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1. How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Author

De Luca L., Colivicchi F., Meessen J., Uguccioni M., Piscione F., Bernabo P., Lardieri G., Granatelli A., Gabrielli D., Gulizia M. M., Silverio A., Benvenga R. M., Mascia F., Fusco A., Cicala S., Oltrona Visconti L., Marinoni B., Canosi U., Cirillo P., Trimarco B., Ziviello F., Grosseto D., Menozzi M., Mezzena D., Mauro C., Sasso A., Bellis A., Calabro P., Gragnano F., Cesaro A., Venturelli V., Porretta V., Borrelli N., Indolfi C., De Rosa S., Torella D., Morici N., Molfese M., Della Rovere F., Caiffa T., Moretto G., Grippo G., Di Vincenzo E., Lucisano L., Pennacchi M., Geraci G., Sanfilippo N., Ledda A., Di Lenarda A., Cherubini A., Russo G., Piemonte F., Di Donato A., Carraturo A., Villari B., Ciampi Q., Contaldi C., Pacher V., Corrada E., Cattani D., Nassiacos D., Meloni S., Barco B., Bonmassari R., Bertoldi A., Tedoldi F., Cannone M., Valenti G., Musci R. L., Caldarola P., Locuratolo N., Sublimi Saponetti L., Gentili L., Maiandi C., Caputo M., Capparuccia C. A., Tonella T., Massari F. M., Lupi A., Tessitori M., Montano M., Scaglione A., Torri A., Tortorella G., Navazio A., Cemin R., Latina L., Briguglia D., Marino R., Scalvini S., Zanelli E., Paganini V., Riboni G., Leiballi E., Della Mattia A., Imperadore F., Tespili M., Santangelo G., Parravicini U., Dellavesa P., Testa R., Venturini E., Feola M., Testa M., Crisci V., Tramontana M., Robiglio L., Varbella F., Meynet I., Galati A., Maddaluna A., Bilato C., Loddo I., Licciardello G., Cassaniti L., Scherillo M., Formigli D., Marullo L., Chianese L., Paolillo C., De Santis A. P. A., Brunetti N. D., Bottigliero D., Della Bona R., Giannico M. B., Tramarin R., Lucibello S., Perna G. P., Marini M., Colavita A. R., Raziliop A., Francese G. M., Mariani M., Collauto F., D'Urbano M., Naio R., Ando G., Saporito F., Assanelli E. M., Cabiati A., Crivaro A., Alberti S., Marchese I., Nejat T., Refice S., Raino R., Aiello A., Cristinziani G. R., Barilla F., Iorio R., Mascelli G., Tartaglione S. N., Di Chiara G., D'Andrea D., Antonicelli R., Malatesta G., Di Mario C., Mattesini A., Tramontana L., Conti S., Sommariva L., Celestini A., Amico F., Giubilato S., Amico A. F., De Filippis M., Pasini G. F., Triggiani M., Ferrara V., Cappetti S., Carugo S., Lucreziotti S., Persico M., Gizzi G., Cipolla T., Caronia A., Buia E., Pastori P., Scarpignato M., Biscottini E., Poletti F., Vimercati C., Pirola R., Barbieri E., Dugo C., De Cesare N., De Benedictis M. L., Ruggeri A., Campana C., Bonura S., Vigna C., Marchese N., Partesana N. G., Bandini P., Farinola G., Santoro D., Cassadonte F., Calabro F., Sansoni M., Abrignani M. G., Bonura F., Benvenuto M., Liso A., Passero T., Mori I., Pozzoni B., Prati F., Finocchiaro M. L., Tufano N., Miserrafiti B., Lacquaniti V., Del Piccolo F., Mohamad B., Spinnler M. T., Bovolo V., Rebulla E., Pieri M., Paloscia L., Di Clemente D., Mazzucco G., Micanti A., Peci P., Ornago O., Proietti F., Michisanti M., Reverzani A., Donatini A., Costa P., Russo S., Franceschini Grisolia E., Mario L., Di Palma F., Dell'Aquila F., Maestroni A., Caico S. I., De Caro G., Attianese L., Perotti S., Cotti Cometti V., Astengo D., Guerri E., Cianflone D., Maranta F., Esposito N., Malvezzi Caracciolo D'Aquino M., Caliendo L., Ricci C., Ceruso C. P., Lanteri S., Serdoz R., Bruno E., De Matteis C., Campagnuolo C., Ammirati M. A., Corrado V. M., Amado Eleas M. A., Fattore L., Ippoliti C., Turiano G., Piergentili C., Chiarella F., Capogrosso P., Perotti M., Di Marco S., Sibilio G., Di Lorenzo L., Aurelio A., Ramondo A. B., Zanna D., Cernetti C., Napolitano G., Negroni S., Alessandri N., Rigo F., Giusti F., Casu G., Vicentini A., Calculli G., Fera M. S., Lettica G. V., Vagheggini G., Piti A., Porfidia A., Di Leo A., Ravera A., Ciotta E., Sacca S., Silvestri O., Isidori S., Natali P., Anselmi M., Testa L., Antonelli A., Tavasci E., Furgi G., Lavorgna A., Gasparetto N., Bisceglia T., De