Pub Date : 2020-12-01Epub Date: 2020-04-23DOI: 10.23736/S0026-4725.20.05165-8
Alessandro Sciahbasi, Mario Babbaro, Pierpaolo Confessore, Maria Cera, Cristian Di Russo, Roberto Patrizi, Silvio Fedele
In the cardiology community, the use of transradial access for percutaneous coronary procedures is progressively increasing all around the world overtaking the use of transfemoral access. The advantages of the transradial access are based on a significant reduction in bleeding and vascular events compared to the femoral access and on a reduction in mortality in the setting of acute coronary syndromes. However, in recent years a slight but significant increase in radiation exposure for patients and operators associated with the radial approach has been detected, increasing concerns about possible long term increased stochastic risk. In particular interventional cardiologists are among physicians performing interventional procedures using X-rays, those exposed to the highest radiation dose during their activity and this exposure is not without possible long-term clinical consequences in term of deterministic and stochastic effects. All the operators should be aware of these risks and manage to reduce their radiation exposure. In this review we analysed the differences in term of radiation exposure comparing the radial and the femoral access for percutaneous coronary procedures. Then, we discussed the possible clinical consequences of these differences and finally we showed the available tools aimed to reduce the operator radiation exposure. In particular the use of adjunctive protective drapes placed on the patient might reduce operator radiation exposure in up to 81% of the dose.
{"title":"Vascular access and radiation exposure during percutaneous coronary procedures.","authors":"Alessandro Sciahbasi, Mario Babbaro, Pierpaolo Confessore, Maria Cera, Cristian Di Russo, Roberto Patrizi, Silvio Fedele","doi":"10.23736/S0026-4725.20.05165-8","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05165-8","url":null,"abstract":"<p><p>In the cardiology community, the use of transradial access for percutaneous coronary procedures is progressively increasing all around the world overtaking the use of transfemoral access. The advantages of the transradial access are based on a significant reduction in bleeding and vascular events compared to the femoral access and on a reduction in mortality in the setting of acute coronary syndromes. However, in recent years a slight but significant increase in radiation exposure for patients and operators associated with the radial approach has been detected, increasing concerns about possible long term increased stochastic risk. In particular interventional cardiologists are among physicians performing interventional procedures using X-rays, those exposed to the highest radiation dose during their activity and this exposure is not without possible long-term clinical consequences in term of deterministic and stochastic effects. All the operators should be aware of these risks and manage to reduce their radiation exposure. In this review we analysed the differences in term of radiation exposure comparing the radial and the femoral access for percutaneous coronary procedures. Then, we discussed the possible clinical consequences of these differences and finally we showed the available tools aimed to reduce the operator radiation exposure. In particular the use of adjunctive protective drapes placed on the patient might reduce operator radiation exposure in up to 81% of the dose.</p>","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":" ","pages":"592-598"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37865400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.23736/S0026-4725.20.05384-0
L. Cabrini, W. Ageno, S. Balbi, F. Baruzzi, E. Candeloro, C. Capra, F. Carimati, B. Castiglioni, V. Conti, R. De Ponti, D. Franchi, G. Gini, A. Giorgianni, Marianna Sartorelli, G. Landoni, D. Locatelli, L. Maffioli, Rita Pradella, P. Severgnini, M. Tozzi, M. Versino, G. Zocchi, A. Zoli
BACKGROUND The Lombardy region, in Northern Italy, suffered a major outbreak of Coronavirus disease 2019 (COVID-19) at the end of February 2020. The health system was rapidly overwhelmed by the pandemic. It became evident that patients suffering from timesensitive medical emergencies like stroke, cerebral hemorrhage, trauma and acute myocardial infarction required timely, effective and safe pathways to be treated. The problem was addressed by a regional decree that created a hub-and-spoke system for time-sensitive medical emergencies. METHODS We report the re-organizational changes adopted at a hub hospital (despite having already destined to COVID-19 patients most resources), and the number of emergent procedures for medical emergencies on the first 30-day of activity. These data were compared with the hospital activity in the same period of the previous year. RESULTS Organizational changes were implemented in few hours. Dedicated pathways for non-COVID-19 patients affected by a medical emergency were set up in the emergency department, in the labs and in the operating theater. Ten intensive beds were implemented from a high-dependency unit; two operating rooms were reserved 24h/day to neurosurgical or trauma emergencies. The number of emergent procedures was not different from that of the previous year, no admission refusal, no treatment delay and no viral transmission to the treated patients were recorded. No viral transmission to health care workers was observed. CONCLUSIONS Re-organization of a hospital in order to adopt a hub-and-spoke model resulted feasible and allowed to face acute coronary syndrome and other time-sensitive medical emergencies timely and safely.
