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9 results on '"Gambarati, G"'

1. Precipitating factors and decision-making processes of short-term worsening heart failure despite 'optimal' treatment (from the IN-CHF Registry)

Author

Opasich, C., Rapezzi, C., Lucci, D., Gorini, M., Pozzar, F., Zanelli, E., Tavazzi, L., Mezzani, Maggioni A. P. AND THE IN CHF Investigators: A., Bielli, M., Milanese, U., Ugliengo, G., Pozzi, R., Rabajoli, F., Bosimini, E., Valsecchi, M. G., Dadda, F., Faggiano, P., Castiglioni, G., Gibelli, G., Turelli, A. L., Belluschi, R., Bianchi, C., Emanuelli, C., Gramenzi, S., Foti, G., Agnelli, D., Volterrani, M., Moroni, E., Gara, E., Turiel, A., Recalcati, F., Valenti, D., Rusconi, F., Palvarini, M., Giusti, A., Inserra, C., Nassiacos, D., Meloni, S., Nicoli, T., Bandini, P., Moizi, M., Pedretti, R., Paolucci, M., Amati, L., Ravetta, M., Morandi, F., Provasoli, S., Planca, E., Quorso, P., Ferro, A., Pedrolli, C., Riggi, L., Tarantini, L., Candelpergher, G., Berton, G., Stefanini, M. G., Cacciavillani, L., Boffa, G. M., Mario, L., Renosto, G., Stritoni, P., Perini, G., Bonadiman, C., Varotto, L., Penzo, M., Giuliano, G., Marini, R., Barducci), E., Humar, F., Albanese, M. C., Fresco, C., Camerini, A., Griffo, R., Derchi, G., Vengo, P., Fazzini, L., Pizzorno, L., Bertoli, D., Morgagni, G., Bruno, G., Iori, E., Melandri, F., Cionini, F., Reggianini, L., Passerini, F., Del Corso, P., Rusconi, L., Marzaloni, M., Mezzetti, M., Gambarati, G. P., Mariani, P. R., Volterrani, C., Venturi, F., Zambaldi, G., Geri Brandinelli, A., Taddei, T., Dalle Luche, A., Arcuri, G., Giannini, R., Gasperini, U., Alunni, G., Bosi, E., Cocchieri, M., Severini, D., Maragoni, G., C. Ferroni, G. Saccomanno, Pasetti, L., Budini, A., Manfrin, M., Coderoni, B., Mori, A., Midi, P., D. Del Sindaco, F. Leggio, Terranova, A., Pulignano, G., Cacciatore, G., Menichelli, M., Ansalone, G., Magris, B., Scaffidi, G., Valtorta, C., Salustri, A., Amaddeo, F., Barbato, G., Aspromonte, N., Renzi, M., Mantini, L., Frattaroli, C., Mariani, A., Di Marco, G., Levantesi, G., Colonna, N., Montano, A., Di Maggio, O., Toscano, G., Capuano, V., Scherillo, M., Sensale, P., Rullo, V., Maurea, N., Miceli, D., Somelli, A., Napolitano, F., Provvisiero, P., Di Muro, M. R., Bottiglieri, P., Rufolo, F., Ciriello, N., Angelini, E., Andriulo, C., De Santis, F., Cocco, F., Zecca, A., Pennetta, A., Mariello, F., Magliari, F., De Giorgi, A., Santoro, V., Pede, S., Renna, A., De Donno, O., De Lorenzi, E., Polimeni, G., Russo, V. A., Mangia, R., Cariello, F. P., Affinita, M., Perticone, F., Cloro, C., Misuraca, G., Caporale, R., Chiappetta, P., Tripodi, E., Tassone, F., Salituri, S., Errigo, C., Meringolo, G., Donnangelo, L., Canonico, G., Coco, R., Franco, M., Coglitore, A., Donato, A., Di Tano, G., Cento, D., DE GREGORIO, Cesare, Mongiovì, M., Schillaci, A. M., Mirto, U., Clemenza, F., Ingrillì, F., Aloisi, B., Porcu, M., Pili, G., and Piras, S.

