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2. ROLE OF VERY LOW DOSE STATIN THERAPY IN PCSK9 INIB. TREATED PATIENTS

Author

Gentile, G, Bentivoglio, F, De Carlini, C, Meles, E, Gorgoglione, M, Bucalo, R, Bruni, F, Masiello, L, and Maggiolini, S

Abstract

Female patient 62 years old Cardiovascular risk factors: Arterial hypertension, smoking, obesity, dyslipidemia, hypercholesterolemia, family history of cardiovascular diseases (father who died from miocardial infarction (MI) and brother with 3 MI). Intolerance to various statins (myalgia) Non–critical atherosclerosis of the supra–aortic trunks. Therapy with PCSK9 inib. started. (evolocumab 140 mg every 2 weeks). Subsequently the patient suffers from acute coronary syndrome (NSTEMI). CACG: fusiform aneurysm of proximal left anterior descending artery (LAD) The new LDL target to be reached < 55 mg/dl is far from the value achieved with the co–administration of PCSK9 inib. and ezetimibe (minimum LDL value reached with this therapy 123 mg/dl) Even with a certain time delay it was decided to introduce a statin at an extremely low dose (rosuvastatin 5 mg 3 times a week). The effect of this strategy is very effective, allowing a reduction in LDL by over 50% and up to a value of 60 (only slightly higher than the target value). However, the patient again suffers from myalgia (without an increase in CPK) and decides to suspend treatment with a new increase in LDL values to 112 mg/dl. The case emphasizes: 1) the synergistic effect of statin with PCSK9 inhibitor therapy. This synergy is already evident with extremely low doses of statin and should always be sought 2) the usefulness of an aggressive drug therapy that tends to bring LDL values within the therapeutic targets in the shortest possible time. Moreover this could highlight intolerances that make it impossible to continue with a specific therapeutic scheme so as to allow the study of new options.

Published
2024
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13. Poster session II * Thursday 9 December 2010, 14:00-18:00

