB) levels were measured every 6 h for 24 h, and C-reactive protein levels were measured daily for 3 days. Results. Group 1 had lower peak plasma CK-MB (141.9 ± 28.3 vs. 203.8 ± 23.3 IU/liter [mean ± SEM], p < 0.014) and C reactive protein levels (16 ± 4 vs. 28 e 4 mg/liter on day 1; 26.6 ± 5.5 vs. 61.8 ± 14.4 mg/liter on day 2; 19.6 ± 4.2 vs. 40.6 ± 6.5 mg/liter on day 3, p < 0.012) and a higher left ventricular ejection fraction (62.9 ± 4% vs. 51.1 ± 5%, p < 0.04) than group 2. Group 1 had lower plasma t-PA antigen levels (15.6 vs. 27 μg/liter, p < 0.006) but higher prothrombin fragment F1+2 (1.8 vs. 1.1 nmol/liter, p < 0.003) and soluble fibrin levels (66.8 vs. 31 nmol/liter, p < 0.01). Coronary patency at 90 min was similar. Conclusions. Early spontaneous intermittent reperfusion during acute myocardial infarction is associated with augmented thrombogenic activity and less subsequent myocardial damage, This finding is consistent with a protective effect of intermittency on the myocardium and a procoagulant effect of spontaneous lysis on blood. It may also reflect a different rate of evolution of coronary thrombosis and myocardial infarction in patients with and those without spontaneous intermittent myocardial reperfusion.

Published
1995

169. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology

Author

Steg, P. G., primary, Huber, K., additional, Andreotti, F., additional, Arnesen, H., additional, Atar, D., additional, Badimon, L., additional, Bassand, J.-P., additional, De Caterina, R., additional, Eikelboom, J. A., additional, Gulba, D., additional, Hamon, M., additional, Helft, G., additional, Fox, K. A. A., additional, Kristensen, S. D., additional, Rao, S. V., additional, Verheugt, F. W. A., additional, Widimsky, P., additional, Zeymer, U., additional, and Collet, J.-P., additional

Published
2011
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170. 32 TRIGLYCERIDE-RICH LIPOPROTEINS AND HIGH-DENSITY LIPOPROTEIN CHOLESTEROL IN PATIENTS AT HIGH RISK OF CARDIOVASCULAR DISEASE: EVIDENCE AND GUIDANCE FOR MANAGEMENT

Author

Chapman, M.J., primary, Ginsberg, H.N., additional, Amarenco, P., additional, Andreotti, F., additional, Borén, J., additional, Catapano, A., additional, Descamps, O.S., additional, Fisher, E., additional, Kovanen, P., additional, Kuivenhoven, J.A., additional, Lesnik, P., additional, Masana, L., additional, Nordestgaard, B.G., additional, Ray, K., additional, Reiner, Z., additional, Taskinen, M.-R., additional, Tokgözoglu, L., additional, Tybjærg-Hansen, A., additional, and Watts, G.F., additional

Published
2011
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171. 4G/5G PAI-1 promoter polymorphism and acute-phase levels of PAI-1 following coronary bypass surgery: A prospective study

Author

Burzotta, Francesco, Iacoviello, Licia, Di Castelnuovo, Augusto Filippo, Zamparelli, Roberto, D'Orazio, Alessia, Amore, C., Schiavello, R., Donati, M. B., Maseri, A., Possati, G., Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Di Castelnuovo A., Zamparelli R. (ORCID:0000-0002-3085-7529), D'Orazio A., Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta, Francesco, Iacoviello, Licia, Di Castelnuovo, Augusto Filippo, Zamparelli, Roberto, D'Orazio, Alessia, Amore, C., Schiavello, R., Donati, M. B., Maseri, A., Possati, G., Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Di Castelnuovo A., Zamparelli R. (ORCID:0000-0002-3085-7529), D'Orazio A., and Andreotti F. (ORCID:0000-0002-1456-6430)