Subjects
Male, medicine.medical_specialty, Heart disease, Decision Making, Risk Factors, Internal medicine, Heart rate, Humans, Medicine, Decompensation, Prospective Studies, Registries, Practice Patterns, Physicians', Intensive care medicine, Prospective cohort study, Aged, Heart Failure, business.industry, Atrial fibrillation, Middle Aged, Prognosis, medicine.disease, Blood pressure, Heart failure, Multivariate Analysis, Emergency medicine, Ambulatory, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

This study sought to prospectively assess which factors were related to short-term worsening heart failure (HF) leading to or not to hospital admission, in long-term outpatients followed by cardiologists. The subsequent decision-making process was also analyzed. The study population consisted of 2,701 outpatients enrolled in the registry of the Italian Network on Congestive Heart Failure (IN-CHF) and followed by 133 cardiology centers (19% of all existing Italian cardiology centers). Clinical and follow-up data were collected by local trained clinicians; 215 patients (8%) had short-term decompensation (on average 2 months after the index outpatient visit). Multivariate analysis showed that previous hospitalization, long duration of symptoms, ischemic etiology, atrial fibrillation, higher functional class (New York Heart Association classification III to IV), higher heart rate, and low systolic blood pressure were independently associated with HF destabilization. Poor compliance (21%) and infection (12%) were the most frequent precipitating factors, but a precipitating factor was not identified in 40% of the patients. Poor compliance was more common in women, but no other clinical characteristics emerged as being related with a specific precipitating factor. Fifty-seven percent of the patients with a short-term recurrence of worsening HF required hospital admission; infusion treatment with inotropes and/or vasodilators was necessary in 19% of them. Long-term therapy was changed in 48% of the patients. Thus, in ambulatory HF patients, short-term worsening HF can be predicted according to the clinical characteristics on an outpatient basis. Nearly 1/3 of precipitating factors can be prevented. Patient education and avoidance of inappropriate treatment may reduce the number of relapses.

Published
2001
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2. Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus

Author

Chesi, G, Colli, Andrea, Mestres, Ca, Gambarati, G, Boni, F, 2006 Jul 26, Gherli T. BMC Infect D. i. s., and 6

Subjects
Male, medicine.medical_specialty, Staphylococcus aureus, Substance-Related Disorders, Heart Valve Diseases, Locus (genetics), Case Report, Drug resistance, Virginiamycin, lcsh:Infectious and parasitic diseases, Microbiology, Medical microbiology, Drug Resistance, Multiple, Bacterial, medicine, polycyclic compounds, Endocarditis, Humans, lcsh:RC109-216, Ultrasonography, Tricuspid valve, business.industry, Osteomyelitis, Endocarditis, Bacterial, Middle Aged, Staphylococcal Infections, biochemical phenomena, metabolism, and nutrition, medicine.disease, bacterial infections and mycoses, Glycopeptide, Anti-Bacterial Agents, Radiography, medicine.anatomical_structure, Infectious Diseases, Infective endocarditis, Methicillin Resistance, Tricuspid Valve, business
Abstract

Background Methicillin-resistant S. aureus (MRSA) with low susceptibility to glycopeptides is uncommon. Case presentation The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE) by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin – rifampicin – cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin. Conclusion The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin

Published
2006

5. GISSI-3 - EFFECTS OF LISINOPRIL AND TRANSDERMAL GLYCERYL TRINITRATE SINGLY AND TOGETHER ON 6-WEEK MORTALITY AND VENTRICULAR-FUNCTION AFTER ACUTE MYOCARDIAL-INFARCTION

