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1. Design and rationale for the Minimizing Adverse haemorrhagic events by TRansradial access site and systemic Implementation of angioX program

Author

Valgimigli, M, Gagnor, A, Calabrò, P, Rubartelli, P, Garducci, S, Ando', Giuseppe, Santarelli, A, Galli, M, Garbo, R, Bramucci, E, Ierna, S, Briguori, C, Cortese, B, Limbruno, U, Violini, R, Presbitero, P, de Cesare, N, Sganzerla, P, Ausiello, A, Tosi, P, Sardella, G, Sabate, M, Brugaletta, S, Saccone, G, Vandoni, P, Zingarelli, A, Liso, A, Rigattieri, S, Di Lorenzo, E, Vigna, C, Palmieri, C, Falcone, C, De Caterina, R, Caputo, M, Esposito, G, Lupi, A, Mazzarotto, P, Varbella, F, Zaro, T, Nazzaro, M, Rao, Sv, van't Hof, Aw, Omerovic, E, Uguccioni, L, Tamburino, C, Ferrari, F, Ceravolo, R, Tarantino, F, Casu, G, Cremonesi, A, Saia, F, Guiducci, V, Dellavalle, A, Curello, S, Mangiacapra, F, Evola, R, Liistro, F, Creaco, M, Colombo, A, Perkan, A, De Servi, S, Fischetti, D, Pucci, E, Romagnoli, E, Moretti, C, Moretti, L, Turturo, M, Bonmassari, R, Penzo, C, Loi, B, Mauro, C, Gabrielli, G, Micari, A, Petronio, As, Comeglio, M, Fresco, C, Pasquetto, G, Belloni, F, Amico, F., Cardiology, Valgimigli, M, Gagnor, A, Calabrò, P, Rubartelli, P, Garducci, S, Andò, G, Santarelli, A, Galli, M, Garbo, R, Bramucci, E, Ierna, S, Briguori, C, Cortese, B, Limbruno, U, Violini, R, Presbitero, P, de Cesare, N, Sganzerla, P, Ausiello, A, Tosi, P, Sardella, G, Sabate, M, Brugaletta, S, Saccone, G, Vandoni, P, Zingarelli, A, Liso, A, Rigattieri, S, Di Lorenzo, E, Vigna, C, Palmieri, C, Falcone, C, De Caterina, R, Caputo, M, Esposito, G, Lupi, A, Mazzarotto, P, Varbella, F, Zaro, T, Nazzaro, M, Rao, Sv, van't Hof, Aw, Omerovic, E, Uguccioni, L, Tamburino, C, Ferrari, F, Ceravolo, R, Tarantino, F, Casu, G, Cremonesi, A, Saia, F, Guiducci, V, Dellavalle, A, Curello, S, Mangiacapra, F, Evola, R, Liistro, F, Creaco, M, Colombo, A, Perkan, A, De Servi, S, Fischetti, D, Pucci, E, Romagnoli, E, Moretti, C, Moretti, L, Turturo, M, Bonmassari, R, Penzo, C, Loi, B, Mauro, C, Gabrielli, G, Micari, A, Petronio, A, Comeglio, M, Fresco, C, Pasquetto, G, Belloni, F, and Amico, F

Subjects
Male, Hirudin, medicine.medical_treatment, Antithrombin, Myocardial Infarction, Peptide Fragment, Bivalirudin, Myocardial infarction, Stroke, Incidence (epidemiology), Heparin, Hirudins, Middle Aged, Recombinant Protein, Recombinant Proteins, Europe, Femoral Artery, Treatment Outcome, Radial Artery, Cardiology, Female, Survival Analysi, Cardiology and Cardiovascular Medicine, medicine.drug, Human, medicine.medical_specialty, Platelet Glycoprotein GPIIb-IIIa Complex, Postoperative Hemorrhage, Acute Coronary Syndrome, Aged, Antithrombins, Humans, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Survival Analysis, Peptide Fragments, Acute coronary syndromes, Transradial intervention, bivalirudin, Internal medicine, medicine, business.industry, Platelet Aggregation Inhibitor, Percutaneous coronary intervention, medicine.disease, Surgery, Access site, business
Abstract

Background Transradial intervention (TRI) and bivalirudin infusion compared with transfemoral coronary intervention or unfractionated heparin plus glycoprotein IIb/IIIa inhibitors decrease bleeding complications in patients with acute coronary syndromes (ACS). Although bleeding is thought to be associated with worse outcomes, it remains unclear whether TRI and bivalirudin both independently lower ischemic or combined ischemic and bleeding complications in ACS patients undergoing contemporary invasive management. Hypotheses The primary objectives of the MATRIX program are to assess whether TRI or bivalirudin as compared, respectively, with transfemoral coronary intervention (MATRIX access site) or unfractionated heparin plus provisional glycoprotein IIb/IIIa inhibitors, (MATRIX antithrombin) decrease the 30-day incidence of an ischemic (ie, death, myocardial infarction or stroke) or an ischemic and bleeding composite end point across the whole spectrum of ACS patients, including clarifying the optimal duration of bivalirudin infusion after percutaneous coronary intervention (MATRIX treatment duration). Study design The MATRIX (NCT01433627) study, which incorporates 3 randomized comparisons in a nonfactorial manner and primary end points at 30 days and clinical follow-up ≤1 year, is a large-scale, multicenter study with blind event adjudication conducted at approximately 100 European sites. With 8,200 patients in the randomized comparison of access sites and 6,800 individuals participating in the randomized comparison of antithrombin regimens, this study will have ≥85% power for the primary end points. Summary The MATRIX program aims at conclusively ascertaining the role of TRI and bivalirudin infusion in the whole spectrum of ACS patients undergoing contemporary invasive management.

