Chiara Bernelli - Academia.edu (original) (raw)
Papers by Chiara Bernelli
Journal of the American College of Cardiology, Oct 1, 2012
Circulation journal, 2016
ciation between ISA and stent thrombosis, 2-4 outlining the importance of investigations aimed at... more ciation between ISA and stent thrombosis, 2-4 outlining the importance of investigations aimed at understanding and possibly preventing this phenomenon. Several mechanisms have already been advocated to explain why ISA occurs more frequently in patients with ST-segment elevation myocardial tent implantation in the setting of primary percutaneous coronary intervention (p-PCI) has been linked with an increased risk of early and late incomplete stent apposition (ISA). 1,2 Importantly, despite the lack of a compelling evidence, multiple studies have highlighted the putative asso-S
Springer eBooks, Nov 1, 2014
Journal of the American College of Cardiology, Nov 1, 2021
Heart, May 1, 2012
in the BMS group. There was no difference in death, MI or stroke between the stent types. Age-adj... more in the BMS group. There was no difference in death, MI or stroke between the stent types. Age-adjusted Cox analysis showed an decrease in the hazard of events for DES compared to BMS (HR 0.60, 95% CIs 0.03 to 0.69) and this was maintained with multiple adjustment (HR 0.52, 95% CIs 0.05 to 0.89). Conclusions In our cohort of patients who had PCI for treatment of SVG disease the use of DES resulted in lower MACE rate compared to BMS over a 5-year follow-up.
Eurointervention, Nov 1, 2015
Catheterization and Cardiovascular Interventions
BackgroundUncovered struts are a determinant of stent failure. The impact of plaque composition a... more BackgroundUncovered struts are a determinant of stent failure. The impact of plaque composition and procedural factors on the occurrence, evolution, and outcomes of uncovered struts in a high‐risk setting has not been investigated.ObjectiveTo investigate the determinants and long‐term clinical impact of largely uncovered struts (LUS) in thin‐struts drug‐eluting stents (DES) implanted in complex lesions by intracoronary optical coherence tomography (OCT).MethodsNinety patients with multivessel disease undergoing staged complete revascularization were randomly assigned to bioabsorbable or durable polymer DES. OCT were serially performed during the index procedure, at 3‐ and 18‐month follow‐up, and analyzed by an independent core lab. Struts were defined uncovered by OCT if no tissue was visible above the struts. LUS were defined as ≥30% of uncovered struts at 3‐month follow‐up. Clinical outcomes were the occurrence of target vessel failure (TVF) and major adverse cardiac and cerebrova...
European Heart Journal - Case Reports, Mar 1, 2022
A 60-year-old male was referred to the emergency department after a European snake bite (Vipera A... more A 60-year-old male was referred to the emergency department after a European snake bite (Vipera Aspis Francisciredi) (Panel A), complaining of vomiting, and mouth's dryness. The first electocardiogram (ECG) was unremarkable. However, during observation patient developed five episodes of ventricular fibrillation (VT), treated with Direct-Current Defibrillation (DC) shock and Advanced Cardiovascular Life Support (ACLS). Repeated ECG demonstrated anterolateral STelevation myocardial infarction (MI) (Panel B). In 2018, for an acute coronary syndrome, he underwent everolimus-eluting-stent (EES) implantation on the left anterior descending artery (LAD) and first diagonal (D1) branch with a T-modified-stent-technique, and he was discharged with ticagrelor 180 mg/day for 1 year. Coronary angiograms revealed a very late EES thrombosis in mid-LAD-D1 (Panel D) which was satisfactorily treated with mechanical thrombectomy and kissing balloon inflations with non-compliant balloons (Panel A). Intracoronary imaging was not performed to assess the potential mechanisms underlying ST due to refractory VT episodes. The patient was treated with bolus and infusion and integrilin. Ticagrelor 90 mg/b.i.d. followed by 60 mg/b.i.d. after 1 year plus aspirin was planned. He was treated with anti-snake venom
European Heart Journal Supplements, 2021
Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial con... more Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial conservative management or immediate revascularization through percutaneous coronary intervention (PCI) remains debated. To investigate the frequency and predictors of choosing a strategy of immediate PCI for SCAD, and to compare the clinical outcomes of immediate PCI patients with those undergoing an initial strategy of medical management. 369 patients enrolled in the multicentre international DIssezioni Spontanee COronariche (DISCO) registry between January 2009 and December 2020 were included. The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction (MI) and any PCI. 240 (65%) patients underwent initial medical management, whereas 129 (35%) had immediate PCI. PCI patients presented more frequently with ST segment-elevation myocardial infarction (STEMI) (68.2% vs. 35%, P < 0.001) and had higher frequency of proxi...