Author

Devita, C., Fazzini, P. F., Geraci, E., Tavazzi, L., Tognoni, G., Vecchio, C., Boeri, R., Damico, G., Loi, U., Marubini, E., Pagliaro, L., Rovelli, F., Franzosi, M. G., Latini, R., Maggioni, A. P., Mauri, F., Volpi, A., Barlera, S., Negri, E., Nicolis, E., Santoro, E., Santoro, L., Bonfanti, E., Capello, T., Casati, A., Corato, A., Gardinale, E., Negrini, M., Nobili, A., Staszewsky, L., Tavanelli, M., Torta, D., Gambelli, G., Moroni, L., Pellanda, J. J., Pietropaolo, F., Balli, E., Barbieri, A., Bechi, S., Carrone, M., Catanzaro, M., Fasciolo, L., Fresco, C., Ghiani, A., Iacuitti, G., Ledda, A., Levantesi, G., Pasini, P., Peci, P., Pizzetti, F., Sagone, A., Turazza, F., Villella, A., Villella, M., Braggio, N., Disertori, M., Frezzati, S., Garattini, S., Marino, P., Maseri, A., Mazzotta, G., Nicolosi, G., Pirelli, S., Sanna, G. P., Valagussa, F., Dargie, H. J., Peto, R., Pocock, S., Sleight, P., Yusuf, S., Giordano, F., Varlese, A., Loparco, G., Iberti, V., Giamundo, L., Anastasi, R., Paciaroni, E., Raffaeli, S., Purcaro, A., Ciampani, N., Rita, E., Cuccaroni, G., Baldinelli, A., Altieri, A., Giornetti, R., Azzaro, G., Ferraguto, P., Salici, G., Laconi, E., Tiburzi, F. M., Bernardi, D., Lunardi, M., Colonna, L., Bovenzi, F., Amodio, F., Sarcina, G., Carpagnano, A., Matera, A., Malacrida, R., Rigotti, R., Dallemule, J., Debiasi, A., Bridda, A., Invernizzi, G., Piti, A., Colombo, L., Tomassini, B., Biasia, R., Solda, P., Scaramuzzino, G., Mirri, A., Bracchetti, D., Decastro, U., Lintner, W., Erlicher, A., Gronda, M., Devecchi, P., Gagliardi, R. S., Battistoni, N., Storelli, A., Guadalupi, M., Nadovezza, S., Zuffiano, D., Depetra, V., Scervino, R., Tabacchi, G., Dessalvi, F., Scorcu, G., Giardina, G., Raffo, M., Boi, W., Cammalleri, G., Gruttadauria, G., Baldini, F., Paolone, P., Pantaleoni, A., Contessotto, F., Deconti, F., Pignatti, F., Frignani, A., Ivaldi, M., Aletto, C., Pettinati, G., Ciricugno, A., Muscella, A., Correale, E., Romano, S., Dandrea, D., Murena, E., Longobardi, R., Dimartino, N., Paolini, E., Gaddi, P., Calvelli, C., Dulcetti, F., Galassi, A., Coco, R., Coppola, A., Centamore, G., Calabrese, G., Sgalambro, G., Circo, A., Raciti, S., Dellamonica, R., Malinconico, M., Deponti, C., Parmigiani, M. L., Bellet, C., Bortolini, F., Buffoli, L., Tiberi, A., Ferrari, A., Rossi, A., Ciglia, C., Dicenso, M., Mangiarotti, E., Ornaghi, M., Do, V., Spapperi, D., Maiolino, P., Delio, U., Carrozza, A., Marinoni, C., Guasconi, C., Sandro Sonnino, Pagliei, M., Ferrari, G., Politi, A., Delazzaro, M., Rinaldis, G., Calcagnile, A., Lusetti, L., Bendinelli, S., Mollaioli, M., Cosmi, F., Plastina, F., Misuraca, G., Serafini, O., Venneri, N., Catelli, P., Poluzzi, C., Bergamaschi, G., Fadin, M. B., Dechiara, F., Zampaglione, G., Elia, M., Racca, E., Meinardi, F., Casasso, F., Bertocchi, P., Donzelli, W., Pessina, S., Tirella, G., Sauro, G., Tessitori, M., Bini, A., Bartoletti, A., Agnelli, D., Zagami, A., Andreoli, L., Bastoni, L., Pucci, P., Santini, A., Buonamici, P. G., Filice, M., Badolati, S., Zerauchek, M., Dematteis, D., Maulucci, G., Dantuono, C., Liberti, R., Menicono, L., Mattoli, A., Tallone, M., Divita, G., Manca, G., Licci, E., Canziani, R., Guidali, P., Rancan, E., Mariello, F., Pennetta, A., Minelli, C., Baldini, M. R., Cazzani, E., Romano, M., Bellotti, P., Camerini, A., Davi, R., Piazza, R., Musso, G., Rossi, P., Giacchero, C., Seu, V., Toselli, A., Digiacinto, N., Dicio, G., Spanghero, M., Cresti, A., Svetoni, N., Bruno, G., Distefano, S., Giovanelli, N., Fini, M., Dethomatis, M., Pandini, R., Carrino, C., Giammaria, M., Pistelli, P., Ronzani, G., Ottello, B., Melappioni, A., Zappelli, L., Marsili, P., Scimia, A., Ragazzini, G., Gramenzi, S., Motto, A., Tullio, D., Tucci, D., Rosselli, P., Gaggioli, G., Bollini, R., Fazio, A. M., Russo, R., Bossi, M., Savoia, M., Valsecchi, M. A., Barbaresi, F., Barbiero, M., Bonofiglio, C., Gemelli, M., Bonaglia, M., Bossoni, E., Lanzini, A., Delbene, P., Cascone, M., Orlandi, M., Oddone, A., Sallazzo, V., Panuccio, D., Cane, G., Moccetti, T., Pasotti, E., Tognoli, T., Caravita, L., Maggi, A., Bardelli, G. C., Tusa, M., Maggi, G., Guerra, G. P., Reggiani, A., Izzo, A., Colombo, G., Foti, F., Consolo, F., Arrigo, F., Sacca, A. M., Mafrici, A., Alberti, A., Belli, C., Dossena, M. G., Spinola, A., Casiraghi, M. G., Azzollini, M., Pozzoni, L., Salmoirago, E., Massironi, L., Sala, R., Bressi, R., Rigo, R., Cappelli, S., Malavasi, V., Pascotto, P., Pasqual, A. S., Sarto, P., Sani, F., Tosoni, D., Spinnler, M. T., Persico, D., Orsi, R., Lugliengo, V., Parolini, V., Zilio, G., Sandri, R., Neri, G., Alitto, F., Petri, D., Cusa, E. N., Mazzitelli, L., Piantadosi, F. R., Daniello, L., Polimeno, S., Mininni, N., Greco, R., Bisconti, C., Cucchiari, C., Dallavilla, W., Randon, L., Allegri, M., Marchi, S. M., Sanna, E., Deluca, C., Manetta, M., Dallavolta, S., Maddalena, F., Donzelli, M., Pulisano, U., Dimaria, B., Celona, G., Marchi, S., Vivirito, A., Carrubba, A., Lamalfa, R. G., Schicchi, R., Bellanca, G., Battaglia, A., Cirrincione, V., Ribaudo, E., Strizzolo, L., Carone, M., Digregorio, D., Mantini, L., Corea, L., Cocchieri, M., Notaristefano, A., Catanese, C., Faleburle, M., Sgarbi, E., Cesaroni, P., Baldini, P. M., Papi, L., Lavarini, L., Lorenzini, M., Tarditi, V., Menara, N., Conti, M., Ferro, M., Gianotti, A., Crivello, R., Micheli, G., Conti, U., Cabani, E., Davini, P., Delciterna, F., Giomi, A., Alfieri, A., Chiti, M., Codeluppi, P., Smerieri, O., Dinapoli, T., Capozzoli, M. R., Topi, P. L., Paperini, L., Topi, A., Zanuttini, D., Nicolosi, G. L., Visentin, P., Charmet, P. A., Petrella, A., Bardazzi, L., Nassi, F., Bianco, G. A., Cellammare, G., Licitra, R., Cintolo, C., Spadola, V., Guarrella, L., Casali, G., Monducci, I., Zobbi, G., Guiducci, U., Cerri, P., Violi, E., Rovelli, G., Triulzi, E., Rusconi, L., Sabattini, R., Desanctis, A., Bock, R., Orazi, S., Palmieri, M., Rossi, F., Pesaresi, A., Cioppi, F., Palamara, A., Mancini, P., Ferraiuolo, G., Azzolini, P., Neja, C. P., Risa, M. P., Borgia, M. C., Borgia, C., Zanchi, E., Risa, A. L., Colace, F., Tozzi, Q., Jesi, A. P., Tassoni, G., Vitucci, N. C., Lironcurti, C., Altieri, T., Viscomi, A., Striano, U., Salituri, S., Tarantino, F., Girardini, D., Zonzin, P., Roncon, L., Ferrarese, E., Ravera, B., Bugatti, U., Padula, G., Gigantino, A., Allemano, P., Reynaud, S., Fanelli, R., Derito, V., Croce, A., Galli, M., Bertoli, D., Vivaldi, F., Pedrazzini, F., Barani, R., Dileo, M., Doronzo, B., Gambarati, G. P., Zobbi, M., Caramanno, G., Craparo, F. G., Giani, P., Antongiovanni, G. B., Grasso, V., Mossuti, E., Rosella, M. G., Skouse, D., Giustiniani, S., Cucchi, G., Conti, E., Fagagnini, L., Pardi, L., Core, A., Staniscia, D., Serafini, N., Cerruti, P., Bazzucchi, M., Petrucci, G., Trinchero, R., Cecchi, E., Demarie, D., Brusasco, G., Gandolfo, N., Saviolo, R., Bergerone, S., Bergandi, G., Barbieri, D., Mina, E., Biondo, G. B., Ledda, G., Trapani, G., Frigo, G., Benettin, A., Galati, A., Accogli, M., Feruglio, G. A., Gianfagna, P., Prelli, L., Giamperi, M., Gheller, G., Cudali, A., Liguori, G., Dimarco, G., Bottari, E., Valente, S., Giglioli, C., Ramoscello, G., Rizzi, G. M., Pellinghelli, G., Perrini, A., Deluca, F., Savelli, S., Capezzuto, A., Gandolfi, P., Bergognoni, G., Ballestra, A. M., and Violo, C.

6. Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus.

Author

Chesi G, Colli A, Mestres CA, Gambarati G, Boni F, and Gherli T

Subjects
Anti-Bacterial Agents therapeutic use, Drug Resistance, Multiple, Bacterial, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial microbiology, Heart Valve Diseases diagnosis, Heart Valve Diseases microbiology, Humans, Male, Methicillin Resistance, Middle Aged, Osteomyelitis drug therapy, Osteomyelitis surgery, Radiography, Staphylococcal Infections diagnosis, Staphylococcal Infections microbiology, Substance-Related Disorders, Ultrasonography, Virginiamycin therapeutic use, Endocarditis, Bacterial drug therapy, Heart Valve Diseases drug therapy, Osteomyelitis microbiology, Staphylococcal Infections drug therapy, Staphylococcus aureus drug effects, Tricuspid Valve diagnostic imaging, Tricuspid Valve microbiology
Abstract

Background: Methicillin-resistant S. aureus (MRSA) with low susceptibility to glycopeptides is uncommon., Case Presentation: The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE) by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin--rifampicin--cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin., Conclusion: The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin.

Published
2006
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7. Combined Abciximab REteplase Stent Study in acute myocardial infarction (CARESS in AMI).

Author

Di Mario C, Bolognese L, Maillard L, Dudek D, Gambarati G, Manari A, Guiducci V, Patrizi G, Rusconi LC, Piovaccari G, Hibon AR, Belpomme V, Indolfi C, Olivari Z, Steffenino G, Zmudka K, Airoldi F, Panzarasa R, Flather M, and Steg PG

Subjects
Abciximab, Cost-Benefit Analysis, Drug Therapy, Combination, Emergency Medical Services, Humans, Myocardial Infarction mortality, Myocardial Infarction therapy, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Prospective Studies, Recurrence, Stents, Treatment Outcome, Antibodies, Monoclonal therapeutic use, Immunoglobulin Fab Fragments therapeutic use, Myocardial Infarction drug therapy, Plasminogen Activators therapeutic use, Recombinant Proteins therapeutic use, Thrombolytic Therapy, Tissue Plasminogen Activator therapeutic use
Abstract

