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

Author

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

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

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

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

Author

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

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

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

Published
2017

6. DETERMINANTS OF 6-MONTH MORTALITY IN SURVIVORS OF MYOCARDIAL-INFARCTION AFTER THROMBOLYSIS - RESULTS OF THE GISSI-2 DATA-BASE

Author

VOLPI A, DEVITA C, FRANZOSI MG, GERACI E, MAGGIONI AP, MAURI F, NEGRI E, SANTORO E, TAVAZZI L, TOGNONI G, FERUGLIO GA, LOTTO A, ROVELLI F, SOLINAS P, BRUNO M, CAPPELLO T, COPPINI A, FINCATI F, MANTOVANI G, PANGRAZZI J, POGNA M, TURAZZA FM, ANSELMI M, BARBONAGLIA L, BIGI R, CAVALLI A, FRIGERIO M, GIORDANO A, GUALTIEROTTI C, TORTA D, CAROLA R, GIORDANO F, BARLOTTI R, LOPARCO G, VIGLINO GL, RUGGERI G, GIAMUNDO L, DANESI A, PACIARONI E, GAMBINI C, URBANO G, PURCARO A, FRANCESCONI M, FIGLIOLIA S, CANNONE M, ANTOLINI R, DEVOTI G, CRISTALLINI P, PORCIELLO PI, TEONI P, BURALI A, ZUCCONELLI V, DEMATTEIS C, IERVOGLINI A, SCATASTA M, AMABILI S, CARATTI CA, ZOLA G, FERRAGUTO P, SALICI G, CENTARO A, ROTIROTI D, GENOVESE M, GINEVRINO P, DAMATO N, ALTAMURA CM, COLONNA L, CASTELLANETA G, BOVENZI F, MESSINA D, GALANTINO A, CAMPOREALE N, CUCCHINI F, CAMPOSTELLA L, MALACRIDA R, GENONI M, PELLEGRINI P, BRIDDA A, RIGGI L, ACONE L, MOSCATIELLO G, BRUNO A, INVERNIZZI G, TESPILI M, GUAGLIUMI G, CASARI A, ALBANO T, TOMASSINI B, DIBIASE G, SCARAMUZZINO G, RUGGERO S, BRACCHETTI D, DECASTRO U, FULVI M, BRAITO E, ERLICHER A, OBERLECHNER W, GAGLIARDI RS, BIGHIGNOLI L, BONIZZATO G, RIZZI GM, SCAZZINA L, PERRINI A, STRANEO G, STRANEO U, SCIRE A, VERRIENTI A, GUADALUPI M, STORELLI A, ZUCCA L, DABUSTI M, ALBONICO B, DEPETRA V, TABACCHI GC, SCERVINO R, MEREU D, MAXIA P, BIANCO A, CRABU E, MANGIAMELI S, CENTAMORE G, MALFITANO D, AMICO C, VANCHERI F, SANTOPUOLI G, BALDINI F, PANTALEONI A, CONTESSOTTO F, TERLIZZI R, MERIGHI A, TURCHI E, TEGLIO V, PIGNATTI F, PEZZANA A, GOZZOLINO G, GIGLIO M, PETTINATI G, IEVA M, CIRICUGNO S, CORREALE E, ROMANO S, DIFUCCIA A, CASTELLANO B, NATALE A, CERNETTI C, CELEGON L, CANDELPERGHER G, ARIENZO F, RUSSO F, DEVIVO L, MAY L, ACHILLI G, BLASI A, SORRENTINO F, DATO A, GALLONE P, PALUMBO C, DELLAMONICA R, PAGANO L, ALBERTI A, ORSELLI L, DEPONTI C, PARMIGIANI ML, FERRARI M, ACITO P, BUSI F, DELLAVITTORIA G, BELLET C, BORTOLINI F, ROSSI A, CORONA C, BONDI S, NICCOLINI D, GAMBERI G, ARCURI G, MAIOLINO P, CARROZZA A, DELIO U, CAPRETTI G, MARINONI C, GUASCONI C, SONNINO S, PAGLIEI M, FERRARI G, LOMBARDI R, AGNELLI D, DERINALDIS G, CALCAGNILE A, SIGNORELLI S, BENDINELLI S, LUSETTI L, MOLLAIOLI M, COSMI F, PLASTINA F, VENNERI N, FERACO E, CATELLI P, POLUZZI C, DISTANTE S, BIANCHI C, COPPETTI S, ZAMPAGLIONE G, GATTO C, ZURLO R, USLENGHI E, MARGARIA