Luca, L., Colivicchi, F., Meessen, J., Uguccioni, M., Piscione, F., Bernabo, P., Lardieri, G., Granatelli, A., Gabrielli, D., Gulizia, M. M., Silverio, A., Benvenga, R. M., Mascia, F., Fusco, A., Cicala, S., Oltrona Visconti, L., Marinoni, B., Canosi, U., Cirillo, P., Trimarco, B., Ziviello, F., Grosseto, D., Menozzi, M., Mezzena, D., Mauro, C., Sasso, A., Bellis, A., Calabro, P., Gragnano, F., Cesaro, A., Venturelli, V., Porretta, V., Borrelli, N., Indolfi, C., De Rosa, S., Torella, D., Morici, N., Molfese, M., Della Rovere, F., Caiffa, T., Moretto, G., Grippo, G., Di Vincenzo, E., Lucisano, L., Pennacchi, M., Geraci, G., Sanfilippo, N., Ledda, A., Di Lenarda, A., Cherubini, A., Russo, G., Piemonte, F., Di Donato, A., Carraturo, A., Villari, B., Ciampi, Q., Contaldi, C., Pacher, V., Corrada, E., Cattani, D., Nassiacos, D., Meloni, S., Barco, B., Bonmassari, R., Bertoldi, A., Tedoldi, F., Cannone, M., Valenti, G., Musci, R. L., Caldarola, P., Locuratolo, N., Sublimi Saponetti, L., Gentili, L., Maiandi, C., Caputo, M., Capparuccia, C. A., Tonella, T., Massari, F. M., Lupi, A., Tessitori, M., Montano, M., Scaglione, A., Torri, A., Tortorella, G., Navazio, A., Cemin, R., Latina, L., Briguglia, D., Marino, R., Scalvini, S., Zanelli, E., Paganini, V., Riboni, G., Leiballi, E., Della Mattia, A., Imperadore, F., Tespili, M., Santangelo, G., Parravicini, U., Dellavesa, P., Testa, R., Venturini, E., Feola, M., Testa, M., Crisci, V., Tramontana, M., Robiglio, L., Varbella, F., Meynet, I., Galati, A., Maddaluna, A., Bilato, C., Loddo, I., Licciardello, G., Cassaniti, L., Scherillo, M., Formigli, D., Marullo, L., Chianese, L., Paolillo, C., De Santis, A. P. A., Brunetti, N. D., Bottigliero, D., Della Bona, R., Giannico, M. B., Tramarin, R., Lucibello, S., Perna, G. P., Marini, M., Colavita, A. R., Francese, G. M., Mariani, M., Collauto, F., D'Urbano, M., Naio, R., Ando, G., Saporito, F., Assanelli, E. M., Cabiati, A., Crivaro, A., Alberti, S., Marchese, I., Nejat, T., Refice, S., Aiello, A., Cristinziani, G. R., Barilla, F., Iorio, R., Mascelli, G., Tartaglione, S. N., Di Chiara, G., D'Andrea, D., Antonicelli, R., Malatesta, G., Di Mario, C., Mattesini, A., Tramontana, L., Conti, S., Sommariva, L., Celestini, A., Amico, F., Giubilato, S., Amico, A. F., De Filippis, M., Pasini, G. F., Triggiani, M., Ferrara, V., Cappetti, S., Carugo, S., Lucreziotti, S., Persico, M., Gizzi, G., Cipolla, T., Caronia, A., Buia, E., Pastori, P., Scarpignato, M., Biscottini, E., Poletti, F., Vimercati, C., Pirola, R., Barbieri, E., Dugo, C., De Cesare, N., De Benedictis, M. L., Ruggeri, A., Campana, C., Bonura, S., Vigna, C., Marchese, N., Partesana, N. G., Bandini, P., Farinola, G., Santoro, D., Cassadonte, F., Calabro, F., Sansoni, M., Abrignani, M. G., Bonura, F., Benvenuto, M., Liso, A., Passero, T., Mori, I., Pozzoni, B., Prati, F., Finocchiaro, M. L., Tufano, N., Miserrafiti, B., Lacquaniti, V., Del Piccolo, F., Mohamad, B., Spinnler, M. T., Bovolo, V., Rebulla, E., Pieri, M., Paloscia, L., Di Clemente, D., Mazzucco, G., Micanti, A., Peci, P., Ornago, O., Proietti, F., Michisanti, M., Reverzani, A., Donatini, A., Costa, P., Russo, S., Franceschini Grisolia, E., Mario, L., Di Palma, F., Dell'Aquila, F., Maestroni, A., Caico, S. I., De Caro, G., Attianese, L., Perotti, S., Cotti Cometti, V., Astengo, D., Guerri, E., Cianflone, D., Maranta, F., Esposito, N., Malvezzi Caracciolo D'Aquino, M., Caliendo, L., Ricci, C., Ceruso, C. P., Lanteri, S., Serdoz, R., Bruno, E., De Matteis, C., Campagnuolo, C., Ammirati, M. A., Corrado, V. M., Amado Eleas, M. A., Fattore, L., Ippoliti, C., Turiano, G., Piergentili, C., Chiarella, F., Capogrosso, P., Perotti, M., Di Marco, S., Sibilio, G., Di Lorenzo, L., Aurelio, A., Ramondo, A. B., Zanna, D., Cernetti, C., Napolitano, G., Negroni, S., Alessandri, N., Rigo, F., Giusti, F., Casu, G., Vicentini, A., Calculli, G., Fera, M. S., Lettica, G. V., Vagheggini, G., Piti, A., Porfidia, A., Di Leo, A., Ravera, A., Ciotta, E., Sacca, S., Silvestri, O., Isidori, S., Natali, P., Anselmi, M., Testa, L., Antonelli, A., Tavasci, E., Furgi, G., Lavorgna, A., Gasparetto, N., Bisceglia, T., Raziliop, A., and Raino, R.