{"title":"Caring for acute coronary syndrome and other time-sensitive medical emergencies during the coronavirus disease 2019 pandemic in Northern Italy: report from a hub centre.","authors":"L. Cabrini, W. Ageno, S. Balbi, F. Baruzzi, E. Candeloro, C. Capra, F. Carimati, B. Castiglioni, V. Conti, R. De Ponti, D. Franchi, G. Gini, A. Giorgianni, Marianna Sartorelli, G. Landoni, D. Locatelli, L. Maffioli, Rita Pradella, P. Severgnini, M. Tozzi, M. Versino, G. Zocchi, A. Zoli","doi":"10.23736/S0026-4725.20.05384-0","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05384-0","url":null,"abstract":"BACKGROUND\u0000The Lombardy region, in Northern Italy, suffered a major outbreak of Coronavirus disease 2019 (COVID-19) at the end of February 2020. The health system was rapidly overwhelmed by the pandemic. It became evident that patients suffering from timesensitive medical emergencies like stroke, cerebral hemorrhage, trauma and acute myocardial infarction required timely, effective and safe pathways to be treated. The problem was addressed by a regional decree that created a hub-and-spoke system for time-sensitive medical emergencies.\u0000\u0000\u0000METHODS\u0000We report the re-organizational changes adopted at a hub hospital (despite having already destined to COVID-19 patients most resources), and the number of emergent procedures for medical emergencies on the first 30-day of activity. These data were compared with the hospital activity in the same period of the previous year.\u0000\u0000\u0000RESULTS\u0000Organizational changes were implemented in few hours. Dedicated pathways for non-COVID-19 patients affected by a medical emergency were set up in the emergency department, in the labs and in the operating theater. Ten intensive beds were implemented from a high-dependency unit; two operating rooms were reserved 24h/day to neurosurgical or trauma emergencies. The number of emergent procedures was not different from that of the previous year, no admission refusal, no treatment delay and no viral transmission to the treated patients were recorded. No viral transmission to health care workers was observed.\u0000\u0000\u0000CONCLUSIONS\u0000Re-organization of a hospital in order to adopt a hub-and-spoke model resulted feasible and allowed to face acute coronary syndrome and other time-sensitive medical emergencies timely and safely.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"65 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72539031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01Epub Date: 2020-06-02DOI: 10.23736/S0026-4725.20.05181-6
Giuseppe Biondi Zoccai, Roberto Carnevale, Matteo Vitali, Luigi Tritapepe, Ombretta Martinelli, Francesco Macrina, Chris Bullen, Mariangela Peruzzi, Elena Cavarretta, Antonino G Marullo, Antonio Abbate, Enrico Romagnoli, Sebastiano Sciarretta, Rebecca Casati, Giuseppe Visconti, Francesco Versaci, Giacomo Frati
Background: Traditional combustible cigarette (TCC) smoking remains a major cause of preventable cardiovascular morbidity and mortality. Modified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) may be safer than TCC but may still have detrimental oxidative, platelet and vascular effects of particular importance to people with symptomatic coronary artery disease (CAD).
Methods: We aimed to compare the acute coronary, systemic and environmental effects of two leading MRP in 20 TCC smokers admitted for invasive coronary assessment of CAD and willing to quit or after prior failed quitting attempts. After confirmation at angiography of an intermediate coronary stenosis, coronary flow reserve (CFR) will be appraised. Patients will then be randomized 1:1 to use a single EVC or a single HNBC in the catheterization laboratory, followed by repeat CFR measurement. The primary endpoint will be the change in CFR before and after product use. Quantitative coronary angiography, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) will also be measured.
Results: We expected to accrue results able to: 1) test whether MRP have in general a detrimental impact on coronary vascular function in TCC smokers; 2) test whether EVC have a different impact than HNBC on coronary function; 3) provide ancillary pathophysiologic and translational insights on the acute risk and safety profile of MRP in TCC smokers with established cardiovascular disease, including complex correlations between coronary, cardiac, systemic and environmental effects. In addition, by directly informing participants of their individual results, they will be further empowered to quit TCC.