F, MILANESE U, LOMANTO B, ZIACCHI V, RIVA D, BERTOCCHI P, TIRELLA G, DAULERIO M, SAURO G, BINI A, MAZZONI V, POGGI P, MARESTA A, JACOPI F, PATRONCINI A, PUPITA F, GAGGI S, FRAUSINI G, ANTONIOLI GE, MALACARNE C, CODECA L, CAPPATO R, ANDREOLI L, VARACCA S, BUIO E, FAZZINI PF, PUCCI P, SARRO F, VERGASSOLA R, BARCHIELLI M, DEMATTEIS D, CARRONE M, BRUNOZZI LT, MENICONI L, LIBERATI R, RADOGNA M, TALLONE M, CONTE R, IERI A, ZIPOLI A, SANSONI M, CANZIANI R, GUIDALI P, CRISTALLO E, MARIELLO F, MUZIO L, BENVENUTO MR, BALDINI MR, VECCHIO C, CHIARELLA F, FALCIDIENO M, CECCHI A, GIULIANO G, SEU V, PERUGINI P, TOSELLI A, BASSO F, CORTI E, ROSSI P, DELFINO R, CAPONNETTO S, GNECCO G, GHIGLIOTTI G, PENNESI A, LOMBARDI G, RUGGIERI A, BERTOLO L, SLOMP L, LANZETTA T, MAZZARONE L, CRESTI A, BELLODI G, ZUARINI AM, VENERI L, PARCHI C, GIOVANELLI N, NEGRONI S, DETHOMATIS M, BARGHINI A, MARINO E, RICCI D, LEMME P, DIGIACOMO U, AQUARO G, RONZANI G, OTTELLO B, VONTI V, MORETTI S, PALERMO R, MARSILI P, SIDERI F, RAGAZZINI G, GRAMENZI S, BATTISTINI S, DIODATO T, VALERIO A, TUCCI C, DEPASQUALE B, GELFO PG, BERTULLA A, BOLLINI R, DEMARCHI E, BACCA F, DEGIORGI V, LOCATELLI V, SAVOIA MT, FERRACINI C, BARBARESI F, COTOGNI A, FRANCO G, PASSONI F, DURBANO M, MORETTI G, PEROTTI S, CAPRETTI M, DELBENE P, CASCONE M, BALDINI U, ORLANDI M, ODDONE A, CAIZZI V, MASINI G, LAZZARI M, BALLERINI B, BOZZI L, MOCETTI T, BERTOLINI A, PASOTTI E, SANGUINETTI M, MANTOVANI R, TOGNOLI T, MAGGI A, TUSA M, CAMERONI E, GUERRA GP, REGGIANI A, REDAELLI S, GIUSTI S, TANTALO L, RIZZI A, DIGIOVANNI N, GUZZO V, GABRIELE M, COLOMBO G, ALBERZONI A, SALVIOLI G, GALFETTI F, DOVICO E, BELLUZZI F, GOLA E, CASELLATO F, LECCHI G, CONSOLO F, SACCA CB, CONSOLO A, PICCOLO E, GASPARINI G, MASSA D, BELLI C, DOSSENA MG, CORSINI C, SANNA GP, AZZOLLINI M, TRUAZZA F, NADOR F, DEMARTINI M, BOZZI G, SEREGNI R, PASTINE I, MORPURGO M, CASAZZA F, REGALIA F, MAGGIOLINI S, RIGO R, PANCALDI S, POZZETTI D, PASCOTTO P, FRANCESCHI L, DAINESE F, MELINI L, CAPPELLI C, BERNARDI C, PALMIERI M, BORGIONI L, ZILIO G, SANDRI R, ALITTO F, MASARO G, VALAGUSSA F, SCHIAVINA R, RAVESI D, DANIELLO L, PIANTADOSI FR, BARRA P, ROMEO D, MININNI N, SEVERINO S, MOSTACCI M, CASTELLARI M, BANDA D, ROLANDI R, VILLA WD, CARBONE V, ALLEGRI M, FASCIOLO L, PITTALIS M, MUREDDU V, SORO F, DELEDDA MG, MARRAS E, MARCHI SM, DELUCA C, MANETTA M, VOLTA SD, SPERANDEO V, DONZELLI M, VITRANO MG, PITROLO F, LAMONICA S, BELLANCA G, MESSINA G, MIRTO U, RAINERI A, TRAINA M, DIBENEDETTO A, RIBAUDO E, DIFRANCESCO M, RONCHITELLI R, CARONE M, DIGREGORIO D, DIPAOLO G, PASQUALE M, COREA L, COCCHIERI M, ALUNNI G, PAPI L, CHIRIATTI G, LUPETTI M, GAZZOLA U, ARRUZZOLI S, VILLANI GQ, MELLINI M, MADRUZZA L, PIAZZA R, MICHELI G, FRANCHINI C, BECHI S, MARTINES C, MARCHESE D, GABBIA G, BIGALLI A, CIUTI M, CABANI E, DELCITERNA F, ALFIERI A, CHITI M, LONGHINI J, CODELUPPI P, NEGRELLI M, ZANUTTINI D, NICOLOSI GL, MARTIN G, PETRELLA A, BARDAZZI L, BIANCO GA, CELLAMARE G, GIANNELLI F, LICITRA