Subjects
Male, Multivariate analysis, Time Factors, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, 0302 clinical medicine, Cardiologists, post‐MI, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, intervention, risk, Dual Anti-Platelet Therapy, focused update, ticagrelor keywords plus:coronary-artery-disease, Atrial fibrillation, General Medicine, clopidogrel, dual antiplatelet therapy, percutaneous coronary intervention, post-mi, secondary prevention, dapt score, duration, management, Middle Aged, Clopidogrel, Treatment Outcome, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, Human, medicine.drug, medicine.medical_specialty, animal structures, Time Factor, Clinical Investigations, Cardiologist, Drug Administration Schedule, Follow-Up Studie, ticagrelor, 03 medical and health sciences, Internal medicine, medicine, Humans, cardiovascular diseases, Aged, Aspirin, post-MI, Follow-Up Studies, Platelet Aggregation Inhibitors, Patient Selection, business.industry, Platelet Aggregation Inhibitor, Percutaneous coronary intervention, medicine.disease, Prospective Studie, Conventional PCI, Observational study, business
Abstract

Background Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI.

Published
2019

2. Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: insights from the EYESHOT study

Author

De Luca, Leonardo, Leonardi, Sergio, Smecca, Ignazio Maria, Formigli, Dario, Lucci, Donata, Gonzini, Lucio, Tuccillo, Bernardino, Olivari, Zoran, Gulizia, Michele Massimo, Bovenzi, Francesco Maria, De Servi, Stefano, Caporale, R., Cavallini, C., Ceravolo, R., Lupi, A., Musumeci, G., Rakar, S., Maggioni, A. P., Lorimer, A., Orsini, G., Fabbri, Giorgio, Bianchini, E., Abrignani, M. G., Bonura, F., Trimarco, B., Galasso, Giorgia, Misuraca, G., Manes, M. T., Irace, Lorenzo, Totis, O., Ledda, A., Mauro, C., Boccalatte, M., Iliceto, S., Cacciavillani, L., Savonitto, S., Tortorella, G., Esposito, L., DE ROSA, Paolo, Calabrò, P., Bianchi, R., Napoletano, C., Lalla Piccioni, L., Pavesi, P. C., Boni, Allegra, Merenda, R., Wolff, S., De Ferrari, G. M., Camporotondo, R., Gambino, Paolo, Cutaia, A., Picariello, C., Cemin, R., Chiarella, F., Grazioli Gauthier, L., Mircoli, L., Del Pinto, M., Finocchiaro, M. L., Scioli, R., Farina, R., Naddeo, C., Scherillo, M., Santopietro, S., Metra, M., Costa, F., Calculli, G., Troito, G., Pennisi, V., Adornato, E. M. F., Pirelli, S., Fadin, B. M., Di Biase, M., Ieva, R., Zuin, G., Sanfilippo, N., Mancuso, LAURA CATERINA, Pani, Luisa Anna, Serra, Eleonora, Marenzi, G., Assanelli, E. M., Ansalone, G., Cacciotti, L., Morocutti, G., Fresco, C., Berti, S., Paradossi, U., Bozzano, A., Mauro, A., Noussan, P., Zanini, P., Bolognese, L., Falsini, G., Costa, P., Manca, G., Caldarola, P., Locuratolo, N., Cipolla, T., Becchina, M., Cocco, Gabriele, Scalera, G., Stefanelli, S., Giunta, N., Sinagra, G., Meloni, L., Lai, O., Chiaranda, G., Luca, G., Sleiman Helou, J., Biscottini, E., Magliari, F., Callerame, M., Uguccioni, M., Pugliese, M., Sanchez, F., Tartaglione, S., Ignone, G., Mavilio, G., Mantovan, R., Bini, R., Caico, S. I., Demolli, V., Proietti, F., Michisanti, M., Musmeci, G., Cantamessa, P., Sicuso, G., Micalef, S. S., Accogli, M., Zaccaria, MICHELA MARIA, Caputo, M., Di Paolo, G., Piatti, L., Farina, A., Vicinelli, P., Paloscia, L., Di Clemente, D., Felis, S., Castini, D., Rota, C., Casu, Gabriella, Bonano, S., Margheri, M., Ricci Lucchi, G., Serdoz, R., Proietti, P., Autore, C., Conti, E., Russo, V., Orlando, P., Ramondo, A. B., Bontorin, M., Marcolongo, M., Marrara, F., Maestroni, A., Vitti, P., Rodella, P., Bonetti, P., Elia, M., Lumare, R., Politi, A., Gritti, S., Poletti, F., Mafrici, A., Fusco, R., Bongo, A. S., Bacchini, S., Gasparetto, V., Ferraiuolo, G., Campana, C., Bonatti, R., Gaita, F., Bergerone, S., Bonmassari, R., Zeni, P., Langialonga, T., Scarcia, A., Caravita, L., Musacchio, E., Augello, G., Usmiani, T., Stomaci, B., Cirino, D., Pierini, S., Bottiglieri, G., Liso, A., Mussardo, M., Tosi, P., Sala, R., Belloni, A., Blengino, S., Lisi, E., Delfino, P., Auguadro, C., Brunazzi, M. C., Pacchioni, E., Fattore, L., Bosco, B., Blandizzi, S., Pajes, G., Patruno, N., Perna, G. P., Francioni, M., Favale, S., Vestito, D., Lombardi, A., Capecchi, A., Ferrero, P., De Vincenzo, C., Magri, G., Indolfi, C., De Rosa, S., Rossi, M., Collarini, L., Agnelli, D., Conti, G., Tonelli, C., Spadaro, C., Negroni, S., Di Noto, G., Lanari, A., Casolo, G., Del Meglio, J., Negrini, M., Celentano, A., Sifola, C., Rellini, G., Della Mattia, A., Molero, U., Piovaccari, G., Grosseto, D., Callegarin, L., Fiasconaro, G., Crivello, R., Thiebat, B., Leone, G., Tamburino, C., Caruso, G., Cassadonte, F., Sassone, B., Fuca, G., Sormani, L., Percoco, G. F., Mazzucco, R., Cazzani, E., Gianni, M., Limido, A., Luvini, M., Guglielmi, R., Mannarini, A., Moruzzi, P., Pastori, P., Golia, B., Marzano, A., Orazi, S., Marchese, I., Anselmi, M., Girardi, P., Nassiacos, D., Meloni, S., Busacca, P., Generali, C. A., Corda, S., Costanza, G., Montalto, S., Argenziano, L., Tommasini, P., Emdin, M., Pasanisi, E. M., Colivicchi, F., Tubaro, M., Azzolini, P., Luciani, C., Doronzo, B., Coppolino, A., Dellavesa, P., Zenone, F., Di Marco, A., De Conti, F., Piccinni, G. C., Gualtieri, M. R., Bisignani, G., Leone, A., Arcuri, G. M., Marinacci, L., Rossi, P., Perotti, S., Cotti Cometti, V., Arcidiacono, S., Tramontana, M., Bazzucchi, M., Mezzetti, P., Romano, M., Villani, R., Di Giovambattista, R., Volpe, B., Tedesco, L., Carini, M., Vinci, S., Paolini, E. A., Busoni, F., Piergentili, C., Navazio, A., Manca, F., Cocco, F., Pennetta, C. A., Maggiolini, S., Galbiati, R., Bruna, C., Ferrero, L., Brigido, S., Barducci, E., Musacchio, D., Manduca, B., Marchese, D., Patrassi, L. A., Pattarino, F. A., Rocchi, M., Briglia, S., Fanelli, R., Villella, M., Gronda, E., Massa, D., Lenti, V., Di Gregorio, L., Bottero, M., Bazzanini, F., Braggion, G., Antoniceli, R., Caraceni, D., Guzzo, V., Di Giovanni, P., Scarpini, S., Severgnini, B., Musolino, M. F., Della Casa, S., Gobbi, M., Arena, G., Bonizzato, S., Agnoletto, V., Sansoni, S., Pes, R. A. M., Denti, S., Polizzi, G. M., Pino, R., Commisso, B., Merlino, A., Di Lorenzo, L., Porchetta, I., Del Furia, F., Colombi, E., Covini, D., Cavalieri, F., Antonaci, S., Rubino, G., Ciulla, A., Bui, F., Casorelli, E., Caliendo, L., Laezza, A., Americo, L., Schillaci, A. M., Cordoni, M., Barsotti, L., Gaudio, C., Barilla, F., Cannone, M., Memeo, R., Truncellito, L., Andriani, A., Salituri, S., Verrina, F., Pafi, M., Sebastiani, M. L., Amico, A. F., Scolozzi, D., D'Alea, A., Catanzariti, D., Angheben, C., Ottaviano, A., and Levantesi, G.