Abstract

Background and objective: The 4G/5G plasminogen activator inhibitor-1 (PAI-1) promoter polymorphism has been associated with basal PAI-1 levels, with ischemic heart disease, and with adverse prognosis in critically ill patients. We hypothesized it might also influence the acute-phase levels of PAI-1 following coronary bypass surgery. Methods: In 111 consecutive patients undergoing elective coronary bypass surgery, 4G/5G genotyping and serial plasma PAI-1 activity and antigen levels were prospectively measured before surgery, daily up to 72 h, and at discharge. The inflammatory reaction was additionally assessed by white cell count, fibrinogen, interleukin-6, and C-reactive protein levels. Results: PAI-1 activity and antigen concentrations increased approximately two-fold after surgery, peaking at 48 hours. Carriers of the 4G-allele, compared with 5G/5G homozygotes, showed approximately 20% higher PAI-1 activity and antigen both preoperatively (P = 0.007 and P = 0.035) and after surgery. White cell count, fibrinogen, interleukin-6, and C-reactive protein values did not differ significantly according to genotypic groups. In multivariate analysis, the 4G/5G genotype was the only significant modulator of postoperative PAI-1 activity (P = 0.003) and the main significant modulator of postoperative PAI-1 antigen (P = 0.013). No significant interaction was found between the effects of time and genotype on postoperative PAI-1. This indicates that the association between 4G/5G and acute-phase PAI-1 levels is secondary to the genotype-related difference of baseline PAI-1. Conclusions: Postoperative PAI-1 concentrations of patients undergoing elective coronary bypass surgery are higher in carriers of the 4G-allele than in 5G/5G homozygotes as a result of higher baseline values. Knowledge of 4G/5G status may be useful to predict acute-phase PAI-1 concentrations. © 2004 Kluwer Academic Publishers.

Published
2003

172. Genetic control of postoperative systemic inflammatory reaction and pulmonary and renal complications after coronary artery surgery

Author

Gaudino, Mario Fulvio Luigi, Di Castelnuovo, Augusto Filippo, Zamparelli, Roberto, Andreotti, Felicita, Burzotta, Francesco, Iacoviello, Licia, Glieca, Franco, Alessandrini, Francesco, Nasso, G., Donati, M. B., Maseri, A., Schiavello, R., Possati, G., Gaudino M. (ORCID:0000-0001-7529-438X), Di Castelnuovo A., Zamparelli R. (ORCID:0000-0002-3085-7529), Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Glieca F. (ORCID:0000-0003-3645-7152), Alessandrini F., Gaudino, Mario Fulvio Luigi, Di Castelnuovo, Augusto Filippo, Zamparelli, Roberto, Andreotti, Felicita, Burzotta, Francesco, Iacoviello, Licia, Glieca, Franco, Alessandrini, Francesco, Nasso, G., Donati, M. B., Maseri, A., Schiavello, R., Possati, G., Gaudino M. (ORCID:0000-0001-7529-438X), Di Castelnuovo A., Zamparelli R. (ORCID:0000-0002-3085-7529), Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Glieca F. (ORCID:0000-0003-3645-7152), and Alessandrini F.

Abstract

Background: Although some data suggest that the individual genetic predisposition for developing major or minor degrees of postoperative systemic inflammatory reaction may influence postoperative morbidity, this hypothesis has not been clinically tested to date. Methods and Results: The -174 G/C polymorphism of the promoter of the interleukin 6 gene was determined preoperatively in 111 consecutive patients submitted to primary isolated coronary artery bypass. The results of the genetic analysis were then correlated with the postoperative interleukin 6 levels and the development of postoperative renal and pulmonary complications. G homozygotes had significantly higher interleukin 6 levels postoperatively (P < .0001 for the difference between areas under the curve). These patients also had worse postoperative pulmonary and renal function. The mean perioperative difference in serum creatinine, potassium, and nitrogen was 0.82 ± 0.34, 0.99 ± 0.44, and 10.1 ± 7.8 mg/dL versus 0.18 ± 0.14, 0.15 ± 0.48, and 2.6 ± 4.1 mg/dL for GG versus non-GG carriers (P < .0001), respectively. The mean respiratory index at 6 and 12 hours was 2.9 ± 0.8 and 2.8 ± 0.3 versus 2.1 ± 0.5 and 1.3 ± 0.1, respectively (P < .0001). The mean duration of mechanical ventilation was 22.5 ± 2.1 versus 12.7 ± 6.7 hours (P < .01). A correlation was found between postoperative interleukin 6 levels and renal and pulmonary complications. Conclusion: The interleukin 6 - 174 G/C polymorphism modulates postoperative interleukin 6 levels and is associated with the degree of postoperative renal and pulmonary dysfunction and in-hospital stay after coronary surgery.