Conclusions: The Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking (SUR-VAPES) 3 trial will provide important insights into the pathophysiologic cardiovascular impact of EVC and HNBC, also suitable to inform patients and individualize their smoking cessation strategy.
{"title":"A randomized trial comparing the acute coronary, systemic, and environmental effects of electronic vaping cigarettes versus heat-not-burn cigarettes in smokers of combustible cigarettes undergoing invasive coronary assessment: rationale and design of the SUR-VAPES 3 trial.","authors":"Giuseppe Biondi Zoccai, Roberto Carnevale, Matteo Vitali, Luigi Tritapepe, Ombretta Martinelli, Francesco Macrina, Chris Bullen, Mariangela Peruzzi, Elena Cavarretta, Antonino G Marullo, Antonio Abbate, Enrico Romagnoli, Sebastiano Sciarretta, Rebecca Casati, Giuseppe Visconti, Francesco Versaci, Giacomo Frati","doi":"10.23736/S0026-4725.20.05181-6","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05181-6","url":null,"abstract":"<p><strong>Background: </strong>Traditional combustible cigarette (TCC) smoking remains a major cause of preventable cardiovascular morbidity and mortality. Modified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) may be safer than TCC but may still have detrimental oxidative, platelet and vascular effects of particular importance to people with symptomatic coronary artery disease (CAD).</p><p><strong>Methods: </strong>We aimed to compare the acute coronary, systemic and environmental effects of two leading MRP in 20 TCC smokers admitted for invasive coronary assessment of CAD and willing to quit or after prior failed quitting attempts. After confirmation at angiography of an intermediate coronary stenosis, coronary flow reserve (CFR) will be appraised. Patients will then be randomized 1:1 to use a single EVC or a single HNBC in the catheterization laboratory, followed by repeat CFR measurement. The primary endpoint will be the change in CFR before and after product use. Quantitative coronary angiography, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR) will also be measured.</p><p><strong>Results: </strong>We expected to accrue results able to: 1) test whether MRP have in general a detrimental impact on coronary vascular function in TCC smokers; 2) test whether EVC have a different impact than HNBC on coronary function; 3) provide ancillary pathophysiologic and translational insights on the acute risk and safety profile of MRP in TCC smokers with established cardiovascular disease, including complex correlations between coronary, cardiac, systemic and environmental effects. In addition, by directly informing participants of their individual results, they will be further empowered to quit TCC.</p><p><strong>Conclusions: </strong>The Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking (SUR-VAPES) 3 trial will provide important insights into the pathophysiologic cardiovascular impact of EVC and HNBC, also suitable to inform patients and individualize their smoking cessation strategy.</p>","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":" ","pages":"548-555"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38008649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.23736/S0026-4725.20.05482-1
V. Cammalleri, G. Idone, Joseph Cosma, M. M. Marino, A. Mauceri, G. Stifano, S. Muscoli, F. Boffi, Francesca De Persis, P. de Vico, F. Versaci, M. Di Luozzo, F. Romeo
BACKGROUND The role of aortic valve Lambl's excrescence (LEs) in determining ischemic events has not been well clarified, but they can represent a potential embolic source during procedures with catheter/device manipulation through the aortic valve. Aim of our study was to assess the prevalence of LEs and the rate of embolism in patients with aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI). METHODS Our population was divided into two groups, named LEs and no-LEs. In each group, the rate of cerebral embolic events was assessed, as well as other TAVI-related complications. RESULTS In our study population 28 patients (37%) had aortic strands and 48 (63%) did not have them. A cerebral protection device was used in 4 patients of LEs group (14% vs 0, p=0.03). The mean procedural time was similar in the two groups: 50±19 and 55±26 minutes (p=0.38) in LEs and no-LEs groups, respectively. The device success was achieved in 96% of LEs and 88% of no-LEs patients (p=0.37). Two patients of no-LEs group died during the procedure. Major complications were observed in both groups without any significant differences. Only one case of stroke occurred in the population without LEs (0 LEs vs 2% no-LEs, 0.78). No cases of peripheral embolism were observed. CONCLUSIONS In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.
