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1. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Author

De Rosa, S, Spaccarotella, C, Basso, C, Calabro, M, Curcio, A, Filardi, P, Mancone, M, Mercuro, G, Muscoli, S, Nodari, S, Pedrinelli, R, Sinagra, G, Indolfi, C, Angelini, F, Barilla, F, Bartorelli, A, Benedetto, F, Bernabo, P, Bolognese, L, Briani, M, Cacciavillani, L, Calabrese, A, Calabro, P, Caliendo, L, Calo, L, Casella, G, Casu, G, Cavallini, C, Ciampi, Q, Ciccone, M, Comito, M, Corrada, E, Crea, F, D'Andrea, A, D'Urbano, M, De Caterina, R, De Ferrari, G, De Ponti, R, Della Mattia, A, DI Mario, C, Donnazzan, L, Esposito, G, Fedele, F, Ferraro, A, Galasso, G, Galie, N, Gnecchi, M, Golino, P, Golia, B, Guarini, P, Leonardi, S, Locuratolo, N, Luzza, F, Manganiello, V, Francesca Marchetti, M, Marenzi, G, Margonato, A, Meloni, L, Metra, M, Milo, M, Mongiardo, A, Monzo, L, Morisco, C, Novo, G, Pancaldi, S, Parollo, M, Paterno, G, Patti, G, Priori, S, Ravera, A, Giuseppe Rebuzzi, A, Rossi, M, Scherillo, M, Semprini, F, Senni, M, Sibilio, G, Siviglia, M, Tamburino, C, Tortorici, G, Versace, F, Villari, B, Volpe, M, De Rosa S., Spaccarotella C., Basso C., Calabro M. P., Curcio A., Filardi P. P., Mancone M., Mercuro G., Muscoli S., Nodari S., Pedrinelli R., Sinagra G., Indolfi C., Angelini F., Barilla F., Bartorelli A., Benedetto F., Bernabo P., Bolognese L., Briani M., Cacciavillani L., Calabrese A., Calabro P., Caliendo L., Calo L., Casella G., Casu G., Cavallini C., Ciampi Q., Ciccone M., Comito M., Corrada E., Crea F., D'Andrea A., D'Urbano M., De Caterina R., De Ferrari G., De Ponti R., Della Mattia A., DI Mario C., Donnazzan L., Esposito G., Fedele F., Ferraro A., Galasso G., Galie N., Gnecchi M., Golino P., Golia B., Guarini P., Leonardi S., Locuratolo N., Luzza F., Manganiello V., Francesca Marchetti M., Marenzi G., Margonato A., Meloni L., Metra M., Milo M., Mongiardo A., Monzo L., Morisco C., Novo G., Pancaldi S., Parollo M., Paterno G., Patti G., Priori S., Ravera A., Giuseppe Rebuzzi A., Rossi M., Scherillo M., Semprini F., Senni M., Sibilio G., Siviglia M., Tamburino C., Tortorici G., Versace F., Villari B., Volpe M., De Rosa, S, Spaccarotella, C, Basso, C, Calabro, M, Curcio, A, Filardi, P, Mancone, M, Mercuro, G, Muscoli, S, Nodari, S, Pedrinelli, R, Sinagra, G, Indolfi, C, Angelini, F, Barilla, F, Bartorelli, A, Benedetto, F, Bernabo, P, Bolognese, L, Briani, M, Cacciavillani, L, Calabrese, A, Calabro, P, Caliendo, L, Calo, L, Casella, G, Casu, G, Cavallini, C, Ciampi, Q, Ciccone, M, Comito, M, Corrada, E, Crea, F, D'Andrea, A, D'Urbano, M, De Caterina, R, De Ferrari, G, De Ponti, R, Della Mattia, A, DI Mario, C, Donnazzan, L, Esposito, G, Fedele, F, Ferraro, A, Galasso, G, Galie, N, Gnecchi, M, Golino, P, Golia, B, Guarini, P, Leonardi, S, Locuratolo, N, Luzza, F, Manganiello, V, Francesca Marchetti, M, Marenzi, G, Margonato, A, Meloni, L, Metra, M, Milo, M, Mongiardo, A, Monzo, L, Morisco, C, Novo, G, Pancaldi, S, Parollo, M, Paterno, G, Patti, G, Priori, S, Ravera, A, Giuseppe Rebuzzi, A, Rossi, M, Scherillo, M, Semprini, F, Senni, M, Sibilio, G, Siviglia, M, Tamburino, C, Tortorici, G, Versace, F, Villari, B, Volpe, M, De Rosa S., Spaccarotella C., Basso C., Calabro M. P., Curcio A., Filardi P. P., Mancone M., Mercuro G., Muscoli S., Nodari S., Pedrinelli R., Sinagra G., Indolfi C., Angelini F., Barilla F., Bartorelli A., Benedetto F., Bernabo P., Bolognese L., Briani M., Cacciavillani L., Calabrese A., Calabro P., Caliendo L., Calo L., Casella G., Casu G., Cavallini C., Ciampi Q., Ciccone M., Comito M., Corrada E., Crea F., D'Andrea A., D'Urbano M., De Caterina R., De Ferrari G., De Ponti R., Della Mattia A., DI Mario C., Donnazzan L., Esposito G., Fedele F., Ferraro A., Galasso G., Galie N., Gnecchi M., Golino P., Golia B., Guarini P., Leonardi S., Locuratolo N., Luzza F., Manganiello V., Francesca Marchetti M., Marenzi G., Margonato A., Meloni L., Metra M., Milo M., Mongiardo A., Monzo L., Morisco C., Novo G., Pancaldi S., Parollo M., Paterno G., Patti G., Priori S., Ravera A., Giuseppe Rebuzzi A., Rossi M., Scherillo M., Semprini F., Senni M., Sibilio G., Siviglia M., Tamburino C., Tortorici G., Versace F., Villari B., and Volpe M.

Abstract

Aims: To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results: We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7-32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3-70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7-6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1-2.8; P = 0.009). Conclusion: Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.

Published
2020

2. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Author

De Rosa, Miriam Stefania, Spaccarotella, C., Basso, C., Calabro, M. P., Curcio, A., Filardi, P. P., Mancone, M., Mercuro, G., Muscoli, S., Nodari, S., Pedrinelli, R., Sinagra, G., Indolfi, C., Angelini, F., Barilla, F., Bartorelli, A., Benedetto, F., Bernabo, P., Bolognese, L., Briani, M., Cacciavillani, L., Calabrese, Anna Chiara, Calabro, P., Caliendo, L., Calo, L., Casella, Gioietta, Casu, G., Cavallini, C., Ciampi, Q., Ciccone, M., Comito, M., Corrada, E., Crea, Filippo, D'Andrea, A., D'Urbano, M., De Caterina, R., De Ferrari, G., De Ponti, R., Della Mattia, A., Di Mario, Clara, Donnazzan, L., Esposito, Gianfranco, Fedele, F., Ferraro, A., Galasso, G., Galie, N., Gnecchi, M., Golino, P., Golia, B., Guarini, P., Leonardi, S., Locuratolo, N., Luzza, F., Manganiello, V., Francesca Marchetti, M., Marenzi, Giancarlo, Margonato, A., Meloni, L., Metra, M., Milo, Anna Maria, Mongiardo, A., Monzo, L., Morisco, C., Novo, G., Pancaldi, S., Parollo, M., Paterno, G., Patti, G., Priori, S., Ravera, A., Giuseppe Rebuzzi, A., Rossi, M., Scherillo, M., Semprini, F., Senni, M., Sibilio, G., Siviglia, M., Tamburino, C., Tortorici, G., Versace, F., Villari, B., Volpe, M., De Rosa S. (ORCID:0000-0002-8869-155X), Calabrese A., Casella G., Crea F. (ORCID:0000-0001-9404-8846), DI Mario C., Esposito G., Marenzi G., Milo M., De Rosa, Miriam Stefania, Spaccarotella, C., Basso, C., Calabro, M. P., Curcio, A., Filardi, P. P., Mancone, M., Mercuro, G., Muscoli, S., Nodari, S., Pedrinelli, R., Sinagra, G., Indolfi, C., Angelini, F., Barilla, F., Bartorelli, A., Benedetto, F., Bernabo, P., Bolognese, L., Briani, M., Cacciavillani, L., Calabrese, Anna Chiara, Calabro, P., Caliendo, L., Calo, L., Casella, Gioietta, Casu, G., Cavallini, C., Ciampi, Q., Ciccone, M., Comito, M., Corrada, E., Crea, Filippo, D'Andrea, A., D'Urbano, M., De Caterina, R., De Ferrari, G., De Ponti, R., Della Mattia, A., Di Mario, Clara, Donnazzan, L., Esposito, Gianfranco, Fedele, F., Ferraro, A., Galasso, G., Galie, N., Gnecchi, M., Golino, P., Golia, B., Guarini, P., Leonardi, S., Locuratolo, N., Luzza, F., Manganiello, V., Francesca Marchetti, M., Marenzi, Giancarlo, Margonato, A., Meloni, L., Metra, M., Milo, Anna Maria, Mongiardo, A., Monzo, L., Morisco, C., Novo, G., Pancaldi, S., Parollo, M., Paterno, G., Patti, G., Priori, S., Ravera, A., Giuseppe Rebuzzi, A., Rossi, M., Scherillo, M., Semprini, F., Senni, M., Sibilio, G., Siviglia, M., Tamburino, C., Tortorici, G., Versace, F., Villari, B., Volpe, M., De Rosa S. (ORCID:0000-0002-8869-155X), Calabrese A., Casella G., Crea F. (ORCID:0000-0001-9404-8846), DI Mario C., Esposito G., Marenzi G., and Milo M.