Published
2003

173. Saturday, 17 July 2010

Author

Dimova, I., primary, Hlushchuk, R., additional, Makanya, A., additional, Djonov, V., additional, Theurl, M., additional, Schgoer, W., additional, Albrecht, K., additional, Beer, A., additional, Patsch, J. R., additional, Schratzberger, P., additional, Mahata, S., additional, Kirchmair, R., additional, Didie, M., additional, Christalla, P., additional, Rau, T., additional, Eschenhagen, T., additional, Schumacher, U., additional, Lin, Q., additional, Zenke, M., additional, Zimmmermann, W., additional, Hoch, M., additional, Fischer, P., additional, Stapel, B., additional, Missol-Kolka, E., additional, Erschow, S., additional, Scherr, M., additional, Drexler, H., additional, Hilfiker-Kleiner, D., additional, Diebold, I., additional, Petry, A., additional, Kennel, P., additional, Djordjevic, T., additional, Hess, J., additional, Goerlach, A., additional, Castellano, J., additional, Aledo, R., additional, Sendra, J., additional, Costales, P., additional, Badimon, L., additional, Llorente-Cortes, V., additional, Dworatzek, E., additional, Mahmoodzadeh, S., additional, Regitz-Zagrosek, V., additional, Posa, A., additional, Varga, C., additional, Berko, A., additional, Veszelka, M., additional, Szablics, P., additional, Vari, B., additional, Pavo, I., additional, Laszlo, F., additional, Brandenburger, M., additional, Wenzel, J., additional, Bogdan, R., additional, Richardt, D., additional, Reppel, M., additional, Hescheler, J., additional, Terlau, H., additional, Dendorfer, A., additional, Heijman, J., additional, Rudy, Y., additional, Westra, R., additional, Volders, P., additional, Rasmusson, R., additional, Bondarenko, V., additional, Ertas Gokhan, M. D., additional, Ural Ertan, M. D., additional, Karaoz Erdal, P. H. D., additional, Aksoy Ayca, P. H. D., additional, Kilic Teoman, M. D., additional, Kozdag Guliz, M. D., additional, Vural Ahmet, M. D., additional, Ural Dilek, M. D., additional, Poulet, C., additional, Christ, T., additional, Wettwer, E., additional, Ravens, U., additional, Van Der Pouw Kraan, C., additional, Schirmer, S., additional, Fledderus, J., additional, Moerland, P., additional, Leyen, T., additional, Piek, J., additional, Van Royen, N., additional, Horrevoets, A., additional, Fleissner, F., additional, Jazbutyte, V., additional, Fiedler, J., additional, Galuppo, P., additional, Mayr, M., additional, Ertl, G., additional, Bauersachs, J., additional, Thum, T., additional, Protze, S., additional, Bussek, A., additional, Li, F., additional, Hoo, R., additional, Lam, K., additional, Xu, A., additional, Subramanian, P., additional, Karshovska, E., additional, Megens, R., additional, Akhtar, S., additional, Heyll, K., additional, Jansen, Y., additional, Weber, C., additional, Schober, A., additional, Zafeiriou, M., additional, Noack, C., additional, Renger, A., additional, Dietz, R., additional, Zelarayan, L., additional, Bergmann, M., 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additional, Heinimann, N., additional, Hewing, B., additional, Stangl, V., additional, Stangl, K., additional, Laule, M., additional, Baumann, G., additional, Ludwig, A., additional, Widmer-Teske, R., additional, Mueller, A., additional, Stieger, P., additional, Tillmanns, H., additional, Braun-Dullaeus, R., additional, Sedding, D., additional, Troidl, K., additional, Eller, L., additional, Benli, I., additional, Apfelbeck, H., additional, Schierling, W., additional, Troidl, C., additional, Schaper, W., additional, Schmitz-Rixen, T., additional, Hinkel, R., additional, Trenkwalder, T., additional, Pfosser, A., additional, Globisch, F., additional, Stachel, G., additional, Lebherz, C., additional, Bock-Marquette, I., additional, Kupatt, C., additional, Seyler, C., additional, Duthil-Straub, E., additional, Zitron, E., additional, Scholz, E., additional, Thomas, D., additional, Gierten, J., additional, Karle, C., additional, Fink, R., additional, Padro, T., additional, Lugano, R., 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additional, Schmidt-Woell, T., additional, Kaetzel, D., additional, Tillmans, H., additional, Kanse, S., additional, Tuncay, E., additional, Kandilci, H., additional, Zeydanli, E., additional, Sozmen, N., additional, Akman, D., additional, Yildirim, S., additional, Turan, B., additional, Nagy, N., additional, Acsai, K., additional, Farkas, A., additional, Papp, J., additional, Toth, A., additional, Viero, C., additional, Mason, S., additional, Williams, A., additional, Marston, S., additional, Stuckey, D., additional, Dyer, E., additional, Song, W., additional, El