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7. Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

Author

Erriquez, Andrea, Uretsky, Barry F., Brugaletta, Salvatore, Spitaleri, Giosafat, Cerrato, Enrico, Quadri, Giorgio, Manfrini, Marco, Pompei, Graziella, Scancarello, Davide, Trichilo, Michele, Marchini, Federico, Caglioni, Serena, Campana, Roberta, Marrone, Andrea, Penzo, Carlo, Tumscitz, Carlo, Tebaldi, Matteo, Verardi, Filippo Maria, Scala, Antonella, Campo, Gianluca, and Biscaglia, Simone

Published
2022
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8. Long-term outcomes of patients treated with sirolimus-eluting resorbable magnesium scaffolds: Insights from the SHERPA-MAGIC study

Author

Pompei, Graziella, Campo, Gianluca, Ruggiero, Rossella, Maffeo, Diego, Sgura, Fabio, Arrotti, Salvatore, Preti, Gerlando, Iannaccone, Mario, Erriquez, Andrea, Biscaglia, Simone, Sganzerla, Paolo, Capecchi, Alessandro, Pignatelli, Gianluca, Dall'Ara, Gianni, Saia, Francesco, Tomassini, Francesco, Rolfo, Cristina, Varbella, Ferdinando, and Cerrato, Enrico

Published
2023
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9. QFR-Based Virtual PCI or Conventional Angiography to Guide PCI: The AQVA Trial

Author

Biscaglia, Simone, Verardi, Filippo Maria, Tebaldi, Matteo, Guiducci, Vincenzo, Caglioni, Serena, Campana, Roberta, Scala, Antonella, Marrone, Andrea, Pompei, Graziella, Marchini, Federico, Scancarello, Davide, Pignatelli, Gianluca, D’Amore, Sergio Musto, Colaiori, Iginio, Demola, Pierluigi, Di Serafino, Luigi, Tumscitz, Carlo, Penzo, Carlo, Erriquez, Andrea, Manfrini, Marco, and Campo, Gianluca

Published
2023
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10. The impact of sex and physical performance on long-term mortality in older patients with myocardial infarction

Author

Tonet, Elisabetta, Ariza-Solé, Albert, Serenelli, Matteo, Formiga, Francesc, Sanchis, Juan, Pavasini, Rita, Diez-Villanueva, Pablo, Vitali, Francesco, Bonanad, Clara, Grazzi, Giovanni, Carol, Antoni, Chiaranda, Giorgio, Pompei, Graziella, Cardelli, Laura Sofia, Caglioni, Serena, Gibiino, Federico, Volpato, Stefano, and Campo, Gianluca

Published
2022
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11. Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary syndrome

Author

Onderzoek Vrouw Hart & Vaatziekten, Circulatory Health, Dirjayanto, Valerie J., Pompei, Graziella, Rubino, Francesca, Biscaglia, Simone, Campo, Gianluca, Mihailidou, Anastasia, den Ruijter, Hester, Kunadian, Vijay, Onderzoek Vrouw Hart & Vaatziekten, Circulatory Health, Dirjayanto, Valerie J., Pompei, Graziella, Rubino, Francesca, Biscaglia, Simone, Campo, Gianluca, Mihailidou, Anastasia, den Ruijter, Hester, and Kunadian, Vijay

Published
2024

12. Reading 2023 ESC ACS guidelines between the lines: Gaps in evidence in women

Author

Team Medisch, Onderzoek Vrouw Hart & Vaatziekten, Circulatory Health, Pompei, Graziella, van de Hoef, Tim P, den Ruijter, Hester M, Kunadian, Vijay, Team Medisch, Onderzoek Vrouw Hart & Vaatziekten, Circulatory Health, Pompei, Graziella, van de Hoef, Tim P, den Ruijter, Hester M, and Kunadian, Vijay

Published
2024

16. Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and High Bleeding Risk: A Randomized Clinical Trial

Author

Erriquez, Andrea, Campo, Gianluca, Guiducci, Vincenzo, Escaned, Javier, Moreno, Raul, Casella, Gianni, Menozzi, Mila, Cerrato, Enrico, Sacchetta, Giorgio, Menozzi, Alberto, Santos, Ignacio Amat, Ibañes, Enrique Gutiérrez, Scarsini, Roberto, Vadalà, Giuseppe, Andò, Giuseppe, Díez-Gil, José Luis, d’Amore, Sergio Musto, Capecchi, Alessandro, Colaiori, Iginio, Gallo, Francesco, Pavasini, Rita, Marrone, Andrea, Pompei, Graziella, Lanzilotti, Valerio, Dudek, Dariusz, Barbato, Emanuele, Tebaldi, Matteo, and Biscaglia, Simone