Abstract

Aims: To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results: We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7-32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3-70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7-6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1-2.8; P = 0.009). Conclusion: Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.

Published
2020

4. Update of the position document of the Italian Society of Interventional Cardiology (SICI-GISE) on the minimum requirements for hospitals and operators performing procedures of a transcatheter implantation of aortic valve prostheses

Author

Tarantini, G., Esposito, G., Musumeci, G., Fraccaro, C., Franzone, A., Castiglioni, B., La Manna, A., Limbruno, U., Marchese, A., Mauro, C., Rigattieri, S., Tarantino, F., Gandolfo, C., Santoro, G., Violini, R., Airoldi, F., Albiero, R., Balbi, M., Baralis, G., Bartorelli, A.L., Bedogni, F., Benassi, A., Berni, A., Bonzani, G., Bortone, A.S., Braito, G., Briguori, C., Brscic, E., Calabrò, P., Calchera, I., Bigazzi, M.C., Caprioglio, F., Castriota, F., Cernetti, C., Cicala, C., Cioffi, P., Colombo, A., Colombo, V., Contegiacomo, G., Cremonesi, A., D'Amico, M., De Benedictis, M., De Leo, A., Di Biasi, M., Di Girolamo, D., Di Lorenzo, E., Di Mario, C., Dominici, M., Ettori, F., Ferrario, M., Fioranelli, M., Fischetti, D., Gabrielli, G., Giordano, A., Giudice, P., Greco, C., Indolfi, C., Leonzi, O., Lettieri, C., Loi, B., Maddestra, N., Marchionni, N., Marrozzini, C., Medda, M., Missiroli, B., Luigi, M., Oreglia, J.A., Palmieri, C., Pantaleo, P., Paparoni, S.R., Parodi, G., Petronio, A.S., Piatti, L., Piccaluga, E., Pierli, C., Perkan, A., Pitì, A., Poli, A., Ramondo, A.B., Reale, M.A., Reimers, B., Ribichini, F.L., Rosso, R., Saccà, S., Sacra, C., Santarelli, A., Sardella, G., Satullo, G., Scalise, F., Siviglia, M., Spedicato, L., Stabile, A., Tamburino, C., Tesorio, T.N.M., Tolaro, S., Tomai, F., Trani, C., Valenti, R., Valsecchi, O., Valva, G., Varbella, F., Vigna, C., Vignali, L., Berti, S., Tarantini, Giuseppe, Esposito, Giovanni, Musumeci, Giuseppe, Fraccaro, Chiara, Franzone, Anna, Castiglioni, Battistina, La Manna, Alessio, Limbruno, Ugo, Marchese, Alfredo, Mauro, Ciro, Rigattieri, Stefano, Tarantino, Fabio, Gandolfo, Caterina, Santoro, Gennaro, Violini, Roberto, Airoldi, Flavio, Albiero, Remo, Balbi, Manrico, Baralis, Giorgio, Bartorelli, Antonio Luca, Bedogni, Francesco, Benassi, Alberto, Berni, Andrea, Bonzani, Giulio, Bortone, Alessandro Santo, Braito, Giuseppe, Briguori, Carlo, Brscic, Elvi, Calabrò, Paolo, Calchera, Ivan, Cappelli Bigazzi, Maurizio, Caprioglio, Francesco, Castriota, Fausto, Cernetti, Carlo, Cicala, Cinzia, Cioffi, Paolo, Colombo, Antonio, Colombo, Virgilio, Contegiacomo, Gaetano, Cremonesi, Alberto, D'Amico, Maurizio, De Benedictis, Mauro, De Leo, Alessandro, Di Biasi, Maurizio, Di Girolamo, Domenico, Di Lorenzo, Emilio, Di Mario, Carlo, Dominici, Marcello, Ettori, Federica, Ferrario, Maurizio, Fioranelli, Massimo, Fischetti, Dionigi, Gabrielli, Gabriele, Giordano, Arturo, Giudice, Pietro, Greco, Cesare, Indolfi, Ciro, Leonzi, Ornella, Lettieri, Corrado, Loi, Bruno, Maddestra, Nicola, Marchionni, Niccolò, Marrozzini, Cinzia, Medda, Massimo, Missiroli, Bindo, Luigi, My, Oreglia, Jacopo Andrea, Palmieri, Cataldo, Pantaleo, Paolo, Paparoni, Saro Roberto, Parodi, Guido, Petronio, Anna Sonia, Piatti, Luigi, Piccaluga, Emanuela, Pierli, Carlo, Perkan, Andrea, Pitì, Antonino, Poli, Arnaldo, Ramondo, Angelo Bruno, Reale, Maurizio Alessandro, Reimers, Bernhard, Ribichini, Flavio Luciano, Rosso, Roberta, Saccà, Salvatore, Sacra, Cosimo, Santarelli, Andrea, Sardella, Gennaro, Satullo, Gaetano, Scalise, Filippo, Siviglia, Massimo, Spedicato, Leonardo, Stabile, Amerigo, Tamburino, Corrado, Tesorio, Tullio Nicola Maria, Tolaro, Salvatore, Tomai, Fabrizio, Trani, Carlo, Valenti, Renato, Valsecchi, Orazio, Valva, Giuseppe, Varbella, Ferdinando, Vigna, Carlo, Vignali, Luigi, and Berti, Sergio

Subjects
Transcatheter aortic valve implantation, Institutions, Operators, Requirements, Training, Cardiology and Cardiovascular Medicine, Requirement, Institution, Operator, Settore MED/11 - Malattie dell'Apparato Cardiovascolare
Abstract

Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program. Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.

Published
2018

8. Update of the position document of the Italian society of interventional Cardiology (SICI-GISE) on the minimum requirements for hospitals and operators performing procedures of a transcatheter implantation of aortic valve prostheses,Update del documento di posizione della Società Italiana di Cardiologia Interventistica (SICI-GISE) sui requisiti minimi per ospedali ed operatori che eseguono procedure di impianto transcatetere di protesi valvolare aortica

Author

Tarantini, G., Esposito, G., Musumeci, G., Chiara Fraccaro, Franzone, A., Castiglioni, B., La Manna, A., Limbruno, U., Marchese, A., Mauro, C., Rigattieri, S., Tarantino, F., Gandolfo, C., Santoro, G., Violini, R., Airoldi, F., Albiero, R., Balbi, M., Baralis, G., Bartorelli, A. L., Bedogni, F., Benassi, A., Berni, A., Bonzani, G., Bortone, A. S., Braito, G., Briguori, C., Brscic, E., Calabrò, P., Calchera, I., Bigazzi, M. C., Caprioglio, F., Castriota, F., Cernetti, C., Cicala, C., Cioffi, P., Colombo, A., Colombo, V., Contegiacomo, G., Cremonesi, A., D Amico, M., Benedictis, M., Leo, A., Di Biasi, M., Di Girolamo, D., Di Lorenzo, E., Di Mario, C., Dominici, M., Ettori, F., Ferrario, M., Fioranelli, M., Fischetti, D., Gabrielli, G., Giordano, A., Giudice, P., Greco, C., Indolfi, C., Leonzi, O., Lettieri, C., Loi, B., Maddestra, N., Marchionni, N., Marrozzini, C., Medda, M., Missiroli, B., My, L., Oreglia, J. A., Palmieri, C., Pantaleo, P., Paparoni, S. R., Parodi, G., Petronio, A. S., Piatti, L., Piccaluga, E., Pierli, C., Perkan, A., Pitì, A., Poli, A., Ramondo, A. B., Reale, M. A., Reimers, B., Ribichini, F. L., Rosso, R., Saccà, S., Sacra, C., Santarelli, A., Sardella, G., Satullo, G., Scalise, F., Siviglia, M., Spedicato, L., Stabile, A., Tamburino, C., Tesorio, T. N. M., Tolaro, S., Tomai, F., Trani, C., Valenti, R., Valsecchi, O., Valva, G., Varbella, F., Vigna, C., Vignali, L., and Berti, S.

9. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

Author

De Rosa, Salvatore, Spaccarotella, Carmen, Basso, Cristina, Calabrò, Maria Pia, Curcio, Antonio, Filardi, Pasquale Perrone, Mancone, Massimo, Mercuro, Giuseppe, Muscoli, Saverio, Nodari, Savina, Pedrinelli, Roberto, Sinagra, Gianfranco, Indolfi, Ciro, Angelini, Filippo, Barillà, Francesco, Bartorelli, Antonio, Benedetto, Francesco, Bernabò, Paola, Bolognese, Leonardo, Briani, Martina, Cacciavillani, Luisa, Calabrese, Alice, Calabrò, Paolo, Caliendo, Luigi, Calò, Leonardo, Casella, Gianni, Casu, Gavino, Cavallini, Claudio, Ciampi, Quirino, Ciccone, Marco, Comito, Michele, Corrada, Elena, Crea, Filippo, D’Andrea, Antonello, D’Urbano, Maurizio, De Caterina, Raffaele, De Ferrari, Gaetano, De Ponti, Roberto, Della Mattia, Alessio, Di Mario, Carlo, Donazzan, Luca, Esposito, Giovanni, Fedele, Francesco, Ferraro, Alessandro, Galasso, Gennaro, Galiè, Nazzareno, Gnecchi, Massimiliano, Golino, Paolo, Golia, Bruno, Guarini, Pasquale, Leonardi, Sergio, Locuratolo, Nicola, Luzza, Francesco, Manganiello, Vincenzo, Francesca Marchetti, Maria, Marenzi, Giancarlo, Margonato, Alberto, Meloni, Luigi, Metra, Marco, Milo, Marco, Mongiardo, Annalisa, Monzo, Luca, Morisco, Carmine, Novo, Giuseppina, Pancaldi, Stefano, Parollo, Matteo, Paternò, Giovanni, Patti, Giuseppe, Priori, Silvia, Ravera, Amelia, Giuseppe Rebuzzi, Antonio, Rossi, Massimo, Scherillo, Marino, Semprini, Franco, Senni, Michele, Sibilio, Gerolamo, Siviglia, Massimo, Tamburino, Corrado, Tortorici, Gianfranco, Versace, Francesco, Villari, Bruno, Volpe, Massimo, De Rosa S., Spaccarotella C., Basso C., Calabro M.P., Curcio A., Filardi P.P., Mancone M., Mercuro G., Muscoli S., Nodari S., Pedrinelli R., Sinagra G., Indolfi C., Angelini F., Barilla F., Bartorelli A., Benedetto F., Bernabo P., Bolognese L., Briani M., Cacciavillani L., Calabrese A., Calabro P., Caliendo L., Calo L., Casella G., Casu G., Cavallini C., Ciampi Q., Ciccone M., Comito M., Corrada E., Crea F., D'Andrea A., D'Urbano M., De Caterina R., De Ferrari G., De Ponti R., Della Mattia A., DI Mario C., Donnazzan L., Esposito G., Fedele F., Ferraro A., Galasso G., Galie N., Gnecchi M., Golino P., Golia B., Guarini P., Leonardi S., Locuratolo N., Luzza F., Manganiello V., Francesca Marchetti M., Marenzi G., Margonato A., Meloni L., Metra M., Milo M., Mongiardo A., Monzo L., Morisco C., Novo G., Pancaldi S., Parollo M., Paterno G., Patti G., Priori S., Ravera A., Giuseppe Rebuzzi A., Rossi M., Scherillo M., Semprini F., Senni M., Sibilio G., Siviglia M., Tamburino C., Tortorici G., Versace F., Villari B., Volpe M., De Rosa, S., Spaccarotella, C., Basso, C., Calabro, M. P., Curcio, A., Filardi, P. P., Mancone, M., Mercuro, G., Muscoli, S., Nodari, S., Pedrinelli, R., Sinagra, G., Indolfi, C., Angelini, F., Barilla, F., Bartorelli, A., Benedetto, F., Bernabo, P., Bolognese, L., Briani, M., Cacciavillani, L., Calabrese, A., Calabro, P., Caliendo, L., Calo, L., Casella, G., Casu, G., Cavallini, C., Ciampi, Q., Ciccone, M., Comito, M., Corrada, E., Crea, F., D'Andrea, A., D'Urbano, M., De Caterina, R., De Ferrari, G., De Ponti, R., Della Mattia, A., DI Mario, C., Donnazzan, L., Esposito, G., Fedele, F., Ferraro, A., Galasso, G., Galie, N., Gnecchi, M., Golino, P., Golia, B., Guarini, P., Leonardi, S., Locuratolo, N., Luzza, F., Manganiello, V., Francesca Marchetti, M., Marenzi, G., Margonato, A., Meloni, L., Metra, M., Milo, M., Mongiardo, A., Monzo, L., Morisco, C., Novo, G., Pancaldi, S., Parollo, M., Paterno, G., Patti, G., Priori, S., Ravera, A., Giuseppe Rebuzzi, A., Rossi, M., Scherillo, M., Semprini, F., Senni, M., Sibilio, G., Siviglia, M., Tamburino, C., Tortorici, G., Versace, F., Villari, B., Volpe, M., De Rosa, S, Spaccarotella, C, Basso, C, Calabro, M, Curcio, A, Filardi, P, Mancone, M, Mercuro, G, Muscoli, S, Nodari, S, Pedrinelli, R, Sinagra, G, Indolfi, C, Angelini, F, Barilla, F, Bartorelli, A, Benedetto, F, Bernabo, P, Bolognese, L, Briani, M, Cacciavillani, L, Calabrese, A, Calabro, P, Caliendo, L, Calo, L, Casella, G, Casu, G, Cavallini, C, Ciampi, Q, Ciccone, M, Comito, M, Corrada, E, Crea, F, D'Andrea, A, D'Urbano, M, De Caterina, R, De Ferrari, G, De Ponti, R, Della Mattia, A, DI Mario, C, Donnazzan, L, Esposito, G, Fedele, F, Ferraro, A, Galasso, G, Galie, N, Gnecchi, M, Golino, P, Golia, B, Guarini, P, Leonardi, S, Locuratolo, N, Luzza, F, Manganiello, V, Francesca Marchetti, M, Marenzi, G, Margonato, A, Meloni, L, Metra, M, Milo, M, Mongiardo, A, Monzo, L, Morisco, C, Novo, G, Pancaldi, S, Parollo, M, Paterno, G, Patti, G, Priori, S, Ravera, A, Giuseppe Rebuzzi, A, Rossi, M, Scherillo, M, Semprini, F, Senni, M, Sibilio, G, Siviglia, M, Tamburino, C, Tortorici, G, Versace, F, Villari, B, Volpe, M, De Rosa, Salvatore, Spaccarotella, Carmen, Basso, Cristina, Calabrò, Maria Pia, Curcio, Antonio, Filardi, Pasquale Perrone, Mancone, Massimo, Mercuro, Giuseppe, Muscoli, Saverio, Nodari, Savina, Pedrinelli, Roberto, Sinagra, Gianfranco, and Indolfi, Ciro

Subjects
Male, Myocardial Infarction, 030204 cardiovascular system & hematology, Settore MED/11, 0302 clinical medicine, Acute myocardial infarction, Cardiac care units, STEMI, Aged, Aged, 80 and over, COVID-19, Female, Hospitalization, Humans, Italy, Male, Middle Aged, SARS-CoV-2, Betacoronavirus, Coronavirus Infections, Myocardial Infarction, Pandemics, Pneumonia, Viral, Case fatality rate, 80 and over, Medicine, 030212 general & internal medicine, Myocardial infarction, Viral, Aged, 80 and over, Acute myocardial infarction, Cardiac care units, COVID-19, SARS-CoV2, STEMI, Aged, Female, Hospitalization, Humans, Italy, Middle Aged, Betacoronavirus, Coronavirus Infections, Pandemics, Pneumonia, Viral, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Fast Track Clinical Research, 03 medical and health sciences, Cardiac care unit, cardiovascular diseases, Betacoronaviru, Pandemic, business.industry, Coronavirus Infection, SARS-CoV-2, Pneumonia, medicine.disease, acute myocardial infarction, cardiac care units, Confidence interval, Relative risk, Emergency medicine, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Myocardial infarction complications, Observational study, Myocardial infarction diagnosis, business, Complication
Abstract

Aims To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). Methods and Results We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7–32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3–70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7–6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1–2.8; P = 0.009). Conclusion Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.