Author

Pabari, P. A., primary, Kyriacou, A., additional, Moraldo, M., additional, Unsworth, B., additional, Baruah, R., additional, Sutaria, N., additional, Hughes, A., additional, Mayet, J., additional, Francis, D. P., additional, Uejima, T., additional, Loboz, K., additional, Antonini-Canterin, F., additional, Polombo, C., additional, Carerj, S., additional, Vinereanu, D., additional, Evangelista, A., additional, Leftheriotis, G., additional, Fraser, A. G., additional, Kiotsekoglou, A., additional, Govindan, M., additional, Govind, S. C., additional, Saha, S. K., additional, Camm, A. J., additional, Azcarate, P. M., additional, Castano, S., additional, Rodriguez-Manero, M., additional, Arraiza, M., additional, Levy, B., additional, Barba, J., additional, Rabago, G., additional, Bastarrika, G., additional, Nemes, A., additional, Takacs, R., additional, Varkonyi, T., additional, Gavaller, H., additional, Baczko, I., additional, Forster, T., additional, Wittmann, T., additional, Papp, J. G., additional, Lengyel, C., additional, Varro, A., additional, Tumasyan, L. R., additional, Adamyan, K. G., additional, Savu, O., additional, Mieghem, T., additional, Dekoninck, P., additional, Gucciardo, L., additional, Jurcut, R., additional, Giusca, S., additional, Popescu, B. A., additional, Ginghina, C., additional, Deprest, J., additional, Voigt, J. U., additional, Versiero, M., additional, Galderisi, M., additional, Esposito, R., additional, Rapacciuolo, A., additional, Esposito, G., additional, Raia, R., additional, Morgillo, T., additional, Piscione, F., additional, De Simone, G., additional, Oraby, M. A., additional, Maklady, F. A., additional, Mohamed, E. M., additional, Eraki, A. Z., additional, Zaliaduonyte-Peksiene, D., additional, Tamuleviciute, E., additional, Janenaite, J., additional, Marcinkeviciene, J., additional, Mizariene, V., additional, Bucyte, S., additional, Vaskelyte, J., additional, Trifunovic, D., additional, Nedeljkovic, I., additional, Popovic, D., additional, Ostojic, M., additional, Vujisic-Tesic, B., additional, Petrovic, M., additional, Stankovic, S., additional, Sobic-Saranovic, D., additional, Banovic, M., additional, Dikic-Djordjevic, A., additional, Savino, K., additional, Lilli, A., additional, Grikstaite, E., additional, Giglio, V., additional, Bordoni, E., additional, Maragoni, G., additional, Cavallini, C., additional, Ambrosio, G., additional, Jakovljevic, B., additional, Beleslin, B., additional, Nedeljkovic, M., additional, Petrovic, O., additional, Moral, S., additional, Rodriguez-Palomares, J., additional, Descalzo, M., additional, Marti, G., additional, Pineda, V., additional, Mahia, P., additional, Gutierrez, L., additional, Gonzalez-Alujas, T., additional, Garcia-Dorado, D., additional, Schnell, F., additional, Donal, E., additional, Thebault, C., additional, Bernard, A., additional, Corbineau, H., additional, Le Breton, H., additional, Kochanowski, J., additional, Scislo, P., additional, Piatkowski, R., additional, Roik, M., additional, Marchel, M., additional, Kosior, D., additional, Opolski, G., additional, Lesniak-Sobelga, A. M., additional, Wicher-Muniak, E., additional, Kostkiewicz, M., additional, Olszowska, M., additional, Suchon, E., additional, Klimeczek, P., additional, Banys, P., additional, Pasowicz, M., additional, Tracz, W., additional, Podolec, P., additional, Laynez, A., additional, Hoefsten, D. E., additional, Loegstrup, B. B., additional, Norager, B., additional, Moller, J. E., additional, Flyvbjerg, A., additional, Egstrup, K., additional, Streb, W., additional, Szulik, M., additional, Nowak, J., additional, Markowicz-Pawlus, E., additional, Duszanska, A., additional, Sedkowska, A., additional, Kalarus, Z., additional, Kukulski, T., additional, Spinelli, L., additional, Morisco, C., additional, Assante Di Panzillo, E., additional, Buono, F., additional, Crispo, S., additional, Trimarco, B., additional, Hawary, A. A., additional, Nasr, G. M., additional, Fawzy, M. M., additional, Faber, L., additional, Scholtz, W., additional, Boergermann, J., additional, Wiemer, M., additional, Kleikamp, G., additional, Bogunovic, N., additional, Dimitriadis, Z., additional, Gummert, J., additional, Hering, D., additional, Horstkotte, D., additional, Luca', F., additional, Gelsomino, S., additional, Lorusso, R., additional, Caciolli, S., additional, Carella, R., additional, Bille', G., additional, De Cicco, G., additional, Pazzagli, V., additional, Gensini, G. F., additional, Borowiec, A., additional, Dabrowski, R., additional, Janas, J., additional, Kraska, A., additional, Firek, B., additional, Kowalik, I., additional, Szwed, H., additional, Marcus, K. A., additional, De Korte, C. L., additional, Feuth, T., additional, Thijssen, J. M., additional, Kapusta, L., additional, Dahl, J., additional, Videbaek, L., additional, Poulsen, M. K., additional, Pellikka, P. A., additional, Veien, K., additional, Andersen, L. I., additional, Haghfelt, T., additional, Haberka, M., additional, Mizia - Stec, K., additional, Adamczyk, T., additional, Mizia, M., additional, Chmiel, A., additional, Pysz, P., additional, Sosnowski, M., additional, Gasior, Z., additional, Trusz - Gluza, M., additional, Tendera, M., additional, Niklewski, T., additional, Wilczek, K., additional, Chodor, P., additional, Podolecki, T., additional, Frycz-Kurek, A., additional, Zembala, M., additional, Yurdakul, S., additional, Yildirimturk, O., additional, Tayyareci, Y., additional, Memic, K., additional, Demiroglu, I. C. C., additional, Aytekin, S., additional, Garcia Alonso, C. J., additional, Ferrer Sistach, E., additional, Delgado, L., additional, Lopez Ayerbe, J., additional, Vallejo Camazon, N., additional, Gual Capllonch, F., additional, Espriu Simon, M., additional, Ruyra, X., additional, Caballero Parrilla, A., additional, Bayes Genis, A., additional, Lecuyer, L., additional, Berrebi, A., additional, Florens, E., additional, Noghin, M., additional, Huerre, C., additional, Achouh, P., additional, Zegdi, R., additional, Fabiani, J. N., additional, De Chiara, B., additional, Moreo, A., additional, Musca, F., additional, De Marco, F., additional, Lobiati, E., additional, Belli, O., additional, Mauri, F., additional, Klugmann, S., additional, Caballero, A., additional, Vallejo, N., additional, Gonzalez Guardia, A., additional, Nunez Aragon, R., additional, Bosch, C., additional, Ferrer, E., additional, Pedro