European Heart Journal, 2013
Background: Transcatheter aortic valve implantation (TAVI) is an accepted alternative to conventi... more Background: Transcatheter aortic valve implantation (TAVI) is an accepted alternative to conventional surgical aortic valve replacement in high risk patients with aortic stenosis. Identifying patients at high risk of short/mid-term mortality remains difficult. We aimed to assess the prognostic value of pre-procedural anemia in patients undergoing TAVI. Methods and results: We studied 150 consecutive patients undergoing TAVI (transfemoral n=96, transapical n=54) (age 81±7 years; logistic EuroSCORE 24±15%). Pre-procedural anemia was defined as a hemoglobin (Hb)<12 in females and<13 mg/dL in males. Severe anemia was defined as a Hb<11.5 in males and <10.5 mg/dL in females. Baseline EuroSCORE was not significantly different between anemic and non-anemic patients (p=0.67). Baseline Hb was significantly related to 30-day mortality independently of age, baseline glomerular filtration rate, type of procedure and left ventricular ejection fraction (OR 0.60, 95% CI 0.42-0.87 per g/dL Hb, p=0.006). Severe anemia was associated with a 3.4-fold higher risk of 30-day mortality compared to the remaining patients. During a median follow-up period of 3.4 months, 45 patients died. Hb emerged as an independent predictor of mortality (HR 0.78, p=0.007) on Cox analysis independently of GFR (HR 0.98, p=0.002), transfemoral or transapical access (HR 1.87, p=0.04), age (p=NS) and left ventricular ejection fraction (p=NS). Kaplan-Meier curves were constructed to illustrate the association between baseline anemia and outcome (Figure). Conclusion: Pre-interventional anemia is a powerful predictor of adverse outcome after TAVI. This association was found to be independent of renal function. The presence of severe anemia should be considered a significant risk factor for mortality in patients undergoing TAVI.
European Heart Journal, 2021
Aims The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SC... more Aims The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SCAD) undergoing initial conservative management is still a matter of debate, with theoretical arguments in favour and against its use. The aims of this article are to assess the use of antiplatelet drugs in medically treated SCAD patients and to investigate the relationship between single (SAPT) and dual (DAPT) antiplatelet regimens and 1-year patient outcomes. Methods and results We investigated the 1-year outcome of patients with SCAD managed with initial conservative treatment included in the DIssezioni Spontanee COronariche (DISCO) multicentre international registry. Patients were divided into two groups according to SAPT or DAPT prescription. Primary endpoint was 12-month incidence of major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction (MI), and any unplanned percutaneous coronary intervention (PCI). Out of 314 patie...
European Heart Journal, 2020
Background Thin-strut drug-eluting stents (DES) and optimal implantation technique reduce the rat... more Background Thin-strut drug-eluting stents (DES) and optimal implantation technique reduce the rate of stent failure significantly. Nevertheless, uncovered struts (US) have been observed as a key factor for stent thrombosis regardless of stent generation and time of follow-up. Associated factors and temporal evolution are currently unknown. Purpose To evaluate the prevalence, mechanisms and long-term clinical impact of largely-US after state-of-the-art DES implantation in complex coronary clinical/lesion cohorts Methods The study was a pre-specified analysis of TRASFORM-OCT, a randomized controlled trial comparing bioabsorbable or durable polymer DES by serial optical coherence tomography (OCT), obtained at baseline, immediately after procedure, at 3 and 18 months follow-up. Methods and results were published previously. For the current analysis enrolled patients (n=90) were divided in 2 groups according to the amount of US identified by OCT at 3 months: a largely US (LUS ≥30%) group...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 22, 2015
Circulation journal : official journal of the Japanese Circulation Society, Jan 8, 2016
The role of culprit plaque and related atherothrombotic components on incomplete stent apposition... more The role of culprit plaque and related atherothrombotic components on incomplete stent apposition (ISA) occurrence after primary percutaneous coronary intervention (p-PCI) is unknown.Methods and Results:ST-segment elevation myocardial infarction (STEMI) patients undergoing p-PCI with an everolimus-eluting stent were prospectively investigated with optical coherence tomography (OCT) of the infarct-related artery before, after stenting and at 9 months. OCT data, aspirated thrombus and serum inflammatory biomarkers were analyzed. 114 patients with 114 lesions were evaluated. Acute ISA occurred in 82 lesions (71.9%), preferentially in larger vessels with a median area of 0.2 mm(2). The presence of thrombus before stent implantation (odds ratio (OR) 5.5, 95% confidence interval (CI) [1.1-26.9], P=0.04) and the lipid content in the target segment (OR 1.3, 95% CI [1.0-1.5], P=0.04) independently predicted acute ISA. At 9-month follow-up, ISA persisted in 46 lesions (56.1%). The volume of a...
Circulation: Cardiovascular Interventions, 2013
Background— The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in pat... more Background— The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in patients undergoing percutaneous interventions for unprotected left main (ULM) disease may affect the prognosis. In this study, we evaluated the immediate results and follow-up of patients with ULM-percutaneous interventions and with or without associated CTO-RCA. Methods and Results— Between March 2002 and December 2008, a total of 568 consecutive patients with ULM stenosis treated with drug-eluting stent were included in this analysis. The mean EuroScore and SYNTAX scores were 4.05±2.62 and 28.12±10.82, respectively. Of these, 522 had ULM lesions without residual CTO-RCA (493 ULM without CTO-RCA+29 ULM with treated CTO-RCA), and 46 patients had residual CTO-RCA. At 1466 days (interquartile range, 1150–1917) follow-up, the cardiac-death occurred in 41 patients (7.2%). Cardiac-death was more frequently observed in patients with ULM and residual CTO-RCA as compared with those without residua...
