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3. 1-year outcomes after transfemoral transcatheter or surgical aortic valve replacement: Results from the Italian OBSERVANT study

Author

Tamburino, C, Barbanti, M, D'Errigo, P, Ranucci, M, Onorati, F, Covello, R, Santini, F, Rosato, S, Santoro, G, Fusco, D, Grossi, C, Seccareccia, F, Marra, S, D'Amico, M, Gaita, F, Moretti, C, De Benedictis, M, Aranzulla, T, Pistis, G, Reale, M, Bedogni, F, Brambilla, N, Ferrario, M, Ferrero, L, Vicinelli, P, Colombo, A, Chieffo, A, Ferrari, A, Inglese, L, Casilli, F, Ettori, F, Frontini, M, Antona, C, Piccaluga, E, Klugmann, S, De Marco, F, Tespili, M, Saino, A, Leonzi, O, Rizzi, A, Grisolia, E, Franceschini Grisolia, E, Isabella, G, Fraccaro, C, Bernardi, G, Bisceglia, T, Armellini, I, Vischi, M, Parodi, E, Vignali, L, Ardissimo, D, Marzocchi, A, Marrozzini, C, Cremonesi, A, Colombo, F, Giannini, C, Pierli, C, Iadanza, A, Meucci, F, Berti, S, Mariani, M, Tomai, F, Ghini, A, Violini, R, Confessore, P, Crea, F, Giubilato, S, Sardella, G, Mancone, M, Ribichini, F, Vassanelli, C, Dandale, R, Giudice, P, Vigorito, F, Liso, A, Specchia, L, Indolfi, C, Spaccarotella, C, Stabile, A, Gandolfo, C, Ussia, G, Comoglio, C, Dyrda, O, Rinaldi, M, Salizzoni, S, Micalizzi, E, Di Gregorio, O, Scoti, P, Costa, R, Casabona, R, Del Ponte, S, Panisi, P, Spira, G, Troise, G, Messina, A, Viganò, M, Aiello, M, Alfieri, O, Denti, P, Menicanti, L, Agnelli, B, Donatelli, F, Muneretto, C, Rambaldini, M, Gamba, A, Tasca, G, Ferrazzi, P, Terzi, A, Gelpi, G, Martinelli, L, Bruschi, G, Graffigna, A, Mazzucco, A, Pappalardo, A, Gatti, G, Livi, U, Pompei, E, Coppola, R, Gucciardo, M, Albertini, A, Caprili, L, Ghidoni, I, Gabbieri, D, La Marra, M, Aquino, T, Gherli, T, Policlinico, S, Di Bartolomeo, R, Savini, C, Popoff, G, Innocenti, D, Bortolotti, U, Pratali, S, Stefano, P, Blanzola, C, Glauber, M, Cerillo, A, Chiaramonti, F, Pardini, A, Fioriello, F, Torracca, L, Rescigno, G, De Paulis, R, Nardella, S, Musumeci, F, Luzi, G, Possati, G, Bonalumi, G, Covino, E, Pollari, F, Sinatra, R, Roscitano, A, Chiariello, L, Nardi, P, Lonobile, T, Baldascino, F, Di Benedetto, G, Mastrogiovanni, G, Piazza, L, Marmo, J, Vosa, C, De Amicis, V, Speziale, G, Visicchio, G, Spirito, R, Gregorini, R, Villani, M, Pano, M, Bortone, A, De Luca Tupputi Schinosa, L, De Cillis, E, Gaeta, R, Di Natale, M, Cassese, M, Antonazzo, A, Argano, V, Santaniello, E, Patanè, L, Gentile, M, Tribastone, S, Follis, F, Montalbano, G, Pilato, M, Stringi, V, Patanè, F, Salamone, G, Ruvolo, G, Pisano, C, Mignosa, C, Bivona, A, Cirio, E, Lixi, G, Maraschini, A, Badoni, G, Onorato, F, De Palma, R, Scandotto, S, Orlando, A, Copello, F, Borgia, P, Marchetta, F, and Porcu, R

Subjects
aortic stenosis, implantation, intermediate risk, transcatheter aortic valve, Settore MED/23 - Chirurgia Cardiaca
Published
2015

5. Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: Results of the multicenter Italian OBSERVANT Registry