Botet, M. L., additional, Gual, F., additional, Cusma-Piccione, M., additional, Zito, C., additional, Oreto, G., additional, Giuffre, R., additional, Todaro, M. C., additional, Barbaro, C. M., additional, Lanteri, S., additional, Longordo, C., additional, Salvia, J., additional, Bensaid, A., additional, Gallet, R., additional, Fougeres, E., additional, Lim, P., additional, Nahum, J., additional, Deux, J. F., additional, Gueret, P., additional, Teiger, E., additional, Dubois-Rande, J. L., additional, Monin, J. L., additional, Behramoglu, F., additional, Colakoglu, Z., additional, Aytekin, V., additional, Demiroglu, C., additional, Gargani, L., additional, Poggianti, E., additional, Bucalo, R., additional, Rizzo, M., additional, Agrusta, F., additional, Landi, P., additional, Sicari, R., additional, Picano, E., additional, Sutandar, A., additional, Siswanto, B. B., additional, Irmalita, I., additional, Harimurti, G., additional, Hayashi, S. Y., additional, Nascimento, M. M., additional, Lindholm, B., additional, Lind, B., additional, Seeberger, A., additional, Pachaly, M. A., additional, Riella, M. C., additional, Bjallmark, A., additional, Brodin, L. A., additional, Poanta, L., additional, Porojan, M., additional, Dumitrascu, D. L., additional, Ikonomidis, I., additional, Tzortzis, S., additional, Lekakis, J., additional, Kremastinos, D. T., additional, Paraskevaidis, I., additional, Andreadou, I., additional, Nikolaou, M., additional, Katsibri, P., additional, Anastasiou-Nana, M., additional, Maceira Gonzalez, A. M., additional, Ripoll, C., additional, Cosin-Sales, J., additional, Igual, B., additional, Salazar, J., additional, Belloch, V., additional, Cosin-Aguilar, J., additional, Pennell, D. J., additional, Masaki, M., additional, Pulido, J. N., additional, Yuasa, T., additional, Gillespie, S., additional, Afessa, B., additional, Brown, D. R., additional, Mankad, S. V., additional, Oh, J. K., additional, Gurghean, A. L., additional, Mihailescu, A. M., additional, Tudor, I., additional, Homentcovschi, C., additional, Muraru, M., additional, Bruckner, I. V., additional, Correia, C. E., additional, Rodrigues, B., additional, Moreira, D., additional, Santos, L. F., additional, Gama, P., additional, Dionisio, O., additional, Cabral, C., additional, Santos, O., additional, Bombardini, T., additional, Gherardi, S., additional, Arpesella, G., additional, Valente, S., additional, Calamai, I., additional, Pasanisi, E., additional, Sansoni, S., additional, Szymanski, P., additional, Dobrowolski, P., additional, Lipczynska, M., additional, Klisiewicz, A., additional, Hoffman, P., additional, Stepowski, D., additional, Kurtz, B., additional, Grezis-Soulie, G., additional, Savoure, A., additional, Anselme, F., additional, Bauer, F., additional, Castillo, J., additional, Herszkowicz, N., additional, Ferreira, C., additional, Goscinska, A., additional, Mizia-Stec, K., additional, Poborski, W., additional, Azevedo, O., additional, Quelhas, I., additional, Guardado, J., additional, Fernandes, M., additional, Miranda, C. S., additional, Gaspar, P., additional, Lourenco, A., additional, Medeiros, R., additional, Almeida, J., additional, L Bennani, S., additional, Algalarrondo, V., additional, Dinanian, S., additional, Guiader, J., additional, Juin, C., additional, Adams, D., additional, Slama, M. S., additional, Onaindia, J. J., additional, Quintana, O., additional, Velasco, S., additional, Astigarraga, E., additional, Cacicedo, A., additional, Gonzalez, J., additional, Rodriguez, I., additional, Sadaba, M., additional, Eneriz, M., additional, Laraudogoitia Zaldumbide, E., additional, Nunez-Gil, I., additional, Luaces, M., additional, Zamorano, J., additional, Garcia Rubira, J. C., additional, Vivas, D., additional, Ibanez, B., additional, Marcos Alberca, P., additional, Fernandez Golfin, C., additional, Alonso, J., additional, Macaya, C., additional, Silva Marques, J., additional, Almeida, A. G., additional, Carvalho, V., additional, Jorge, C., additional, Silva, D., additional, Gato Varela, M., additional, Martins, S., additional, Brito, D., additional, Lopes, M. G., additional, Tripodi, E., additional, Miserrafiti, B., additional, Montemurro, V., additional, Scali, R., additional, Tripodi, P., additional, Winkler, A., additional, Madej, A., additional, Hausmanowa-Petrusewicz, I., additional, Fijalkowski, M., additional, Koprowski, A., additional, Jaguszewski, M., additional, Galaska, R., additional, Taszner, M., additional, Rynkiewicz, A., additional, Citro, R., additional, Rigo, F., additional, Provenza, G., additional, Ciampi, Q., additional, Patella, M. M., additional, D'andrea, A., additional, Vriz, O., additional, Astarita, C., additional, Bossone, E., additional, Heggemann, F., additional, Walter, T. H., additional, Kaelsch, T. H., additional, Sueselbeck, T., additional, Papavassiliu, T. H., additional, Borggrefe, M., additional, Haghi, D., additional, Monk-Hansen, T., additional, Have Dall, C., additional, Bisgaard Christensen, S., additional, Snoer, M., additional, Gustafsson, F., additional, Rasmusen, H., additional, Prescott, E., additional, Finocchiaro, G., additional, Pinamonti, B., additional, Merlo, M., additional, Barbati, G., additional, Di Lenarda, A., additional, Bussani, R., additional, Sinagra, G., additional, Butz, T., additional, Lang, C. N., additional, Meissner, A., additional, Plehn, G., additional, Yeni, H., additional, Langer, C., additional, Trappe, H. J., additional, Gu, X., additional, Gu, X. Y., additional, He, Y. H., additional, Li, Z. A., additional, Han, J. C., additional, Chen, J., additional, Gaudron, P., additional, Niemann, M., additional, Herrmann, S., additional, Hu, K., additional, Bijnens, B., additional, Hillenbrand, H., additional, Beer, M., additional, Ertl, G., additional, Weidemann, F., additional, Mazzone, A., additional, Mariani, M., additional, Foffa, I., additional, Vianello, A., additional, Del Ry, S., additional, Bevilacqua, S., additional, Andreassi, M. G., additional, Glauber, M., additional, Berti, S., additional, Grabowski, M., additional, Postula, M., additional, Dragulescu, A., additional, Van Arsdell, G., additional, Al-Radi, O., additional, Caldarone, C., additional, Mertens, L., additional, Lee, K. J., additional, Casula, R. P., additional, Yadav, H., additional, Cherian, A., additional, Hughes, A. D., additional, Vitarelli, A., additional, D'orazio, S., additional, Nguyen, B. L., additional, Iorio, G., additional, Battaglia, D., additional, Caranci, F., additional, Padella, V., additional, Capotosto, L., additional, Alessandroni, L., additional, Barilla, F., additional, Cardin, C., additional, Hascoet, S., additional, Saudron, M., additional, Caudron, G., additional, Arnaudis, B., additional, Acar, P., additional, Sun, M. M., additional, Shu, X. H., additional, Pan, C. Z., additional, Fang, X. Y., additional, Kong, D. H., additional, Fang, F., additional, Zhang, Q., additional, Chan, Y. S., additional, Xie, J. M., additional, Yip, W. K., additional, Lam, Y. Y., additional, Sanderson, J. E., additional, Yu, C. M., additional, Rosca, M., additional, O' Connor, K., additional, Romano, G., additional, Magne, J., additional, Calin, A., additional, Muraru, D., additional, Pierard, L., additional, Lancellotti, P., additional, Roushdy, A., additional, Elfiky, I., additional, El