Abstract

IMPORTANCE: Patients with high bleeding risk (HBR) have a poor prognosis, and it is not known if they may benefit from complete revascularization after myocardial infarction (MI). OBJECTIVE: To investigate the benefit of physiology-guided complete revascularization vs a culprit-only strategy in patients with HBR, MI, and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified analysis of the Functional Assessment in Elderly MI Patients With Multivessel Disease (FIRE) randomized clinical trial data. FIRE was an investigator-initiated, open-label, multicenter trial. Patients 75 years or older with MI and multivessel disease were enrolled at 34 European centers from July 2019 through October 2021. Physiology treatment was performed either by angiography- or wire-based assessment. Patients were divided into HBR or non-HBR categories in accordance with the Academic Research Consortium HBR document. INTERVENTIONS: Patients were randomized to either physiology-guided complete revascularization or culprit-only strategy. MAIN OUTCOMES AND MEASURES: The primary outcome comprised a composite of death, MI, stroke, or revascularization at 1 year. Secondary outcomes included a composite of cardiovascular death or MI and Bleeding Academic Research Consortium (BARC) types 3 to 5. RESULTS: Among 1445 patients (mean [SD] age, 81 [5] years; 917 male [63%]), 1025 (71%) met HBR criteria. Patients with HBR were at higher risk for the primary end point (hazard ratio [HR], 2.01; 95% CI, 1.47-2.76), cardiovascular death or MI (HR, 1.89; 95% CI, 1.26-2.83), and BARC types 3 to 5 (HR, 3.28; 95% CI, 1.40-7.64). The primary end point was significantly reduced with physiology-guided complete revascularization as compared with culprit-only strategy in patients with HBR (HR, 0.73; 95% CI, 0.55-0.96). No indication of interaction was noted between revascularization strategy and HBR status for primary and secondary end points. CONCLUSIONS AND RELEVANCE: HBR status is prevalent among older patients with MI, significantly increasing the likelihood of adverse events. Physiology-guided complete revascularization emerges as an effective strategy, in comparison with culprit-only revascularization, for mitigating ischemic adverse events, including cardiovascular death and MI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03772743

Published
2024
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17. Coronary Artery Plaque Phenotype and 5-Year Clinical Outcomes in Older Patients with Non-ST Elevation Acute Coronary Syndrome.

Author

Rubino, Francesca, Brugaletta, Salvatore, Mills, Gregory, Pompei, Graziella, Scarsini, Roberto, Ribichini, Flavio, Räber, Lorenz, and Kunadian, Vijay

Abstract

Background: Lesions with thin-cap fibroatheroma (TCFA), small luminal area and large plaque burden (PB) have been considered at high risk of cardiovascular events. Older patients were not represented in studies which demonstrated correlation between clinical outcome and plaque characteristics. This study aims to investigate the prognostic role of high-risk plaque characteristics and long-term outcome in older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS). Methods: This study recruited older patients aged ≥75 years with NSTEACS undergoing virtual-histology intravascular ultrasound (VH-IVUS) imaging from the Improve Clinical Outcomes in high-risk patieNts with acute coronary syndrome (ICON-1). Primary endpoint was the composite of major adverse cardiovascular events (MACE) consisting of all-cause mortality, myocardial infarction (MI), and any revascularisation. Every component of MACE and target vessel failure (TVF) including MI and any revascularisation were considered as secondary endpoints. Results: Eighty-six patients with 225 vessels undergoing VH-IVUS at baseline completed 5-year clinical follow-up. Patients with minimal lumen area (MLA) ≤4 mm² demonstrated increased risk of MACE (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.00-5.59, p = 0.048) with a worse event-free survival (Log Rank 4.17, p = 0.041) than patients with MLA >4 mm². Patients with combination of TCFA, MLA ≤4 mm² and PB =70% showed high risk of MI (HR 5.23, 95% CI 1.05-25.9, p = 0.043). Lesions with MLA ≤4 mm² had 6-fold risk of TVF (HR 6.16, 95% CI 1.24-30.5, p = 0.026). Conclusions: Small luminal area appears as the major prognostic factor in older patients with NSTEACS at long-term follow-up. Combination of TCFA, MLA ≤4 mm² and PB =70% was associated with high risk of MI. Clinical Trial Registration: NCT01933581. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Cognitive impairment and outcomes in older adults with non-ST-elevation acute coronary syndrome.