Kadri, M., additional, Hart, G., additional, Hussain, M., additional, Faltinova, A., additional, Gaburjakova, J., additional, Urbanikova, L., additional, Hajduk, M., additional, Tomaskova, B., additional, Antalik, M., additional, Zahradnikova, A., additional, Steinwascher, P., additional, Jaquet, K., additional, Muegge, A., additional, Wang, G., additional, Zhang, M., additional, Tesi, C., additional, Ter Keurs, H., 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R., additional, De Almeida, A., additional, Van Oort, R., additional, Lohmann, H., additional, Saes, M., additional, Messer, A., additional, Copeland, O., additional, Leung, M., additional, Matthes, F., additional, Steinbrecher, J., additional, Salinas-Riester, G., additional, Opitz, L., additional, Hasenfuss, G., additional, Lehnart, S., additional, Caracciolo, G., additional, Eleid, M., additional, Carerj, S., additional, Chandrasekaran, K., additional, Khandheria, B., additional, Sengupta, P., additional, Riaz, I., additional, Tyng, L., additional, Dou, Y., additional, Seymour, A., additional, Dyer, C., additional, Griffin, S., additional, Haswell, S., additional, Greenman, J., additional, Yasushige, S., additional, Amorim, P., additional, Nguyen, T., additional, Schwarzer, M., additional, Mohr, F., additional, Doenst, T., additional, Popin Sanja, S., additional, Lalosevic, D., additional, Capo, I., additional, Momcilov Popin, T., additional, Astvatsatryan, A., additional, Senan, 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Shih, J., additional, Kass, D., additional, Di Lisa, F., additional, Paolocci, N., additional, Vinet, L., additional, Pezet, M., additional, Briec, F., additional, Previlon, M., additional, Rouet-Benzineb, P., additional, Hivonnait, A., additional, Charpentier, F., additional, Mercadier, J., additional, Cobo, M., additional, Llano, M., additional, Montalvo, C., additional, Exposito, V., additional, Meems, L., additional, Westenbrink, B., additional, Biesmans, L., additional, Bito, V., additional, Driessen, R., additional, Huysmans, C., additional, Mourouzis, I., additional, Pantos, C., additional, Galanopoulos, G., additional, Gavra, M., additional, Perimenis, P., additional, Spanou, D., additional, Cokkinos, D., additional, Panasenko, T., additional, Partsch, S., additional, Harjung, C., additional, Bogdanova, A., additional, Mihov, D., additional, Mocharla, P., additional, Yakushev, S., additional, Vogel, J., additional, Gassmann, M., additional, Tavakoli, R., additional, Johansen, D., additional, Sanden, E., additional, Xi, C., additional, Sundset, R., additional, Ytrehus, K., additional, Bliksoen, M., additional, Rutkovskiy, A., additional, Mariero, L., additional, Vaage, I., additional, Stenslokken, K., additional, Pisarenko, O., additional, Shulzhenko, V., additional, Studneva, I., additional, Serebryakova, L., additional, Tskitishvili, O., additional, Pelogeykina, Y., additional, Timoshin, A., additional, Vanin, A., additional, Ziberna, L., additional, Lunder, M., additional, Drevensek, G., additional, Passamonti, S., additional, Gorza, L., additional, Ravara, B., additional, Scapin, C., additional, Vitadello, M., additional, Zigrino, F., additional, Gwathmey, J., additional, Del Monte, F., additional, Vilahur, G., additional, Juan-Babot, O., additional, Onate, B., additional, Casani, L., additional, Lemoine, S., additional, Calmettes, G., additional, Jaspard-Vinassa, B., additional, Duplaa, C., additional, Couffinhal, T., additional, Diolez, P., additional, Dos Santos, P., additional, Fusco, A., additional, Sorriento, D., additional, Cervero, P., additional, Feliciello, A., additional, Barnucz, E., additional, Kozichova, K., additional, Hlavackova, M., additional, Neckar, J., additional, Kolar, F., additional, Novakova, O., additional, Novak, F., additional, Barsanti, C., additional, Abraham, N., additional, Muntean, D., additional, Mirica, S., additional, Duicu, O., additional, Raducan, A., additional, Hancu, M., additional, Fira-Mladinescu, O., additional, Ordodi, V., additional, Voelkl, J., additional, Haubner, B., additional, Neely, G., additional, Moriell, C., additional, Seidl, S., additional, Pachinger, O., additional, Penninger, J., additional, and Metzler, B., additional