Subjects
Male, Ticagrelor, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Conservative strategy, Population, Acute coronary syndromes, Revascularization, acute coronary syndromes, anticoagulant, antithrombotic therapy, conservative strategy, prasugrel, ticagrelor, aged, coronary care units, female, fibrinolytic agents, follow-up studies, hospital mortality, humans, iItaly, length of stay, male, myocardial revascularization, retrospective studies, survival rate, thrombolytic therapy, practice guidelines as topic, Fibrinolytic Agents, Anticoagulant, Antithrombotic therapy, Prasugrel, Acute Coronary Syndrome, Aged, Coronary Care Units, Female, Follow-Up Studies, Hospital Mortality, Humans, Italy, Length of Stay, Myocardial Revascularization, Retrospective Studies, Survival Rate, Thrombolytic Therapy, Practice Guidelines as Topic, Cardiology and Cardiovascular Medicine, Pharmacology (medical), Internal medicine, Antithrombotic, medicine, education, Survival rate, education.field_of_study, business.industry, Clopidogrel, medicine.disease, Cardiology, business, Fibrinolytic agent, medicine.drug
Abstract

Aims Patients with acute coronary syndromes (ACSs) who are managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. Methods and results We assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients with ACS enrolled in the prospective, multicentre, nationwide EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) registry. Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P < 0.0001 and 50 vs. 33, P < 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively). Conclusion Almost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did. Clinical Trial Registration Unique identifier: [NCT02015624][1], . [10.1093/ehjcvp/pvv017][2] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02015624&atom=%2Fehjcardpharm%2F1%2F3%2F168.atom [2]: /lookup/doi/10.1093/ehjcvp/pvv017

Published
2015
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3. Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units Registry