Author

Onorati, Francesco, D'Errigo, Paola, Barbanti, Marco, Rosato, Stefano, Covello, Remo Daniel, Maraschini, Alice, Ranucci, Marco, Santoro, Gennaro, Tamburino, Corrado, Grossi, Claudio, Santini, Francesco, Menicanti, Lorenzo, Seccareccia, Fulvia, Badoni, Gabriella, Fusco, Danilo, De Palma, Rossana, Scondotto, Salvatore, Orlando, Anna, Copello, Francesco, Zanier, Loris, Zocchetti, Carlo, Cecchi, Mario, Borgia, Piero, Celentano, Egidio, Mauro, Aldo, De Luca, Giovanni, Marchetta, Fausto, Antonelli, Antonello, Porcu, Rosanna, Marra, S., D'Amico, M., Gaita, F., Moretti, C., De Benedictis, M., Aranzulla, T., Pistis, G., Reale, M., Bedogni, F., Brambilla, N., Colombo, A., Chieffo, A., Ferrari, A., Inglese, L., Casilli, F., Ettori, F., Frontini, M., Antona, C., Piccaluga, E., Klugmann, S., De Marco, F., Tespili, M., Saino, A., Franceschini Grisolia, E., Isabella, G., Fraccaro, C., Proclemer, A., Bisceglia, T., Armellini, I., Vischi, M., Parodi, E., Petronio, S., Giannini, C., Pierli, C., Iadanza, A., Santoro, G., Meucci, F., Tomai, F., Ghini, A., Sardella, Gennaro, Mancone, M., Ribichini, F., Vassanelli, C., Dandale, R., Giudice, P., Vigorito, F., Bortone, A., De Luca Tupputi Schinosa, L., De Cillis, E., Indolfi, C., Spaccarotella, C., Stabile, A., Gandolfo, C., Tamburino, C., Ussia, G., Rinaldi, M., Salizzoni, S., Grossi, C., Di Gregorio, O., Scoti, P., Costa, R., Casabona, R., Del Ponte, S., Panisi, P., Spira, G., Troise, G., Messina, A., Viganò, M., Aiello, M., Alfieri, O., Denti, P., Menicanti, L., Agnelli, B., Muneretto, C., Rambaldini, M., Gamba, A., Tasca, G., Ferrazzi, P., Terzi, A., Gelpi, G., Martinelli, L., Bruschi, G., Graffigna, A. C., Mazzucco, A., Pappalardo, A., Gatti, G., Livi, U., Pompei, E., Passerone, G., Bortolotti, U., Pratali, S., Stefano, P., Blanzola, C., Glauber, M., Cerillo, A., Chiaramonti, F., Pardini, A., Fioriello, F., Torracca, L., Rescigno, G., De Paulis, R., Nardella, S., Musumeci, F., Luzi, G., Possati, G., Bonalumi, G., Covino, E., Pollari, F., Sinatra, Riccardo, Roscitano, A., Chiariello, L., Nardi, P., Lonobile, T., Baldascino, F., Di Benedetto, G., Mastrogiovanni, G., Piazza, L., Marmo, J., Vosa, C., De Amicis, V., Villani, M., Pano, M. A., Cassese, M., Antonazzo, A., Patanè, L., Gentile, M., Tribastone, S., Follis, F., Montalbano, G., Pilato, M., Stringi, V., Patanè, F., Salamone, G., Ruvolo, G., Pisano, C., Mignosa, C., Bivona, A., Cirio, E. M., Lixi, G., Onorati, F., D'Errigo, P., Barbanti, M., Rosato, S., Covello, R. D., Maraschini, A., Ranucci, M., Santoro, G., Tamburino, C., Grossi, C., Santini, F., Menicanti, L., Seccareccia, F., Badoni, G., Fusco, D., De Palma, R., Scondotto, S., Orlando, A., Copello, F., Zanier, L., Zocchetti, C., Cecchi, M., Borgia, P., Celentano, E., Mauro, A., De Luca, G., Marchetta, F., Antonelli, A., Porcu, R., Marra, S., D'Amico, M., Gaita, F., Moretti, C., De Benedictis, M., Aranzulla, T., Pistis, G., Reale, M., Bedogni, F., Brambilla, N., Colombo, A., Chieffo, A., Ferrari, A., Inglese, L., Casilli, F., Ettori, F., Frontini, M., Antona, C., Piccaluga, E., Klugmann, S., De Marco, F., Tespili, M., Saino, A., Franceschini Grisolia, E., Isabella, G., Fraccaro, C., Proclemer, A., Bisceglia, T., Armellini, I., Vischi, M., Parodi, E., Petronio, S., Giannini, C., Pierli, C., Iadanza, A., Meucci, F., Tomai, F., Ghini, A., Sardella, G., Mancone, M., Ribichini, F., Vassanelli, C., Dandale, R., Giudice, P., Vigorito, F., Bortone, A., De Luca Tupputi Schinosa, L., De Cillis, E., Indolfi, C., Spaccarotella, C., Stabile, A., Gandolfo, C., Ussia, G., Rinaldi, M., Salizzoni, S., Di Gregorio, O., Scoti, P., Costa, R., Casabona, R., Del Ponte, S., Panisi, P., Spira, G., Troise, G., Messina, A., Vigano, M., Aiello, M., Alfieri, O., Denti, P., Agnelli, B., Muneretto, C., Rambaldini, M., Gamba, A., Tasca, G., Ferrazzi, P., Terzi, A., Gelpi, G., Martinelli, L., Bruschi, G., Graffigna, A. C., Pappalardo, A., Mazzucco, A., Livi, U., Pompei, E., Passerone, G., Bortolotti, U., Pratali, S., Stefano, P., Blanzola, C., Glauber, M., Cerillo, A., Chiaramonti, F., Pardini, A., Fioriello, F., Torracca, L., Rescigno, G., De Paulis, R., Nardella, S., Musumeci, F., Luzi, G., Possati, G., Bonalumi, G., Covino, E., Pollari, F., Sinatra, R., Roscitano, A., Chiariello, L., Nardi, P., Lonobile, T., Baldascino, F., Di Benedetto, G., Mastrogiovanni, G., Piazza, L., Marmo, J., Vosa, C., De Amicis, V., Villani, M., Pano, M. A., Cassese, M., Antonazzo, A., Patane, L., Gentile, M., Tribastone, S., Montalbano, G., Follis, F., Pilato, M., Stringi, V., Patane, F., Salamone, G., Ruvolo, G., Pisano, C., Mignosa, C., Bivona, A., Cirio, E. M., and Lixi, G.