G, LICITRA R, LETTICA GV, TUMIOTTO G, BELLANTI G, BOSI S, CASALI G, MONDUCCI I, BARONE A, PARENTI F, HEYMAN J, COZZI E, BALDACCI G, BACCOS D, BRIGHI F, DESANCTIS A, BOCK R, ROSSI F, AMATI P, SEMPRINI P, NARDELLI A, BOTTERO G, VARTOLO C, MILAZZOTTO F, DICROCE G, DIMARIO F, ANGRISANI G, AZZOLINI P, NEJA CP, MANZOLI U, ROSSI E, TRANI C, MASINI V, SEBASTIANI F, TOPAI M, BORGIA MC, LUCIANI C, FERRI F, DEPAOLA D, CAPURSO S, TUGNOLI F, VETTA C, ALTIERI T, BORZI M, VISCOMI A, STRIANO U, SALITURI S, ZONZIN P, FIORENCIS R, BADIN A, RAVERA B, BALDI C, SILVESTRI F, ALLEMANO P, REYNAUD S, SANSON A, MILANI L, DESIMONE MV, RUSSO A, VILLELLA A, GRAZINI M, AMIDEI S, ANSELMI L, PICCANICOLINO R, MASCELLI G, TAGLIAMONTE A, MESSINA V, TEDESCHI C, BOSSI M, BISIOLI M, TACCHI G, PAGNI G, VIVALDI F, IBBA GV, SANNIA L, PEDRAZZINI F, BAGNI E, FABII S, ALVINO A, ANTONIELLI E, DORONZO B, MARTINENGO E, BECCHI G, SALMOIRAGHI A, DIGIOVANNA F, CARAMANNO G, CAPORICCI D, BRUN M, GIANI P, FERRARIO G, PECI P, RONCONI G, SKOUSE D, GIUSTINIANI S, CUCCHI GF, TAVASCI E, SILVERII A, MARCELLINI G, SPECA G, STANISCIA D, CIMINO A, SERAFINI N, DEBONIS P, CERRUTI P, BAZZUCCHI M, DALPRA F, SPEROTTO C, MOLE GD, BARBANO G, POMARI F, GASCHINO G, PARIGI A, GANDOLFO N, RONDONI F, BRUSCA A, DILEO M, GOLZIO PG, ABRATE M, SCLAVO MG, ROCCI R, POGGIO G, GIANI S, CUZZUCREA D, BRASCHI GB, SCIACCA R, SAMMARTANO A, FURLANELLO F, BRAITO G, CUZZATO V, TOTIS O, FAURETTO F, LEO F, GALATI A, PALMA P, CAMERINI F, MORGERA T, BARBIERI L, SLAVICK GA, FRESCO C, CUDA A, SARNICOLA P, ARZILLO P, BINAGHI G, MACCHI G, CALVERI G, DIMARCO G, LEVANTESI G, PANERAI C, CATURELLI G, FACCHIN L, SARTORE G, ZARDINI P, MARINO P, CARBONIERI E, NAVA S, MAZZINI C, NAVA R, SERRA N, SASSARA M, NICROSINI F, GANDOLFI P, BERGOGNONI G, BALLESTRA AM, VIOLO C, VOLPI A, DEVITA C, FRANZOSI MG, GERACI E, MAGGIONI AP, MAURI F, NEGRI E, SANTORO E, TAVAZZI L, TOGNONI G, FERUGLIO GA, LOTTO A, ROVELLI F, SOLINAS P, BRUNO M, CAPPELLO T, COPPINI A, FINCATI F, MANTOVANI G, PANGRAZZI J, POGNA M, TURAZZA FM, ANSELMI M, BARBONAGLIA L, BIGI R, CAVALLI A, FRIGERIO M, GIORDANO A, GUALTIEROTTI C, TORTA D, CAROLA R, GIORDANO F, BARLOTTI R, LOPARCO G, VIGLINO GL, RUGGERI G, GIAMUNDO L, DANESI A, PACIARONI E, GAMBINI C, URBANO G, PURCARO A, FRANCESCONI M, FIGLIOLIA S, CANNONE M, ANTOLINI R, DEVOTI G, CRISTALLINI P, PORCIELLO PI, TEONI P, BURALI A, ZUCCONELLI V, DEMATTEIS C, IERVOGLINI A, SCATASTA M, AMABILI S, CARATTI CA, ZOLA G, FERRAGUTO P, SALICI G, CENTARO A, ROTIROTI D, GENOVESE M, GINEVRINO P, DAMATO N, ALTAMURA CM, COLONNA L, CASTELLANETA G, BOVENZI F, MESSINA D, GALANTINO A, CAMPOREALE N, CUCCHINI F, CAMPOSTELLA L, MALACRIDA R, GENONI M, PELLEGRINI P, BRIDDA A, RIGGI L, ACONE L, MOSCATIELLO G, BRUNO A, INVERNIZZI G, TESPILI M, GUAGLIUMI G, CASARI A, ALBANO T, TOMASSINI B, DIBIASE G, SCARAMUZZINO G, RUGGERO S, BRACCHETTI D, DECASTRO U, FULVI M, BRAITO E, ERLICHER A, OBERLECHNER W, GAGLIARDI RS, BIGHIGNOLI L, BONIZZATO G, RIZZI GM, SCAZZINA