背景:主动脉瓣兰博氏增生(LEs)在确定缺血事件中的作用尚未得到很好的阐明，但在通过主动脉瓣的导管/装置操作的过程中，它们可能是一个潜在的栓塞源。我们的研究目的是评估经导管主动脉瓣置入术(TAVI)的主动脉瓣狭窄患者的LEs患病率和栓塞率。方法将人群分为LEs组和no-LEs组。在每组中，评估脑栓塞事件的发生率以及其他tavi相关并发症。结果在我们的研究人群中，28例(37%)患者有主动脉束，48例(63%)患者无主动脉束。LEs组4例患者使用脑保护装置(14% vs 0, p=0.03)。两组的平均手术时间相似:有LEs组为50±19分钟，无LEs组为55±26分钟(p=0.38)。96%的LEs患者和88%的无LEs患者成功使用该装置(p=0.37)。无les组2例患者在手术过程中死亡。两组主要并发症发生率无明显差异。在没有LEs的人群中，只有1例卒中发生(0例LEs vs 2例无LEs, 0.78)。未发现外周栓塞病例。结论在我国人群中，LEs的观察并不少见。尽管假定栓塞的风险很高，但我们尚未观察到LEs患者脑缺血事件或其他TAVI相关并发症的发生率增加。
{"title":"Lambl's excrescence in transcatheter aortic valve implantation: prevalence and risk of embolic events.","authors":"V. Cammalleri, G. Idone, Joseph Cosma, M. M. Marino, A. Mauceri, G. Stifano, S. Muscoli, F. Boffi, Francesca De Persis, P. de Vico, F. Versaci, M. Di Luozzo, F. Romeo","doi":"10.23736/S0026-4725.20.05482-1","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05482-1","url":null,"abstract":"BACKGROUND\u0000The role of aortic valve Lambl's excrescence (LEs) in determining ischemic events has not been well clarified, but they can represent a potential embolic source during procedures with catheter/device manipulation through the aortic valve. Aim of our study was to assess the prevalence of LEs and the rate of embolism in patients with aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI).\u0000\u0000\u0000METHODS\u0000Our population was divided into two groups, named LEs and no-LEs. In each group, the rate of cerebral embolic events was assessed, as well as other TAVI-related complications.\u0000\u0000\u0000RESULTS\u0000In our study population 28 patients (37%) had aortic strands and 48 (63%) did not have them. A cerebral protection device was used in 4 patients of LEs group (14% vs 0, p=0.03). The mean procedural time was similar in the two groups: 50±19 and 55±26 minutes (p=0.38) in LEs and no-LEs groups, respectively. The device success was achieved in 96% of LEs and 88% of no-LEs patients (p=0.37). Two patients of no-LEs group died during the procedure. Major complications were observed in both groups without any significant differences. Only one case of stroke occurred in the population without LEs (0 LEs vs 2% no-LEs, 0.78). No cases of peripheral embolism were observed.\u0000\u0000\u0000CONCLUSIONS\u0000In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83003824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.23736/S0026-4725.20.05353-0
Mahesh V. Madhavan, B. Bikdeli, B. Redfors, B. Redfors, G. Biondi‐Zoccai, Nicholas Varunok, John R. Burton, Aaron Crowley, D. Francese, Aakriti Gupta, C. Nigoghossian, S. Chatterjee, T. Palmerini, U. Benedetto, S. You, M. Ohman, A. Kastrati, P. Steg, C. Gibson, D. Angiolillo, H. Krumholz, G. Stone
INTRODUCTION The optimal choice of oral P2Y12 receptor inhibitors has the potential to significantly influence outcomes. We seek to compare the safety and efficacy of the three most commonly used oral P2Y12 receptor inhibitors (clopidogrel, prasugrel, and ticagrelor) in acute coronary syndromes (ACS) via a comprehensive systematic review and network meta-analysis. EVIDENCE ACQUISITION We will perform a comprehensive search for randomized clinical trials which compared cardiovascular and hemorrhagic outcomes after use of at least two of the distinct oral P2Y12 receptor inhibitors (i.e. clopidogrel, prasugrel, and ticagrelor). In addition, key inclusion criteria will be trial size of at least 100 patients and at least 1 month of follow-up time. Several pre-specified subgroups will be explored, including Asian patients, patients presenting with ST-elevation myocardial infarction, patients of advanced age, and others. EVIDENCE SYNTHESIS Exploratory frequentist pairwise meta-analyses will be based primarily on a random-effects method, relying on relative risks (RR) for short-term endpoints and incidence rate ratios (IRR) for long-term endpoints. Inferential frequentist network meta-analysis will be based primarily on a random-effects method, relying on RR and IRR as specified above. Results will be reported as point summary of effect, 95% CI, and p-values for effect, and graphically represented using forest plots. CONCLUSIONS An international collaborative network meta-analysis has begun to comprehensively analyze the safety and efficacy of prasugrel, ticagrelor and clopidogrel, each on a background of aspirin, for management of patients with ACS. It is our hope that the rigor and breadth of the undertaking described herein will provide novel insights that will inform optimal patient care for patients with ACS treated conservatively, or undergoing revascularization.