Subjects
Aortic valve, Registrie, Age Factors, Aged, Aged, 80 and over, Aortic Valve, Aortic Valve Stenosis, Blood Transfusion, Chi-Square Distribution, Comorbidity, Female, Heart Valve Prosthesis Implantation, Hospital Mortality, Humans, Italy, Linear Models, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Postoperative Complications, Prospective Studies, Registries, Risk Assessment, Risk Factors, Severity of Illness Index, Sex Factors, Time Factors, Treatment Outcome, Cardiac Catheterization, Health Status Disparities, Surgery, Medicine (all), Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, medicine.medical_treatment, Sex Factor, Aortic valve replacement, 80 and over, Age Factor, Myocardial infarction, Multivariate Analysi, education.field_of_study, Ejection fraction, medicine.anatomical_structure, Aortic valve stenosis, Cardiology, Linear Model, Human, medicine.medical_specialty, Logistic Model, Time Factor, Population, Internal medicine, medicine, education, business.industry, Risk Factor, Percutaneous coronary intervention, Settore MED/23 - Chirurgia Cardiaca, EuroSCORE, medicine.disease, Aortic Valve Stenosi, Prospective Studie, Postoperative Complication, business
Abstract

Background: Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods: There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results: Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level (P ≤.02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level (P ≤.005), but with a similar New York Heart Association class, frailty score, EuroSCORE (P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention (P ≤.01). Women showed a smaller aortic annulus than men in both populations (P

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7. Adipokines, Ghrelin and Obesity-Associated Insulin Resistance in Nondiabetic Patients with Acute Coronary Syndrome

Author

Mauro Giacca, Cosimo Carriere, Rocco Barazzoni, Gianfranco Sinagra, Franca Dore, Gianfranco Guarnieri, Ilaria Armellini, Maria Rosa Cattin, Aneta Aleksova, Michela Zanetti, Barazzoni, Rocco, Aleksova, Aneta, Armellini, I., Cattin, M. R., Zanetti, Michela, Carriere, C., Giacca, Mauro, Dore, F., Guarnieri, Gianfranco, and Sinagra, Gianfranco