Published
2020

10. Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI

Author

Giuseppe De Luca, Pierre Deharo, Pierfrancesco Agostoni, Gabriele Gabrielli, Francisco Bosa Ojeda, Ylitalo Antti, Lisette Okkels Jensen, Bor Wilbert, Luigi Vignali, Fortunato Scotto Di Uccio, Dariusz Dudek, Marco Boccalatte, Monica Verdoia, Edouard Benit, Gianni Casella, Heidi Lehtola, Alessandra Scoccia, Tim Kinnaird, Massimo Siviglia, Raul Moreno, Vladimir Ganyukov, Arpad Lux, Mika Laine, Adrian P. Banning, Santiago Camacho-Freiere, Guido Parodi, José Moreu, Michał Kidawa, Miha Cercek, Victor Becerra, Stephane Manzo, Elvin Kedhi, Marija Vavlukis, Filippo Zilio, Ciro De Simone, Nikola Bakraceski, Xavier Carrillo, Giuseppe Uccello, Maurizio Menichelli, Gerard Rourai Ferrer, Dimitrios Alexopoulos, Benjamin Faurie, Jurriën M. ten Berg, Lucia Marinucci, Juan Sanchis Forés, Giovanni Amoroso, Sébastien Levesque, Bernardo Tuccillo, Enrico Fabris, Peter Ludman, Rui Campante Teles, Wojtek Wojakowski, Leonardo Spedicato, Lucian Calmac, Yves Cottin, Maurits T. Dirksen, Petr Kala, Thomas W Johnson, Xacobe Flores Rios, Gianluca Caiazzo, Clemens van Birgelen, Francesco Versaci, Alexander Ijsselmuiden, Luca Donazzan, Kees-Jan Royaards, Adriaan O. Kraaijeveld, Alejandro Gutierrez Barrios, Gennaro Galasso, Vincenzo Guiducci, Julinda Mehilli, Giuseppe Cirrincione, Andrea Santucci, Giuliana Cortese, José Luis Díez Gil, Iñigo Lozano Martínez-Luengas, Bruno Scheller, Periklis Davlouros, Tomas Kovarnik, Arturo García-Touchard, Pieter C. Smits, De Luca, G., Verdoia, M., Cercek, M., Jensen, L. O., Vavlukis, M., Calmac, L., Johnson, T., Ferrer, G. R., Ganyukov, V., Wojakowski, W., Kinnaird, T., van Birgelen, C., Cottin, Y., Ijsselmuiden, A., Tuccillo, B., Versaci, F., Royaards, K. -J., Berg, J. T., Laine, M., Dirksen, M., Siviglia, M., Casella, G., Kala, P., Diez Gil, J. L., Banning, A., Becerra, V., De Simone, C., Santucci, A., Carrillo, X., Scoccia, A., Amoroso, G., Lux, A., Kovarnik, T., Davlouros, P., Mehilli, J., Gabrielli, G., Rios, X. F., Bakraceski, N., Levesque, S., Cirrincione, G., Guiducci, V., Kidawa, M., Spedicato, L., Marinucci, L., Ludman, P., Zilio, F., Galasso, G., Fabris, E., Menichelli, M., Garcia-Touchard, A., Manzo, S., Caiazzo, G., Moreu, J., Fores, J. S., Donazzan, L., Vignali, L., Teles, R., Benit, E., Agostoni, P., Bosa Ojeda, F., Lehtola, H., Camacho-Freiere, S., Kraaijeveld, A., Antti, Y., Boccalatte, M., Deharo, P., Martinez-Luengas, I. L., Scheller, B., Alexopulos, D., Moreno, R., Kedhi, E., Uccello, G., Faurie, B., Gutierrez Barrios, A., Di Uccio, F. S., Wilbert, B., Smits, P., Cortese, G., Parodi, G., Dudek, D., banning, adrian/0000-0002-2842-7861, GUIDUCCI, VINCENZO/0000-0002-0833-2785, vavlukis, marija/0000-0002-4479-6691, Bor, Willem L/0000-0002-3253-5961, DAVLOUROS, PERIKLIS/0000-0002-1439-1992, Uccello, Giuseppe/0000-0002-6163-8468, Kidawa, Michal/0000-0002-5000-6561, [De Luca, Giuseppe] Univ Piemonte Orientale, Div Cardiol, Azienda Osped Univ Maggiore Carita, Novara, Italy, [Verdoia, Monica] Osped Inferm Biella, ASL Biella, Div Cardiol, Biella, Italy, [Cercek, Miha] Univ Med Ctr, Ctr Intens Internal Med, Ljubljana, Slovenia, [Jensen, Lisette Okkels] Odense Univ Hosp, Div Cardiol, Odense, Denmark, [Vavlukis, Marija] Ss Cyril & Methodius Univ, Med Fac, Univ Clin Cardiol, Skopje, North Macedonia, [Calmac, Lucian] Clin Emergency Hosp Bucharest, Bucharest, Romania, [Johnson, Tom] Univ Hosp Bristol NHSFT, Bristol Heart Inst, Div Cardiol, Bristol, Avon, England, [Johnson, Tom] Univ Bristol, Bristol, Avon, England, [Ferrer, Gerard Rourai] Hosp Univ Bellvitge, Heart Dis Inst, Intervent Cardiol Unit, Barcelona, Spain, [Ganyukov, Vladimir] State Res Inst Complex Issues Cardiovasc Dis, Div Cardiol, Kemerovo, Russia, [Wojakowski, Wojtek] Med Univ Silezia, Div Cardiol, Katowice, Poland, [Kinnaird, Tim] Univ Hosp Wales, Div Cardiol, Cardiff, Wales, [van Birgelen, Clemens] Thoraxctr Twente, Dept Cardiol, Med Spectrum Twente, Enschede, Netherlands, [Cottin, Yves] Univ Hosp, Div Cardiol, Dijon, France, [IJsselmuiden, Alexander] Amphia Hosp, Div Cardiol, Breda, Netherlands, [Tuccillo, Bernardo] Osped Mare, Div Cardiol, Naples, Italy, [Di Uccio, Fortunato Scotto] Osped Mare, Div Cardiol, Naples, Italy, [Versaci, Francesco] Osped Santa Maria Goretti, Div Cardiol, Latina, Italy, [Royaards, Kees-Jan] Maasstad Ziekenhuis, Div Cardiol, Rotterdam, Netherlands, [Smits, Pieter] Maasstad Ziekenhuis, Div Cardiol, Rotterdam, Netherlands, [Ten Berg, Jurrien] St Antonius Hosp, Div Cardiol, Nieuwegein, Netherlands, [Wilbert, Bor] St Antonius Hosp, Div Cardiol, Nieuwegein, Netherlands, [Laine, Mika] Helsinki Univ Cent Hosp, Div Cardiol, Helsinki, Finland, [Dirksen, Maurits] Northwest Clin, Div Cardiol, Alkmaar, Netherlands, [Siviglia, Massimo] Osped Riuniti Reggio Calabria, Div Cardiol, Reggio Di Calabria, Italy, [Casella, Gianni] Osped Maggiore Bologna, Div Cardiol, Bologna, Italy, [Kala, Petr] Masaryk Univ, Univ Hosp Brno, Med Fac, Brno, Czech Republic, [Diez Gil, Jose Luis] H Univ & Politecn La Fe, Valencia, Spain, [Banning, Adrian] John Radcliffe Hosp, Oxford, England, [Becerra, Victor] Hosp Clin Univ Virgen Victoria, Malaga, Spain, [De Simone, Ciro] Clin Villa Fiori, Div Cardiol, Acerra, Italy, [Santucci, Andrea] Osped Santa Maria Misericordia, Perugia, Italy, [Carrillo, Xavier] Hosp Germans Triasi Pujol, Badalona, Spain, [Scoccia, Alessandra] Osped St Anna, Div Cardiol, Ferrara, Italy, [Amoroso, Giovanni] Onze Lieve Vrouwe Gasthuis OLVG, Amsterdam, Netherlands, [Lux, Arpad] Mastricht Univ, Med Ctr, Maastricht, Netherlands, [Kovarnik, Tomas] Charles Univ Hosp, Prague, Czech Republic, [Davlouros, Periklis] Patras Univ Hosp, Invas Cardiol & Congenital Heart Dis, Patras, Greece, [Mehilli, Julinda] Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Munich, Germany, [Gabrielli, Gabriele] Azienda Osped Univ, Intervent Cardiol Unit, Osped Riuniti, Ancona, Italy, [Rios, Xacobe Flores] Complexo Hosp Univ La Coruna, La Coruna, Spain, [Bakraceski, Nikola] Ctr Cardiovasc Dis, Ohrid, North Macedonia, [Levesque, Sebastien] CHU Poitiers, Univ Hosp, Poitiers, France, [Cirrincione, Giuseppe] Osped Civ Arnas, Div Cardiol, Palermo, Italy, [Guiducci, Vincenzo] AUSL IRCCS, Reggio Emilia, Italy, [Kidawa, Michal] Med Univ Lodz, Cent Hosp, Lodz, Poland, [Spedicato, Leonardo] Osped Santa Maria Misericordia, Div Cardiol, Udine, Italy, [Marinucci, Lucia] Osped Riuniti Marche Nord, Div Cardiol, Azienda Osped, Pesaro, Italy, [Ludman, Peter] Univ Hosp Birmingham, Birmingham, W Midlands, England, [Zilio, Filippo] Osped Santa Chiara, Trento, Italy, [Galasso, Gennaro] Osped San Giovanni Dio Ruggi Aragona, Div Cardiol, Salerno, Italy, [Fabris, Enrico] Univ Ospedali Riuniti, Azienda Osped, Trieste, Italy, [Menichelli, Maurizio] Osped F Spaziani, Div Cardiol, Frosinone, Italy, [Garcia-Touchard, Arturo] Hosp Puerta Hierro, Div Cardiol, Majadahonda, Spain, [Manzo, Stephane] Paris 07 Univ, CHU Lariboisiere, AP HP, Div Cardiol,INSERM,UMRS 942, Paris, France, [Caiazzo, Gianluca] Osped G Moscati, Div Cardiol, Aversa, Italy, [Moreu, Jose] Complejo Hosp Toledo, Div Cardiol, Toledo, Spain, [Sanchis Fores, Juan] Hosp Clin Univ Valencia, Div Cardiol, Valencia, Spain, [Donazzan, Luca] Osped S Maurizio Bolzano, Div Cardiol, Bolzano, Italy, [Vignali, Luigi] Azienda Osped Sanitaria, Intervent Cardiol Unit, Parma, Italy, [Teles, Rui] Hosp Santa Cruz, Div Cardiol, CHLO Carnaxide, Lisbon, Portugal, [Benit, Edouard] Jessa Ziekenhuis, Div Cardiol, Hasselt, Belgium, [Agostoni, Pierfrancesco] Ziekenhuis Netwerk Antwerpen ZNA Middelheim, Div Cardiol, Antwerp, Belgium, [Bosa Ojeda, Francisco] Hosp Univ Canarias, Div Cardiol, Santa Cruz De Tenerife, Spain, [Lehtola, Heidi] Oulu Univ Hosp, Div Cardiol, Oulu, Finland, [Camacho-Freiere, Santiago] Juan Ramon Jimenez Hosp, Div Cardiol, Huelva, Spain, [Kraaijeveld, Adriaan] UMC Utrecht, Div Cardiol, Utrecht, Netherlands, [Antti, Ylitalo] Univ Hosp, Heart Ctr, Div Cardiol, Turku, Finland, [Boccalatte, Marco] Osped Santa Maria Grazie, Div Cardiol, Pozzuoli, Italy, [Deharo, Pierre] Aix Marseille Univ, CHU Timone, Div Cardiol, Marseille, France, [Lozano Martinez-Luengas, Inigo] Hosp Cabuenes, Div Cardiol, Gijon, Spain, [Scheller, Bruno] Univ Saarland, Div Cardiol Clin & Expt Intervent Cardiol, Homburg, Germany, [Alexopoulos, Dimitrios] Attikon Univ Hosp, Div Cardiol, Athens, Greece, [Moreno, Raul] Hosp Paz, Div Cardiol, Madrid, Spain, [Kedhi, Elvin] St Jan Hosp, Div Cardiol, Brugge, Belgium, [Uccello, Giuseppe] Osped A Manzoni Lecco, Div Cardiol, Lecce, Italy, [Faurie, Benjamin] Grp Hosp Mutualiste Grenoble, Div Cardiol, Grenoble, France, [Gutierrez Barrios, Alejandro] Hosp Puerta Mar, Div Cardiol, Cadiz, Spain, [Cortese, Giuliana] Univ Padua, Dept Stat Sci, Padua, Italy, [Parodi, Guido] Azienda Osped Univ Sassari, Sassari, Italy, [Dudek, Dariusz] Jagiellonian Univ Med Coll, Inst Cardiol, Krakow, Poland, RS: Carim - H01 Clinical atrial fibrillation, and Cardiologie