Published
2014

2. Vorapaxar in the secondary prevention of atherothrombotic events

Author

Braunwald E, Morrow DA, Scirica BM, Bonaca MP, McCabe CH, Morin S, Fish P, Lamp J, Gershman E, Murphy S, Deenadayalu N, Skene A, Hill K, Bennett L, Strony J, Plat F, Berman G, Lipka L, Kilian A, He W, Liu X, Fox KA, Aylward P, Bassand JP, Betriu A, Bounameaux H, Corbalan R, Creager M, Dalby A, De Ferrari G, Dellborg M, Diehm CH, Dietz R, Goto S, Grande P, Gurbel P, Hankey G, Isaza D, Jensen P, Kiss R, Lewis B, Merlini P, Moliterno D, Morais J, Nicolau JC, Nieminen M, Nilsen D, Olin J, Ophuis TO, Paolasso E, Pichler M, Shinohara Y, Spinar J, Teal P, Tendera M, Theroux P, Thomassen L, Van de Werf F, White H, Wilcox R, Alberts M, Ameriso S, Diener H, Mohr J, Welch M, Wiviott SD, Awtry E, Berger C, Desai A, Gelfand E, Ho C, Leeman D, Link M, Norden A, Pande A, Rost N, Ruberg R, Silverman S, Singhal A, Vita J, Frye RL, Bailey KR, Easton J, Hochman J, Steg PG, Verheught F, Lee K, Mauro DO, Centurion A, Carlevaro O, Cardozo E, Cartasegna L, Soccini N, Farras HA, Molina Aguirre E, Duronto E, Arrechavala L, Rey R, Stilman A, Fernández H, Marinsalta G, Tartaglione J, Chekherdemian M, Povedano G, Casares E, Kantor P, Reges P, Cuneo C, Martinez G, MacKinnon I, Bagnato B, Fernandez A, Funosas C, Lozada A, Barilati P, Ferrari J, Ferrari N, Llanos J, Casaccia G, Giannaula R, García Méndez C, Cirio J, García Dávila C, Estol C, Chiezzo D, Ramirez J, Garrido S, López M, Hominal M, Bianchini MV, Ramos M, Verdini E, Herrera G, Monne H, Ioli P, Samudio MA, Rotta Escalante R, Tarulla A, Reich E, Perez G, Milesi R, Berli M, Marino J, Funes I, Prado A, Bezi M, Fernandez R, Rojas M, Cimbaro Canella JP, Galarza Salazan M, Chew D, Horsfall L, Claxton A, French J, O'Brien K, Nelson G, Loxton A, McCann A, Downey C, Aroney C, Cleave P, Worthley S, Roach A, Amerena J, Long A, Thompson P, Ferguson L, Fitzpatrick M, Mackenzie M, Youssef G, Goldsmith H, Jayasinghe R, Quinlan S, Arstall M, Rose J, Counsell J, Martin M, Crimmins D, Slattery A, Anderson C, Paraskevaidis T, Davis S, Silver G, Gerraty RP, Gapper J, Donnan G, Petrolo S, Whelan A, Tulloch G, Singh B, Campo Ma, Dick R, Savage C, Hill A, Conway B, Waites J, Keays P, Kopp K, Hainzer D, Podczeck Schweighofer A, Priesnitz T, Drexel H, Hagspiel V, Foeger B, Hilbe C, Trinka E, Sinadinoska D, Pilger E, Brodmann M, Stöllberger C, Jungbauer LV, Koppensteiner R, Hoke M, Grisold W, Berger O, Gaul GB, Fazekas N, Wandaller C, Stockenhuber F, Rek A, Willeit J, Zangerle A, Kiechl S, Sturm W, Theurl M, Gruber F, Schacherl S, Auer J, Primus C, Eber B, Ammer M, Hofer JF, Mayr H, Moser S, Hoellmueller I, Van der Werf F, Motte S, Jorion M, Schroë H, Zwinnen W, Vermassen F, Geenens M, De Wolf L, Briké C, De Deyn P, Ongena P, De Klippel N, Meeuwissen K, Desfontaines P, Tincani G, Vandermeeren Y, de Fays K, Pandolfo M, Alaerts N, Peeters A, Findik A, Tack P, deGrande E, Thijs V, Marcelis E, Van Landegem W, Vanhagendoren S, Vanhooren G, Schotte V, Celen H, Bes N, De Letter J, Holvoet G, Claerbout B, Verhamme P, Debaveye B, Bourgeois P, Debrabandere K, Stalpaert S, Dhondt E, De Maeseneire S, De Bleecker J, de Koning K, Vincent M, Tahon S, Monté C, Maes J, Vossaert R, Vandenhoven C, Roosen J, Vissers C, Sinnaeve P, de Velder L, Thoeng J, Cauwenberghs J, Deceuninck F, Nicolau J, Ardito WR, Queirantes C, de Araujo Filho JD, Queirantes CS, Ribeiro JP, Guizzardi SP, Chaves ML, Titton NF, Pereira AH, Webber I, da Silva DG Jr, Uehara RM, Brasileiro J, Maia LN, Souza A, Bodanese LC, Homem R, Friedrich MA, Macagnan AP, Dutra OP, Brum AB, Rossi PR, Herek L, Feitosa GS, Bernardes Ade S, Braga J, Rodrigues D, Guimarães A, Teixeira AB, Marin Neto JA, Tonani M, Piegas LS, Amato V, Leães P, Osorio RL, Ganem F, Vieira AP, Leao P, Kanashiro V, Franken RA, Martins EP, Gagliardi RJ, Silva L, Caffaro RA, Novaes GS, Carvalho A, Laet VL, Miranda F. Jr, Crippa BA, Saraiva JF, Ormundo CT, Speciali JG, Guandolini G, de Albuquerque DC, Silva V, Abrantes JA, Pinheiro L, Teixeira MS, Guanaes DF, Resende ES, Andrade SF, Alves ÁR Jr, Oliveira OM, Tauil CB, Araujo E, de Souza J, de Freitas GR, Horokosky AP, Barbosa EC, Muniz P, de Moraes JB Jr, Cabral M, Faria Neto