L, PERRINI A, STRANEO G, STRANEO U, SCIRE A, VERRIENTI A, GUADALUPI M, STORELLI A, ZUCCA L, DABUSTI M, ALBONICO B, DEPETRA V, TABACCHI GC, SCERVINO R, MEREU D, MAXIA P, BIANCO A, CRABU E, MANGIAMELI S, CENTAMORE G, MALFITANO D, AMICO C, VANCHERI F, SANTOPUOLI G, BALDINI F, PANTALEONI A, CONTESSOTTO F, TERLIZZI R, MERIGHI A, TURCHI E, TEGLIO V, PIGNATTI F, PEZZANA A, GOZZOLINO G, GIGLIO M, PETTINATI G, IEVA M, CIRICUGNO S, CORREALE E, ROMANO S, DIFUCCIA A, CASTELLANO B, NATALE A, CERNETTI C, CELEGON L, CANDELPERGHER G, ARIENZO F, RUSSO F, DEVIVO L, MAY L, ACHILLI G, BLASI A, SORRENTINO F, DATO A, GALLONE P, PALUMBO C, DELLAMONICA R, PAGANO L, ALBERTI A, ORSELLI L, DEPONTI C, PARMIGIANI ML, FERRARI M, ACITO P, BUSI F, DELLAVITTORIA G, BELLET C, BORTOLINI F, ROSSI A, CORONA C, BONDI S, NICCOLINI D, GAMBERI G, ARCURI G, MAIOLINO P, CARROZZA A, DELIO U, CAPRETTI G, MARINONI C, GUASCONI C, SONNINO S, PAGLIEI M, FERRARI G, LOMBARDI R, AGNELLI D, DERINALDIS G, CALCAGNILE A, SIGNORELLI S, BENDINELLI S, LUSETTI L, MOLLAIOLI M, COSMI F, PLASTINA F, VENNERI N, FERACO E, CATELLI P, POLUZZI C, DISTANTE S, BIANCHI C, COPPETTI S, ZAMPAGLIONE G, GATTO C, ZURLO R, USLENGHI E, MARGARIA F, MILANESE U, LOMANTO B, ZIACCHI V, RIVA D, BERTOCCHI P, TIRELLA G, DAULERIO M, SAURO G, BINI A, MAZZONI V, POGGI P, MARESTA A, JACOPI F, PATRONCINI A, PUPITA F, GAGGI S, FRAUSINI G, ANTONIOLI GE, MALACARNE C, CODECA L, CAPPATO R, ANDREOLI L, VARACCA S, BUIO E, FAZZINI PF, PUCCI P, SARRO F, VERGASSOLA R, BARCHIELLI M, DEMATTEIS D, CARRONE M, BRUNOZZI LT, MENICONI L, LIBERATI R, RADOGNA M, TALLONE M, CONTE R, IERI A, ZIPOLI A, SANSONI M, CANZIANI R, GUIDALI P, CRISTALLO E, MARIELLO F, MUZIO L, BENVENUTO MR, BALDINI MR, VECCHIO C, CHIARELLA F, FALCIDIENO M, CECCHI A, GIULIANO G, SEU V, PERUGINI P, TOSELLI A, BASSO F, CORTI E, ROSSI P, DELFINO R, CAPONNETTO S, GNECCO G, GHIGLIOTTI G, PENNESI A, LOMBARDI G, RUGGIERI A, BERTOLO L, SLOMP L, LANZETTA T, MAZZARONE L, CRESTI A, BELLODI G, ZUARINI AM, VENERI L, PARCHI C, GIOVANELLI N, NEGRONI S, DETHOMATIS M, BARGHINI A, MARINO E, RICCI D, LEMME P, DIGIACOMO U, AQUARO G, RONZANI G, OTTELLO B, VONTI V, MORETTI S, PALERMO R, MARSILI P, SIDERI F, RAGAZZINI G, GRAMENZI S, BATTISTINI S, DIODATO T, VALERIO A, TUCCI C, DEPASQUALE B, GELFO PG, BERTULLA A, BOLLINI R, DEMARCHI E, BACCA F, DEGIORGI V, LOCATELLI V, SAVOIA MT, FERRACINI C, BARBARESI F, COTOGNI A, FRANCO G, PASSONI F, DURBANO M, MORETTI G, PEROTTI S, CAPRETTI M, DELBENE P, CASCONE M, BALDINI U, ORLANDI M, ODDONE A, CAIZZI V, MASINI G, LAZZARI M, BALLERINI B, BOZZI L, MOCETTI T, BERTOLINI A, PASOTTI E, SANGUINETTI M, MANTOVANI R, TOGNOLI T, MAGGI A, TUSA M, CAMERONI E, GUERRA GP, REGGIANI A, REDAELLI S, GIUSTI S, TANTALO L, RIZZI A, DIGIOVANNI N, GUZZO V, GABRIELE M, COLOMBO G, ALBERZONI A, SALVIOLI G, GALFETTI F, DOVICO E, BELLUZZI F, GOLA E, CASELLATO F, LECCHI G, CONSOLO F, SACCA CB, CONSOLO A, PICCOLO E, GASPARINI G, MASSA D, BELLI C, DOSSENA MG, CORSINI C, SANNA GP, AZZOLLINI