Subjects
Male, Internationality, medical decision-making, medicine.medical_treatment, 030204 cardiovascular system & hematology, Rate ratio, COVID-19 (coronavirus), Settore MED/06, 0302 clinical medicine, Pandemic, Percutaneous Coronary Intervention/statistics & numerical data, Medicine, Viral, 030212 general & internal medicine, Myocardial infarction, Registries, Acute myocardial-infarction, Original Investigation, STEMI, ST-segment elevation myocardial infarction, Middle Aged, 3. Good health, Europe, fibrinolysis, Female, COVID-19, primary angioplasty, STEMI, Aged, Humans, Percutaneous Coronary Intervention, Retrospective Studies, ST Elevation Myocardial Infarction, Coronavirus Infections, Pandemics, Pneumonia, Viral, Cardiology and Cardiovascular Medicine, Editorial Comment, ACUTE MYOCARDIAL-INFARCTION, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Primary angioplasty, IRR, incidence rate ratio, Europe/epidemiology, 03 medical and health sciences, Betacoronavirus, cardiovascular diseases, Mortality, PCI, percutaneous coronary intervention, DES, drug-eluting stent(s), business.industry, ST Elevation Myocardial Infarction/mortality, PPCI, primary PCI, SARS-CoV-2, MORTALITY, Percutaneous coronary intervention, Retrospective cohort study, Pneumonia, medicine.disease, Confidence interval, ST-segment elevation myocardial infarction, CI, confidence interval, Emergency medicine, COVID-19, STEMI, primary angioplasty, ACS, acute coronary syndrome, business
Abstract

Background The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality. Objectives The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of “at-risk” patient cohorts for failure to present or delays to treatment. Methods This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality. Results A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p, Central Illustration

Published
2020
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11. Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

Author

Pierre Deharo, Pieter C. Smits, Giuseppe De Luca, Luigi Vignali, Clemens von Birgelen, Michał Kidawa, Lucia Marinucci, Gabriele Gabrielli, Miha Cercek, Francisco Bosa Ojeda, Bernardo Tuccillo, Lisette Okkels Jensen, Gennaro Galasso, Vincenzo Guiducci, Pierfrancesco Agostoni, Monica Verdoia, Edouard Benit, Ewout Bruwiere, Massimo Siviglia, Maurizio Menichelli, Heidi Lehtola, Stephane Manzo, Benjamin Faurie, Filippo Zilio, Gerard Rourai Ferrer, José Moreu, Guido Parodi, Ylitalo Antti, Rui Campante Teles, Giovanni Amoroso, Jurriën M. ten Berg, Sébastien Levesque, Bor Wilbert, Fortunato Scotto Di Uccio, Maurits T. Dirksen, Raul Moreno, Kees Jan Royaards, Xavier Carrillo, Giuseppe Uccello, Alejandro Gutierrez Barrios, Lucian Calmac, Victor Becerra, Petr Kala, Thomas W Johnson, Wojtek Wojakowski, Marija Vavlukis, Leonardo Spedicato, Adriaan O. Kraaijeveld, Francesco Versaci, Marco Boccalatte, Xacobe Flores Rios, Alessandra Scoccia, Arnoud W J van 't Hof, Efthymia Varytimiadi, Peter Ludman, José Luis Díez Gil, Tomas Kovarnik, Gianni Casella, Tim Kinnaird, Adrian P. Banning, Vladimir Ganyukov, Arturo García-Touchard, Marek Milewski, Ciro De Simone, Nikola Bakraceski, Julinda Mehilli, Giuseppe Cirrincione, Grigorios Tsigkas, Juan Sanchis Forés, Andrea Santucci, Elvin Kedhi, Gianluca Caiazzo, Luca Donazzan, Alexander Ijsselmuiden, Iñigo Lozano Martínez-Luengas, Bruno Scheller, Enrico Fabris, Mika Laine, Yves Cottin, Niels Debel, Santiago Camacho-Freiere, Health Technology & Services Research, RS: Carim - H01 Clinical atrial fibrillation, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), HUS Heart and Lung Center, Kardiologian yksikkö, De Luca, G., Debel, N., Cercek, M., Jensen, L. O., Vavlukis, M., Calmac, L., Johnson, T., Ferrer, G. R., Ganyukov, V., Wojakowski, W., Kinnaird, T., von Birgelen, C., Cottin, Y., Ijsselmuiden, A., Tuccillo, B., Versaci, F., Royaards, K. -J., Berg, J. T., Laine, M., Dirksen, M., Siviglia, M., Casella, G., Kala, P., Diez Gil, J. L., Banning, A., Becerra, V., De Simone, C., Santucci, A., Carrillo, X., Scoccia, A., Amoroso, G., van't Hof, A. W., Kovarnik, T., Tsigkas, G., Mehilli, J., Gabrielli, G., Rios, X. F., Bakraceski, N., Levesque, S., Cirrincione, G., Guiducci, V., Kidawa, M., Spedicato, L., Marinucci, L., Ludman, P., Zilio, F., Galasso, G., Fabris, E., Menichelli, M., Garcia-Touchard, A., Manzo, S., Caiazzo, G., Moreu, J., Fores, J. S., Donazzan, L., Vignali, L., Teles, R., Benit, E., Agostoni, P., Ojeda, F. B., Lehtola, H., Camacho-Freiere, S., Kraaijeveld, A., Antti, Y., Boccalatte, M., Deharo, P., Martinez-Luengas, I. L., Scheller, B., Varytimiadi, E., Moreno, R., Uccello, G., Faurie, B., Gutierrez Barrios, A., Milewski, M., Bruwiere, E., Smits, P., Wilbert, B., Di Uccio, F. S., Parodi, G., Kedhi, E., Verdoia, M., vavlukis, marija/0000-0002-4479-6691, banning, adrian/0000-0002-2842-7861, Agostoni, Pierfrancesco/0000-0002-1505-9369, Jensen, Lisette Okkels/0000-0002-4838-2429, Cercek, Miha/0000-0001-6193-0349, Milewski, Marek/0000-0001-5459-9125, Johnson, Thomas/0000-0003-4638-601X, and Calmac, Lucian/0000-0002-3031-8023