Author

Dirjayanto, Valerie Josephine, Alkhalil, Mohammad, Dodson, John, Mills, Gregory, Pompei, Graziella, Rubino, Francesca, and Kunadian, Vijay

Subjects
ACUTE coronary syndrome, TRANSIENT ischemic attack, MYOCARDIAL infarction, OLDER people, COGNITION disorders, MONTREAL Cognitive Assessment, ST elevation myocardial infarction, DELIRIUM
Abstract

This article discusses a study that explores the impact of cognitive impairment on the long-term risk of major adverse cardiovascular events (MACEs) in older adults with non-ST-elevation acute coronary syndrome (NSTEACS) undergoing invasive treatment. The study found that cognitive impairment was associated with an increased risk of all-cause mortality, even after adjusting for frailty and other factors. However, there was no significant difference in the occurrence of MACEs between the cognitively impaired group and the normal cognition group. The findings suggest that routine cognitive screening may be beneficial in risk stratification for older adults with NSTEACS. [Extracted from the article]

Published
2024
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19. The role of physiology in the contemporary management of coronary artery disease.

Author

Rubino, Francesca, Pompei, Graziella, Brugaletta, Salvatore, Collet, Carlos, and Kunadian, Vijay

Subjects
MYOCARDIAL infarction, INTRAVASCULAR ultrasonography, CHEST pain, CORONARY artery disease, ST elevation myocardial infarction, PERCUTANEOUS coronary intervention, LDL cholesterol, HDL cholesterol
Abstract

This document provides a concise summary of the given text, which discusses the role of physiology in the management of coronary artery disease (CAD). It emphasizes the importance of coronary physiology assessment in guiding revascularization procedures and improving patient outcomes. The text also highlights the benefits of functional assessment in terms of improving quality of life and reducing the risk of cardiac events and residual angina. It mentions ongoing clinical trials that aim to further investigate the prognostic impact of these assessments and explore therapeutic strategies to protect the microcirculation after percutaneous coronary intervention (PCI). Overall, the document presents coronary physiology assessment as an essential tool for improving the prognosis and quality of life of patients with CAD. [Extracted from the article]

Published
2024
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22. Reading 2023 ESC ACS guidelines between the lines: Gaps in evidence in women.

Author

Pompei, Graziella, van de Hoef, Tim P., den Ruijter, Hester M., and Kunadian, Vijay

Subjects
*ATHEROSCLEROTIC plaque, *EVIDENCE gaps, *MEDICAL personnel, *HEALTH facilities, *ACUTE coronary syndrome, *SPONTANEOUS coronary artery dissection
Abstract

This article explores the gaps in knowledge and evidence surrounding the management of acute coronary syndromes (ACS) in women, as outlined in the 2023 guidelines from the European Society of Cardiology (ESC). It emphasizes the importance of understanding the differences between male and female patients in terms of access to emergency care, treatment, risk factors, and underlying mechanisms of ACS. The article also discusses the role of intracoronary imaging, coronary function testing, patient education, and antithrombotic therapy in managing ACS. It concludes by highlighting the need for increased representation of female patients in clinical trials to inform optimal management strategies for women with ACS. The text also addresses the gaps in knowledge regarding antithrombotic therapy in women, particularly in the context of ACS and spontaneous coronary artery dissection (SCAD). It stresses the need for more research and clinical trials specifically focused on women, as they are often underrepresented in these studies. The article also emphasizes the importance of considering diverse socioeconomic backgrounds and addressing potential sex biases in the management of ACS. The overall goal is to ensure that women with ACS receive evidence-based care and that future guidelines are informed by sex-stratified analyses. [Extracted from the article]

Published
2024
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24. [The EBC MAIN study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies for the treatment of left main bifurcation lesions]

Author

Pompei, Graziella, Barioli, Alberto, D'Agosta, Guido, Ruggiero, Rossella, Demola, Pierluigi, Bianchini, Francesco, Burzotta, Francesco, Masiero, Giuliano, Burzotta, Francesco (ORCID:0000-0002-6569-9401), Masiero, Giulia, Pompei, Graziella, Barioli, Alberto, D'Agosta, Guido, Ruggiero, Rossella, Demola, Pierluigi, Bianchini, Francesco, Burzotta, Francesco, Masiero, Giuliano, Burzotta, Francesco (ORCID:0000-0002-6569-9401), and Masiero, Giulia