M, TRUAZZA F, NADOR F, DEMARTINI M, BOZZI G, SEREGNI R, PASTINE I, MORPURGO M, CASAZZA F, REGALIA F, MAGGIOLINI S, RIGO R, PANCALDI S, POZZETTI D, PASCOTTO P, FRANCESCHI L, DAINESE F, MELINI L, CAPPELLI C, BERNARDI C, PALMIERI M, BORGIONI L, ZILIO G, SANDRI R, ALITTO F, MASARO G, VALAGUSSA F, SCHIAVINA R, RAVESI D, DANIELLO L, PIANTADOSI FR, BARRA P, ROMEO D, MININNI N, SEVERINO S, MOSTACCI M, CASTELLARI M, BANDA D, ROLANDI R, VILLA WD, CARBONE V, ALLEGRI M, FASCIOLO L, PITTALIS M, MUREDDU V, SORO F, DELEDDA MG, MARRAS E, MARCHI SM, DELUCA C, MANETTA M, VOLTA SD, SPERANDEO V, DONZELLI M, VITRANO MG, PITROLO F, LAMONICA S, BELLANCA G, MESSINA G, MIRTO U, RAINERI A, TRAINA M, DIBENEDETTO A, RIBAUDO E, DIFRANCESCO M, RONCHITELLI R, CARONE M, DIGREGORIO D, DIPAOLO G, PASQUALE M, COREA L, COCCHIERI M, ALUNNI G, PAPI L, CHIRIATTI G, LUPETTI M, GAZZOLA U, ARRUZZOLI S, VILLANI GQ, MELLINI M, MADRUZZA L, PIAZZA R, MICHELI G, FRANCHINI C, BECHI S, MARTINES C, MARCHESE D, GABBIA G, BIGALLI A, CIUTI M, CABANI E, DELCITERNA F, ALFIERI A, CHITI M, LONGHINI J, CODELUPPI P, NEGRELLI M, ZANUTTINI D, NICOLOSI GL, MARTIN G, PETRELLA A, BARDAZZI L, BIANCO GA, CELLAMARE G, GIANNELLI F, LICITRA G, LICITRA R, LETTICA GV, TUMIOTTO G, BELLANTI G, BOSI S, CASALI G, MONDUCCI I, BARONE A, PARENTI F, HEYMAN J, COZZI E, BALDACCI G, BACCOS D, BRIGHI F, DESANCTIS A, BOCK R, ROSSI F, AMATI P, SEMPRINI P, NARDELLI A, BOTTERO G, VARTOLO C, MILAZZOTTO F, DICROCE G, DIMARIO F, ANGRISANI G, AZZOLINI P, NEJA CP, MANZOLI U, ROSSI E, TRANI C, MASINI V, SEBASTIANI F, TOPAI M, BORGIA MC, LUCIANI C, FERRI F, DEPAOLA D, CAPURSO S, TUGNOLI F, VETTA C, ALTIERI T, BORZI M, VISCOMI A, STRIANO U, SALITURI S, ZONZIN P, FIORENCIS R, BADIN A, RAVERA B, BALDI C, SILVESTRI F, ALLEMANO P, REYNAUD S, SANSON A, MILANI L, DESIMONE MV, RUSSO A, VILLELLA A, GRAZINI M, AMIDEI S, ANSELMI L, PICCANICOLINO R, MASCELLI G, TAGLIAMONTE A, MESSINA V, TEDESCHI C, BOSSI M, BISIOLI M, TACCHI G, PAGNI G, VIVALDI F, IBBA GV, SANNIA L, PEDRAZZINI F, BAGNI E, FABII S, ALVINO A, ANTONIELLI E, DORONZO B, MARTINENGO E, BECCHI G, SALMOIRAGHI A, DIGIOVANNA F, CARAMANNO G, CAPORICCI D, BRUN M, GIANI P, FERRARIO G, PECI P, RONCONI G, SKOUSE D, GIUSTINIANI S, CUCCHI GF, TAVASCI E, SILVERII A, MARCELLINI G, SPECA G, STANISCIA D, CIMINO A, SERAFINI N, DEBONIS P, CERRUTI P, BAZZUCCHI M, DALPRA F, SPEROTTO C, MOLE GD, BARBANO G, POMARI F, GASCHINO G, PARIGI A, GANDOLFO N, RONDONI F, BRUSCA A, DILEO M, GOLZIO PG, ABRATE M, SCLAVO MG, ROCCI R, POGGIO G, GIANI S, CUZZUCREA D, BRASCHI GB, SCIACCA R, SAMMARTANO A, FURLANELLO F, BRAITO G, CUZZATO V, TOTIS O, FAURETTO F, LEO F, GALATI A, PALMA P, CAMERINI F, MORGERA T, BARBIERI L, SLAVICK GA, FRESCO C, CUDA A, SARNICOLA P, ARZILLO P, BINAGHI G, MACCHI G, CALVERI G, DIMARCO G, LEVANTESI G, PANERAI C, CATURELLI G, FACCHIN L, SARTORE G, ZARDINI P, MARINO P, CARBONIERI E, NAVA S, MAZZINI C, NAVA R, SERRA N, SASSARA M, NICROSINI F, GANDOLFI P, BERGOGNONI G, BALLESTRA AM, and VIOLO C