Subjects
Registrie, ST Elevation Myocardial Infarction/diagnosis, medicine.medical_treatment, PRIMARY ANGIOPLASTY, 030204 cardiovascular system & hematology, SARS-CoV-2, ST segment elevation myocardial infarction, 0302 clinical medicine, Retrospective Studie, Registries, 030212 general & internal medicine, Myocardial infarction, skin and connective tissue diseases, THROMBUS ASPIRATION, Percutaneous Coronary Intervention/adverse effects, Thrombosis(please add them), education.field_of_study, Thrombosis, 3. Good health, Treatment Outcome, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Humans, Reperfusion, Retrospective Studies, COVID-19, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction, Population, Article, 03 medical and health sciences, Internal medicine, medicine, cardiovascular diseases, Platelet activation, education, METAANALYSIS, business.industry, MORTALITY, ELEVATION MYOCARDIAL-INFARCTION, Percutaneous coronary intervention, Retrospective cohort study, medicine.disease, body regions, 3121 General medicine, internal medicine and other clinical medicine, Heart failure, Conventional PCI, business
Abstract

Background and aims SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure. Results Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p, Graphical abstract Image 1

Published
2021
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12. Contrast-enhanced excimer laser stepwise approach during PCI for resistant coronary lesions.

Author

Vizzari G, Caminiti R, Ielasi A, Vetta G, Parlavecchio A, Mazzone P, Sacchetta G, Magnocavallo M, Della Rocca DG, Siviglia M, Versace AG, Contarini M, and Micari A

Subjects
Humans, Retrospective Studies, Male, Female, Aged, Treatment Outcome, Middle Aged, Italy, Coronary Angiography, Predictive Value of Tests, Time Factors, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention adverse effects, Stents, Risk Factors, Lasers, Excimer therapeutic use, Atherectomy, Coronary adverse effects, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Contrast Media administration & dosage
Abstract

Background: The treatment of resistant coronary lesions (RCL) is a great challenge for interventional cardiologists. The excimer laser coronary atherectomy (ELCA) is a plaque modification tool based on a main mechanism of photomechanical effect leading to mechanical disruption of the plaque. Contrast dye injection during laser delivery has demonstrated to enhance its power., Aim: To evaluate the effectiveness and safety of the contrast-enhanced ELCA by a stepwise approach in the treatment of RCLs., Methods: We retrospectively examined consecutive patients undergoing contrast-enhanced ELCA-assisted PCI between 2018 and 2021 at two Italian sites. RCLs were defined as novo or in-stent undilatable/uncrossable with conventional balloons (SC/NC balloon). The primary endpoint was ELCA technical success defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis., Results: We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI: 58% of the patients had acute coronary syndrome while the left anterior descending artery was the target vessel in 42.1% of cases. The target lesion was most commonly in-stent (56.2%). The 0.9 mm ELCA catheter tip was employed in 89.5% of cases. The most used frequency/fluency profile was 70/70 (39.5%). The use of contrast-enhanced ELCA was associated with high technical, procedural, and clinical success rates (97.4%, 93.7%, and 90.1%, respectively)., Conclusions: The contrast-enhanced ELCA seems to be a safe and effective treatment option for the management of both de novo and in-stent-resistant coronary lesions., (© 2024 Wiley Periodicals LLC.)

Published
2024
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13. Device-related complications after Impella mechanical circulatory support implantation: an IMP-IT observational multicentre registry substudy.

Author

Ancona MB, Montorfano M, Masiero G, Burzotta F, Briguori C, Pagnesi M, Pazzanese V, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Casu G, Garbo R, Preti G, Nicolini E, Sclafani R, Colonna G, Mojoli M, Siviglia M, Denurra C, Caprioglio F, Scandroglio AM, Tarantini G, and Chieffo A

Subjects
Humans, Registries, Retrospective Studies, Shock, Cardiogenic epidemiology, Shock, Cardiogenic etiology, Treatment Outcome, Heart-Assist Devices adverse effects, Percutaneous Coronary Intervention
Abstract

Aims: To report the incidence, the predictors and clinical impact of device-related complications (DRCs) in the IMP-IT (IMPella Mechanical Circulatory Support Device in Italy) registry. Impella is percutaneous left ventricular assist devices, which provides mechanical circulatory support both in cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). The IMP-IT registry is a multicentre registry evaluating the trends in use and clinical outcomes of Impella in Italy., Methods and Results: A total of 406 patients have been included in this registry: 56.4% in the setting of CS, while 43.6% patients in the setting of HR-PCI. DRCs were defined as a composite endpoint of access-site bleeding, limb ischaemia, vascular complication requiring treatment, haemolysis, aortic injury, and left ventricular perforation. DRC incidence in the overall population was 25.6%, with significantly higher rate in the CS (37.1%) than in the HR-PCI (10.7%) group. The most frequent complication was haemolysis (11.8%), which occurred almost exclusively in CS population. Access-site bleeding was observed in 9.6% of the overall population, with no significant difference between the two groups. Limb ischaemia was observed in 8.3% of the overall population, with significantly higher rate in the CS group. CS and right ventricular dysfunction appear as the strongest independent predictors of DRC. One-year mortality in patients with DRC appears higher than in patients with no DRC. However, DRC was not confirmed as an independent predictor of 1-year mortality at multivariate analysis., Conclusion: In the IMP-IT registry, the rate of DRC was 25.6%, with CS being the strongest independent predictor. DRC was not found as an independent predictor of 1-year mortality., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Published
2021
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14. Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry.

Author

De Luca G, Debel N, Cercek M, Jensen LO, Vavlukis M, Calmac L, Johnson T, Ferrer GR, Ganyukov V, Wojakowski W, Kinnaird T, von Birgelen C, Cottin Y, IJsselmuiden A, Tuccillo B, Versaci F, Royaards KJ, Berg JT, Laine M, Dirksen M, Siviglia M, Casella G, Kala P, Díez Gil JL, Banning A, Becerra V, De Simone C, Santucci A, Carrillo X, Scoccia A, Amoroso G, Van't Hof AW, Kovarnik T, Tsigkas G, Mehilli J, Gabrielli G, Rios XF, Bakraceski N, Levesque S, Cirrincione G, Guiducci V, Kidawa M, Spedicato L, Marinucci L, Ludman P, Zilio F, Galasso G, Fabris E, Menichelli M, Garcia-Touchard A, Manzo S, Caiazzo G, Moreu J, Forés JS, Donazzan L, Vignali L, Teles R, Benit E, Agostoni P, Ojeda FB, Lehtola H, Camacho-Freiere S, Kraaijeveld A, Antti Y, Boccalatte M, Deharo P, Martínez-Luengas IL, Scheller B, Varytimiadi E, Moreno R, Uccello G, Faurie B, Gutierrez Barrios A, Milewski M, Bruwiere E, Smits P, Wilbert B, Di Uccio FS, Parodi G, Kedhi E, and Verdoia M

Subjects
Humans, Registries, Reperfusion, Retrospective Studies, SARS-CoV-2, Treatment Outcome, COVID-19, Percutaneous Coronary Intervention adverse effects, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction surgery
Abstract

Background and Aims: SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI)., Methods: We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure., Results: Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and a significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29% vs 5.5%, p < 0.001), definite in-stent thrombosis (8.1% vs 1.6%, p = 0.004) and heart failure (22.6% vs 10.6%, p = 0.001) that was confirmed after adjustment for confounding factors., Conclusions: Our study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Published
2021
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15. Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI.