Subjects
Adult, Male, medicine.medical_specialty, obesity, Endocrinology, Diabetes and Metabolism, Population, Medicine (miscellaneous), Adipokine, 030204 cardiovascular system & hematology, Acute coronary syndromes, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Insulin resistance, Adipokines, Internal medicine, insulin resistance, medicine, Homeostasis, Humans, Acute Coronary Syndrome, education, Aged, 030304 developmental biology, Aged, 80 and over, 0303 health sciences, education.field_of_study, Nutrition and Dietetics, Adiponectin, business.industry, Leptin, digestive, oral, and skin physiology, nutritional and metabolic diseases, Middle Aged, medicine.disease, Obesity, Ghrelin, C-Reactive Protein, Italy, Female, Acute coronary syndrome, business, Body mass index, hormones, hormone substitutes, and hormone antagonists
Abstract

Altered glucose metabolism negatively modulates outcome in acute coronary syndromes (ACS). Insulin resistance is commonly associated with increasing BMI in the general population and these associations may involve obesity-related changes in circulating ghrelin and adipokines. We aimed at investigating interactions between BMI, insulin resistance and ACS and their associations with plasma ghrelin and adipokine concentrations. Homeostasis model assessment of insulin resistance (HOMA(IR))-insulin resistance index, plasma adiponectin, leptin, total (T-Ghrelin), acylated (Acyl-Ghrelin), and desacylated ghrelin (Desacyl-Ghrelin) were measured in 60 nondiabetic ACS patients and 44 subjects without ACS matched for age, sex, and BMI. Compared with non-ACS, ACS patients had similar HOMA(IR) and plasma adipokines, but lower T- and Desacyl-Ghrelin and higher Acyl-Ghrelin. Obesity (BMI > 30) was associated with higher HOMA(IR), lower adiponectin, and higher leptin (P < 0.05) similarly in ACS and non-ACS subjects. In ACS (n = 60) HOMA(IR) remained associated negatively with adiponectin and positively with leptin independently of BMI and c-reactive protein (CRP) (P < 0.05). On the other hand, low T- and Desacyl-Ghrelin with high Acyl-Ghrelin characterized both obese and non-obese ACS patients and were not associated with HOMA(IR). In conclusion, in ACS patients, obesity and obesity-related changes in plasma leptin and adiponectin are associated with and likely contribute to negatively modulate insulin resistance. ACS per se does not however enhance the negative impact of obesity on insulin sensitivity. High acylated and low desacylated ghrelin characterize ACS patients independently of obesity, but are not associated with insulin sensitivity.

Published
2012

8. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients over 85 years old.

Author

Sponga S, Isola M, Bagur R, Torracchi L, Mazzaro E, Grillo MT, Lechiancole A, Pompei E, Armellini I, and Livi U

Subjects
Age Factors, Aged, 80 and over, Female, Frail Elderly, Heart Valve Prosthesis Implantation methods, Humans, Incidence, Italy epidemiology, Male, Propensity Score, Risk Factors, Survival Rate trends, Aortic Valve surgery, Aortic Valve Stenosis surgery, Postoperative Complications epidemiology, Transcatheter Aortic Valve Replacement methods
Abstract

Objectives: Surgical aortic valve replacement (SAVR) for the treatment of in very old patients with severe aortic stenosis is associated with a high risk of morbidity and mortality. Transcatheter aortic valve implantation (TAVI) has become the preferred alternative. Therefore, we sought to evaluate outcomes in very old patients who underwent SAVR versus TAVI., Methods: A total of 169 consecutive patients aged ≥85 years underwent TAVI (n = 68) or SAVR (n = 101). A propensity score adjustment was used to compare outcomes including cost analysis., Results: The propensity score generated 40 pairs of patients with similar baseline characteristics. The TAVI group experienced atrioventricular block (37.5% vs 5%, P < 0.01) more frequently, a longer stay in the intensive care unit (median 5 days, range 1-35 vs median 2 days, range 1-6, P < 0.01) but a lower rate of new-onset atrial fibrillation (15% vs 47.5%, P < 0.01). The 30-day mortality rate was similar in the unmatched and matched cohorts (8.8% vs 5.0%, P = 0.32; 10% vs 7.5%, P = 0.69). One, 3- and 5-year overall survival rates (80% vs 90%, 56% vs 79%, 37% vs 71%, P < 0.01) and freedom from major adverse cardiac and cardiovascular events (72% vs 90%, 46% vs 76%, 17% vs 68%, P < 0.01) were lower in the TAVI group. An overall cost analysis indicated that TAVI was more expensive (€2084 vs €19 891)., Conclusions: In patients 85 years and older, SAVR seems to offer good short- and mid-term clinical outcomes compared to TAVI. Advanced age alone would not be an indication for TAVI in old-old patients., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Published
2017
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9. [Role of emergent coronary angiography in post-cardiac arrest care: from literature review to clinical practice].