Subjects
cardiovascular diseases
Abstract

Background. Current knowledge of risk assessment in survivors of myocardial infarction is largely based on data gathered before the advent of thrombolysis. It must be determined whether and to what extent available information and proposed criteria of prognostication are applicable in the thrombolytic era. Methods and Results. We reassessed risk prediction in the 10 219 survivors of myocardial infarction with follow-up data available (ie, 98% of the total) who had been enrolled in the GISSI-2 trial, relying on a set of prespecified variables. The 3.5% 6-month all-cause mortality rate of these patients compared with the higher value of 4.6% found in the corresponding GISSI-1 cohort, originally allocated to streptokinase therapy, indicates a 24% reduction in postdischarge 6-month mortality. On multivariate analysis (Cox model), the following variables were predictors of 6-month all-cause mortality: ineligibility for exercise test for both cardiac (relative risk [RR], 3.30; 95% confidence interval [CI], 2.36-4.62) and noncardiac reasons (RR, 3.28; 95% CI, 2.23-4.72), early left ventricular failure (RR, 2.41; 95% Cl, 1.87-3.09), echocardiographic evidence of recovery phase left ventricular dysfunction (RR, 2.30; 95% CI, 1.78-2.98), advanced (more than 70 years) age (RR, 1.81; 95% Cl, 1.43 -2.30), electrical instability (ie, frequent and/or complex ventricular arrhythmias) (RR, 1.70; 95% Cl, 1.32-2.19), late left ventricular failure (RR, 1.54; 95% Cl, 1.17-2.03), previous myocardial infarction (RR, 1.47; 95% CI, 1.14-1.89), and a history of treated hypertension (RR, 1.32; 95% Cl, 1.05-1.65). Early post-myocardial infarction angina, a positive exercise test, female sex, history of angina, history of insulin-dependent diabetes, and anterior site of myocardial infarction were not risk predictors. On further multivariate analysis, performed on 8315 patients with the echocardiographic indicator of left ventricular dysfunction available, only previous myocardial infarction was not retained as an independent risk predictor. Conclusions. A decline in 6-month mortality of myocardial infarction survivors, seen within 6 hours of symptom onset, has been observed in recent years. Ineligibility for exercise test, early left ventricular failure, and recovery-phase left ventricular dysfunction are the most powerful (RR, >2) predictors of 6-month mortality among patients recovering from myocardial infarction after thrombolysis. Qualitative variables reflecting residual myocardial ischemia do not appear to be risk predictors. The lack of an independent adverse influence of early post-myocardial infarction angina on 6-month survival represents a major difference between this study and those of the prethrombolytic era.

10. Usefulness of dipyridamole stress echocardiography for predicting graft patency after coronary artery bypass grafting.

Author

Chirillo F, Bruni A, De Leo A, Olivari Z, Franceschini-Grisolia E, Totis O, and Stritoni P

Subjects
Aged, Coronary Angiography, Coronary Circulation, Coronary Vessels physiology, Echocardiography methods, Exercise Test, Female, Graft Occlusion, Vascular diagnostic imaging, Humans, Male, Mammary Arteries transplantation, Postoperative Period, Predictive Value of Tests, Regional Blood Flow, Sensitivity and Specificity, Vascular Patency, Ventricular Function, Left, Coronary Artery Bypass, Dipyridamole, Echocardiography standards, Graft Occlusion, Vascular diagnosis, Vasodilator Agents
Abstract