JR, Belemer A, Paiva MS, Brito A, Hernandes ME, Amorim R, Pittella FJ, Brito HH, Kouz S, Roy M, Gosselin G, David M, Huynh T, Boudreault C, Heath J, Scott L, Bhargava R, Stafford C, Klinke WP, Martin L, Chan YK, Zaniol D, Rebane T, Abramovich M, Vizel S, Fox B, Kornder J, Breakwell L, Constance C, Gauthier M, Cleveland D, Valley S, Dion D, Morissette A, Vertes G, Ross B, Pandey AS, Byrne M, Abramson B, Sodhi N, Ervin F, Thiessen S, Halperin F, Stedham V, Pesant Y, Sardin V, Saw J, Tarry L, Pouliot J, Marquette S, Belisle P, Gagne D, Ducas J, Munoz A, Sussex B, Newman S, Madan M, Hsu E, Bata I, Cossett J, Glanz A, Vilag C, Paddock V, Collings E, Sabbah E, Chausse I, Fortin C, Lepage C, Chehayeb R, Viau C, Ma P, Seib M, Lamy A, Rizzo A, Rajakumar AR, Eikel L, Nigro F, Stoger S, Welsh R, Lindholm L, Parker JD, Webber S, Winkler L, Hannah G, Gupta M, Kubiak A, Mukherjee A, Bozek B, Nguyen M, Dufort L, Haichin R, Toyota V, Bujold S, Syan G, Chinnasane S, Houde G, Rousseau S, Poirier P, Lariviere M, Dupuis R, Ouimet F, Audet J, Darveau C, Labonte R, Rice T, Nawaz S, Cantor W, Robbins K, Boucher P. Jr, Roberge J, Zadra R, McPherson C, Prieto JC, Noriega V, Cereño C, Mestas M, Yovaniniz P, Ferrada W, Pincetti C, Torres G, Perez L, Villan C, Escobar E, Martin R, Padilla I, Ramirez M, Hormazabal R, Pedemonte O, Suazo E, Hasbun S, Mejias M, Cardenas F, Donoso L, Godoy I, Henriquez P, Mariné L, Vergara T, Juri C, Vergara E, Muñoz M, Solano E, Toro J, Cardenas S, Mendoza F, Martinez S, Saaibi JF, Castillo KM, Ruiz NP, Castillo T, Orozco A, Muñoz C, Martínez J, Lopez D, Ochoa J, Andrade J, Jaramillo C, Garces GP, Botero R, Cáceres A, Jaramillo M, Mejia C, Schlesinger A, Munevar V, Rodriguez J, Granados LM, Jaramillo N, Aristizabal C, Cano N, Salazar JC, Urina M, Manco T, Valenzuela C, Hernandez HJ, Delgado PS, Vagner B, Castaño LA, Ucros P, Tellez M, Delgado JA, Piedrahita CA, Crump J, Fernandez V, Quintero CA, Moreno M, Hernandez Triana E, Cuentas I, Accini JL, Accini M, Manzur F, Rivera E, Reynales H, Huertas D, Hovorka J, Filipovsky J, Hirmerova J, Peska S, Jura R, Kanovsky P, Herzig R, Jansky P, Fiala R, Kalita Z, Gatkova A, Bauer J, Fiksa J, Sedlacek J, Monhart Z, Bren J, Linhart A, Skalicka L, Vitovec J, Hlinomaz O, Parenica J, Soucek M, Rihacek I, Branny M, Sknouril L, Klimsa Z, Holub M, Línkova H, Rektor I, Mikulik R, Mayer O. Sr, Novakova B, Bar M, Brodova P, Polasek R, Sabl P, Kos P, Lorenc Z, Macel I, Graversen KH, Galatius S, Soderberg LH, Sillesen H, Madelung S, Overgård K, Stan V, Rasmussen LH, Mortensen B, Iversen HK, Back C, Olesen C, Christensen H, Pedersen A, Nielsen T, Hasain M, Tanggaard L, Husted S, Christensen LL, Haas L, Mickley H, Hosbond S, Rosenlund I, Jepsen J, Kaspersen BB, Bronnum Schou J, Hempel H, Nyvad O, Feldthaus B, Jensen BS, Jensen MK, Andersen G, Thomsen RB, Rokkedal J, Joergensen A, Bülow M, Jeppesen J, Lederballe O, Scheibel I, Sjol A, Larsen J, Graner M, Svahn T, Melin J, Kaakkomäki A, Airaksinen J, Vasankari T, Tatlisumak T, Metso M, Remes A, Näppä M, Jäkälä P, Sivenius J, Kalinen M, Roine RO, Ketola R, Bassand J, Pales D, Coisne D, Berger N, Galinier M, Rosolin N, Elbaz M, Lacassagne L, Montalescot G, Vignolles N, Gully C, Lepage I, Roynard J, Hamon M, Brucato S, Macquin Mavier I, Beitar T, Berthezene P, Medkour T, Amarenco P, Gueblaoui N, Timsit S, Riou D, Mahagne M, Suissa L, Quere I, Clouzot S, Emmerich J, Martinez I, Moulin T, Cole M, Hosseini H, Monod V, Cottin Y, Bichat F, Galley D, Beltra C, Samson Y, Pires R, Bura Riviere A, Pelvet B, Giroud M, Lecheneaut C, Ohlmann P, Ait m. bark Z, Farah B, Petit F, Caussin C, Braun C, Diehm C, Mehrhof F, Inkrot S, Darius H, Heinze H, Radke P, Kulikowsky C, Ferrari M, Utschig S, Strasser R, Haacke K, Felix SB, Bruder M, Nienaber C, Pfaff H, Sohn H, Baylacher M, Mudra H, Setzer P, Konstantinides S, Hallmann A, Kreuzer J, Tsoy I, Schneider P, Appel KF, Habermeier A, Zeiher AM, Kretschmer T, Mitrovic V, Lehinant S, Bohlscheid V, Palme B, Heuer H, Espinola Klein C, Savvidis S, Kleinertz K, Hänel J, Schmidt E, Schmidt A, Ringleb PA, Ludwig I, Dietzold M, Schaffranka A, Ranft J, Cegla C, Berrouschot J, Stoll A, Tanislav C, Brandtner MA, Rosenkranz M, Otto D, Görtler