Abstract

n/a

Published
2023

25. Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

Author

Erriquez, Andrea, Uretsky, Barry F., Brugaletta, Salvatore, Spitaleri, Giosafat, Cerrato, Enrico, Quadri, Giorgio, Manfrini, Marco, Pompei, Graziella, Scancarello, Davide, Trichilo, Michele, Marchini, Federico, Caglioni, Serena, Campana, Roberta, Marrone, Andrea, Penzo, Carlo, Tumscitz, Carlo, Tebaldi, Matteo, Verardi, Filippo Maria, Scala, Antonella, Campo, Gianluca, and Biscaglia, Simone

Abstract

To test whether quantitative flow ratio (QFR)-based trans-stent gradient (TSG) is associated with adverse clinical events at follow-up. A post-hoc analysis of the multi-center HAWKEYE study was performed. Vessels post-PCI were divided into four groups (G) as follows: G1: QFR ≥ 0.90 TSG = 0 (n = 412, 54.8%); G2: QFR ≥ 0.90, TSG > 0 (n = 216, 28.7%); G3: QFR < 0.90, TSG = 0 (n = 37, 4.9%); G4: QFR < 0.90, TSG > 0 (n = 86, 11.4%). Cox proportional hazards regression model was used to analyze the effect of baseline and prognostic variables. The final reduced model was obtained by backward stepwise variable selection. Receiver operating characteristic (ROC) was plotted and area under the curve (AUC) was calculated and reported. Overall, 449 (59.8%) vessels had a TSG = 0 whereas (40.2%) had TSG > 0. Ten (2.2%) vessel-oriented composite endpoint (VOCE) occurred in vessels with TSG = 0, compared with 43 (14%) in vessels with TSG > 0 (p < 0.01). ROC analysis showed an AUC of 0.74 (95% CI: 0.67 to 0.80; p < 0.001). TSG > 0 was an independent predictor of the VOCE (HR 2.95 [95% CI 1.77–4.91]). The combination of higher TSG and lower final QFR (G4) showed the worst long-term outcome while low TSG and high QFR showed the best outcome (G1) while either high TSG or low QFR (G2, G3) showed intermediate and comparable outcomes. Higher trans-stent gradient was an independent predictor of adverse events and identified a subgroup of patients at higher risk for poor outcomes even when vessel QFR was optimal (> 0.90).

Published
2024
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27. Clinical Outcome of FFR-Guided Revascularization Strategy of Coronary Lesions: The HALE-BOPP Study

Author

Tebaldi, Matteo, primary, Gallo, Francesco, primary, Scoccia, Alessandra, primary, Durante, Alessandro, primary, Tedeschi, Delio, primary, Verdoliva, Sebastiano, primary, Cortese, Bernardo, primary, Bilotta, Ferruccio, primary, Watkins, Stuart, primary, Ielasi, Alfonso, primary, Valentini, Giuliano, primary, Pavasini, Rita, primary, Serenelli, Matteo, primary, D’Aniello, Emanuele, primary, Arena, Marco, primary, Pompei, Graziella, primary, Scala, Antonella, primary, Scollo, Ennio, primary, Gibiino, Federico, primary, Caglioni, Serena, primary, Mele, Daniela, primary, Marrone, Andrea, primary, Biscaglia, Simone, primary, Barbato, Emanuele, primary, and Campo, Gianluca, primary

Published
2023
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30. 304 CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY FOR THE ASSESSMENT OF SIROLIMUS-ELUTING RESORBABLE MAGNESIUM SCAFFOLD

Author

Pompei, Graziella, primary, Tonet, Elisabetta, additional, Cossu, Alberto, additional, Caglioni, Serena, additional, Mele, Daniela, additional, Boccadoro, Alberro, additional, Micillo, Marco, additional, Cocco, Marta, additional, De Raffele, Martina, additional, Giganti, Melchiorre, additional, Biscaglia, Simone, additional, Sgura, Fabio, additional, Preti, Gerlando, additional, Quadri, Giorgio, additional, Cerrato, Enrico, additional, Campo, Gianluca, additional, and Ruggiero, Rossella, additional