Noninvasive techniques often provide controversial results in patients who have coronary artery bypass grafts (CABGs). Vasodilator stress echocardiography allows semi-simultaneous imaging of CABG flow and segmental left ventricular wall motion. To assess the comparative and additive value of regional flow and function for noninvasive evaluation of graft patency status, we evaluated 110 consecutive patients who underwent CABG and who were scheduled for coronary angiography. All patients underwent stress echocardiography with dipyridamole (0.84 mg/kg) and atropine (1 mg), including wall motion analysis by 2-dimensional echocardiography and Doppler evaluation of flow reserve of each CABG. Echocardiographic findings were compared with angiographic data. Four patients had inadequate acoustic windows. The remaining 106 patients had 226 grafts performed. Stress echocardiography showed 67% sensitivity, 91% specificity, and 71% accuracy for identification of 50% to 100% stenosis in the graft or in the recipient coronary vessel. There was a fair agreement with angiography (kappa coefficient 0.60). Identification of impaired coronary bypass flow reserve (i.e., <1.9 for internal mammary grafts and <1.6 for saphenous vein grafts) by Doppler had 91% sensitivity, 88% specificity, and 89% accuracy for graft stenosis. There was good agreement with angiographic findings (kappa 0.77). The combination of the 2 techniques achieved 93% sensitivity, 93% specificity, and 93% accuracy, showing a very good agreement with the patency status of the grafts as evaluated at angiography (kappa 0.85). The combined assessment of wall motion and flow reserve in patients who underwent CABG is feasible and provides an accurate estimate of graft patency status by increasing sensitivity of stress echocardiography and specificity of Doppler flow reserve.

Published
2004
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11. Hemodynamic evaluation of 23 mm Pericarbon and 23 mm Hancock II bioprostheses in the aortic position at mid-term follow up.

Author

Ius P, Totis O, Chirillo F, Cavarzerani A, Zussa C, Piccoli C, and Valfrè C

Subjects
Aged, Aorta, Echocardiography, Echocardiography, Doppler, Female, Follow-Up Studies, Humans, Male, Middle Aged, Bioprosthesis, Heart Valve Prosthesis, Hemodynamics physiology
Abstract

Background and Aims of the Study: Pericardial xenografts were introduced for clinical use following evidence of their good hemodynamic characteristics in laboratory tests; however, their efficiency in comparison with porcine valves has not been fully assessed. Pericarbon, a new type of pericardial bioprosthesis, has been recently developed in order to provide better hemodynamic performances and longer durability than such bioprostheses currently in use., Methods: Fifteen patients operated on for aortic valve replacement with a 23 mm Pericarbon and a sex- and age-matched group operated on with a 23 mm Hancock II bioprosthesis were submitted to echocardiographic and Doppler examinations in order to compare the hemodynamic performance of the two devices., Results: Peak transvalvular gradients for Pericarbon and Hancock II bioprostheses (38.9 +/- 13.0 vs. 33.9 +/- 13.0 mmHg; p = 0.294) and mean transvalvular gradients (24.7 +/- 7.6 vs. 20.8 +/- 9.9 mmHg, p = 0.24) showed no significant difference. However, the indexed effective prosthetic dynamic area was significantly larger for the Hancock II device (0.73 +/- 0.14 vs. 0.62 +/- 0.13 cm2; p < 0.05)., Conclusions: When installed as 23 mm pericardial bioprostheses, the Pericarbon device appears not to demonstrate superior hemodynamic performance to that of the Hancock II; however, additional studies are needed to provide a definitive conclusion.

Published
1996

12. Echocardiography in infective endocarditis: reassessment of the diagnostic criteria of vegetation as evaluated from the precordial and transesophageal approach.

Author

Chirillo F, Bruni A, Giujusa T, Totis O, Cavarzerani A, and Stritoni P

Subjects
Aged, Aortic Valve diagnostic imaging, Aortic Valve microbiology, Discriminant Analysis, Endocarditis, Bacterial pathology, Female, Humans, Image Enhancement, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve microbiology, Motion, Sensitivity and Specificity, Thrombosis pathology, Tricuspid Valve diagnostic imaging, Tricuspid Valve microbiology, Echocardiography methods, Echocardiography, Transesophageal, Endocarditis, Bacterial diagnostic imaging
Abstract