Published
2010
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174. Antithrombotic management of atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing coronary stenting: executive summary--a Consensus Document of the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association (EHRA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Author

Lip, G. Y. H., primary, Huber, K., additional, Andreotti, F., additional, Arnesen, H., additional, Airaksinen, J. K., additional, Cuisset, T., additional, Kirchhof, P., additional, and Marin, F., additional

Published
2010
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175. Prothrombotic response to coronary angioplasty in patients with unstable angina and raised C-reactive protein.

Author

Sciahbasi, A, Andreotti, F, De Cristofaro, Raimondo, Fischetti, D, Leone, Am, Schiavoni, G, Maseri, A, Landolfi, Raffaele, De Cristofaro, Raimondo (ORCID:0000-0002-8066-8849), Landolfi, Raffaele (ORCID:0000-0002-7913-8576), Sciahbasi, A, Andreotti, F, De Cristofaro, Raimondo, Fischetti, D, Leone, Am, Schiavoni, G, Maseri, A, Landolfi, Raffaele, De Cristofaro, Raimondo (ORCID:0000-0002-8066-8849), and Landolfi, Raffaele (ORCID:0000-0002-7913-8576)

Abstract

BACKGROUND: To better understand the mechanisms linking C reactive protein (CRP) to the risk of coronary thrombosis, we investigated the relation between inflammatory state and hemostatic response to coronary angioplasty in patients with either stable or unstable angina. METHODS: Plasma levels of von Willebrand factor (vWF) antigen, vWF collagen binding activity, vWF-cleaving-protease, CRP, and whole-blood platelet reactivity were measured before and 24 h after angioplasty in 18 patients with recent unstable angina and in 17 with stable angina. Each group was divided according to preprocedural CRP levels: >or=3 mg/l (in 9 unstable and 9 stable patients) or <3 mg/l (in 9 unstable and 8 stable patients). RESULTS: Baseline hemostatic parameters did not differ significantly among the four subgroups of patients. After angioplasty, virtually all patients with unstable angina and raised preprocedural CRP showed increased vWF antigen (P = 0.01), vWF collagen-binding (P = 0.001), CRP (P = 0.008), and platelet reactivity (P = 0.0007) compared to baseline, whereas no significant change of these variables was seen within the other three sets of patients. In the overall population, the changes in vWF antigen and vWF-collagen-binding induced by angioplasty correlated with those in CRP levels (r = 0.47, P = 0.004 and r = 0.44, P = 0.008). Baseline levels of vWF cleaving protease and modifications of this enzyme with angioplasty did not differ significantly among subgroups. CONCLUSIONS: Our data suggest that high preprocedural levels of CRP predict a significant vWF rise after angioplasty in patients with unstable angina. The rise in vWF is associated with that in CRP and with enhanced platelet reactivity. Such changes may contribute to the worse prognosis of unstable patients with raised indices of inflammation.

Published
2002

176. Normothermia does not improve postoperative hemostasis nor does it reduce inflammatory activation in patients undergoing primary isolated coronary artery bypass

Author

Gaudino, Mario Fulvio Luigi, Zamparelli, Roberto, Andreotti, Felicita, Burzotta, Francesco, Iacoviello, Licia, Glieca, Franco, Benedetti, Marta, Maseri, A., Schiavello, R., Possati, G., Gaudino M. (ORCID:0000-0001-7529-438X), Zamparelli R. (ORCID:0000-0002-3085-7529), Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Glieca F. (ORCID:0000-0003-3645-7152), Benedett M., Gaudino, Mario Fulvio Luigi, Zamparelli, Roberto, Andreotti, Felicita, Burzotta, Francesco, Iacoviello, Licia, Glieca, Franco, Benedetti, Marta, Maseri, A., Schiavello, R., Possati, G., Gaudino M. (ORCID:0000-0001-7529-438X), Zamparelli R. (ORCID:0000-0002-3085-7529), Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Glieca F. (ORCID:0000-0003-3645-7152), and Benedett M.

Abstract

Background: Despite its common acceptance in clinical practice, the effective benefits of normothermic systemic perfusion during coronary artery bypass operations are far from established. Methods: A total of 113 patients undergoing primary isolated coronary artery bypass were randomly assigned to normothermic (37°C) or hypothermic (26°C) systemic perfusion. The clinical course of the patients was prospectively recorded, and several inflammatory and fibrinolytic markers (C-reactive protein, fibrinogen, interleukin 6, plasminogen activator inhibitor 1, prothrombin time, activated partial thromboplastin time, platelets, and white blood cell counts) were determined before surgical intervention; 24, 48, and 72 hours thereafter; and at hospital discharge. Results: Postoperatively, 2 in-hospital deaths occurred in the normothermic series and none in the hypothermic series. Four patients had a myocardial infarction, 1 had respiratory insufficiency, 1 had to be reoperated on for graft malfunction, and none had renal insufficiency in the hypothermic group versus 1 patient with each of these complications in the normothermic series. Mean blood loss in the first 24 hours was 766 ± 223 mL in the normothermic group and 740 ± 220 mL in the hypothermic group. None of these differences was statistically significant. Similarly, no significant difference in the postoperative level of any of the measured variables at any time point was evident between the patients in the normothermic and hypothermic groups. Conclusion: Normothermic systemic perfusion does not influence the clinical course or the extent of inflammatory and hemostatic activation in patients undergoing primary isolated coronary artery bypass.