Shahid, G., additional, Elfiky, A., additional, El Sayed, M., additional, Wierzbowska-Drabik, K., additional, Chrzanowski, L., additional, Kapusta, A., additional, Plonska-Goscinak, E., additional, Krzeminska-Pakula, M., additional, Kurpesa, M., additional, Rechcinski, T., additional, Trzos, E., additional, Kasprzak, J. D., additional, Ersboll, M. K., additional, Valeur, N., additional, Mogensen, U. M., additional, Andersen, M., additional, Hassager, C., additional, Sogaard, P., additional, Kober, L. V., additional, Kloeckner, M., additional, Hayat, D., additional, Dussault, C., additional, Lellouche, N., additional, Elbaz, N., additional, Demopoulos, A., additional, Hatzigeorgiou, G., additional, Leontiades, E., additional, Motsi, A., additional, Karatasakis, G., additional, Athanassopoulos, G., additional, Zycinski, P., additional, Kasprzak, J., additional, Vazquez Alvarez, M. C., additional, Medrano Lopez, C., additional, Camino Lopez, M., additional, Granja, S., additional, Zunzunegui Martinez, J. L., additional, Maroto Alvaro, E., additional, Tsai, W.-C., additional, Chen, J.-Y., additional, Liu, Y.-W., additional, Lin, C.-C., additional, Tsai, L.-M., additional, Gomes, D. C., additional, Robalo Martins, S., additional, Gois, M. R., additional, Ribeiro, S., additional, Nunes Diogo, A., additional, Sengupta, P., additional, Di Bella, G., additional, Caracciolo, G., additional, Lentini, S., additional, Kinova, E., additional, Zlatareva, N., additional, Goudev, A., additional, Papagiannis, N., additional, Mpouki, M., additional, Papagianni, A., additional, Vorria, M., additional, Mpenetos, G., additional, Lytra, D., additional, Papadopoulou, E., additional, Sgourakis, P., additional, Malakos, J., additional, Kyriazis, J., additional, Kodali, V., additional, Toole, R., additional, Gopal, A. S., additional, Celutkiene, J., additional, Rudys, A., additional, Grabauskiene, V., additional, Glaveckaite, S., additional, Sadauskiene, E., additional, Lileikiene, Z., additional, Bickauskaite, N., additional, Ciburiene, E., additional, Skorniakov, V., additional, Laucevicius, A., additional, Attenhofer Jost, C. H., additional, Pfyffer, M., additional, Lindquist, R., additional, Santos, J. L. F., additional, Coelho, O. R. C., additional, Mady, C. M., additional, Picard, M. H. P., additional, Salemi, V. M. C., additional, Funk, L., additional, Prull, M. W., additional, Shih, J.-Y., additional, Huang, Y.-Y., additional, O'connor, K., additional, Moonen, M., additional, Pierard, L. A., additional, Cozma, D. C., additional, Mornos, C., additional, Ionac, A., additional, Petrescu, L., additional, Dragulescu, D., additional, Dan, R., additional, Popescu, I., additional, Dragulescu, S. I., additional, Von Lueder, T. G., additional, Hodt, A., additional, Gjerdalen, G. F., additional, Andersen, T. E., additional, Solberg, E. E., additional, Steine, K., additional, Van Mieghem, T., additional, Rostek, M., additional, Pikto-Pietkiewicz, W., additional, Dluzniewski, M., additional, Antoniewicz, A., additional, Poletajew, S., additional, Borowka, A., additional, Pasierski, T., additional, Malyutina, S. K., additional, Ryabikov, M., additional, Ragino, J., additional, Ryabikov, A., additional, Sitia, S., additional, Tomasoni, L., additional, Atzeni, F., additional, Gianturco, L., additional, Sarzi-Puttini, P., additional, De Gennaro Colonna, V., additional, Turiel, M., additional, Gutierrez, F. R., additional, Lefhtheriotis, G., additional, Hurst, R. T., additional, Nelson, M. R., additional, Mookadam, F., additional, Thota, V., additional, Emani, U., additional, Al Harthi, M., additional, Stepanek, J., additional, Cha, S., additional, Lester, S. J., additional, Ho, E. M. M., additional, Hemeryck, L., additional, Hall, M., additional, Scott, K., additional, Bennett, K., additional, Mahmud, A., additional, Daly, C., additional, King, G., additional, Murphy, R. T., additional, Brown, A. S., additional, Teske, A. J., additional, D'Hooge, J., additional, Claus, P., additional, Rademakers, F., additional, Santos, L., additional, Cortez-Dias, N., additional, Goncalves, S., additional, Almeida Ribeiro, M., additional, Bordalo E Sa, A., additional, Magnino, C., additional, Marcos-Alberca, P., additional, Milan, A., additional, Almeria, C., additional, Caniadas, V., additional, Rodrigo, J. L., additional, Perez De Isla, L., additional, Zamorano, J. L., additional, Gustafsson, U., additional, Larsson, M., additional, Lindqvist, P., additional, Brodin, L., additional, Waldenstrom, A., additional, Roosens, B., additional, Hernot, S., additional, Droogmans, S., additional, Van Camp, G., additional, Lahoutte, T., additional, Cosyns, B., additional, Rao, C. M., additional, Aguglia, D., additional, Casciola, G., additional, Imbesi, C., additional, Marvelli, A., additional, Sgro, M., additional, Benedetto, D., additional, Tripepi, R., additional, Zoccali, C., additional, Benedetto, F. A., additional, Badano, L. P., additional, Cardillo, M., additional, Del Mestre, L., additional, Gianfagna, P., additional, Proclemer, A., additional, Tschernich, H. D., additional, Mora, B., additional, Base, E., additional, Weber, U., additional, Dumfarth, J., additional, Mukherjee, C., additional, Skaltsiotis, H. S., additional, Kaladaridis, A. K., additional, Bramos, D. B., additional, Kottis, G. K., additional, Antoniou, A. A., additional, Agrios, I. A., additional, Takos, D. T., additional, Vasiladiotis, N. V., additional, Pamboucas, K. P., additional, Toumanidis, S. T. T., additional, Shim, A., additional, Lipec, P., additional, Michalski, B., additional, Wozniakowski, B., additional, Stefanczyk, L., additional, Rotkiewicz, A., additional, Cameli, M., additional, Lisi, M., additional, Padeletti, M., additional, Bigio, E., additional, Bernazzali, S., additional, Tsoulpas, C., additional, Maccherini, M., additional, Henein, M., additional, Mondillo, S., additional, Garcia Lunar, I., additional, Mingo Santos, S., additional, Monivas Palomero, V., additional, Mitroi, C., additional, Beltran Correas, P., additional, Ruiz Bautista, L., additional, Muniz Lozano, A., additional, Gonzalez Gonzalez, M., additional, Pabari, P. A., additional, Stegemann, B., additional, Willson, K., additional, Zeppellini, R., additional, Iavernaro, A., additional, Zadro, M., additional, Carasi, M., additional, De Domenico, R., additional, Rigo, T., additional, Artuso, E., additional, Erente, G., additional, Ramondo, A., additional, Le, T. T., additional, Huang, F. Q., additional, Gu, Y., additional, and Tan, R. S., additional