M, Barleben M, Haberl R, Miedl S, Maschke M, Schröder K, Aral Becher B, Herzog Hauff S, Guenther A, Herzau C, Hoffmann U, Roth Zetzsche S, Grond M, Becker M, Hamann G, Simon K, Köhrmann M, Glahn J, Wuttig H, Nabavi DG, Seraphin D, Schellong S, Frommhold R, Dichgans M, Doerr A, Blessing E, Buss I, Butter C, Bettin D, Grosch B, Blank E, Wong L, Liu R, Lee S, Kong S, Yu C, So E, Jakal Á, Masszi G, Czuriga I, Kapocsi J, Soós E, Csiba L, Fekete K, Valikovics A, Dioszeghy P, Muskóczki E, Csányi A, Matoltsy A, Yuval R, Bornstein N, Elimelech R, Chajek Shaul T, Bursztyn M, Hayek T, Hazbon K, Gavish D, Anat N, Wexler D, Azar P, Mosseri M, Tsirulnikov E, Rozenman Y, Logvinenko S, Tanne D, Don A, Gross B, Feldman Y, Klainman E, Genin Dmitrishin I, Eldar M, Eizenberg N, Atar S, Lasri E, Hammerman H, Aharoni G, Zimlichman R, Zuker S, Telman G, Afanasiev S, Katz A, Biton A, Goldhaber A, Goldhaber M, Elian D, Linor A, Meyuhas S, Tsalihin D, Kissos D, Lampl Y, Israelson M, Gottlieb S, Dotan L, Elis A, Karny M, Hussein O, Shestatski K, Brenner H, Segal E, Baldini U, Gavazzi A, Poloni M, Censori B, Aiazzi L, Maraglino C, Marenzi G, Specchia G, Tritto I, Golino P, CIANFLONE , DOMENICO, Martignoni A, Tamburino C, Rubartelli P, Ardissino D, Tadonio I, Stramba Badiale M, Cernuschi P, Nardulli R, Sommariva L, Giordano A, Berni A, Cavallini C, Fiscella A, Azzarelli S, Esposito G, Cassese S, Danzi G, Fattore L, Barbieri E, De Caterina R, Odero A, Puttini M, Corrada E, Monzini N, Vadalà A, Pistarini C, Scrutinio D, Ferratini M, Marcheselli S, Moretti L, Partemi L, Pupilella T, Lazzari A, Ledda A, Geraci G, Rasura M, Beccia M, Cassadonte F, Vatrano M, Bongiorni D, Mos L, Marcuzzi G, Murena E, Uguccioni L, Ferretti C, Piti ATerrosu P, Perrone PF, Marconi R, Grasso L, Severi S, Evola R, Russo N, Agnelli G, Paci C, Carugo S, Silvestri O, Testa R, Novo S., Braunwald, E, Morrow, Da, Scirica, Bm, Bonaca, Mp, Mccabe, Ch, Morin, S, Fish, P, Lamp, J, Gershman, E, Murphy, S, Deenadayalu, N, Skene, A, Hill, K, Bennett, L, Strony, J, Plat, F, Berman, G, Lipka, L, Kilian, A, He, W, Liu, X, Fox, Ka, Aylward, P, Bassand, Jp, Betriu, A, Bounameaux, H, Corbalan, R, Creager, M, Dalby, A, De Ferrari, G, Dellborg, M, Diehm, Ch, Dietz, R, Goto, S, Grande, P, Gurbel, P, Hankey, G, Isaza, D, Jensen, P, Kiss, R, Lewis, B, Merlini, P, Moliterno, D, Morais, J, Nicolau, Jc, Nieminen, M, Nilsen, D, Olin, J, Ophuis, To, Paolasso, E, Pichler, M, Shinohara, Y, Spinar, J, Teal, P, Tendera, M, Theroux, P, Thomassen, L, Van de Werf, F, White, H, Wilcox, R, Alberts, M, Ameriso, S, Diener, H, Mohr, J, Welch, M, Wiviott, Sd, Awtry, E, Berger, C, Desai, A, Gelfand, E, Ho, C, Leeman, D, Link, M, Norden, A, Pande, A, Rost, N, Ruberg, R, Silverman, S, Singhal, A, Vita, J, Frye, Rl, Bailey, Kr, Easton, J, Hochman, J, Steg, Pg, Verheught, F, Lee, K, Mauro, Do, Centurion, A, Carlevaro, O, Cardozo, E, Cartasegna, L, Soccini, N, Farras, Ha, Molina Aguirre, E, Duronto, E, Arrechavala, L, Rey, R, Stilman, A, Fernández, H, Marinsalta, G, Tartaglione, J, Chekherdemian, M, Povedano, G, Casares, E, Kantor, P, Reges, P, Cuneo, C, Martinez, G, Mackinnon, I, Bagnato, B, Fernandez, A, Funosas, C, Lozada, A, Barilati, P, Ferrari, J, Ferrari, N, Llanos, J, Casaccia, G, Giannaula, R, García Méndez, C, Cirio, J, García Dávila, C, Estol, C, Chiezzo, D, Ramirez, J, Garrido, S, López, M, Hominal, M, Bianchini, Mv, Ramos, M, Verdini, E, Herrera, G, Monne, H, Ioli, P, Samudio, Ma, Rotta Escalante, R, Tarulla, A, Reich, E, Perez, G, Milesi, R, Berli, M, Marino, J, Funes, I, Prado, A, Bezi, M, Fernandez, R, Rojas, M, Cimbaro Canella, Jp, Galarza Salazan, M, Chew, D, Horsfall, L, Claxton, A, French, J, O'Brien, K, Nelson, G, Loxton, A, Mccann, A, Downey, C, Aroney, C, Cleave, P, Worthley, S, Roach, A, Amerena, J, Long, A, Thompson, P, Ferguson, L, Fitzpatrick, M, Mackenzie, M, Youssef, G, Goldsmith, H, Jayasinghe, R, Quinlan, S, Arstall, M, Rose, J, Counsell, J, Martin, M, Crimmins, D, Slattery, A, Anderson, C, Paraskevaidis, T, Davis, S, Silver, G, Gerraty, Rp, Gapper, J, Donnan, G, Petrolo, S, Whelan, A, Tulloch, G, Singh, B, Campo, Ma, Dick, R, Savage, C, Hill, 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Abstract