Author

De Luca, L., Musumeci, G., Leonardi, S., Gonzini, L., Cavallini, C., Calabro, P., Mauro, C., Cacciavillani, L., Savonitto, S., De Servi, S., Caporale, R., Ceravolo, R., Formigli, D., Lupi, A., Rakar, S., Smecca, I. M., Maggioni, A. P., Lucci, D., Lorimer, A., Orsini, G., Fabbri, G., Bianchini, E., Abrignani, M. G., Bonura, F., Trimarco, B., Galasso, G., Misuraca, G., Manes, M. T., Tuccillo, B., Irace, L., Olivari, Z., Totis, O., Ledda, A., Boccalatte, M., Iliceto, S., Tortorella, G., Esposito, L., De Rosa, P., Bianchi, R., Napoletano, C., Piccioni, L. L., Pavesi, P. C., Bovenzi, F. M., Boni, A., Merenda, R., Wolff, S., De Ferrari, G. M., Camporotondo, R., Gambino, P., Cutaia, A., Picariello, C., Cemin, R., Chiarella, F., Gauthier, L. G., Mircoli, L., Del Pinto, M., Finocchiaro, M. L., Scioli, R., Farina, R., Naddeo, C., Scherillo, M., Santopietro, S., Metra, M., Costa, F., Calculli, G., Troito, G., Pennisi, V., Adornato, E. M. F., Pirelli, S., Fadin, B. M., DI Biase, M., Ieva, R., Zuin, G., Sanfilippo, N., Mancuso, L., Pani, A., Serra, E., Marenzi, G., Assanelli, E. M., Ansalone, G., Cacciotti, L., Morocutti, G., Fresco, C., Berti, S., Paradossi, U., Bozzano, A., Mauro, A., Noussan, P., Zanini, P., Bolognese, L., Falsini, G., Costa, P., Manca, G., Caldarola, P., Locuratolo, N., Cipolla, T., Becchina, M., Cocco, G., Scalera, G., Stefanelli, S., Giunta, N., Sinagra, G., Meloni, L., Lai, O., Chiaranda, G., Luca, G., Helou, J. S., Biscottini, E., Magliari, F., Callerame, M., Uguccioni, M., Pugliese, M., Sanchez, F., Tartaglione, S., Ignone, G., Mavilio, G., Mantovan, R., Bini, R., Caico, S. I., Demolli, V., Proietti, F., Michisanti, M., Musmeci, G., Cantamessa, P., Sicuso, G., Micalef, S. S., Accogli, M., Zaccaria, M., Caputo, M., DI Paolo, G., Piatti, L., Farina, A., Vicinelli, P., Paloscia, L., DI Clemente, D., Felis, S., Castini, D., Rota, C., Casu, G., Bonano, S., Margheri, M., Lucchi, G. R., Serdoz, R., Proietti, P., Autore, C., Conti, E., Russo, V., Orlando, P., Ramondo, A. B., Bontorin, M., Marcolongo, M., Santagostino, M., Maestroni, A., Vitti, P., Rodella, P., Bonetti, P., Elia, M., Lumare, R., Politi, A., Gritti, S., Poletti, F., Mafrici, A., Fusco, R., Bongo, A. S., Bacchini, S., Gasparetto, V., Ferraiuolo, G., De Luca, M., Campana, C., Bonatti, R., Gaita, F., Bergerone, S., Bonmassari, R., Zeni, P., Langialonga, T., Scarcia, A., Caravita, L., Musacchio, E., Augello, G., Usmiani, T., Stomaci, B., Cirino, D., Pierini, S., Bottiglieri, G., Liso, A., Mussardo, M., Tosi, P., Sala, R., Belloni, A., Blengino, S., Lisi, E., Delfino, P., Auguadro, C., Brunazzi, M. C., Pacchioni, E., Fattore, L., Bosco, B., Blandizzi, S., Pajes, G., Patruno, N., Perna, G. P., Francioni, M., Favale, S., Vestito, D., Lombardi, A., Capecchi, A., Ferrero, P., De Vincenzo, C., Magri, G., Indolfi, C., De Rosa, S., Rossi, M., Collarini, L., Agnelli, D., Conti, G., Tonelli, C., Spadaro, C., Negroni, S., DI Noto, G., Lanari, A., Casolo, G., Del Meglio, J., Negrini, M., Celentano, A., Sifola, C., Rellini, G., Mattia, A. D., Molero, U., Piovaccari, G., Grosseto, D., Callegarin, L., Fiasconaro, G., Crivello, R., Thiebat, B., Leone, G., Tamburino, C., Caruso, G., Cassadonte, F., Sassone, B., Fuca, G., Sormani, L., Percoco, G. F., Mazzucco, R., Cazzani, E., Gianni, M., Limido, A., Luvini, M., Guglielmi, R., Mannarini, A., Moruzzi, P., Pastori, P., Golia, B., Marzano, A., Orazi, S., Marchese, I., Anselmi, M., Girardi, P., Nassiacos, D., Meloni, S., Busacca, P., Generali, C. A., Corda, S., Costanza, G., Montalto, S., Argenziano, L., Tommasini, P., Emdin, M., Pasanisi, E. M., Colivicchi, F., Tubaro, M., Azzolini, P., Luciani, C., Doronzo, B., Coppolino, A., Dellavesa, P., Zenone, F., DI Marco, A., De Conti, F., Piccinni, G. C., Gualtieri, M. R., Bisignani, G., Leone, A., Arcuri, G. M., Marinacci, L., Rossi, P., Perotti, S., Cometti, V. C., Arcidiacono, S., Tramontana, M., Bazzucchi, M., Mezzetti, P., Romano, M., Villani, R., DI Giovambattista, R., Volpe, B., Tedesco, L., Carini, M., Vinci, S., Paolini, E. A., Busoni, F., Piergentili, C., Navazio, A., Manca, F., Cocco, F., Pennetta, C. A., Maggiolini, S., Galbiati, R., Bruna, C., Ferrero, L., Brigido, S., Barducci, E., Musacchio, D., Manduca, B., Marchese, D., Patrassi, L. A., Pattarino, F. A., Rocchi, M., Briglia, S., Fanelli, R., Villella, M., Gronda, E., Massa, D., Lenti, V., DI Gregorio, L., Bottero, M., Bazzanini, F., Braggion, G., Antoniceli, R., Caraceni, D., Guzzo, V., DI Giovanni, P., Scarpini, S., Severgnini, B., Musolino, M. F., Casa, S. D., Gobbi, M., Arena, G., Bonizzato, S., Agnoletto, V., Sansoni, S., Pes, R. A. M., Denti, S., Polizzi, G. M., Pino, R., Commisso, B., Merlino, A., DI Lorenzo, L., Porchetta, I., Del Furia, F., Colombi, E., Covini, D., Cavalieri, F., Antonaci, S., Rubino, G., Ciulla, A., Bui, F., Casorelli, E., Caliendo, L., Laezza, A., Americo, L., Schillaci, A. M., Cordoni, M., Barsotti, L., Gaudio, C., Barilla, F., Cannone, M., Memeo, R., Truncellito, L., Andriani, A., Salituri, S., Verrina, F., Pafi, M., Sebastiani, M. L., Amico, A. F., Scolozzi, D., Lupi, G., D'Alea, A., Catanzariti, D., Angheben, C., Ottaviano, A., Levantesi, G., de Luca, Leonardo, Musumeci, Giuseppe, Leonardi, Sergio, Gonzini, Lucio, Cavallini, Claudio, Calabrò, Paolo, Mauro, Ciro, Cacciavillani, Luisa, Savonitto, Stefano, de Servi, Stefano, Caporale, Roberto, Ceravolo, Roberto, Formigli, Dario, Lupi, Alessandro, Rakar, Sadir, Smecca, Ivan, Maggioni, Aldo Pietro, Lucci, Donata, Lorimer, Andrea, Orsini, Giampietro, Fabbri, Gianna, Bianchini, Elisa, Abrignani, Maurizio Giuseppe, Bonura, Francesc, Trimarco, Bruno, Galasso, Gennaro, Misuraca, Gianfranco, Manes, Maria Teresa, Tuccillo, Bernardino, and Irace, Luigi.