Published
2010
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14. Long-term outcomes comparison of different types of des in elderly patients from a real-world experience

Author

Sanfilippo, A., Cumbo, M., Caggegi, A. M., Monaco, S., Bucalo, R., Ruperto, C., Tamburino, C., Ussia, G. P., Galassi, A. R., Capranzano, P., Davide Capodanno, Sanfilippo A., Cumbo M., Caggegi A.M., Monaco S., Bucalo R., Ruperto C., Tamburino C., Ussia G.P., Galassi A.R., Capranzano P., and Capodanno D.

Subjects
Elderly, Drug-eluting stent, Paclitaxel-eluting stent, Sirolimus-eluting stent
Abstract

OBJECTIVE: We sought to evaluate the impact on long-term clinical outcomes of different types of drug-eluting stents (DES) in elderly patients. BACKGROUND: Elderly patients constitute a fast-growing portion of cardiovascular patients, however, they are not adequately represented in clinical trials. Moreover, few data comparing different type of DES in elderly patients are available. METHODS: From a total of 2,330 consecutive patients treated at our institution with DES, we selected 207 elderly patients (≥ 75 years of age) who underwent, from May 2002 to December 2006, sirolimus-eluting stent (SES group, 116 patients [pts], 56%) or paclitaxel-eluting stent (PES group, 91 pts, 43.9%) implantation. We evaluated the 24-month incidence of major adverse cardiac events (MACE). RESULTS: Higher rates of hypertension (78.4% vs. 90.1%; p = 0.01), diabetes (37.9 vs. 45.1; p = 0.01) and previous coronary artery bypass grafts (10.3% vs. 19.4%; p = 0.04) in the PES group were observed, whereas in the SES group, there were more smokers (26.6% vs. 12.1%; p = 0.007) and a higher incidence of previous myocardial infarction (MI) (50% vs. 35.2%; p = 0.02). Procedural success and in-hospital MACE were similar in both groups. At follow up, there was a higher incidence of MACE (22.4% vs. 10.9%; p = 0.04) and target lesion revascularization (7.1% vs. 3.0%; p = 0.02) in the SES group compared to the PES group. The incidence of cardiac death and MI were comparable between the two groups, as well as the rate of stent thrombosis. After adjustment for clinical and angiographic characteristics, no significant differences in outcomes were observed between SES and PES. CONCLUSIONS: In this real-word experience, no significant differences were found in the safety and efficacy profiles between SES and PES use in elderly patients.