Background: Most patients with acute myocardial infarction (AMI) are admitted to hospitals without percutaneous transluminal coronary angioplasty (PTCA) facilities or are initially managed in a prehospital mobile unit. Thrombolysis remains the most readily available reperfusion treatment in those settings, but the optimal subsequent strategy in those patients is unclear. If a mechanical recanalization is likely to be performed in an emergency, it is probably desirable that the patient receives abciximab, the glycoprotein IIb/IIIa antagonist with the strongest evidence of benefit for angioplasty in AMI., Objective: The aim of this trial is to compare the effects on clinical outcome and cost-effectiveness of 2 strategies after immediate treatment with abciximab and half-dose reteplase for ST-elevation AMI: to manage the patients conservatively (referring them for rescue PTCA only if needed) or to immediately send all patients for emergency coronary angioplasty., Methods: The Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction (CARESS in AMI) is an open, prospective, randomized, multicenter clinical trial conducted in patients with high-risk ST-segment elevation AMI treated within 12 hours from symptom onset in hospitals without PTCA facilities or in a prehospital mobile intensive care unit. Apart from contraindications to thrombolysis, the main exclusion criteria are age > or =75 years and a past history of CABG surgery or a percutaneous coronary intervention procedure involving the infarct-related artery. Enrollment will be performed in hospitals without PTCA facilities or directly in the ambulance if a dedicated system is in place for prehospital diagnosis and treatment of AMI. Patients will receive half-dose reteplase and full-dose abciximab and will subsequently be randomized to conventional medical therapy (with referral for emergency rescue PTCA allowed in selected cases) or emergency angioplasty. The primary end point is the 30-day combined incidence of mortality, reinfarction, and refractory ischemia. In order to obtain a 95% power (2-sided) to detect a 42% reduction in the primary end point, 900 patients are required in each arm of the study. Secondary end points include the 1-year composite end point of mortality, reinfarction, refractory ischemia, and hospital readmission because of heart failure; resource use at 30 days and 1 year; and the incidence of inhospital stroke and bleeding complications in the 2 groups., Results: Seventy-four patients have been randomized (as of March 10, 2004); results are expected in June 2005., Conclusion: This study will establish whether angioplasty must be started as soon as possible in all patients who receive combined pharmacologic reperfusion with the glycoprotein IIb/IIIa inhibitor abciximab and half-dose thrombolysis or whether it can be postponed or skipped in patients with signs of successful reperfusion, with obvious organizational advantages.

Published
2004
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8. Angioplasty in acute myocardial infarction after low-dose alteplase and abciximab in transferred patients. A comparison with primary angioplasty on site.

Author

Manari A, Guiducci V, Muià N, Giacometti P, Fioroni S, Navazio A, Gambarati G, Bendinelli S, and Bruno G

Subjects
Abciximab, Aged, Coronary Angiography, Coronary Artery Bypass mortality, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Italy, Male, Middle Aged, Myocardial Infarction physiopathology, Patient Admission, Postoperative Complications etiology, Postoperative Complications mortality, Postoperative Complications physiopathology, Reoperation, Survival Analysis, Treatment Outcome, Vascular Patency physiology, Angioplasty, Balloon, Coronary mortality, Antibodies, Monoclonal administration & dosage, Fibrinolytic Agents administration & dosage, Immunoglobulin Fab Fragments administration & dosage, Myocardial Infarction therapy, Platelet Aggregation Inhibitors administration & dosage, Tissue Plasminogen Activator administration & dosage, Transportation of Patients
Abstract

Background: The most important limitation in primary percutaneous coronary interventions (PCI) for acute myocardial infarction (AMI) is the small number of catheterization laboratories and their non-homogeneous territorial distribution. The aim of this study was to evaluate the safety and efficacy of an organizational model based on a network including tertiary referral centers and community hospitals for the treatment of AMI with alteplase plus abciximab followed by PCI., Methods: From October to November 2002, 232 patients < or = 75 years with AMI at high risk (84 transferred from four community hospitals and 148 patients admitted directly at the tertiary center) underwent PCI at our Institution. We compared procedural results and clinical outcome in patients with AMI undergoing PCI with or without transfer to tertiary centers., Results: Patient transferal from community hospitals determines a greater door-to-balloon time (120 vs 55 min, p < 0.001), while complications observed during transportation are limited (5.9%). Transferred patients have a greater percentage of infarct-related artery patency (77 vs 22%, p < 0.001) and of ST-segment resolution 90 min post-PCI (77 vs 57%, p < 0.005) in comparison with direct-access patients. The incidence of clinical events (death, reinfarction, angina) was not different between the two groups at 30 days and at 6 months of follow-up., Conclusions: In our experience the integrated model between tertiary centers and community hospitals represents a valid network system offering homogeneous therapeutic (alternatives) options to all patients with AMI regardless of the hospital where they are first admitted.

Published
2003

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