Published
2002

177. Increased prevalence of the G20210A prothrombin gene variant in acute coronary syndromes without metabolic or acquired risk factors or with limited extent of disease

Author

Burzotta, Francesco, Paciaroni, Katia, De Stefano, Valerio, Chiusolo, Patrizia, Manzoli, A., Casorelli, I., Leone, Antonio Maria, Rossi, Elena, Leone, Maria Grazia, Maseri, A., Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), Paciaroni K., De Stefano V. (ORCID:0000-0002-5178-5827), Chiusolo P. (ORCID:0000-0002-1355-1587), Leone A. M. (ORCID:0000-0002-1276-9883), Rossi E. (ORCID:0000-0002-7572-9379), Leone G., Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta, Francesco, Paciaroni, Katia, De Stefano, Valerio, Chiusolo, Patrizia, Manzoli, A., Casorelli, I., Leone, Antonio Maria, Rossi, Elena, Leone, Maria Grazia, Maseri, A., Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), Paciaroni K., De Stefano V. (ORCID:0000-0002-5178-5827), Chiusolo P. (ORCID:0000-0002-1355-1587), Leone A. M. (ORCID:0000-0002-1276-9883), Rossi E. (ORCID:0000-0002-7572-9379), Leone G., and Andreotti F. (ORCID:0000-0002-1456-6430)

Abstract

Aims: To investigate the prevalence of the G20210A prothrombin and G1691A factor V gene variants in patients with acute coronary syndrome stratified according to risk factor profile and to extent of coronary disease, in comparison with matched healthy controls. Methods and Results: The 20210 prothrombin and the 1691 factor V loci were genotyped in 247 patients ≤65 years of age (190 myocardial infarction and 57 unstable angina as first presentation of disease) and in 247 healthy age- and sex-matched controls. The prevalence of the 1691A factor V allele was similar in cases and controls. The frequency of heterozygotes for the 20210A prothrombin allele was 6·5% among patients and 2·8% among controls (OR 2·4, 95% CI 1·0-5·9), increasing to 8·7% in patients with a family history of myocardial infarction (OR 3·3, 95% CI 1·2-9·1), to 9·9% in patients (n=81) with ≤1 vessel disease (OR 3·8, 95% CI 1·3-10·8), and to 13·0% in patients who were normocholesterolaemic, non-diabetic, normotensive and non-smokers (OR 5·1, 95% CI 1·2-21·4). Conclusions: These findings suggest that the 20210A prothrombin allele represents an inherited risk factor for acute coronary syndrome among patients who have limited extent of coronary disease at angiography or who lack major metabolic and acquired risk factors. © 2001 The European Society of Cardiology.

Published
2002

178. Inflammatory and fibrinolytic activation after coronary artery bypass graft

Author

Gaudino, Mario Fulvio Luigi, Nasso, G., Zamparelli, Roberto, Andreotti, Felicita, Burzotta, Francesco, Iacoviello, L., Santarelli, F., Lapenna, E., Bruno, P., Di Pietrantonio, F., Schiavello, R., Maseri, A., Possati, G., Gaudino M. (ORCID:0000-0001-7529-438X), Zamparelli R. (ORCID:0000-0002-3085-7529), Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta F. (ORCID:0000-0002-6569-9401), Gaudino, Mario Fulvio Luigi, Nasso, G., Zamparelli, Roberto, Andreotti, Felicita, Burzotta, Francesco, Iacoviello, L., Santarelli, F., Lapenna, E., Bruno, P., Di Pietrantonio, F., Schiavello, R., Maseri, A., Possati, G., Gaudino M. (ORCID:0000-0001-7529-438X), Zamparelli R. (ORCID:0000-0002-3085-7529), Andreotti F. (ORCID:0000-0002-1456-6430), and Burzotta F. (ORCID:0000-0002-6569-9401)