BACKGROUND:Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1.METHODS:We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage.RESULTS:At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P

Published
2012

3. Thrombin-receptor antagonist vorapaxar in acute coronary syndromes

Author

Tricoci, P, Huang, Z, Held, C, Moliterno, Dj, Armstrong, Pw, Van de Werf, F, White, Hd, Aylward, Pe, Wallentin, L, Chen, E, Lokhnygina, Y, Pei, J, Leonardi, S, Rorick, Tl, Kilian, Am, Jennings, Lh, Ambrosio, G, Bode, C, Cequier, A, Cornel, Jh, Diaz, R, Erkan, A, Huber, K, Hudson, Mp, Jiang, L, Jukema, Jw, Lewis, Bs, Lincoff, Am, Montalescot, G, Nicolau, Jc, Ogawa, H, Pfisterer, M, Prieto, Jc, Ruzyllo, W, Sinnaeve, Pr, Storey, Rf, Valgimigli, M, Whellan, Dj, Widimsky, P, Strony, J, Harrington, Ra, Mahaffey, Kw, Huo, Y, Lixin, J, Isaza, D, Grande, P, Laine, M, Wong, L, Ofner, P, Yamaguchi, T, Park, Sj, Nordrehaug, Je, Providencia, L, Cheem, Th, Dalby, A, Betriu, A, Chen, Mf, Verheugt, F, Frye, Rl, Hochman, J, Steg, Pg, Bailey, Kr, Easton, Jd, Lincoff, A, Underwood, Fd, Wrestler, J, Larson, D, Vandyne, B, Kilian, A, Harmelin-Kadouri, R, Layton, L, Lipka, L, Petrauskas, S, Qidwai, M, Sorochuck, C, Temple, T, Mason, D, Sydlowski, D, Gallagher, B, Villasin, A, Beernaert, A, Douglas, S, 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Nakao, K, Kakuta, T, Nakamura, S, Nishi, Y, Kawajiri, K, Nagai, Y, Takahashi, A, Ikari, Y, Hara, K, Koga, T, Fujii, K, Tobaru, T, Tsunoda, R, Uchiyama, T, Hirayama, H, Fujimoto, K, Sakurai, S, Tanigawa, T, Ohno, M, Yamamoto, E, Ikuta, S, Kato, A, Kikuta, K, Takami, A, Chong, Wp, Ong, Tk, Yusof, A, Maskon, O, Kahar, A, Breedveld, Rw, Bendermacher, Pe, Hamer, Bj, Oude Ophuis AJ, Nierop, Pr, Westendorp, Ic, Beijerbacht, Hp, Herrman, Jp, van 't Hof AW, Troquay, Rp, van der Meer, P, Peters, Rh, van Rossum, P, Liem, A, Pieterse, Mg, van Eck JW, van der Zwaan, C, Pasupati, S, Elliott, J, Tisch, J, Hart, H, Luke, R, Scott, D, Ternouth, I, White, H, Hamer, A, Harding, S, Wilkins, G, O'Meeghan, T, Harrison, N, Nilsen, D, Thalamus, J, Aaberge, L, Brunvand, H, Lutterbey, G, Omland, Tm, Eritsland, J, Wiseth, R, Aase, O, Campos, C, Horna, M, Toce, L, Salazar, M, Przewlocki, T, Ponikowski, P, Kasprzak, J, Kopaczewski, J, Musial, W, Mazurek, W, Kawecka-Jaszcz, K, Pluta, W, Dobrzycki, S, Loboz-Grudzien, K, Lewczuk, J, Karwowski, D, Grajek, S, Dudek, D, Trusz-Gluza, M, Kornacewicz-Jach, Z, Gil, R, Ferreira, J, Gavina, C, Ferreira, R, Martins, D, Garcia-Rinaldi, R, Ufret, R, Vazquez-Tanus, J, Banchs, H, Wong, A, Tan, Hc, Guerra, M, Ebrahim, I, Roux, J, Blomerus, P, Saaiman, A, Corbett, C, Pillay, T, Freeman, V, Horak, A, Zambakides, C, Burgess, L, Yoon, Jh, Ahn, Th, Gwon, Hc, Seong, Iw, Kim, Hs, Jeong, Mh, Kim, Yd, Chae, Sc, Hernandez, Jm, Pique, M, Fernandez Portales, J, Paz, Ma, Lopez Palop, R, Iniguez, A, Diaz Fernandez, J, Alvarez, P, Sanz, E, Heras, M, Sala, J, Goicolea, J, Cruz Fernandez, J, Serra, A, Fernandez Ortiz, A, Calle, G, Barriales, V, Albarran, A, Curos, A, Molano Casimiro FJ, Suarez, Ma, Franco, Sn, Bayon, J, Suarez, J, Belchi, J, Moreu, J, San Martin, M, Melgares Moreno, R, Aguirre Salcedo, J, Gonzalez Juanatey JR, Martinez Romero, P, Galache Osuna JG, Albertsson, P, Diderholm, E, Lycksell, M, Rasmanis, G, Swahn, E, Cherfan, P, Christensen, K, Lundman, P, Larson, Le, Vasko, P, Pripp, Cm, Johansson, A, Moccetti, T, Corti, R, Pieper, M, Mach, F, Eberli, F, Jeger, R, Rickli, H, Vogt, P, Windecker, S, Wu, Cj, Kao, Hl, Charng, Mj, Chang, Kc, Chen, Zc, Tsa, Cd, Shyu, Kg, Lai, Wt, Hsieh, Ic, Hou, Jy, Yeh, Hi, Ueng, Kc, Yin, Wh, Timurkaynak, T, Yigit, Z, Yilmaz, M, Boyaci, A, Sahin, M, Goktekin, O, Bozkurt, E, Ercan, E, Yildirir, A, Muthusamy, R, Keeling, P, Levy, T, Zaman, A, Cohen, A, Gorog, D, Baumbach, A, Oldroyd, K, Kadr, H, Tait, G, Bellenger, N, Davis, G, Shakespeare, C, Senior, R, Bruce, D, Uren, N, Trouton, T, Ahsan, A, Hamed, A, Malik, I, Sarma, J, Millar-Craig, M, Robson, H, Kennon, S, Sprigings, D, Brodie, B, Kang, Gs, Thomas, G, Cheng, Sc, Espinoza, A, Kassas, S, Jafar, Z, Kumar, P, Izzo, M, Wiseman, A, Chandna, H, Felten, W, D'Urso, M, Gudipati, Cr, Coram, R, Gill, S, Bengtson, J, Chang, M, Raisinghani, A, Blankenship, J, Harbor, Wf, Kraft, P, Ashraf, R, Chambers, J, Albirini, A, Malik, A, Ziada, K, Slepian, M, Taussig, A, Vernon, H, Jetty, P, Islam, Ma, Canaday, D, Martin, T, Burchenal, Jj, Gencheff, N, Nygaard, T, Panchal, V, Merritt, R, Abrahams, L, Lambert, C, Reyes, P, Leimbach, W, Chhabra, A, Caputo, R, Imburgia, M, Erickson, B, Kleiman, N, Hunter, J, Dehning, M, Graham, B, Strain, J, White, Jk, Mcgarvey, J Jr, Henderson, D, Treasure, C 2nd, Mirro, M, Pancholy, S, Helmy, T, Westerhausen, D, Dib, N, Penny, W, Kim, H, Degregorio, M, Jay, D, Kmonicek, J, Berlowitz, M, Starling, M, Langevin, E, Nelson, R, Singer, A, Siachos, A, Gibson, G, Parrott, C, Held, J, Puleo, P, Wolford, T, Omar, B, Brilakis, E, Lewis, S, Heller, L, Brener, S, Addo, T, Lieberman, S, Eisenberg, D, Feldman, R, Waksman, R, Waltman, J, Schulman, S, Bounds, C, Voyce, S, Batchelor, W, Dobies, D, Pasnoori, V, Chandrashekhar, Y, Vetrovec, G, Azrin, M, Spriggs, D, Hirsch, C, Smucker, M, Chetcuti, S, Stella, R, Levite, H, Shoukfeh, M, Vidovich, M, Saucedo, J, Fintel, D, Low, R, Gellman, J, Ahsan, C, Unks, Dm, Tolleson, T, Ceccoli, H, Aggarwal, K, Bhaktaram, V, Olson, C, Decaro, M, Kaluski, E, Mehta, V, Puma, J, Singh, V, Fulmer, J, Lewis, D, Khadra, S, Staniloae, C, East, M, Sundram, Ps, Anderson, J, Wasserman, H, Guy, D, Brill, D, Kruse, K, Ebrahimi, R, Nguyen, T, Keating, F, Srivastava, R, Wassmer, P, Todd, J 3rd, Stein, M, Hamzeh, I, Laxson, D, Hodson, R, Puri, S, Vijayaraghavan, K, Gazmuri, R, Chu, A, Vijay, N, Rabinowitz, A, Block, T, Agarwal, H, Martin, J, Zetterlund, P, Fortuin, D, Macdonell, A 3rd, Zouzoulas, S, Chepuri, V, Schmalfuss, C, Karve, M, Aviles, R, Lieberman, E, Amlani, M, Murphy, S, Shapiro, T, Herzog, E, Ariani, K, Bhagwat, R, Hockstad, E, Kai, W, Saririan, M, Roth, R, Weiland, F, Atassi, K, Harjai, K, Muhlestein, J, Marsh, R, Shokooh, S, Nahhas, A, Labroo, A, Mayor, M, Koshy, S, Tariq, M, Rayos, G, Jones, S, Klugherz, B, Dewey, R, Rashid, Hu, Wohns, D, Feiring, A, Bowles, M, Rohrbeck, S, Monroe, Vs, De Gottlieb, A, Gumm, D, Brown, C 3rd, Chang, D, Kalaria, V, Minisi, A, Joumaa, M, Josephson, R, Kleczka, J, Silver, K, Coleman, P, Brachfeld, C, Saltiel, F, Reiner, J, Carell, E, Hanovich, G, Rosenberg, M, Das, G, Blick, D, and Universitat de Barcelona