Published
2022
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31. 1140 CLINICAL OUTCOME OF FRACTIONAL FLOW RESERVE GUIDED REVASCULARIZATION STRATEGY OF CORONARY LESIONS: THE HALE-BOPP STUDY

Author

Caglioni, Serena, primary, Campo, Gianluca, additional, Gallo, Francesco, additional, Scoccia, Alessandra, additional, Durante, Alessandro, additional, Tedeschi, Delio, additional, Verdoliva, Sebastiano, additional, Cortese, Bernardo, additional, Bilotta, Ferruccio, additional, Watkins, Stuart, additional, Ielasi, Alfonso, additional, Valentini, Giuliano, additional, Arena, Marco, additional, Mele, Daniela, additional, Pavasini, Rita, additional, Serenelli, Matteo, additional, Pompei, Graziella, additional, Scala, Antonella, additional, Gibiino, Federico, additional, Scollo, Ennio, additional, D´aniello, Emanuele, additional, Biscaglia, Simone, additional, Barbato, Emanuele, additional, and Tebaldi, Matteo, additional

Published
2022
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32. Coronary Computed Tomography Angiography for the Assessment of Sirolimus-Eluting Resorbable Magnesium Scaffold

Author

Tonet, Elisabetta, primary, Cossu, Alberto, additional, Pompei, Graziella, additional, Ruggiero, Rossella, additional, Caglioni, Serena, additional, Mele, Daniela, additional, Boccadoro, Alberto, additional, Micillo, Marco, additional, Cocco, Marta, additional, De Raffele, Martina, additional, Giganti, Melchiore, additional, Biscaglia, Simone, additional, Sgura, Fabio, additional, Preti, Gerlando, additional, Yin, Youbing, additional, Wang, Yi, additional, Quadri, Giorgio, additional, Cerrato, Enrico, additional, and Campo, Gianluca, additional

Published
2022
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34. Circulating Biomarkers of Endothelial Dysfunction and Inflammation in Predicting Clinical Outcomes in Diabetic Patients with Critical Limb Ischemia

Author

Vieceli Dalla Sega, Francesco, primary, Cimaglia, Paolo, additional, Manfrini, Marco, additional, Fortini, Francesca, additional, Marracino, Luisa, additional, Bernucci, Davide, additional, Pompei, Graziella, additional, Scala, Antonella, additional, Trichilo, Michele, additional, De Carolis, Beatrice, additional, Dalla Paola, Luca, additional, Ferrari, Roberto, additional, Rizzo, Paola, additional, and Campo, Gianluca, additional

Published
2022
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38. Procalcitonin Predicts Bacterial Infection, but Not Long-Term Occurrence of Adverse Events in Patients with Acute Coronary Syndrome

Author

Pavasini, Rita, primary, Fabbri, Gioele, additional, Marchini, Federico, additional, Bianchi, Nicola, additional, Deserio, Maria Angela, additional, Sanguettoli, Federico, additional, Verardi, Filippo Maria, additional, Segala, Daniela, additional, Pompei, Graziella, additional, Tonet, Elisabetta, additional, Serenelli, Matteo, additional, Caglioni, Serena, additional, Guardigli, Gabriele, additional, Campo, Gianluca, additional, and Cultrera, Rosario, additional

Published
2022
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40. 448 Comparison of quantitative flow ratio, Pd/Pa, and diastolic hyperaemia-free ratio vs. fractional flow reserve in non-culprit lesion of patients with non-ST-segment elevation myocardial infarction

Author

Tebaldi, Matteo, primary, Biscaglia, Simone, additional, Erriquez, Andrea, additional, Penzo, Carlo, additional, Tumscitz, Carlo, additional, Scoccia, Alessandra, additional, Marrone, Andrea, additional, Scala, Antonella, additional, Gibiino, Federico, additional, Pompei, Graziella, additional, Tolomeo, Paolo, additional, and Campo, Gianluca, additional

Published
2021
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42. 80 The impact of sex and physical performance on long-term mortality in older patients with myocardial infarction

Author

Tonet, Elisabetta, primary, Ariza-solé, Albert, additional, Serenelli, Matteo, additional, Formiga, Francesc, additional, Juan, Sanchis, additional, Pavasini, Rita, additional, Diez-villanueva, Pablo, additional, Vitali, Francesco, additional, Bonanad, Clara, additional, Grazzi, Giovanni, additional, Carol, Antoni, additional, Chiaranda, Giorgio, additional, Pompei, Graziella, additional, Cardelli, Laura Sofia, additional, Caglioni, Serena, additional, Gibiino, Federico, additional, Volpato, Stefano, additional, and Campo, Gianluca, additional