Subjects
Male, Prasugrel, medicine.medical_treatment, Myocardial Infarction, antithrombotic therapy, 030204 cardiovascular system & hematology, acute coronary syndromes, bivalirudin, heparins, percutaneous coronary intervention, prasugrel, ticagrelor, 0302 clinical medicine, Antithrombotic, 80 and over, Bivalirudin, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, Registries, Aged, 80 and over, General Medicine, Hirudins, Middle Aged, Recombinant Proteins, Italy, Female, Cardiology and Cardiovascular Medicine, Ticagrelor, medicine.drug, medicine.medical_specialty, Platelet Glycoprotein GPIIb-IIIa Complex, NO, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, medicine, Humans, Acute Coronary Syndrome, Aged, Aspirin, business.industry, Heparin, Percutaneous coronary intervention, Anticoagulants, medicine.disease, Peptide Fragments, Clinical trial, Cross-Sectional Studies, Logistic Models, Conventional PCI, Multivariate Analysis, business
Abstract

Aims In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02015624.

Published
2017

7. [The noninvasive identification of patients with angina and normal coronary arteries]

Author

Rusticali G, Di Clemente D, Augusto Ruggeri, Borghi A, and Bugiardini R

Subjects
Adult, Male, Electrocardiography, Verapamil, Exercise Test, Humans, Female, Single-Blind Method, Isosorbide Dinitrate, Middle Aged, Coronary Angiography, Angina Pectoris, Microvascular Angina
Abstract

Although patients with syndrome X (angina and normal coronary arteries, in absence of coronary spasm, cardiomyopathy or valvulopathy) and those with stable angina as well as documented coronary artery disease share a similar clinical presentation (effort related symptoms, positive exercise stress testing and reversible perfusion defects), their prognosis is markedly different. Coronary atherosclerosis is usually progressive relative to morbidity and mortality. Conversely prognosis both in terms of persistence of pain and mortality appears to be benign in syndrome X. Most cardiologists favor proceeding with coronary angiography in all patients presenting with exercise induced ST depression and reversible perfusion defects. However, it should not be assumed that this strategy will remain the preferred one. The aim of this study was to assess whether non invasive testing could identify underlying coronary artery anatomy, thus prognosis in the above subset of patients. The approach was selected on a clearly stated objective of how isosorbide dinitrate and verapamil may influence coronary flow reserve, thus exercise stress testing in syndrome X. Nitrates have been shown to reduce coronary flow reserve during stress tachycardia. The opposite occurs with calcium blockers.We studied 48 patients with effort angina referred to our laboratory for diagnostic evaluation. All patients underwent two separate sessions at one-day interval. Each session consisted of exercise stress testing before and after isosorbide dinitrate (s.l.; 5-10 mg) or verapamil (i.v.; 10 mg), given in a randomized crossover fashion. Angiography was performed within 3 months from testing. Efficacy of drugs in terms of exercise capacity was assessed by using the following criteria: 1) prevention of significant (or = 0.1 mV) ST depression while reaching same workload levels attained during baseline testing; 2) improvement in the ischemic thresholds, that is an increase in: time to 0.1 mV ST depressionor = 120 sec., with heart rate (or = 10 bpm) and rate pressure product (or = 2 U x 1000) greater than those attained during baseline testing; 3) increase in time to peak exercise (or = 120 sec).In syndrome X, both drugs resulted ineffective in one patient, one patient showed a favourable response to isosorbide dinitrate whereas the remaining 13/15 patients improved exercise capacity following verapamil, but not isosorbide dinitrate. The opposite occurred in coronary artery disease patients: both isosorbide dinitrate and verapamil were effective in 21/33 patients, and ineffective in 8/33 patients. The remaining 4 patients responded to isosorbide dinitrate but not to verapamil.1) Verapamil, but not isosorbide dinitrate, improves exercise capacity in syndrome X; 2) this does not apply to patients with stable angina; 3) a favourable response to verapamil but not to isosorbide dinitrate is both a sensitive (86%) and specific (100%) method for identifying patients with angina and normal coronary arteries; 4) non invasive testing may select those effort angina patients who have to proceed directly to coronary angiography; 5) some patients with effort related angina may not require further investigation.

Published
1995

8. [Myocardial infarct with normal coronary vessels: an association with dysfunction of the coronary microcirculation]

Author

Di Clemente D, Borghi A, Gl, Morgagni, Gm, Costa, Rusticali G, and Raffaele Bugiardini

Subjects
Adult, Male, Cardiac Catheterization, Chi-Square Distribution, Microcirculation, Cardiac Pacing, Artificial, Hemodynamics, Myocardial Infarction, Middle Aged, Coronary Vessels, Coronary Circulation, Cricetinae, Animals, Humans, Female, Aged
Abstract

The association of acute myocardial infarction (AMI) with normal coronary arteries was analyzed prospectively. A series of 128 consecutive patients underwent coronary angiography within 1 week from AMI. Seven patients, all females, had no coronary artery lesions and were considered eligible for the study. All 7 patients underwent atrial pacing (10 g/min increments every 2 min), ergonovine testing (E; total dose 0.650 mg i.v.). Great cardiac vein flow (GCVF; thermodilution technique), mean aortic pressure (MAP), anterior coronary resistance (ACR) and myocardial lactate extraction [(Lac art-Lac gcv)/Lac art] were measured at baseline and during testing. Pacing-induced typical chest pain occurred in 5 patients: 4 of them showed concurrent significant (or = 0.15 mV) ST downsloping. At peak pacing, GCVF increased only by50%, or even decreased, in all patients. Baseline lactate extraction (0.13 +/- 0.11) changed to lactate production (-0.15 +/- 0.10) in 7/7 patients. None of the patients showed focal epicardial coronary artery spasm following E. During testing, however, all 7 patients showed decrease in GCVF (110 +/- 47 versus 74 +/- 21; p0.005), increase in ACR (0.92 +/- 0.29 versus 1.43 +/- 0.20; p0.001), and significant coronary lactate production (-0.18 +/- 0.12). Six patients referred slight to moderate chest pain, which was accompanied by ST downsloping in 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1994