Subjects
Male, Pyridines, medicine.medical_treatment, Kaplan-Meier Estimate, law.invention, Lactones, Randomized controlled trial, law, Thrombin receptor antagonist, clopidogrel, placebo, thienopyridine derivative, vorapaxar, antithrombocytic agent, lactone, proteinase activated receptor 1, pyridine derivative, Coronary Artery Bypass, Vorapaxar, Cardiovascular diseases [NCEBP 14], Drugs, General Medicine, Middle Aged, Combined Modality Therapy, Cardiovascular diseases, Cardiovascular Diseases, Cardiology, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, Plaquetes sanguínies, Intracranial Hemorrhages, Major bleeding, Medicaments, medicine.drug, medicine.medical_specialty, Acute coronary syndrome, Bypass cardiopulmonary, Hemorrhage, Pharmacotherapy, Blood platelets, Double-Blind Method, Angioplasty, Internal medicine, medicine, Humans, Receptor, PAR-1, Acute Coronary Syndrome, Aged, business.industry, Malalties cardiovasculars, medicine.disease, Surgery, Bypass cardiopulmonar, business, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

Item does not contain fulltext BACKGROUND: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. METHODS: In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. RESULTS: Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P=0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P

Published
2012
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8. Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background.

Author

Tagliati C, Fogante M, Palmisano A, Catapano F, Lisi C, Monti L, Lanni G, Cerimele F, Bernardini A, Procaccini L, Argalia G, Esposto Pirani P, Marcucci M, Rebonato A, Cerimele C, Luciano A, Cesarotto M, Belgrano M, Pagnan L, Sarno A, Cova MA, Ventura F, Regnicolo L, Polonara G, Uguccioni L, Quaranta A, Balardi L, Barbarossa A, Stronati G, Guerra F, Chiocchi M, Francone M, Esposito A, and Schicchi N

Subjects
Humans, Tomography, X-Ray Computed, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease diagnostic imaging
Abstract

A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.

Published
2023
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9. One-year results from the Assessing MICRO-vascular resistances via IMR to predict outcome in ST-elevation myocardial infarction patients with multivessel disease undergoing primary PCI (AMICRO) trial.

Author

Fineschi M, Verna E, Barioli A, Mezzapelle G, Bartolini D, Turiano G, Guiducci V, Manari A, Lucarelli K, Uguccioni L, Repetto A, and Tarantini G

Abstract

Background: In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce., Aims: We designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling., Methods: The study enrolled 242 STEMI patients with MVD. Both fractional flow reserve (FFR) and IMR of the IRA were assessed after successful PPCI. Then, FFR/IMR measurements were repeated in the IRA at a staged angiography, and FFR-guided angioplasty was performed in non-IRA lesions. The primary endpoint was the composite of cardiovascular death, re-infarction, re-hospitalization for heart failure, resuscitation or appropriate ICD shock at 1-year follow-up., Results: A significant improvement of IRA-IMR values (from 47.9 to 34.2, p < 0.0001) was observed early after PPCI. Staged FFR-guided angioplasty was performed in 102 non-IRA lesions. We failed to find a correlation between IRA-IMR, clinical events and LV remodeling. Notwithstanding, in patients with anterior STEMI an inverse correlation between initial IMR values and LV function at follow-up was observed., Conclusion: After successful PPCI, a significant proportion of patients with STEMI and MVD had coronary microvascular dysfunction as assessed by IMR that recovered early after reperfusion. Higher IMR values predicted lack of improvement of LV function only in anterior STEMI., Clinical Trial Registration: https://clinicaltrials.gov/, identifier [NCT02325973]., Competing Interests: Authors MF, EV, and GM report speaker honoraria from St. Jude Medical Italia (now Abbott). Authors MF and EV also report consulting fees for St. Jude Medical Italia (now Abbott). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fineschi, Verna, Barioli, Mezzapelle, Bartolini, Turiano, Guiducci, Manari, Lucarelli, Uguccioni, Repetto and Tarantini.)