Published
2021
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43. Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Author

Pavasini, Rita, primary, Tebaldi, Matteo, additional, Bugani, Giulia, additional, Tonet, Elisabetta, additional, Campana, Roberta, additional, Cimaglia, Paolo, additional, Maietti, Elisa, additional, Grazzi, Giovanni, additional, Pompei, Graziella, additional, Fabbri, Gioele, additional, Fiorio, Alessio, additional, Rubboli, Andrea, additional, Mazzoni, Gianni, additional, Vitali, Francesco, additional, Serenelli, Matteo, additional, Campo, Gianluca, additional, and Biscaglia, Simone, additional

Published
2021
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46. Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies’ consensus document

Author

Tayal, Upasana, Pompei, Graziella, Wilkinson, Ian, Adamson, Dawn, Sinha, Aish, Hildick-Smith, David, Cubbon, Richard, Garbi, Madalina, Ingram, Thomas E, Colebourn, Claire L, Camm, C Fielder, Guzik, Tomasz J, Anderson, Lisa, Page, Stephen P, Wicks, Eleanor, Jenkins, Petra, Rosen, Stuart D, Eftychiou, Stavros, Roberts, Eleri, Eftekhari, Helen, Probert, Heather, Cowie, Aynsley, Thakkar, Raj, Moore, Jim, Berry, Colin, Captur, Gaby, Deshpande, Aparna, Brown, Sarah, Malkin, Roland, Harrison, Mary, Lawson, Claire, Ng, G Andre, and Kunadian, Vijay

Abstract

Despite significant progress in cardiovascular pharmacotherapy and interventional strategies, cardiovascular disease (CVD), in particular ischaemic heart disease, remains the leading cause of morbidity and mortality among women in the UK and worldwide. Women are underdiagnosed, undertreated and under-represented in clinical trials directed at management strategies for CVD, making their results less applicable to this subset. Women have additional sex-specific risk factors that put them at higher risk of future cardiovascular events. Psychosocial risk factors, socioeconomic deprivation and environmental factors have an augmented impact on women’s cardiovascular health, highlighting the need for a holistic approach to care that considers risk factors specifically related to female biology alongside the traditional risk factors. Importantly, in the UK, even in the context of a National Health Service, there exist significant regional variations in age-standardised mortality rates among patients with CVD. Given most CVDs are preventable, concerted efforts are necessary to address the unmet needs and ensure parity of care for women with CVD. The present consensus document, put together by the British Cardiovascular Society (BCS)’s affiliated societies, specifically portrays the current status on the sex-related differences in the diagnosis and treatment of each of the major CVD areas and proposes strategies to overcome the barriers in accessing diagnoses and treatments among women. This document aims at raising awareness of the scale of the current problem and hopes to stimulate a multifaceted approach to address sex disparities and enable future comprehensive sex- and gender-based research through collaboration across different affiliated societies within the BCS.

Published
2024
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47. Role of physiology in the management of multivessel disease among patients with acute coronary syndrome.

Author

Ganzorig N, Pompei G, Jenkins K, Wang W, Rubino F, Gill K, and Kunadian V

Abstract

Multivessel coronary artery disease (CAD), defined as ≥50% stenosis in 2 or more epicardial arteries, is associated with a high burden of morbidity and mortality in acute coronary syndrome (ACS) patients. A salient challenge for managing this cohort is selecting the optimal revascularisation strategy, for which the use of coronary physiology has been increasingly recognised. Fractional flow reserve (FFR) is an invasive, pressure wire-based, physiological index measuring the functional significance of coronary lesions. Understanding this can help practitioners evaluate which lesions could induce myocardial ischaemia and, thus, decide which vessels require urgent revascularisation. Non-hyperaemic physiology-based indices, such as instantaneous wave-free ratio (iFR), provide valid alternatives to FFR. While FFR and iFR are recommended by international guidelines in stable CAD, there is ongoing discussion regarding the role of physiology in patients with ACS and multivessel disease (MVD); growing evidence supports FFR use in the latter. Compelling findings show FFR-guided complete percutaneous coronary intervention (PCI) can reduce adverse cardiovascular events, mortality, and repeat revascularisations in ACS and MVD patients compared to angiography-based PCI. However, FFR is limited in identifying non-flow-limiting vulnerable plaques, which can disadvantage high-risk patients. Here, integrating coronary physiology assessment with intracoronary imaging in decision-making can improve outcomes and quality of life. Further research into novel physiology-based tools in ACS and MVD is needed. This review aims to highlight the key evidence surrounding the role of FFR and other functional indices in guiding PCI strategy in ACS and MVD patients., Competing Interests: The authors have no conflicts of interest to declare.