15. A letter to father.

Author

Sweeney, K.C. and Bucalo, R.

Subjects
CREEK (North American people), PRESIDENTS of the United States, CHILDREN of presidents, BIOGRAPHIES
Abstract

Relates the events which brought Lyncoya, a Creek Indian boy, into the life of General Andrew Jackson. A letter Lyncoya wrote to Jackson about his feelings as an Indian is included.

Published
1991

16. A novel approach to define risk of stent thrombosis after percutaneous coronary intervention with drug-eluting stents: the DERIVATION score

Author

Davide Capodanno, Alessandra Sanfilippo, Corrado Tamburino, Alfredo R. Galassi, Piera Capranzano, Gianpaolo Ussia, Rita Bucalo, Anna Caggegi, Cettina Ruperto, Capodanno D., Capranzano P., Bucalo R., Sanfilippo A., Ruperto C., Caggegi A., Ussia G., Galassi A.R., and Tamburino C.

Subjects
Male, Risk, medicine.medical_specialty, Databases, Factual, medicine.medical_treatment, Revascularization, Coronary Angiography, Predictive score, Coronary artery disease, Angioplasty, Internal medicine, Medicine, Humans, Prospective Studies, Acute Coronary Syndrome, Angioplasty, Balloon, Coronary, Aged, Framingham Risk Score, business.industry, Stent thrombosis, Percutaneous coronary intervention, Drug-Eluting Stents, Thrombosis, General Medicine, Odds ratio, Middle Aged, medicine.disease, Prognosis, Logistic Models, Conventional PCI, Multivariate Analysis, Cardiology, Female, Radiology, Drug-eluting stent, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, Follow-Up Studies, Forecasting
Abstract

Recent studies of drug-eluting stents (DES) use in routine clinical practice have led to concern regarding their long-term safety and to questions about the adequacy of current antiplatelet therapy guidelines. This study sought to derivate a risk score for predicting stent thrombosis after drug-eluting stenting. The large single center DES Real-world Incremental Value in the erA of percutaneous revascularizaTION (DERIVATION) database, collecting data about 1,377 patients of any age undergoing PCI with DES as treatment for symptomatic coronary artery disease, was use for this purpose. Logistic regression and bootstrap procedure were used to select correlates of stent thrombosis that were subsequently weighted and integrated into an integer scoring system. Five variables selected from the initial multivariate model were weighted proportionally to their respective odds ratio for stent thrombosis [baseline left ventricular ejection fraction

Published
2008

17. [Endothelial dysfunction. An integrated overview of the physiopatologic and diagnostic aspects].

Author

Del Turco S, Bianchini E, Bucalo R, Basta G, Bruno RM, and Sicari R

Subjects
Biomarkers, Humans, Cardiovascular Diseases diagnosis, Cardiovascular Diseases physiopathology, Endothelium, Vascular physiopathology
Abstract

Endothelial dysfunction is an early alteration in the atherosclerotic process. Cardiovascular risk factors induce endothelial dysfunction, characterized by impaired endothelium-dependent vasodilatation and by new proatherogenic, proinflammatory and prothrombotic properties. It is evident as the study of the endothelium could play a key role in the cardiovascular research and can be an useful tool for risk stratification in primary prevention of cardiovascular disease. An ideal approach for the comprehensive evaluation on endothelial physiopathology would take into account and integrate informations about endothelial biology (activation, injury and regenerative capacity) and endothelial function, so to be correlated with clinical data.

Published
2012
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18. Impact of diabetes mellitus on long-term follow-up of percutaneous coronary intervention based on clinical presentation of coronary artery disease.

Author

Ruperto C, Capodanno D, Blundo A, Capranzano P, Sanfilippo A, Caggegi A, Bucalo R, Giaimo V, and Tamburino C

Subjects
Acute Coronary Syndrome mortality, Acute Coronary Syndrome therapy, Aged, Coronary Artery Disease mortality, Coronary Artery Disease therapy, Drug-Eluting Stents, Follow-Up Studies, Humans, Middle Aged, Myocardial Infarction physiopathology, Myocardial Revascularization, Retrospective Studies, Treatment Outcome, Acute Coronary Syndrome physiopathology, Angioplasty, Balloon, Coronary, Coronary Artery Disease physiopathology, Diabetes Mellitus physiopathology
Abstract