Author

De Luca G, Verdoia M, Cercek M, Jensen LO, Vavlukis M, Calmac L, Johnson T, Ferrer GR, Ganyukov V, Wojakowski W, Kinnaird T, van Birgelen C, Cottin Y, IJsselmuiden A, Tuccillo B, Versaci F, Royaards KJ, Berg JT, Laine M, Dirksen M, Siviglia M, Casella G, Kala P, Díez Gil JL, Banning A, Becerra V, De Simone C, Santucci A, Carrillo X, Scoccia A, Amoroso G, Lux A, Kovarnik T, Davlouros P, Mehilli J, Gabrielli G, Rios XF, Bakraceski N, Levesque S, Cirrincione G, Guiducci V, Kidawa M, Spedicato L, Marinucci L, Ludman P, Zilio F, Galasso G, Fabris E, Menichelli M, Garcia-Touchard A, Manzo S, Caiazzo G, Moreu J, Forés JS, Donazzan L, Vignali L, Teles R, Benit E, Agostoni P, Bosa Ojeda F, Lehtola H, Camacho-Freiere S, Kraaijeveld A, Antti Y, Boccalatte M, Deharo P, Martínez-Luengas IL, Scheller B, Alexopoulos D, Moreno R, Kedhi E, Uccello G, Faurie B, Gutierrez Barrios A, Di Uccio FS, Wilbert B, Smits P, Cortese G, Parodi G, and Dudek D

Subjects
Aged, COVID-19, Europe epidemiology, Female, Humans, Male, Middle Aged, Retrospective Studies, ST Elevation Myocardial Infarction therapy, Coronavirus Infections, Pandemics, Percutaneous Coronary Intervention statistics & numerical data, Pneumonia, Viral, Registries, ST Elevation Myocardial Infarction mortality
Abstract

Background: The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality., Objectives: The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment., Methods: This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality., Results: A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic., Conclusions: The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655)., Competing Interests: Author Relationship With Industry This study was promoted by the Eastern Piedmont University, Novara, Italy, without any financial support. Dr. Cortese has been funded by PRIN2017 (20178S4EK9). All authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2020
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16. [Updated SICI-GISE position paper on institutional and operator requirements for transcatheter aortic valve implantation].

Author

Tarantini G, Esposito G, Musumeci G, Fraccaro C, Franzone A, Castiglioni B, La Manna A, Limbruno U, Marchese A, Mauro C, Rigattieri S, Tarantino F, Gandolfo C, Santoro G, Violini R, Airoldi F, Albiero R, Balbi M, Baralis G, Bartorelli AL, Bedogni F, Benassi A, Berni A, Bonzani G, Bortone AS, Braito G, Briguori C, Brscic E, Calabrò P, Calchera I, Cappelli Bigazzi M, Caprioglio F, Castriota F, Cernetti C, Cicala C, Cioffi P, Colombo A, Colombo V, Contegiacomo G, Cremonesi A, D'Amico M, De Benedictis M, De Leo A, Di Biasi M, Di Girolamo D, Di Lorenzo E, Di Mario C, Dominici M, Ettori F, Ferrario M, Fioranelli M, Fischetti D, Gabrielli G, Giordano A, Giudice P, Greco C, Indolfi C, Leonzi O, Lettieri C, Loi B, Maddestra N, Marchionni N, Marrozzini C, Medda M, Missiroli B, My L, Oreglia JA, Palmieri C, Pantaleo P, Paparoni SR, Parodi G, Petronio AS, Piatti L, Piccaluga E, Pierli C, Perkan A, Pitì A, Poli A, Ramondo AB, Reale MA, Reimers B, Ribichini FL, Rosso R, Saccà S, Sacra C, Santarelli A, Sardella G, Satullo G, Scalise F, Siviglia M, Spedicato L, Stabile A, Tamburino C, Tesorio TNM, Tolaro S, Tomai F, Trani C, Valenti R, Valsecchi O, Valva G, Varbella F, Vigna C, Vignali L, and Berti S

Subjects
Aortic Valve Stenosis physiopathology, Biomedical Technology trends, Humans, Italy, Severity of Illness Index, Transcatheter Aortic Valve Replacement instrumentation, Aortic Valve Stenosis surgery, Program Development methods, Transcatheter Aortic Valve Replacement methods
Abstract

Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.

Published
2018
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17. Cystatin C is associated with an increased coronary atherosclerotic burden and a stable plaque phenotype in patients with ischemic heart disease and normal glomerular filtration rate.

Author

Niccoli G, Conte M, Della Bona R, Altamura L, Siviglia M, Dato I, Ferrante G, Leone AM, Porto I, Burzotta F, Brugaletta S, Biasucci LM, and Crea F

Subjects
Aged, Biomarkers blood, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Cystatin C, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Phenotype, Prognosis, Coronary Artery Disease blood, Coronary Artery Disease pathology, Cystatins blood, Severity of Illness Index
Abstract

Objective: Cystatin C (Cys-C) is an accurate marker of renal function. Recent studies have shown that serum Cys-C levels predict the risk of cardiovascular events. The causes of this association, however, are largely unknown., Methods and Results: Seventy consecutive patients (age 62+/-12, male sex 87%) undergoing coronary angiography because of typical chest pain and found to have coronary artery disease were included in the present study. Patients with abnormal creatinine-derived glomerular filtration rate (<90ml/min/1.73m(2)) were excluded in order to avoid the well-known effect of overt renal insufficiency on coronary atherosclerosis. Coronary angiography was evaluated by two expert angiographers who assessed disease severity and extent according to the Sullivan's score and lesion morphology. In all patients, Cys-C and C-Reactive Protein (CRP) serum levels were measured on admission. Multivariable analysis was performed to assess independent predictors of angiographic measures. Diabetes was the only predictor of disease severity (p=0.005), while male sex (p=0.03), hypercholesterolemia (p=0.04), diabetes (p<0.0001) and Cys-C (p<0.0001) were independent predictors of disease extent. Independent predictors of smooth lesions were diabetes (p<0.001) and Cys-C (p=0.005). No correlation was found between Cys-C and CRP serum levels (p=0.6)., Conclusion: Cys-C is associated with coronary atherosclerosis extent and a smooth lesion morphology. The long-term prognostic role of Cys-C might be accounted for by a greater atherosclerotic burden, a necessary substrate for plaque destabilization.

Published
2008
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18. Adjunctive devices in primary or rescue PCI: a meta-analysis of randomized trials.

Author

Burzotta F, Testa L, Giannico F, Biondi-Zoccai GG, Trani C, Romagnoli E, Mazzari M, Mongiardo R, Siviglia M, Niccoli G, De Vita M, Porto I, Schiavoni G, and Crea F

Subjects
Angioplasty, Balloon, Coronary methods, Cardiac Catheterization, Coronary Angiography, Coronary Circulation physiology, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Prospective Studies, Risk Assessment, Severity of Illness Index, Stents, Survival Analysis, Treatment Outcome, Vascular Patency, Angioplasty, Balloon, Coronary instrumentation, Coronary Thrombosis prevention & control, Meta-Analysis as Topic, Myocardial Infarction therapy, Prostheses and Implants, Randomized Controlled Trials as Topic
Abstract

Objectives: To overview and summarize the results emerging from the studies on adjunctive devices (AD) with theoretical anti-embolic properties in patients with ST-elevation acute myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCI)., Background: A series of small-to-medium size randomized studies have compared different AD with standard PCI (SP) in the setting of STEMI. The reported results are conflicting., Methods: Eighteen prospective randomized studies on 3180 STEMI patients comparing AD with SP were identified and entered the meta-analysis. Pre-specified angiographic, electrocardiographic (absence of ST-segment resolution, STR) and early (up to 30 days) clinical end-points were assessed., Results: AD were associated with lower rates of angiographically evident distal embolization: OR (95% CI): 0.54 (0.37-0.81). Analyses of angiographic and electrocardiographic reperfusion showed striking heterogeneity among studies and an overall trend toward better results with AD: OR (95% CI) 0.76 (95% CI 0.51-1.12) for TIMI<3, 0.53 (0.37-0.76) for myocardial blush grade (MBG)<3, 0.60 (0.45-0.78) for absence of STR. Subgroup analysis according to the type of AD for the end-point of no STR showed concordant absence of benefit in studies testing distal protection devices, positive results being confined to the studies using thrombectomy devices (OR 0.46, 95% CI 0.32-0.66). However, the possibility of a "small study" bias within thrombectomy studies cannot be discharged (significant heterogeneity and positive Egger's test). Early major adverse cardiac events were not different between AD and SP., Conclusions: AD use may be associated with reduced rate of angiographic distal embolization, and improved MBG 3 and STR rates. However, efficacy might vary with the type of device employed. Moreover, early clinical outcome is not modified suggesting that further, larger, studies are needed to assess the clinical impact of AD., Condensed Abstract: We conducted a meta-analysis of 18 prospective randomized trials comparing adjunctive devices (AD) with standard PCI in the setting of STEMI. The use of AD was associated with lower rates of (angiographically evident) distal embolization. Analyses of angiographic and electrocardiographic reperfusion showed striking heterogeneity and an overall trend toward better results with AD. Subgroup analysis suggested that different types of device may have different effects. Early major adverse cardiac events were similar between AD and SP.