Abstract

Background. The aim of this study was to determine the course of the main inflammatory and fibrinolytic markers in patients undergoing primary elective coronary artery bypass graft with extracorporeal circulation. Methods. One hundred and thirteen patients (105 males, 8 females) undergoing primary isolated coronary artery bypass with normo- (37°C) or hypothermic (26°C) systemic perfusion were prospectively studied. The clinical course of the patients was recorded and inflammatory and fibrinolytic markers (C-reactive protein, fibrinogen, interleukin-6, plasminogen activator inhibitor-1, prothrombin time, activated partial thromboplastin time, platelets and white blood cell counts) were determined before surgery, 24, 48 and 72 hours thereafter, and at hospital discharge. Results. Two patients died (mortality 1.7%) and 6 had a major complication (event free survival > 94%). Interleukin-6, lymphocyte, neutrophil and monocyte levels increased after surgery but returned to normal at hospital discharge. C-reactive protein levels increased after 24 hours and remained high at hospital discharge. Plasminogen activator inhibitor-1, prothrombin time, and activated partial thromboplastin time increased from few hours postoperatively and returned to normal before discharge. Platelets decreased immediately after surgery and normalized only at hospital discharge. Fibrinogen decreased in the first 24 postoperative hours, raised later and remained elevated at hospital discharge. Conclusions. Cardiopulmonary bypass activates inflammatory response and hemostatic/fibrinolytic balance in patients undergoing primary isolated coronary artery bypass.

Published
2002

181. Relation of the -174 G/C polymorphism of interleukin-6 to interleukin-6 plasma levels and to length of hospitalization after surgical coronary revascularization

Author

Burzotta, Francesco, Iacoviello, Licia, Di Castelnuovo, Augusto Filippo, Glieca, Franco, Luciani, Nicola, Zamparelli, Roberto, Schiavello, R., Donati, M. B., Maseri, A., Possati, G., Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Di Castelnuovo A., Glieca F. (ORCID:0000-0003-3645-7152), Luciani N. (ORCID:0000-0002-9407-0303), Zamparelli R. (ORCID:0000-0002-3085-7529), Andreotti F. (ORCID:0000-0002-1456-6430), Burzotta, Francesco, Iacoviello, Licia, Di Castelnuovo, Augusto Filippo, Glieca, Franco, Luciani, Nicola, Zamparelli, Roberto, Schiavello, R., Donati, M. B., Maseri, A., Possati, G., Andreotti, Felicita, Burzotta F. (ORCID:0000-0002-6569-9401), Iacoviello L., Di Castelnuovo A., Glieca F. (ORCID:0000-0003-3645-7152), Luciani N. (ORCID:0000-0002-9407-0303), Zamparelli R. (ORCID:0000-0002-3085-7529), and Andreotti F. (ORCID:0000-0002-1456-6430)

Abstract

Interleukin (IL)-6 plasma levels are predictive of major cardiovascular events. The -174 G/C promoter polymorphism of the IL-6 gene affects basal levels in vivo and transcription rates in vitro, but its association with IL-6 acute phase levels among patients with coronary artery disease has not been investigated. In 111 patients with multivessel coronary artery disease undergoing elective coronary artery bypass graft surgery, we prospectively assessed genotype at position -174 and serial blood levels of IL-6 and other inflammatory indexes. Clinical and surgical characteristics did not differ among genotypic groups. IL-6 levels - measured daily up to 72 hours before surgery, after surgery, and at discharge - showed a mean 17-fold increase, peaking at 24 hours (p <0.0001). IL-6 levels (but not fibrinogen, white-blood cell count, and C-reactive protein values) differed significantly according to the -174 genotype (p = 0.042 for difference between areas under the curve), the 62 GG homozygotes exhibiting higher concentrations than the 49 carriers of the C allele (widest difference at 48 hours, p = 0.015 in multivariate analysis). GG homozygosity was associated with longer stays in the intensive care unit (2.5 ± 3.4 vs 1.4 ± 0.9 days, p = 0.02) and in the hospital (6.7 ± 4.0 vs 5.3 ± 1.4 days, p = 0.02) than C carriership. Rates of postoperative death, myocardial infarction, and stroke were 8% in GG homozygotes and 2% in C-carriers (p = 0.16). The IL-6-174 GG genotype is associated with higher acute phase levels of IL-6 and with longer stays in the hospital and in the intensive care unit than C allele carriership after surgical coronary revascularization. © 2001 by Excerpta Medica, Inc.