Author

Armellini I, Zanuttini D, Nucifora G, and Proclemer A

Subjects
Electrocardiography, Humans, Hypothermia, Induced methods, Out-of-Hospital Cardiac Arrest etiology, Out-of-Hospital Cardiac Arrest mortality, Percutaneous Coronary Intervention methods, Survival, Coronary Angiography methods, Coronary Thrombosis complications, Out-of-Hospital Cardiac Arrest therapy
Abstract

Out-of-hospital cardiac arrest is a relatively common event. Acute coronary thrombotic events are the main trigger of sudden cardiac arrest. Mortality of patients, in whom return of spontaneous circulation is obtained, is still high, mainly due to anoxic brain injury and progressive cardiac failure. In the last years, the implementation of "post-cardiac arrest care" led to a significant improvement of hospital survival of these patients. Mild therapeutic hypothermia has become the foundation for improvement of survival with good neurological outcome after cardiac arrest. Recently, there is a growing interest in emergent invasive coronary strategies, including emergent coronary angiography and subsequent percutaneous coronary interventions when indicated. Emergent coronary angiography is strongly recommended in patients with ST-segment elevation on the ECG performed after return of spontaneous circulation. Conversely, whether patients without ST-segment elevation on ECG or patients who remain unconscious after return of spontaneous circulation should always undergo emergent coronary angiography is still unclear. Recent observational stud ies have shown that emergent invasive coronary strategies may improve hospital survival also in this patient subset. This suggests that resuscitated cardiac arrest victims without an obvious non-cardiac etiology should always undergo emergent coronary angiography, in association with therapeutic hypothermia if indicated.

Published
2014
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10. Transcatheter aortic valve implantation for degenerative aortic valve regurgitation long after heart transplantation.

Author

Zanuttini D, Armellini I, Bisceglia T, Spedicato L, Bernardi G, Muzzi R, Proclemer A, and Livi U

Subjects
Aged, Catheterization, Humans, Male, Severity of Illness Index, Time Factors, Aortic Valve surgery, Aortic Valve Insufficiency surgery, Heart Transplantation, Heart Valve Prosthesis Implantation methods, Postoperative Complications surgery
Abstract

Transcatheter aortic valve implantation (TAVI) has become a feasible therapeutic option for the management of high-risk patients with severe degenerative aortic stenosis. Recently it has been extended to high-risk patients with severe aortic regurgitation. Degenerative aortic valve disease is generally uncommon in heart transplant recipients. We report the case of a 75-year-old man in whom severe degenerative aortic regurgitation developed 14 years after heart transplantation (HTx). Because of multiple comorbidities and high surgical risk, TAVI was preferred. A 29-mm CoreValve prosthesis (Medtronic Inc, Minneapolis, MN) was successfully implanted using a transfemoral approach., (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Published
2013
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11. Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest.

Author

Zanuttini D, Armellini I, Nucifora G, Grillo MT, Morocutti G, Carchietti E, Trillò G, Spedicato L, Bernardi G, and Proclemer A

Subjects
Acute Coronary Syndrome therapy, Age Distribution, Aged, Angioplasty, Balloon, Coronary methods, Angioplasty, Balloon, Coronary mortality, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation mortality, Cohort Studies, Comorbidity, Coronary Angiography methods, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease epidemiology, Coronary Artery Disease therapy, Female, Humans, Incidence, Male, Middle Aged, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest therapy, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk Assessment, Sex Distribution, Survival Analysis, Treatment Outcome, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome epidemiology, Electrocardiography methods, Hospital Mortality, Out-of-Hospital Cardiac Arrest epidemiology
Abstract