Published
2022
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10. Association of acute kidney injury and bleeding events with mortality after radial or femoral access in patients with acute coronary syndrome undergoing invasive management: secondary analysis of a randomized clinical trial.

Author

Rothenbühler M, Valgimigli M, Odutayo A, Frigoli E, Leonardi S, Vranckx P, Turturo M, Moretti L, Amico F, Uguccioni L, Contarini M, Gómez-Hospital JA, Mainar V, Creaco M, Petronio AS, Cremonesi A, Tamburino C, Fresco C, Bonmassari R, Díaz Fernández JF, Romagnoli E, Beyersmann J, Heg D, and Jüni P

Subjects
Acute Coronary Syndrome diagnostic imaging, Acute Kidney Injury etiology, Case-Control Studies, Coronary Angiography methods, Femoral Artery surgery, Hemorrhage etiology, Humans, Percutaneous Coronary Intervention methods, Radial Artery surgery, ST Elevation Myocardial Infarction physiopathology, Treatment Outcome, Acute Coronary Syndrome mortality, Acute Coronary Syndrome therapy, Acute Kidney Injury prevention & control, Hemorrhage prevention & control, Percutaneous Coronary Intervention adverse effects
Abstract

Aims: In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) trial, adults with acute coronary syndrome undergoing coronary intervention who were allocated to radial access had a lower risk of bleeding, acute kidney injury (AKI), and all-cause mortality, as compared with those allocated to femoral access. The mechanism of the mortality benefit of radial access remained unclear., Methods and Results: We used multistate and competing risk models to determine the effects of radial and femoral access on bleeding, AKI and all-cause mortality in the MATRIX trial and to disentangle the relationship between these different types of events. There were large relative risk reductions in mortality for radial compared with femoral access for the transition from AKI to death [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.31-0.97] and for the pathway from coronary intervention to AKI to death (HR 0.49, 95% CI 0.26-0.92). Conversely, there was little evidence for a difference between radial and femoral groups for the transition from bleeding to death (HR 1.05, 95% CI 0.42-2.64) and the pathway from coronary intervention to bleeding to death (HR 0.84, 95% CI 0.28-2.49)., Conclusion: The prevention of AKI appeared predominantly responsible for the mortality benefit of radial as compared with femoral access in the MATRIX trial. There was little evidence for an equally important, independent role of bleeding., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Published
2019
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11. Assessing MICRO-vascular resistances via IMR to predict outcome in STEMI patients with multivessel disease undergoing primary PCI (AMICRO): Rationale and design of a prospective multicenter clinical trial.

Author

Fineschi M, Verna E, Mezzapelle G, Bartolini D, Turiano G, Manari A, Lucarelli K, Uguccioni L, Repetto A, and Tarantini G

Subjects
Coronary Angiography, Echocardiography, Humans, Prognosis, Prospective Studies, Research Design, ST Elevation Myocardial Infarction diagnostic imaging, Treatment Outcome, Ventricular Remodeling physiology, Microcirculation physiology, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction physiopathology, ST Elevation Myocardial Infarction surgery
Abstract

Background: In STEMI patients treated with primary percutaneous coronary angioplasty (PPCI) the evaluation of coronary microcirculatory resistance index (IMR) predict the extent of microvascular damage and left ventricular (LV) remodeling. However, the impact of IMR on the clinical outcome after PPCI in patients with multivessel disease (MVD) remains unsettled., Aim: We designed a prospective multicenter controlled clinical trial to evaluate the prognostic value of IMR in terms of clinical outcome and left ventricular remodeling in STEMI patients with MVD undergoing PPCI., Methods and Design: The study will involve 242 patients with MVD defines as the presence of at least a non-culprit lesion of >50% stenosis at index coronary angiography. Both fractional flow reserve (FFR) and IMR will be measured in the infarct-related artery (IRA) after successful PPCI. Measurements of FFR and IMR will be repeated in the IRA and performed in the non-culprit vessels at staged angiography. The non-culprit vessel lesions will be treated only in the presence of a FFR<0.75. A 2D echocardiographic evaluation of the left ventricular (LV) volumes and ejection fraction will be performed before hospital discharge and at 1-year follow-up. The primary end-point of the study will be the composite of cardiovascular death, re-hospitalization for heart failure and resuscitation or appropriate ICD shock during 1-year of follow-up. Secondary end-points will be the impact of IMR in predicting LV remodeling during follow-up and correlations between IMR and ST-segment resolution. Other secondary endpoints will be need for new revascularization, stent thrombosis and re-infarction of the non-culprit vessels territory., Implications: If IMR significantly correlates with differences in outcome and LV remodeling, it will emerge as a potential prognostic index after PPCI in patients with MVD., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Published
2017
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12. Aortic rupture after thoracic endovascular repair in a patient with familial thoracic aortic aneurysm and dissections type 6 (FTAAD6).

Author

Parisi R, Goffi L, Ritelli M, Marinucci L, Secco GG, Uguccioni L, Cocco G, Colombi M, and Fattori R

Subjects
Actins genetics, Angiography, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic genetics, Aortic Rupture diagnosis, Aortic Rupture genetics, Echocardiography, Transesophageal, Fatal Outcome, Humans, Iris surgery, Livedo Reticularis diagnosis, Livedo Reticularis genetics, Male, Middle Aged, Septal Occluder Device, Actins deficiency, Aortic Aneurysm, Thoracic surgery, Aortic Rupture etiology, Endovascular Procedures adverse effects, Iris abnormalities, Livedo Reticularis surgery
Published
2016

13. Time-related changes in neointimal tissue coverage of a novel Sirolimus eluting stent: Serial observations with optical coherence tomography.