11. [An analysis of the variability of the heart rate and its significance in the risk stratification of patients with unstable angina]

Author

Ml, Loricchio, Di Clemente D, Saccone V, Caccamo L, Borghi A, and Raffaele Bugiardini

Subjects
Male, Chi-Square Distribution, Middle Aged, Coronary Angiography, Prognosis, Logistic Models, Italy, Heart Rate, Risk Factors, Electrocardiography, Ambulatory, Humans, Female, Angina, Unstable, Aged, Follow-Up Studies
Abstract

Decreased heart rate variability (HRV) correlates with increased sympathetic or decreased vagal tone. This could contribute to increase local coronary hyperreactivity caused by atherosclerotic plaque disruption, thus facilitating progression from unstable angina to acute myocardial infarction (AMI). To test this hypothesis we studied 92 patients admitted to the coronary care unit for episodes of chest pain at rest associated with transient ST shifts (0.15 mV). Patients who developed AMI in the first 24 hours, as well as those with previous AMI, concomitant valvular or myocardial diseases or diabetes mellitus were not enrolled in the study. Thirty age-matched subjects without any evidence of coronary artery disease were chosen as controls. All patients underwent a 2 to 5 day continuous Holter monitoring during full medical treatment (including beta-blockers, heparin and aspirin). Angiography was performed within 1 week in 88 of the 92 patients. During follow-up (mean duration of 16 +/- 5 days), 26 patients (Group I) had a major coronary event (6 deaths, 7 non fatal AMI, 13 urgent revascularizations). The remaining 66 patients (Group II) had a good clinical outcome. ECG recordings during ST shifts were excluded from Holter monitoring analysis. Time domain measurements of HRV predicted mortality and total events. The most powerful predictors was the standard deviation of the means of the 5 min R-R intervals (SDANN index) which was significantly (p0.001) lower in Group I than Group II (55 +/- 18 versus 87 +/- 29).(ABSTRACT TRUNCATED AT 250 WORDS)

18. Early invasive versus early conservative strategy in non-ST-elevation acute coronary syndrome: An outcome research study.

Author

Tubaro M, Sciahbasi A, Ricci R, Ciavolella M, Di Clemente D, Bisconti C, Ferraiuolo G, Del Pinto M, Mennuni M, Monti F, Vinci E, Semeraro R, Greco C, Berti S, Romano C, Aiello A, Lo Bianco F, Pellecchia R, Azzolini P, Ciuffetta D, Zappulo R, Gigantino A, Arima S, Colivicchi F, and Santini M

Subjects
Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome physiopathology, Aged, Female, Humans, Male, Acute Coronary Syndrome therapy, Conservative Treatment standards, Electrocardiography, Intention to Treat Analysis methods, Myocardial Revascularization standards, Practice Guidelines as Topic, Time-to-Treatment
Abstract

Background: An early invasive strategy (EIS) has been shown to yield a better clinical outcome than an early conservative strategy (ECS) in patients with non-ST-elevation acute coronary syndromes (NSTEACSs), particularly in those at higher risk according to the GRACE risk score. However, findings of the clinical trials have not been confirmed in registries., Objective: To investigate the outcome of patients with NSTEACS treated according to an EIS or a ECS in a real-world all-comers outcome research study., Methods: The primary hypothesis of the study was the non-inferiority of an ECS in comparison with an EIS as to a combined primary end-point of death, non-fatal myocardial infarction and hospital readmission for acute coronary syndromes at one year. Participating centres were divided into two groups: those with a pre-specified routine EIS and those with a pre-specified routine ECS. Two statistical analyses were performed: a) an 'intention to treat' analysis: all patients were considered to be treated according to the pre-specified routine strategy of that centre; b) a 'per protocol' analysis: patients were analysed according to the actual treatment applied. Cox model including propensity score correction was applied for all analyses., Results: The intention to treat analysis showed an equivalence between EIS and ECS (11.4% vs. 11.1%) with regard to the primary end-point incidence at one year. In the three subgroups of patients according to the GRACE risk score (⩽ 108, 109-140, > 140), EIS and ECS confirmed their equivalence (5.3% vs. 3.9%, 8.4% vs. 7.6%, and 20.3% vs. 20.9%, respectively). When the per protocol analysis was applied, a reduction of the primary end-point at one year with EIS vs. ECS was demonstrated (6.2% vs. 15.3%, p=0.021); analysis of the subgroups according to the GRACE risk score numerically confirmed these data (3.1% vs. 6.5%, 5.1% vs. 10.0%, and 10.8% vs. 24.5%, respectively)., Conclusions: In a real-life registry of all-comers NSTEACS patients, ECS was non-inferior to EIS; however, when EIS was applied according to clinical judgement, a reduction of clinical events at one year was demonstrated.

Published
2017
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19. Spondin-2, a secreted extracellular matrix protein, is a novel diagnostic biomarker for prostate cancer.

Author

Lucarelli G, Rutigliano M, Bettocchi C, Palazzo S, Vavallo A, Galleggiante V, Trabucco S, Di Clemente D, Selvaggi FP, Battaglia M, and Ditonno P

Subjects
Aged, Aged, 80 and over, Biomarkers blood, Case-Control Studies, Humans, Male, Middle Aged, Prospective Studies, Prostate-Specific Antigen blood, Sarcosine blood, Extracellular Matrix Proteins blood, Neoplasm Proteins blood, Prostatic Neoplasms blood, Prostatic Neoplasms diagnosis
Abstract