The echocardiographic characteristics of vegetation used by precordial echocardiography (PE) have been transferred unchanged to transesophageal echocardiography (TEE), which has different image definition and structural resolution. Twelve diagnostic criteria of vegetation were tested for their accuracy in 52 patients evaluated by PE and TEE for suspected endocarditis (36 men, 16 women; mean age, 62 +/- 18 years; 42 with proven endocarditis). Results of PE and TEE were validated against gross anatomic and histologic findings. Significant differences (P < .05) included the fact that TEE disclosed more vegetations not prolapsing in the subvalvular region and in absence of valvular regurgitation. At TEE vegetations presented motion distinct from the endocardial surface, irregular conformation, and uneven margins. Only chaotic motion was significantly associated with vegetations at PE; size < 0.5 cm and increased echogenicity characterized pseudovegetations at PE. Other features such as shaggy echoes or location out of the annular zone (previously indicated as typical of vegetations) were not significantly associated with infective lesions. Discriminant analysis of TEE characteristics of vegetations disclosed that chaotic motion was the variable most significantly (P = .008) associated with vegetation. Coexistence of this sign with size < 0.5 cm and uneven margins was associated with 93.3% sensitivity and 83.7% specificity. In conclusion, the echocardiographic aspect of vegetations is rather different when examined from the precordial and the transesophageal approach. Learning about pitfalls and normal variants should improve TEE specificity in the assessment of infective lesions.

Published
1995

13. Comparative diagnostic value of transesophageal echocardiography and retrograde aortography in the evaluation of thoracic aortic dissection.

Author

Chirillo F, Cavallini C, Longhini C, Ius P, Totis O, Cavarzerani A, Bruni A, Valfré C, and Stritoni P

Subjects
Adult, Aged, Aortic Dissection diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Aortic Dissection diagnosis, Aortic Aneurysm, Thoracic diagnosis, Aortography methods, Echocardiography, Transesophageal
Abstract

The aim of this study was to assess the comparative diagnostic value of transesophageal echocardiography (TEE) and retrograde aortography for morphologic evaluation and anatomic mapping of aortic dissection. Seventy patients (aged 18 to 79 years) were prospectively evaluated with both techniques for suspected aortic dissection. In 64 patients, findings on aortography and TEE could be validated against intraoperative (n = 53) and postmortem (n = 11) findings. Examination time was significantly shorter for TEE (9 +/- 6 vs 48 +/- 25 minutes; p < 0.001). For the detection of aortic dissection, aortography showed lower sensitivity (87.5% vs 97.5%) and negative predictive value (85.3% vs 96.7%; both trends did not reach statistical significance) due mostly to the inability to identify noncommunicating dissection (dissection without intimal tears). For the epiphenomena of aortic dissection, aortography was significantly more accurate (97.2% vs 78%; p < 0.05) in assessing the site of entry, and TEE was more accurate in identifying thrombus formation (90% vs 65%; p < 0.05). There was no significant difference between aortography and TEE with regard to assessing secondary tears, aortic regurgitation, coronary dissection, and extension of the dissection. Thus, both TEE and aortography offer detailed anatomic mapping for guided surgical interventions. In elective patients, integration of both techniques seems the best approach; in unstable patients, TEE may be preferential because it is less invasive, requires no contrast injection, and provides accurate diagnosis in a short time at the bedside.

Published
1994
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14. Fortuitous detection of prosthetic valve endocarditis caused by an uncommon etiologic agent.

Author

Zussa C, Ius P, Cesari F, Valfré C, Totis O, Canova C, and Pugina P

Subjects
Echocardiography, Endocarditis, Bacterial etiology, Gram-Negative Bacterial Infections etiology, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Prosthesis-Related Infections etiology, Bioprosthesis adverse effects, Endocarditis, Bacterial diagnostic imaging, Gram-Negative Bacterial Infections diagnostic imaging, Heart Valve Prosthesis adverse effects, Prosthesis-Related Infections diagnostic imaging, Veillonella
Published
1994

15. Aortic endocarditis after percutaneous balloon valvuloplasty: the role of transesophageal echocardiography in early detection and follow-up.

Author

Chirillo F, Cavarzerani A, Totis O, Bruni A, Giommi L, Marton F, and Cuzzato V

Subjects
Aged, Aortic Valve diagnostic imaging, Endocarditis, Bacterial diagnostic imaging, Humans, Male, Staphylococcal Infections diagnostic imaging, Catheterization adverse effects, Echocardiography methods, Endocarditis, Bacterial microbiology, Staphylococcal Infections etiology, Staphylococcus epidermidis isolation & purification
Published
1992
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16. Transesophageal echocardiographic findings in partial and complete papillary muscle rupture complicating acute myocardial infarction.

Author

Chirillo F, Totis O, Cavarzerani A, Bruni A, Risica G, and Cuzzato V

Subjects
Humans, Male, Middle Aged, Echocardiography methods, Heart Rupture, Post-Infarction diagnostic imaging, Papillary Muscles diagnostic imaging
Abstract

Papillary muscle rupture occurred in two patients with recent inferior myocardial infarction. In one case with partial rupture transesophageal echocardiography in the standard four-chamber view did not visualize the rupture and in the second case with complete rupture it provided incomplete diagnostic information. A not previously described transgastric longitudinal scanning of the left ventricle provided complete delineation of the lesion and it was of great value in the diagnosis and management of this potentially lethal complication. Both patients were operated upon and had a favourable outcome.

Published
1992
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