Aims: In the drug-eluting stent (DES) era, diabetes mellitus is still associated with poor clinical and angiographic outcome after PCI. Whether this phenomenon is exacerbated in the setting of acute coronary syndromes (ACS) is unclear. We investigated the long-term interaction of diabetes mellitus and clinical presentation in patients treated with percutaneous coronary intervention (PCI)., Methods: Consecutive patients undergoing PCI and DES implantation were retrospectively analyzed. The 3-year composite of death, non-fatal myocardial infarction (MI) or target vessel revascularization (TVR) was assessed., Results: Four subgroups of patients were identified: diabetes mellitus and ACS (n = 302); diabetes mellitus and no-ACS (n = 191); no-diabetes mellitus and ACS (n = 573); no-diabetes mellitus and no-ACS (n = 396). Compared to non-diabetes mellitus, diabetes mellitus patients experienced higher 3-year rates of death, non-fatal MI or TVR (32.3 vs. 21.9%, P < 0.001). Diabetes mellitus was significantly associated with the composite of death, non-fatal MI or TVR in the no-ACS group [adjusted hazard ratio (AHR) 1.307, 95% confidence interval (CI) 1.090-1.566, P = 0.004] and, albeit to a lesser extent, in the ACS group (AHR 1.177, 95% CI 1.006-1.377, P = 0.041). No statistically significant interaction was observed between diabetes mellitus and clinical presentation (P for interaction = 0.802)., Conclusions: No significant interaction between diabetes mellitus and clinical presentation was noted in this study. The high rates of cardiac events observed in diabetes mellitus patients despite recent advances in interventional techniques outline the need for a multidisciplinary approach in the management of diabetes mellitus patients, including optimization of glycemic control, aggressive medical therapy and more complete coronary revascularization.

Published
2011
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19. Sirolimus versus paclitaxel-eluting stents in small coronary vessels: long-term outcomes from a single-center registry.

Author

Bucalo R, Capranzano P, Conti G, Capodanno D, Ruperto C, Blundo A, Caggegi A, Tamburino C, Sanfilippo A, and Tamburino C

Subjects
Aged, Coronary Artery Disease pathology, Coronary Vessels pathology, Female, Humans, Male, Middle Aged, Organ Size, Retrospective Studies, Treatment Outcome, Antineoplastic Agents therapeutic use, Coronary Artery Disease drug therapy, Drug-Eluting Stents, Paclitaxel therapeutic use, Sirolimus therapeutic use
Abstract

Objective: Several studies showed that small vessel diameter is a determinant of increased risk of adverse events after stenting. The efficacy of different drug-eluting stent types implanted in small vessels has still not been established. The aim of the present observational study was to compare long-term clinical outcomes after sirolimus-eluting stent (SES) or paclitaxel-eluting stent (PES) implantation in lesions located in small coronary vessels., Methods: For the purpose of this analysis patients undergoing SES or PES implantation in vessels with diameter 2.5 mm or less, from May 2002 to December 2006, were included. Long-term rates of major adverse cardiac events were evaluated and compared between the two groups. Independent predictors of major adverse cardiac events were also investigated., Results: A total of 336 patients were included, 225 were treated only with SES and 111 only with PES. During a mean follow-up of 23.3 +/- 12.1 months the major adverse cardiac events rates were 12.8 versus 13.6%, P = 0.98 in SES versus PES groups, respectively. The rates of target lesion revascularization (8.0 versus 6.3%, P = 0.75), mortality (3.5 versus 4.5%, P = 0.88) and myocardial infarction (2.6 versus 4.5%, P = 0.41) were similar between SES and PES, respectively. The overall thrombosis rate was also not significantly different in SES and PES groups (1.3% SES versus 4.5% PES, P = 0.12)., Conclusion: In this study SES and PES provided similar long-term results after treatment of lesions in small vessels. Nevertheless, larger randomized studies are needed to confirm these findings.

Published
2010
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20. EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention.

Author

Capodanno D, Miano M, Cincotta G, Caggegi A, Ruperto C, Bucalo R, Sanfilippo A, Capranzano P, and Tamburino C

Subjects
Age Factors, Aged, Angioplasty, Balloon, Coronary mortality, Cohort Studies, Confidence Intervals, Coronary Angiography methods, Coronary Disease classification, Coronary Disease diagnostic imaging, Female, Humans, Italy, Kaplan-Meier Estimate, Male, Middle Aged, Predictive Value of Tests, Probability, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Sex Factors, Survival Analysis, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Disease mortality, Coronary Disease therapy, Coronary Vessels pathology, Severity of Illness Index
Abstract

Background: Whether SYNTAX score should be used as a stand-alone tool or whether its performance may be improved by the parallel use of clinical scores focusing on comorbidities, such as EuroSCORE, is a matter of debate., Methods: A combined risk model including both clinical and angiographic information was developed, and its performance tested on a contemporary population of 255 patients with left main disease undergoing percutaneous coronary intervention (PCI). A global risk classification (GRC) system was created by combination of SYNTAX score and EuroSCORE strata, and new classes of risk were defined., Results: When EuroSCORE was fitted into the SYNTAX score model, c-statistic increased from 0.681 to 0.732 for the prediction of cardiac mortality. The likelihood ratio test for the significance of adding the EuroSCORE term to the model was chi(2) = 4.109 (P = .043) with a net reclassification improvement of 26% (P = .002). GRC showed the best prediction and discriminative ability in terms of two-year cardiac mortality (HR 3.40, 95% CI 1.79-6.43, P < .001; c-statistic 0.756) as compared with SYNTAX score (HR 2.87, 95% CI 1.35-6.10, P = .006; c-statistic 0.747) and EuroSCORE (HR 3.04, 95% CI 1.41-6.57, P = .005; c-statistic 0.708) alone., Conclusions: We found a significant improvement in the prediction of cardiac mortality with the inclusion of EuroSCORE in a SYNTAX score-based model. The degree of reclassification between treatment threshold categories indicates that clinical and angiographic information are both important for assessing individual risk of patients undergoing left main PCI., (Copyright 2010 Mosby, Inc. All rights reserved.)