{"title":"Antiplatelet strategies in acute coronary syndromes: design and methodology of an international collaborative network meta-analysis of randomized controlled trials.","authors":"Mahesh V. Madhavan, B. Bikdeli, B. Redfors, B. Redfors, G. Biondi‐Zoccai, Nicholas Varunok, John R. Burton, Aaron Crowley, D. Francese, Aakriti Gupta, C. Nigoghossian, S. Chatterjee, T. Palmerini, U. Benedetto, S. You, M. Ohman, A. Kastrati, P. Steg, C. Gibson, D. Angiolillo, H. Krumholz, G. Stone","doi":"10.23736/S0026-4725.20.05353-0","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05353-0","url":null,"abstract":"INTRODUCTION\u0000The optimal choice of oral P2Y12 receptor inhibitors has the potential to significantly influence outcomes. We seek to compare the safety and efficacy of the three most commonly used oral P2Y12 receptor inhibitors (clopidogrel, prasugrel, and ticagrelor) in acute coronary syndromes (ACS) via a comprehensive systematic review and network meta-analysis.\u0000\u0000\u0000EVIDENCE ACQUISITION\u0000We will perform a comprehensive search for randomized clinical trials which compared cardiovascular and hemorrhagic outcomes after use of at least two of the distinct oral P2Y12 receptor inhibitors (i.e. clopidogrel, prasugrel, and ticagrelor). In addition, key inclusion criteria will be trial size of at least 100 patients and at least 1 month of follow-up time. Several pre-specified subgroups will be explored, including Asian patients, patients presenting with ST-elevation myocardial infarction, patients of advanced age, and others.\u0000\u0000\u0000EVIDENCE SYNTHESIS\u0000Exploratory frequentist pairwise meta-analyses will be based primarily on a random-effects method, relying on relative risks (RR) for short-term endpoints and incidence rate ratios (IRR) for long-term endpoints. Inferential frequentist network meta-analysis will be based primarily on a random-effects method, relying on RR and IRR as specified above. Results will be reported as point summary of effect, 95% CI, and p-values for effect, and graphically represented using forest plots.\u0000\u0000\u0000CONCLUSIONS\u0000An international collaborative network meta-analysis has begun to comprehensively analyze the safety and efficacy of prasugrel, ticagrelor and clopidogrel, each on a background of aspirin, for management of patients with ACS. It is our hope that the rigor and breadth of the undertaking described herein will provide novel insights that will inform optimal patient care for patients with ACS treated conservatively, or undergoing revascularization.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76065847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.23736/S0026-4725.20.05396-7
S. A. Banifatemeh, Parham Sadeghipour, M. Alemzadeh-Ansari, A. Fakhrabadi, Fereshteh Zolfaghari, A. Zahedmehr, B. Mohebbi, R. Kiani, Farshad Shakerian, A. Rashidinejad, Zahra Hosseini, A. Firouzi
BACKGROUND In patients with ST-segment-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PPCI) is the treatment of choice. Stent undersizing might occur due to catecholamine release and coronary spasm. Although routine oversizing has been promising in several investigations, it has never been tested in randomized clinical trials. In this single-center open-label randomized clinical trial, we evaluated the role of stent oversizing in PPCI. METHODS Candidates for PPCI were randomly divided into oversized and non-oversized groups. In the oversized group, the stent was oversized by 10% according to the mean lumen diameter, retrieved from the quantitative coronary analysis. Primary composite endpoints were defined as the occurrence of complete total ST-segment (STR)resolution and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade III. RESULTS The study population was comprised of 122 patients, allocated to the oversized group (n = 61) and the non-oversized group (n = 61). There was no significant difference between the 2 groups regarding the final TIMI flow grade. Complete STR was marginally more favorable in the non-oversized group (56.05 ± 55.12 vs 64.64 ± 23.28; P = 0.056). The troponin ratio, CK-MB ratio, and 6-month follow up outcome-defined as target lesion revascularization, heart failure, and cardiovascular death-were comparable between the 2 groups. CONCLUSIONS Our study showed that routine oversizing in patients undergoing PPCI had no benefit regarding ST-segment resolution and the final TIMI flow, as well as hard cardiac events, during the follow-up.