Published
2008
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19. Instability mechanisms in unstable angina according to baseline serum levels of C-reactive protein: the role of thrombosis, fibrinolysis and atherosclerotic burden.

Author

Niccoli G, Biasucci LM, Biscione C, Buffon A, Siviglia M, Conte M, Porto I, Graziani F, Liuzzo G, and Crea F

Subjects
Aged, Angina, Unstable diagnosis, Atherosclerosis diagnosis, Biomarkers blood, Female, Humans, Male, Middle Aged, Thrombosis diagnosis, Angina, Unstable blood, Atherosclerosis blood, C-Reactive Protein metabolism, Fibrinolysis physiology, Thrombosis blood
Abstract

Background: Mechanisms of instability in patients affected by unstable angina and who exhibit low levels of C-reactive protein (CRP) on admission are unclear. We compared levels of markers of thrombin generation [thrombin-antithrombin complexes (TAT), of fibrinolysis [plasmin-antiplasmin complexes (PAP)], and angiographic severity and extent of coronary atherosclerosis in patients with severe unstable angina and high or low systemic levels of CRP., Methods: Forty consecutive patients (age 59.7+/-8.7, 76% males) admitted to our coronary care unit with severe unstable angina (Braunwald class IIIB) were included in the present study. We assayed TAT and PAP using commercially available ELISA assays and CRP with high sensitivity nephelometry. The evaluation of atherosclerotic disease severity and extent was performed. Patients were divided in two groups according to CRP levels: G1=CRP>3 mg/L and G2=CRP<3 mg/L., Results: Number of diseased vessels and number of stenoses plus occlusion were similar between the two groups (1.8+/-0.9 in G1 vs 2.2+/-0.9 in G2, p=NS and 2.6+/-1.9 in G1 vs 2.7+/-1.3 in G2, p=NS, respectively), as well as extent score and index (8.4+/-4.5 in G1 vs 9.2+/-3.1 in G2, p=NS and 0.6+/-0.3 in G1 vs 0.6+/-0.27 in G2, p=NS, respectively). Episodic activation of thrombin generation, as assessed by TAT was more frequent in G1 than in G2 (85% vs 47%, p=0.03). Episodic activation of the fibrinolysis was more frequent in G1 than in G2 (80% vs 40%, p=0.01)., Conclusion: Patients with coronary instability and systemic evidence of inflammation exhibit more frequent activation of the thrombin/fibrinolysis system than patients with a similar clinical presentation but no evidence of systemic inflammation, whereas the coronary atherosclerotic burden is similar. The mechanisms of coronary instability in the absence of systemic evidence of inflammation need to be elucidated by future studies.

Published
2007
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20. Postoperative coronary artery spasm complicating aortic valve replacement: implications for identification and treatment.

Author

Pragliola C, Altamura L, Niccoli G, Siviglia M, De Paulis S, and Possati GF

Subjects
Aged, Amiodarone therapeutic use, Coronary Angiography, Coronary Vasospasm diagnostic imaging, Coronary Vasospasm drug therapy, Drug Therapy, Combination, Humans, Injections, Intra-Arterial, Male, Nitrates administration & dosage, Nitrates therapeutic use, Vasodilator Agents administration & dosage, Vasodilator Agents therapeutic use, Verapamil administration & dosage, Verapamil therapeutic use, Anti-Arrhythmia Agents therapeutic use, Aortic Valve Insufficiency surgery, Coronary Vasospasm etiology, Heart Valve Prosthesis adverse effects
Abstract

We report a case of coronary spasm soon after aortic valve replacement associated with hemodynamic and arrhythmic instability. The spasm was demonstrated at coronary angiography and was resolved with the intracoronary infusion of nitrates and antiarrhythmics.

Published
2007
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21. Outcome of overlapping heterogenous drug-eluting stents and of overlapping drug-eluting and bare metal stents.

Author

Burzotta F, Siviglia M, Altamura L, Trani C, Leone AM, Romagnoli E, Mazzari MA, Mongiardo R, Niccoli G, Brancati M, Biondi-Zoccai G, Rebuzzi AG, Schiavoni G, and Crea F

Subjects
Aged, Antineoplastic Agents, Phytogenic pharmacology, Coronary Angiography, Coronary Disease diagnostic imaging, Female, Follow-Up Studies, Humans, Immunosuppressive Agents pharmacology, Male, Middle Aged, Paclitaxel pharmacology, Prospective Studies, Prosthesis Design, Sirolimus pharmacology, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Coated Materials, Biocompatible, Coronary Disease therapy, Metals, Stents
Abstract

Overlapping homogenous drug-eluting stents (DESs) may be used instead of overlapping bare metal stents (BMSs) to treat coronary lesions longer than available stents. Yet, no data are available on patients treated with overlapping heterogenous DESs or DESs and BMSs. We prospectively assessed 9-month clinical outcome and 6-month angiographic late loss (evaluated at 5 different lesion segments) in a consecutive series of 40 patients who received overlapping homogenous DESs (sirolimus-eluting stent [SES] or paclitaxel-eluting stent [PES]), heterogenous DESs (SES + PES), or overlapping DESs and BMSs. In 8 patients (7 with angiographic follow-up) with overlapping heterogenous DESs, no angiographic or clinical adverse event was observed. Moreover, in-segment late loss was similar to that of patients who received homogenous DESs. In 8 patients (7 with angiographic follow-up) with overlapping DESs and BMSs, there was a higher incidence of major adverse events (3 repeat percutaneous coronary interventions and 1 death, 50% adverse event rate) and worse in-segment binary restenosis rate compared with patients treated with homogenous or heterogenous DESs (p = 0.02 and 0.012, respectively). Late lumen loss at the site of stent overlap showed significant differences according to type of overlapped stent (1.00 +/- 0.76 mm in DES-BMS overlap, 0.32 +/- 0.55 mm in PES-PES overlap, 0.13 +/- 0.11 in SES-PES overlap, and 0.08 +/- 0.10 mm in SES-SES overlap, p = 0.005). In conclusion, the present study suggests that overlap of DESs and BMSs should be avoided because the antirestenotic effect of DESs is skewed by contiguous BMS implantation. Overlap between SESs and PESs in this very preliminary report was associated with no specific adverse event.

Published
2007
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22. A case of fatal stent thrombosis after Carbostent implantation: is clopidogrel alone antiplatelet therapy a safe alternative to aspirin alone antiplatelet therapy?

Author

Niccoli G, Siviglia M, De Vita M, Altamura L, Fusco B, Leone AM, Ferrante G, Rebuzzi AG, and Crea F

Subjects
Aged, Clopidogrel, Fatal Outcome, Humans, Male, Ticlopidine therapeutic use, Aspirin therapeutic use, Platelet Aggregation Inhibitors therapeutic use, Stents adverse effects, Thrombosis etiology, Ticlopidine analogs & derivatives
Abstract

We describe a case of fatal stent thrombosis after Carbostent implantation and clopidogrel alone antiplatelet therapy in a patient affected by rectal cancer who does not tolerate aspirin. He had three-vessel disease, with occlusion of the right and left anterior descending coronary artery and a severe stenosis of the proximal left circumflex. High-risk circumflex percutaneous coronary intervention (PCI) was performed under left ventricular assistance by Impella device with an optimal final angiographic result. After 2 h, however, the patient developed chest pain with marked ST segment elevation in the infero-lateral leads, due to stent thrombosis, and hypotention which rapidly degenerated into cardiac arrest, electromechanical dissociation and death. At the present time the choice between PCI at high risk of stent thrombosis followed by low risk cancer resection and cancer resection at high risk of peri-operative myocardial infarction followed by low risk PCI remains difficult.

Published
2007
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