Published
2001

182. The C807T/G873A polymorphism in the platelet glycoprotein Ia gene and the risk of acute coronary syndrome in the Italian population

Author

Casorelli, I., De Stefano, Valerio, Leone, Antonio Maria, Chiusolo, Patrizia, Burzotta, Francesco, Paciaroni, Katia, Rossi, Elena, Andreotti, Felicita, Leone, Maria Grazia, Maseri, A., De Stefano V. (ORCID:0000-0002-5178-5827), Leone A. M. (ORCID:0000-0002-1276-9883), Chiusolo P. (ORCID:0000-0002-1355-1587), Burzotta F. (ORCID:0000-0002-6569-9401), Paciaroni K., Rossi E. (ORCID:0000-0002-7572-9379), Andreotti F. (ORCID:0000-0002-1456-6430), Leone G., Casorelli, I., De Stefano, Valerio, Leone, Antonio Maria, Chiusolo, Patrizia, Burzotta, Francesco, Paciaroni, Katia, Rossi, Elena, Andreotti, Felicita, Leone, Maria Grazia, Maseri, A., De Stefano V. (ORCID:0000-0002-5178-5827), Leone A. M. (ORCID:0000-0002-1276-9883), Chiusolo P. (ORCID:0000-0002-1355-1587), Burzotta F. (ORCID:0000-0002-6569-9401), Paciaroni K., Rossi E. (ORCID:0000-0002-7572-9379), Andreotti F. (ORCID:0000-0002-1456-6430), and Leone G.

Abstract

Membrane glycoprotein (GP) Ia/IIa mediates platelet adhesion to collagen. The linked C807T/G873A polymorphisms in the GP Ia gene are correlated with a variable expression of the platelet surface receptor, the 807 TT/873 AA genotype being associated with a higher receptor density. Our study aimed to evaluate the possible role of the GP Ia C807T/G873A polymorphism as a risk factor for acute coronary syndrome in the Italian population. We investigated 157 patients with acute coronary syndrome (117 with myocardial infarction and 40 with severe unstable angina) as the first manifestation of coronary disease occurring before 65 years of age, compared with 312 healthy controls. All individuals were of Italian ancestry and were genotyped for the GP Ia C807T/G873A polymorphism. Complete linkage between the 807 and 873 sites was found in all samples. The 807 TT genotype was present in 12.7% of cases and in 4.8% of controls; the odds ratio for acute coronary syndrome was 2.9 (95% CI 1.4-5.8) for the 807 TT genotype compared with C-allele carriers and 0.6 (95% CI 0.4-0.9) for the 807 CC genotype compared with T-allele carriers. For the TT genotype, compared with CC homozygotes, the increase in risk was 3.4-fold in patients with at least one risk factor (smoking, hypercholesterolaemia, diabetes, systemic hypertension) and 4.1-fold in patients with angiographically diagnosed two- or three-vessel disease. We conclude that the GP Ia 807 TT (873 AA) genotype is associated with an increased risk of acute coronary syndrome in the Italian population; conversely, the GP Ia 807 CC (873 GG) genotype seems to represent a protective factor.

Published
2001

186. G20210A prothrombin gene polymorphism and extent of coronary disease

Author

Burzotta, Francesco, Paciaroni, Katia, Andreotti, Felicita, Casorelli, I, De Stefano, Valerio, Burzotta, F (ORCID:0000-0002-6569-9401), Paciaroni, K, Andreotti, F (ORCID:0000-0002-1456-6430), De Stefano, V (ORCID:0000-0002-5178-5827), Burzotta, Francesco, Paciaroni, Katia, Andreotti, Felicita, Casorelli, I, De Stefano, Valerio, Burzotta, F (ORCID:0000-0002-6569-9401), Paciaroni, K, Andreotti, F (ORCID:0000-0002-1456-6430), and De Stefano, V (ORCID:0000-0002-5178-5827)

Abstract

N/A

Published
2000

189. Homocysteine and arterial occlusive disease: a concise review

Author

Andreotti, Felicita, Burzotta, Francesco, Mazza, A, Manzoli, A, Robinson, K, Maseri, A, Andreotti, F (ORCID:0000-0002-1456-6430), Burzotta, F (ORCID:0000-0002-6569-9401), Andreotti, Felicita, Burzotta, Francesco, Mazza, A, Manzoli, A, Robinson, K, Maseri, A, Andreotti, F (ORCID:0000-0002-1456-6430), and Burzotta, F (ORCID:0000-0002-6569-9401)

Abstract

N/A

Published
1999

190. Fibrinogen as a marker of inflammation: a clinical view

Author

Andreotti, Felicita, Burzotta, Francesco, Maseri, A, Andreotti, F (ORCID:0000-0002-1456-6430), Burzotta, F (ORCID:0000-0002-6569-9401), Andreotti, Felicita, Burzotta, Francesco, Maseri, A, Andreotti, F (ORCID:0000-0002-1456-6430), and Burzotta, F (ORCID:0000-0002-6569-9401)

Abstract

N/A

Published
1999

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