背景st段抬高型心肌梗死(STEMI)患者，首选经皮冠状动脉介入治疗(PPCI)。由于儿茶酚胺释放和冠状动脉痉挛，可能发生支架尺寸过小。尽管在几项研究中，常规的超大尺寸已经很有希望，但从未在随机临床试验中进行过测试。在这项单中心开放标签随机临床试验中，我们评估了支架过大在PPCI中的作用。方法将PPCI候选者随机分为超大组和非超大组。在超大组，根据定量冠脉分析得出的平均管腔直径，支架超大10%。主要复合终点定义为心肌梗死(TIMI)血流等级III的完全st段(STR)溶解和手术后溶栓的发生。结果研究人群122例，分为超大组(n = 61)和非超大组(n = 61)。两组最终的TIMI血流等级无显著差异。完全STR在非超大组稍有利(56.05±55.12 vs 64.64±23.28;P = 0.056)。肌钙蛋白比率、CK-MB比率和6个月随访结果(定义为靶病变血运重建、心力衰竭和心血管死亡)在两组之间具有可比性。结论:我们的研究表明，在随访期间，PPCI患者常规过大对st段溶解、最终TIMI流量以及硬心事件没有好处。
{"title":"Role of stent oversizing in patients undergoing primary percutaneous coronary intervention. An open-labeled randomized controlled trial.","authors":"S. A. Banifatemeh, Parham Sadeghipour, M. Alemzadeh-Ansari, A. Fakhrabadi, Fereshteh Zolfaghari, A. Zahedmehr, B. Mohebbi, R. Kiani, Farshad Shakerian, A. Rashidinejad, Zahra Hosseini, A. Firouzi","doi":"10.23736/S0026-4725.20.05396-7","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05396-7","url":null,"abstract":"BACKGROUND\u0000In patients with ST-segment-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PPCI) is the treatment of choice. Stent undersizing might occur due to catecholamine release and coronary spasm. Although routine oversizing has been promising in several investigations, it has never been tested in randomized clinical trials. In this single-center open-label randomized clinical trial, we evaluated the role of stent oversizing in PPCI.\u0000\u0000\u0000METHODS\u0000Candidates for PPCI were randomly divided into oversized and non-oversized groups. In the oversized group, the stent was oversized by 10% according to the mean lumen diameter, retrieved from the quantitative coronary analysis. Primary composite endpoints were defined as the occurrence of complete total ST-segment (STR)resolution and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade III.\u0000\u0000\u0000RESULTS\u0000The study population was comprised of 122 patients, allocated to the oversized group (n = 61) and the non-oversized group (n = 61). There was no significant difference between the 2 groups regarding the final TIMI flow grade. Complete STR was marginally more favorable in the non-oversized group (56.05 ± 55.12 vs 64.64 ± 23.28; P = 0.056). The troponin ratio, CK-MB ratio, and 6-month follow up outcome-defined as target lesion revascularization, heart failure, and cardiovascular death-were comparable between the 2 groups.\u0000\u0000\u0000CONCLUSIONS\u0000Our study showed that routine oversizing in patients undergoing PPCI had no benefit regarding ST-segment resolution and the final TIMI flow, as well as hard cardiac events, during the follow-up.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"130 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77881784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-01DOI: 10.23736/S0026-4725.20.05418-3
M. Manfrin, G. Mugnai, G. Chierchia, C. de Asmundis, C. Bilato, W. Rauhe
BACKGROUND The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction who underwent PV isolation and its implication for AF catheter ablation. METHODS Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure ≥ 15 mm Hg. RESULTS A total of 98 consecutive patients (71 males, 72%; mean age 60.3±8.4 years) were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 11.7±5.5 mmHg; LAH occurred in 24 (24.5%) patients. At a mean follow up of 14.6±7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). Older age, LA volume and LAH were significantly associated with early AF recurrence during the blanking period. However, only LAH independently remained a significant predictor of late AF recurrence (HR 3.02, 1.36-6.72, p=0.007). CONCLUSIONS Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences.