Aims: Acute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). Aim of the present study was to assess the predictive value of ST-segment changes in diagnosing the presence of acute coronary lesions among OHCA patients, Methods: Findings of coronary angiography (CA) performed in patients resuscitated from OCHA were retrospectively reviewed and related to ST-segment changes on post-ROSC electrocardiogram (ECG) RESULTS: Ninety-one patients underwent CA after OHCA; 44% of patients had ST-segment elevation and 56% of patients had other ECG patterns on post-ROSC ECG. Significant coronary artery disease (CAD) was found in 86% of patients; CAD was observed in 98% of patients with ST-segment elevation and in 77% of patients with other ECG patterns on post-ROSC ECG (p=0.004). Acute or presumed recent coronary artery lesions were diagnosed in 56% of patients, respectively in 85% of patients with ST-segment elevation and in 33% of patients with other ECG patterns (p<0.001). ST-segment analysis on post-ROSC ECG has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (85% and 67%, respectively), Conclusions: Electrocardiographic findings after OHCA should not be considered as strict selection criteria for performing emergent CA in patients resuscitated from OHCA without obvious extra-cardiac cause; even in the absence of ST-segment elevation on post-ROSC ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Published
2013
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12. Impact of emergency coronary angiography on in-hospital outcome of unconscious survivors after out-of-hospital cardiac arrest.

Author

Zanuttini D, Armellini I, Nucifora G, Carchietti E, Trillò G, Spedicato L, Bernardi G, and Proclemer A

Subjects
Aged, Angioplasty, Balloon, Coronary, Cardiopulmonary Resuscitation mortality, Emergency Service, Hospital, Emergency Treatment, Female, Hospital Mortality, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest therapy, Prognosis, Survival Rate, Unconsciousness, Cardiopulmonary Resuscitation methods, Coronary Angiography, Out-of-Hospital Cardiac Arrest diagnostic imaging
Abstract

Acute coronary thrombotic occlusion is the most common trigger of cardiac arrest. The aim of the present study was to assess the impact of an invasive strategy characterized by emergency coronary angiography and subsequent percutaneous coronary intervention (PCI), if indicated, on in-hospital survival of resuscitated patients with out-of-hospital cardiac arrest (OHCA) and no obvious extracardiac cause who do not regain consciousness soon after recovery of spontaneous circulation. Ninety-three consecutive patients (67 ± 12 years old, 76% men) were included in the study. Clinical characteristics and coronary angiographic and in-hospital outcome data were retrospectively collected. Multivariate Cox proportional-hazards analysis was performed to identify independent determinants of in-hospital survival. Coronary angiography was performed in 66 patients (71%). Forty-eight patients underwent emergency coronary angiography; in the remaining 18 patients, mean time from OHCA to coronary angiography was 13 ± 10 days. In patients referred to emergency coronary angiography, successful emergency PCI of a culprit coronary lesion was performed in 25 patients (52%). In-hospital survival rate was 54%. At multivariate analysis, emergency coronary angiography (hazard ratio 2.32, 95% confidence interval 1.23 to 4.38, p = 0.009) and successful emergency PCI (hazard ratio 2.54, 95% confidence interval 1.35 to 4.8, p = 0.004) were independently related to in-hospital survival in the overall study population; delay in performing coronary angiography (hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.013) was independently related to in-hospital mortality in patients referred to coronary angiography. In conclusion, an invasive strategy characterized by emergency coronary angiography and subsequent PCI, if indicated, seems to improve in-hospital outcome of resuscitated but unconscious patients with OHCA without obvious extracardiac cause., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Published
2012
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13. Adipokines, ghrelin and obesity-associated insulin resistance in nondiabetic patients with acute coronary syndrome.

Author

Barazzoni R, Aleksova A, Armellini I, Cattin MR, Zanetti M, Carriere C, Giacca M, Dore F, Guarnieri G, and Sinagra G

Subjects
Acute Coronary Syndrome epidemiology, Acute Coronary Syndrome etiology, Adult, Aged, Aged, 80 and over, Body Mass Index, Female, Homeostasis, Humans, Italy epidemiology, Male, Middle Aged, Obesity complications, Obesity epidemiology, Acute Coronary Syndrome metabolism, Adipokines metabolism, C-Reactive Protein metabolism, Ghrelin metabolism, Insulin Resistance, Obesity metabolism
Abstract