Author

Secco GG, Mattesini A, Fattori R, Parisi R, Castriota F, Vercellino M, Dall'Ara G, Uguccioni L, Marinucci L, De Luca G, Marino PN, Pistis G, and Di Mario C

Subjects
Aged, Coronary Restenosis prevention & control, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Prosthesis Design, Sirolimus administration & dosage, Time Factors, Coronary Stenosis surgery, Drug-Eluting Stents, Neointima, Sirolimus therapeutic use, Tomography, Optical Coherence
Abstract

Background: DES has reduced rates of restenosis compared with BMS but it has been associated with delayed healing and increase of stent thrombosis. The aim of our study was to evaluate the vascular time-related changes following implantation of a new SES coated with an amorphous silicon carbide that allows faster re-endothelisation (Orsiro-Biotronik)., Methods: This prospective registry enrolled STEMI-patients with multi-vessel disease, thus candidates for a two-step procedure. PCI of the culprit lesion was performed with at least one Orsiro stent that was OCT-analysed during the second-step procedure (deferred to 30,90 and 180-days)., Results: 16 of the 95 patients with MVD underwent an OCT evaluation of the study device implanted in the culprit lesion during the second-step staged procedure and were enrolled in the present Registry. A total of 3060-struts were analysed. The percentage of uncovered struts was 19.6% at30-days, 1.3% at90-days and 1.8% at180-days (p<0.001). The percentage of cross section with ≥1 uncovered struts were 51.3% at30-days, 6.5% at90-days and 5.7% at180-days (p<0.001). The percentage of cross sections containing thrombus was 6.2% at30-days while no thrombus was detected both at90 and 180-days., Conclusions: Our data shows that the new Orsiro stent promotes early and persistent strut coverage with low peri-strut thrombus. This pilot OCT evaluation might suggest a low incidence of late adverse events and anticipate safe outcome after early withdrawal of dual antiplatelet therapy., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Published
2016
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14. The Role of Cardiac Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy.

Author

Marchesini M, Uguccioni L, Parisi R, Mattioli G, Terzi F, Olivieri R, Capucci A, and Fattori R

Subjects
Contrast Media, Diagnosis, Differential, Humans, Image Interpretation, Computer-Assisted, Imaging, Three-Dimensional, Phenotype, Cardiomyopathy, Hypertrophic diagnostic imaging, Magnetic Resonance Imaging methods
Abstract

Until recently, the only imaging technique for the diagnosis and management of hypertrophic cardiomyopathy (HCM) was two-dimensional echocardiography, and the use of cardiac magnetic resonance imaging (cMRI) was limited to patients with poor acoustic windows. Now, cMRI has gained an essential role in the diagnosis of HCM, providing superior visualization of myocardial hypertrophy-even in remote zones of the left ventricle-and visualization of subtle changes in thickness and contractility over time. The morphologic accuracy of cMRI allows for the differentiation of HCM from other pathologic conditions with hypertrophic phenotype. Moreover, cMRI sheds light on the in vivo fibrotic changes in cardiac ultrastructure, offering an important advantage in the understanding of pathologic mechanisms of the disease, allowing early identification, risk stratification, and timely therapeutic management.

Published
2016
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16. Transradial versus transfemoral approach for primary percutaneous coronary interventions in elderly patients.

Author

Secco GG, Marinucci L, Uguccioni L, Parisi R, Uguccioni S, and Fattori R

Subjects
Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary, Female, Humans, Male, Retrospective Studies, Time Factors, Treatment Outcome, Femoral Artery, Myocardial Infarction therapy, Percutaneous Coronary Intervention methods, Radial Artery
Abstract

Background: The use of transradial approach (TRA) in the STEMI setting is still debated because of the worry that TRA intervention can lead to a delay in the reperfusion time, especially in the elderly, where more advanced atherosclerosis is usually encountered. The aim of this study is to compare the reperfusion time between radial versus femoral approach in patients older than 75 years of age undergoing primary percutaneous coronary intervention (PCI)., Methods: From January 2008 to December 2011, a total of 283 consecutive patients older than 75 years of age underwent primary PCI at our institution. Of these, 177 were treated using the TRA while the remaining 106 had the transfemoral approach (TFA). Demographic and procedural data including door-to-balloon time, time of arterial puncture, and inflation of the balloon were recorded., Results: Door-to-balloon time was 103.1 ± 58.4 minutes in the TRA group compared with 110.3 ± 62.4 minutes in the TFA group (P=NS). Time of arterial puncture was 10.6 ± 4.1 minutes in the TRA group compared with 12.1 ± 4.5 minutes in the TFA group (P<.01). Time of balloon inflation was 19.6 ± 8.7 minutes in the TRA group compared with 24.2 ± 14.9 minutes in the TFA group (P<.01)., Conclusions: Our data suggest that the radial approach does not lead to a lengthening of the door-to-balloon time, suggesting the efficacy of this approach in STEMI patients without cardiogenic shock at presentation.

Published
2013

17. Primary pulmonary hypertension: insights into pathogenesis from epidemiology.

Author

Galiè N, Manes A, Uguccioni L, Serafini F, De Rosa M, Branzi A, and Magnani B

Subjects
Adult, Female, Humans, Hypertension, Pulmonary epidemiology, Hypertension, Pulmonary therapy, Male, Mass Screening, Medical Informatics Computing, Registries, Risk Factors, Hypertension, Pulmonary etiology
Abstract

Primary pulmonary hypertension (PPH) is a rare disease that affects young people predominantly of female gender. Early epidemiologic studies have shown that the diagnosis is usually made 1 to 2 years after symptoms onset, and the mean survival is reduced to 2 to 3 years thereafter. New insights into the pathogenesis of PPH by epidemiologic studies may be obtained through the utilization of informatic technologies coupled to a clear definition of the disease. Early stages of precapillary pulmonary hypertension could be identified through screening tests like echocardiography in populations with higher incidence, such as familial PPH and the conditions associated with pulmonary hypertension. These latter conditions are hemodynamically and pathologically similar to the primary form, and they can give insight into several possible aspects of the pathogenesis of PPH. Prospective registries are very useful in coordinating the collection of epidemiologic data, and new technologies, such as informatics, may improve the management and the continuous updating of the databases.

Published
1998
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