Published
2010
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21. Long-term outcomes comparison of different types of DES in elderly patients from a real-world experience.

Author

Sanfilippo A, Cumbo M, Caggegi AM, Monaco S, Bucalo R, Ruperto C, Tamburino C, Ussia GP, Galassi AR, Capranzano P, Capodanno D, and Tamburino C

Subjects
Age Factors, Aged, Aged, 80 and over, Aging, Coronary Angiography, Coronary Restenosis mortality, Female, Humans, Male, Multivariate Analysis, Myocardial Infarction mortality, Myocardial Infarction prevention & control, Proportional Hazards Models, Registries, Retrospective Studies, Time Factors, Treatment Outcome, Antineoplastic Agents, Phytogenic therapeutic use, Coronary Restenosis prevention & control, Drug-Eluting Stents, Immunosuppressive Agents therapeutic use, Paclitaxel therapeutic use, Sirolimus therapeutic use
Abstract

Objective: We sought to evaluate the impact on long-term clinical outcomes of different types of drug-eluting stents (DES) in elderly patients., Background: Elderly patients constitute a fast-growing portion of cardiovascular patients, however, they are not adequately represented in clinical trials. Moreover, few data comparing different type of DES in elderly patients are available., Methods: From a total of 2,330 consecutive patients treated at our institution with DES, we selected 207 elderly patients (> or = 75 years of age) who underwent, from May 2002 to December 2006, sirolimus-eluting stent (SES group, 116 patients [pts], 56%) or paclitaxel-eluting stent (PES group, 91 pts, 43.9%) implantation. We evaluated the 24-month incidence of major adverse cardiac events (MACE)., Results: Higher rates of hypertension (78.4% vs. 90.1%; p = 0.01), diabetes (37.9 vs. 45.1; p = 0.01) and previous coronary artery bypass grafts (10.3% vs. 19.4%; p = 0.04) in the PES group were observed, whereas in the SES group, there were more smokers (26.6% vs. 12.1%; p = 0.007) and a higher incidence of previous myocardial infarction (MI) (50% vs. 35.2%; p = 0.02). Procedural success and in-hospital MACE were similar in both groups. At follow up, there was a higher incidence of MACE (22.4% vs. 10.9%; p = 0.04) and target lesion revascularization (7.1% vs. 3.0%; p = 0.02) in the SES group compared to the PES group. The incidence of cardiac death and MI were comparable between the two groups, as well as the rate of stent thrombosis. After adjustment for clinical and angiographic characteristics, no significant differences in outcomes were observed between SES and PES., Conclusions: In this real-word experience, no significant differences were found in the safety and efficacy profiles between SES and PES use in elderly patients.

Published
2009

22. A novel approach to define risk of stent thrombosis after percutaneous coronary intervention with drug-eluting stents: the DERIVATION score.

Author

Capodanno D, Capranzano P, Bucalo R, Sanfilippo A, Ruperto C, Caggegi A, Ussia G, Galassi AR, and Tamburino C

Subjects
Acute Coronary Syndrome therapy, Aged, Coronary Angiography, Databases, Factual, Female, Follow-Up Studies, Forecasting methods, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Platelet Aggregation Inhibitors administration & dosage, Prognosis, Prospective Studies, Risk, Thrombosis epidemiology, Angioplasty, Balloon, Coronary methods, Drug-Eluting Stents, Thrombosis etiology
Abstract

Recent studies of drug-eluting stents (DES) use in routine clinical practice have led to concern regarding their long-term safety and to questions about the adequacy of current antiplatelet therapy guidelines. This study sought to derivate a risk score for predicting stent thrombosis after drug-eluting stenting. The large single center DES Real-world Incremental Value in the erA of percutaneous revascularizaTION (DERIVATION) database, collecting data about 1,377 patients of any age undergoing PCI with DES as treatment for symptomatic coronary artery disease, was use for this purpose. Logistic regression and bootstrap procedure were used to select correlates of stent thrombosis that were subsequently weighted and integrated into an integer scoring system. Five variables selected from the initial multivariate model were weighted proportionally to their respective odds ratio for stent thrombosis [baseline left ventricular ejection fraction <50% (4 points), angioplasty in the setting of acute coronary syndromes (3 points), bifurcation lesion (2 points), left anterior descending as target vessel (2 points), multiple stenting (2 points)]. Three strata of risk were defined (low risk, 0-2; intermediate risk, 3-6; high risk >or=7) with good prognostic accuracy for early, late and very late thrombosis (c statistic = 0.75, 0.65 and 0.73, respectively) in the derivation set. In conclusion, the DERIVATION score may be used as a simple clinical tool for the identification of a sizable cohort in whom close monitoring and aggressive therapy may be beneficial.

Published
2009
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