Purpose: SPON2 belongs to the F-spondin family of secreted extracellular matrix proteins. It is deregulated in some tumors, including prostate cancer. In this prospective study we assessed the role of serum SPON2 as a biomarker for prostate cancer diagnosis as well as any association between SPON2 levels and clinicopathological features. We also compared the diagnostic performance of this biomarker to that of serum sarcosine, and percent free-to-total and total prostate specific antigen., Materials and Methods: SPON2 was measured using a sandwich enzyme linked immunosorbent assay in serum samples from 286 patients with prostate cancer and 68 with no evidence of malignancy, as confirmed by 10 to 12-core ultrasound guided prostate biopsy. Nonparametric statistical tests and ROC analysis were done to assess the diagnostic performance of SPON2 vs the other biomarkers., Results: Median serum SPON2 was significantly higher in patients with prostate cancer than in those with no evidence of malignancy (77.5 vs 23.6 ng/ml, p<0.0001). ROC analysis showed a higher predictive value of SPON2 (AUC 0.952) than of serum sarcosine (AUC 0.674), percent free-to-total prostate specific antigen (AUC 0.806) and total prostate specific antigen (AUC 0.561). Moreover, patients with low grade prostate cancer had higher median SPON2 levels (p=0.001). Spearman rank correlation confirmed a negative association with Gleason score (rs=-0.29, p=0.0005)., Conclusions: We found evidence that SPON2 levels were significantly higher in patients with prostate cancer than in healthy individuals. Moreover, this biomarker had better diagnostic performance than serum sarcosine, and percent free-to-total and total prostate specific antigen. This greater accuracy was also present in a subset of patients with normal prostate specific antigen., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Published
2013
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20. Phosphorylcholine impairs susceptibility to biofilm formation of hydrogel contact lenses.

Author

Selan L, Palma S, Scoarughi GL, Papa R, Veeh R, Di Clemente D, and Artini M

Subjects
Anti-Bacterial Agents pharmacology, Bacterial Adhesion drug effects, Gentamicins pharmacology, Imipenem pharmacology, Microbial Sensitivity Tests, Microscopy, Confocal, Penicillanic Acid analogs & derivatives, Penicillanic Acid pharmacology, Piperacillin pharmacology, Piperacillin, Tazobactam Drug Combination, Polyhydroxyethyl Methacrylate, Pseudomonas aeruginosa drug effects, Silicon, Staphylococcus epidermidis drug effects, Biofilms drug effects, Coated Materials, Biocompatible, Contact Lenses, Hydrophilic microbiology, Hydrogel, Polyethylene Glycol Dimethacrylate, Phosphorylcholine pharmacology, Pseudomonas aeruginosa physiology, Staphylococcus epidermidis physiology
Abstract

Purpose: To compare silicone-hydrogel, poly(2-hydroxyethyl methacrylate) (pHEMA), and phosphorylcholine-coated (PC-C) contact lenses in terms of their susceptibility to biofilm formation by Staphylococcus epidermidis and Pseudomonas aeruginosa., Design: Laboratory investigation., Methods: Biofilm formation on colonized test lenses was evaluated with confocal microscopy and in vitro antibiotic susceptibility assays. The results of the latter assays were compared with those performed on planktonic cultures of the same organism., Results: For both microorganisms, sessile colonies on silicone-hydrogel and pHEMA lenses displayed lower antibiotic susceptibility than their planktonic counterparts. In contrast, the susceptibility of cultures growing on PC-C lenses was comparable with that for planktonic cultures. In particular, minimum inhibitory concentration for Tazocin (piperacillin plus tazobactam; Wyeth Pharmaceuticals, Aprilia, Italy; S. epidermidis) and gentamicin (P. aeruginosa) was identical, either in the presence of PC-C support or in planktonic cultures (Tazocin,

Published
2009
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21. [Single coronary artery with a right origin: angiography identification of the R-II subgroup].

Author

Bucci M, Zimarino M, Di Clemente D, Scarpignato M, Cappelletti L, and Barsotti A

Subjects
Aged, Coronary Angiography, Coronary Vessel Anomalies pathology, Humans, Male, Coronary Vessel Anomalies diagnostic imaging
Abstract

This case report illustrates the clinical and angiographic findings of 2 patients undergoing coronary angiography for ischemic heart disease and with the unexpected presence of anomalous origin of the left coronary artery from the right aortic sinus. The angiographic classification of the different subgroups of single coronary artery is reviewed and the 2 cases are identified as type R-II with septal and anterior course of the left main stem.

Published
1999

22. [An analysis of the variability of the heart rate and its significance in the risk stratification of patients with unstable angina].

Author

Loricchio ML, Di Clemente D, Saccone V, Caccamo L, Borghi A, and Bugiardini R

Subjects
Aged, Angina, Unstable diagnosis, Angina, Unstable epidemiology, Chi-Square Distribution, Coronary Angiography statistics & numerical data, Electrocardiography, Ambulatory statistics & numerical data, Female, Follow-Up Studies, Humans, Italy epidemiology, Logistic Models, Male, Middle Aged, Prognosis, Risk Factors, Angina, Unstable physiopathology, Heart Rate
Abstract

Decreased heart rate variability (HRV) correlates with increased sympathetic or decreased vagal tone. This could contribute to increase local coronary hyperreactivity caused by atherosclerotic plaque disruption, thus facilitating progression from unstable angina to acute myocardial infarction (AMI). To test this hypothesis we studied 92 patients admitted to the coronary care unit for episodes of chest pain at rest associated with transient ST shifts (> 0.15 mV). Patients who developed AMI in the first 24 hours, as well as those with previous AMI, concomitant valvular or myocardial diseases or diabetes mellitus were not enrolled in the study. Thirty age-matched subjects without any evidence of coronary artery disease were chosen as controls. All patients underwent a 2 to 5 day continuous Holter monitoring during full medical treatment (including beta-blockers, heparin and aspirin). Angiography was performed within 1 week in 88 of the 92 patients. During follow-up (mean duration of 16 +/- 5 days), 26 patients (Group I) had a major coronary event (6 deaths, 7 non fatal AMI, 13 urgent revascularizations). The remaining 66 patients (Group II) had a good clinical outcome. ECG recordings during ST shifts were excluded from Holter monitoring analysis. Time domain measurements of HRV predicted mortality and total events. The most powerful predictors was the standard deviation of the means of the 5 min R-R intervals (SDANN index) which was significantly (p < 0.001) lower in Group I than Group II (55 +/- 18 versus 87 +/- 29).(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1994

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