背景:左房高压(LAH)在房颤(AF)患者中的临床作用及其在肺静脉(PV)隔离患者中的预测作用尚不清楚。本研究的目的是分析非瓣膜性房颤和保留左室射血分数的患者接受PV隔离后发生LAH的发生率及其对房颤导管消融的意义。方法回顾性分析在意大利Bolzano San Maurizio地区医院进行PV隔离的连续耐药房间隔患者。左房高血压定义为左室平均压≥15 mm hg。结果连续98例患者(男性71例，72%;平均年龄60.3±8.4岁)纳入分析。11例(11%)行射频消融术，87例(89%)行冷冻球囊消融术。平均左室压为11.7±5.5 mmHg;24例(24.5%)患者发生LAH。平均随访14.6±7.1个月(中位14个月)，无抗心律失常治疗的成功率为71.4% (70/98;考虑到空白期)。年龄、LA容积和LAH与AF早期复发有显著相关性。然而，只有LAH仍然是AF晚期复发的重要独立预测因子(HR 3.02, 1.36-6.72, p=0.007)。结论24%的PV隔离患者存在左心房高压，且左心房高压与房颤早期和晚期复发均有显著关系。
{"title":"Left atrial hypertension invasively measured during pulmonary vein isolation predicts atrial fibrillation recurrence.","authors":"M. Manfrin, G. Mugnai, G. Chierchia, C. de Asmundis, C. Bilato, W. Rauhe","doi":"10.23736/S0026-4725.20.05418-3","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05418-3","url":null,"abstract":"BACKGROUND\u0000The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction who underwent PV isolation and its implication for AF catheter ablation.\u0000\u0000\u0000METHODS\u0000Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure ≥ 15 mm Hg.\u0000\u0000\u0000RESULTS\u0000A total of 98 consecutive patients (71 males, 72%; mean age 60.3±8.4 years) were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 11.7±5.5 mmHg; LAH occurred in 24 (24.5%) patients. At a mean follow up of 14.6±7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). Older age, LA volume and LAH were significantly associated with early AF recurrence during the blanking period. However, only LAH independently remained a significant predictor of late AF recurrence (HR 3.02, 1.36-6.72, p=0.007).\u0000\u0000\u0000CONCLUSIONS\u0000Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82758949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-04DOI: 10.23736/S0026-4725.20.05405-5
J. Marazzato, G. Cappabianca, F. Angeli, Matteo Crippa, M. Golino, S. Ferrarese, C. Beghi, R. De Ponti
BACKGROUND Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients. METHODS Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. reentrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed. RESULTS Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; p<0.0001). CONCLUSIONS Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macroreentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.
背景:关于二尖瓣手术后心房心动过速的导管消融的资料很少。通过查阅文献，本研究旨在评估导管消融的可行性及消融心房心律失常患者的特点。方法选择评估心房心动过速主要手术参数和电生理表现的研究。电生理机制(局灶性与再入性心律失常)、心律失常起源部位(左心房与右心房)及其与特定手术通路和/或先前Cox-Maze IV手术的解剖相关性都得到了解决。结果对206例经导管消融的二尖瓣术后发生的297例心律失常形态进行了分析。仅2例(0.9%)出现严重并发症。96%的患者恢复了窦性心律。以大可重入性心律失常居多(90.4%)，局灶性心律失常比例不可忽略(9.6%)。左侧心律失常很常见(54.4%)，但三尖瓣峡部依赖性心律失常也经常被报道(33%)。尽管特定的心房切开术显示出所研究的心律失常的特殊位置的趋势，Cox-Maze IV手术是左侧心律失常的唯一独立预测因子(OR=17.3;95% ci 7.2-41.2;p < 0.0001)。结论导管消融治疗二尖瓣手术后发生的心律失常是可行的，在这种情况下，绝大多数心律失常形态学基于大再入，约三分之一的病例表现为腔三尖瓣峡部依赖性心律失常。先前的Cox-Maze-IV与二尖瓣手术相关是可能由非跨壁手术病变引起的左侧心律失常的独立预测因子。
{"title":"Ablation of atrial tachycardia in the setting of prior mitral valve surgery.","authors":"J. Marazzato, G. Cappabianca, F. Angeli, Matteo Crippa, M. Golino, S. Ferrarese, C. Beghi, R. De Ponti","doi":"10.23736/S0026-4725.20.05405-5","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05405-5","url":null,"abstract":"BACKGROUND\u0000Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients.\u0000\u0000\u0000METHODS\u0000Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. reentrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed.\u0000\u0000\u0000RESULTS\u0000Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; p<0.0001).\u0000\u0000\u0000CONCLUSIONS\u0000Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macroreentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":"50 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78130135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-04DOI: 10.23736/S0026-4725.20.05370-0