Altered glucose metabolism negatively modulates outcome in acute coronary syndromes (ACS). Insulin resistance is commonly associated with increasing BMI in the general population and these associations may involve obesity-related changes in circulating ghrelin and adipokines. We aimed at investigating interactions between BMI, insulin resistance and ACS and their associations with plasma ghrelin and adipokine concentrations. Homeostasis model assessment of insulin resistance (HOMA(IR))-insulin resistance index, plasma adiponectin, leptin, total (T-Ghrelin), acylated (Acyl-Ghrelin), and desacylated ghrelin (Desacyl-Ghrelin) were measured in 60 nondiabetic ACS patients and 44 subjects without ACS matched for age, sex, and BMI. Compared with non-ACS, ACS patients had similar HOMA(IR) and plasma adipokines, but lower T- and Desacyl-Ghrelin and higher Acyl-Ghrelin. Obesity (BMI > 30) was associated with higher HOMA(IR), lower adiponectin, and higher leptin (P < 0.05) similarly in ACS and non-ACS subjects. In ACS (n = 60) HOMA(IR) remained associated negatively with adiponectin and positively with leptin independently of BMI and c-reactive protein (CRP) (P < 0.05). On the other hand, low T- and Desacyl-Ghrelin with high Acyl-Ghrelin characterized both obese and non-obese ACS patients and were not associated with HOMA(IR). In conclusion, in ACS patients, obesity and obesity-related changes in plasma leptin and adiponectin are associated with and likely contribute to negatively modulate insulin resistance. ACS per se does not however enhance the negative impact of obesity on insulin sensitivity. High acylated and low desacylated ghrelin characterize ACS patients independently of obesity, but are not associated with insulin sensitivity.

Published
2012
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14. The acute myocardial infarction with ST segment elevation Udine registry (Come-to-Udine): predictors of 3 years mortality.

Author

Bernardi G, Di Chiara A, and Armellini I

Subjects
Aged, Combined Modality Therapy, Female, Health Care Rationing organization & administration, Humans, Italy epidemiology, Kaplan-Meier Estimate, Male, Middle Aged, Patient Selection, Proportional Hazards Models, Registries, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary mortality, Health Services Accessibility organization & administration, Hospitals, Community organization & administration, Myocardial Infarction mortality, Myocardial Infarction therapy, Patient Transfer organization & administration, Thrombolytic Therapy mortality
Abstract

Background: Percutaneous coronary intervention (PCI) is considered the best treatment for acute myocardial infarction with ST segment elevation (STEMI), but it is difficult to deliver., Objectives: To report on long-term mortality predictors in a registry based on a 'hub and spoke' model, according to the initial strategy: thrombolysis followed or not by PCI, invasive strategy followed or not by primary PCI and no reperfusion., Methods and Results: From May 2001 to June 2003, 514 patients (mean age 67 +/- 12) with STEMI onset less than 12 h (<24 h if pain ongoing) were enrolled, 34% transferred from spoke centers. Patients were stratified according to thrombolysis in myocardial infarction risk score (TRS) and to local high-risk criteria (LHRC, one of the following: contraindication to thrombolysis, cardiogenic shock, anterior or right ventricular location, ST segment elevation in > or =6 leads, Killip class >1 and previous STEMI). Mean TRS score was 4.0 and 53% of patients met LHRC. Thrombolysis was undertaken in 49% of patients, invasive strategy in 29% and no reperfusion in 22%. The latter had higher TRS (4.9) but only 40% met LHRC. Reperfusion time was significantly longer in patients who underwent PCI as compared with those who underwent thrombolysis (223 vs. 120 min, P < 0.0001). Patients in the thrombolysis group had better risk profiles and underwent emergency or elective revascularization within 30 days in 66% of cases. Overall, long-term mortality rate (36 months) was 23.3%. Both TRS and LHRC identified patients with higher mortality (43 and 32%, respectively). Multivariate analysis showed age, left ventricular ejection fraction and Killip class more than 1 to be significant predictors of mortality (P < 0.0001/P < 0.0001/P = 0.0103), whereas reperfusion strategy and time to treatment were not., Conclusion: An initial strategy of thrombolysis followed by emergency or elective PCI as appropriate is still an option in a setting in which limited resources are available. Decision-making based on risk scores and time from symptom onset lead to proper patient selection and even to foregoing reperfusion without affecting mortality.

Published
2009
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