Published
2024
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48. [Ticagrelor monotherapy in patients with acute coronary syndrome receiving new generation drug-eluting stents: results of the T-PASS randomized clinical trial].

Author

Ruggiero R, Beneduce A, Demola P, Pompei G, Barioli A, Ryan N, Barbato E, and Toselli M

Subjects
Humans, Purinergic P2Y Receptor Antagonists administration & dosage, Purinergic P2Y Receptor Antagonists therapeutic use, Treatment Outcome, Male, Middle Aged, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors therapeutic use, Female, Drug-Eluting Stents, Acute Coronary Syndrome therapy, Acute Coronary Syndrome drug therapy, Ticagrelor administration & dosage, Ticagrelor therapeutic use
Published
2024
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49. [Percutaneous revascularization in non-ST-elevation acute coronary syndromes: complete or incomplete?]

Author

Bernelli C, Campo G, Di Pasquale G, Maggioni AP, Tonet E, Cocco M, and Pompei G

Subjects
Humans, Vascular Surgical Procedures, Treatment Outcome, Acute Coronary Syndrome surgery, Acute Coronary Syndrome complications, Coronary Artery Disease, Percutaneous Coronary Intervention methods, ST Elevation Myocardial Infarction complications
Abstract

Non-ST-elevation myocardial infarction with multivessel coronary disease is increasing in patients presenting with acute coronary syndrome (ACS) and it is associated with a high rate of mortality. Complete revascularization may reduce major adverse cardiac events in patients with ACS. However, the preferred revascularization strategies (complete vs incomplete) of non-culprit lesions in this setting, as well as the correct timing of revascularization are still matters of debate. This is mostly related to the heterogeneity of patients with this clinical presentation, who are often older and affected by multiple comorbidities. The present review aims to evaluate this topic highlighting the pros and cons of complete revascularization according to anatomical or functional and imaging evaluation and based on timing and patient's clinical phenotype.

Published
2024
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50. Vasospastic angina: a review on diagnostic approach and management.

Author

Jenkins K, Pompei G, Ganzorig N, Brown S, Beltrame J, and Kunadian V

Subjects
Humans, Quality of Life, Coronary Angiography adverse effects, Chest Pain complications, Spasm complications, Angina Pectoris, Variant diagnosis, Angina Pectoris, Variant therapy, Angina Pectoris, Variant complications, Coronary Vasospasm diagnosis, Coronary Vasospasm therapy, Coronary Vasospasm complications, Coronary Artery Disease, Myocardial Infarction
Abstract

Vasospastic angina (VSA) refers to chest pain experienced as a consequence of myocardial ischaemia caused by epicardial coronary spasm, a sudden narrowing of the vessels responsible for an inadequate supply of blood and oxygen. Coronary artery spasm is a heterogeneous phenomenon that can occur in patients with non-obstructive coronary arteries and obstructive coronary artery disease, with transient spasm causing chest pain and persistent spasm potentially leading to acute myocardial infarction (MI). VSA was originally described as Prinzmetal angina or variant angina, classically presenting at rest, unlike most cases of angina (though in some patients, vasospasm may be triggered by exertion, emotional, mental or physical stress), and associated with transient electrocardiographic changes (transient ST-segment elevation, depression and/or T-wave changes). Ischaemia with non-obstructive coronary arteries (INOCA) is not a benign condition, as patients are at elevated risk of cardiovascular events including acute coronary syndrome, hospitalization due to heart failure, stroke and repeat cardiovascular procedures. INOCA patients also experience impaired quality of life and associated increased healthcare costs. VSA, an endotype of INOCA, is associated with major adverse events, including sudden cardiac death, acute MI and syncope, necessitating the study of the most effective treatment options currently available. The present literature review aims to summarize current data relating to the diagnosis and management of VSA and provide details on the sequence that treatment should follow.

Published
2024
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