J. Chiabrando, G. Vescovo, M. Lombardi, M. D. Del Buono, F. Romeo, D. Berrocal, G. Biondi‐Zoccai, L. Guzmán, A. Abbate
BACKGROUND Long term efficacy and safety of either surgical or percutaneous treatment left main coronary artery disease treatment is lacking. METHODS We conducted a systematic review and meta-analysis of the most updated randomized clinical trials that compared the efficacy of coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the Left Main Coronary Artery (LMCA) disease. RESULTS We identified 6 studies, providing data on 5812 patients. The mean follow-up was 6.7 years. PCI was associated with an increased risk of major vascular events (MACE) (IRR 1.24, 95% confidence interval (CI) [1.03-1.67], p<0.01), and coronary revascularization (IRR 1.69, 95% CI [1.42-2.03], p<0.01) compared to CABG. Furthermore, all-cause death, MI and stroke events were not statistically different between the two therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24], p=0.47, IRR 1.35, 95% CI [0.84-2.16], p=0.03 and IRR 0.66, 95% CI [0.43-1.01], p=0.05, respectively). CONCLUSIONS LMCA PCI has an overall same survival compared to CABG in the long term follow up. Nevertheless, MACE and revascularization events were more frequent in PCI compared to CABG.
背景:目前尚缺乏手术或经皮治疗左主干冠状动脉疾病的长期疗效和安全性。方法:我们对最新的随机临床试验进行了系统回顾和荟萃分析，比较了冠状动脉搭桥手术(CABG)或经皮冠状动脉介入治疗(PCI)治疗左主干冠状动脉(LMCA)疾病的疗效。结果我们纳入了6项研究，提供了5812例患者的数据。平均随访时间为6.7年。与CABG相比，PCI与主要血管事件(MACE) (IRR 1.24, 95%可信区间(CI) [1.03-1.67]， p<0.01)和冠状动脉血运重建术(IRR 1.69, 95% CI [1.42-2.03]， p<0.01)的风险增加相关。此外，两种治疗性血运重建方法的全因死亡、心肌梗死和卒中事件无统计学差异(IRR分别为1.06,95% CI [0.90-1.24]， p=0.47, IRR为1.35,95% CI [0.84-2.16]， p=0.03, IRR为0.66,95% CI [0.43-1.01]， p=0.05)。结论在长期随访中，slmca PCI与CABG的总体生存率相同。然而，与CABG相比，PCI中MACE和血运重建事件更频繁。
{"title":"Long term outcomes of percutaneous or surgical treatment in left main disease.","authors":"J. Chiabrando, G. Vescovo, M. Lombardi, M. D. Del Buono, F. Romeo, D. Berrocal, G. Biondi‐Zoccai, L. Guzmán, A. Abbate","doi":"10.23736/S0026-4725.20.05370-0","DOIUrl":"https://doi.org/10.23736/S0026-4725.20.05370-0","url":null,"abstract":"BACKGROUND\u0000Long term efficacy and safety of either surgical or percutaneous treatment left main coronary artery disease treatment is lacking.\u0000\u0000\u0000METHODS\u0000We conducted a systematic review and meta-analysis of the most updated randomized clinical trials that compared the efficacy of coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) for the Left Main Coronary Artery (LMCA) disease.\u0000\u0000\u0000RESULTS\u0000We identified 6 studies, providing data on 5812 patients. The mean follow-up was 6.7 years. PCI was associated with an increased risk of major vascular events (MACE) (IRR 1.24, 95% confidence interval (CI) [1.03-1.67], p<0.01), and coronary revascularization (IRR 1.69, 95% CI [1.42-2.03], p<0.01) compared to CABG. Furthermore, all-cause death, MI and stroke events were not statistically different between the two therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24], p=0.47, IRR 1.35, 95% CI [0.84-2.16], p=0.03 and IRR 0.66, 95% CI [0.43-1.01], p=0.05, respectively).\u0000\u0000\u0000CONCLUSIONS\u0000LMCA PCI has an overall same survival compared to CABG in the long term follow up. Nevertheless, MACE and revascularization events were more frequent in PCI compared to CABG.","PeriodicalId":18565,"journal":{"name":"Minerva cardioangiologica","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72381008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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