Cardiovascular OCT Imaging, 2014
Journal of the American College of Cardiology, 2012
Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patie... more Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patients with severe symptomatic tricuspid aortic valve stenosis. However, the role of TAVI in the treatment of the stenosed bicuspid aortic valve has not been clearly demonstrated. Methods: Consecutive patients with bicuspid aortic valve disease in our center treated with TAVI from November 2007 to May 2012 were included. All data was collected from a comprehensive prospective database and events were adjudicated according to the Valve Academic Research Consortium (VARC) definitions. Results: In total, 8 patients undergoing TAVI were identified to have an anatomical bicuspid aortic valve. The mean age was 75.8 Ϯ 5.5 years and 75.0% were female. The patients were deemed high risk for surgery, with a median STS score of 6.5 (interquartile range [IQR] 3.7-13.8). Of the patients nϭ5 (62.5%) underwent implantation of the Medtronic CoreValve® ReValving system device (Medtronic Inc., Minneapolis, MN) and nϭ3 (37.5%) the Edwards SAPIEN™/SAPIEN XT™ (Edwards Lifesciences, Irvine, California). At 30 days, there were 2 deaths, both secondary to aortic dissection (one peri-procedural and one 24 hours post-procedure). There were no events of myocardial infarction or stroke. With regards to the procedure, there were no cases of device embolization. The overall VARC device success was nϭ6 (75.0%), with both failures due to residual significant aortic regurgitation. At a median of 435 (IQR 399-507) days follow-up, there was one further death secondary to hepatic failure. One other patient was readmitted to hospital at day 75 due to acute cardiac compensation. This resulted in a combined efficacy endpoint of 50.0% at follow-up. Conclusions: Despite small numbers, the outcomes of TAVI for the stenosed bicuspid aortic valve may not be optimal and hence require further investigation prior to this becoming an acceptable treatment option in this group of patients.
Journal of the American College of Cardiology, 2012
Background: To compare the incidence and clinical significance of new bundle branch block in pati... more Background: To compare the incidence and clinical significance of new bundle branch block in patients undergoing transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve and Edwards-Sapien prosthesis. Methods: We analyzed data from 336 patients (pts) with no prior pacemaker who underwent TAVI with CoreValve (nϭ130) or Edwards (nϭ206) prosthesis between 2007 and 2011 in our centre. We examined the 12-lead ECGs and documented the conduction disturbances after TAVI and before discharge as compared to baseline. Results: Mean age was similar in CoreValve (79.4Ϯ7.3 years) vs. Edwards group (79.7Ϯ8.1 years, pϭ0.43). New onset of left bundle branch block (LBBB) was documented in 65 (19.3%) pts: 21 (32.2%) in Edwards vs. 44 (67.7%) in CoreValve pts (pϭ0.001). Of them 18 (27.7%) pts showed also a 1st atrioventricular block (AVB): 3 in Edwards and 16 in CoreValve pts (pϭ0.001). Permanent Pacemaker implantation (PPM) was required in 9 (13.8%) pts because of 3rd AVB (Edwards nϭ3; CoreValve nϭ4), LBBB and 1st AVB (CoreValve nϭ1) and LBBB with sinus bradycardia (CoreValve nϭ1). In 14 (21.5%) pts, LBBB was temporary (5 pts, 23.8% Edwards vs. 9pts, 20.4% CoreValve), whereas LBBB persisted in 61.9% of Edwards and in 65.9% of CoreValve pts (pϭ0.5) at discharge. On multivariable analysis, the predictors of LBBB were: CoreValve prosthesis (OR:5.3 95%-CI:2.9-9.8, pϽ0.001), and previous CABG (OR:1.9, 95%-CI:0.9-4, pϽ0.064). New onset of LBBB was not a predictor of overall (log rank pϭ0.56) and cardiovascular mortality (log rank pϭ0.61). A new onset of right bundle branch block (RBBB) was documented in 12 (3.6%) pts (6 both in Edwards and in CoreValve pts): 1.5% with left anterior hemiblock (LAH), 0.3% with 1st AVB and 0,6% with both LAH and 1st AVB. There were no statistically significant differences between Edwards and CoreValve prosthesis. 9 pts developed a new isolated 1st AVB. Conclusions: New LBBB and RBBB are frequent intraventricular conduction disturbances after TAVI with a higher incidence in CoreValve prosthesis. In the majority of pts, the LBBB persists but is not a predictor of overall and cardiovascular mortality. These preliminary conclusions needs to be confirmed in a lorger cohort of patients.
Journal of the American College of Cardiology, 2012
Journal of the American College of Cardiology, 2012
Journal of the American College of Cardiology, Oct 1, 2012
Circulation journal, 2016
ciation between ISA and stent thrombosis, 2-4 outlining the importance of investigations aimed at... more ciation between ISA and stent thrombosis, 2-4 outlining the importance of investigations aimed at understanding and possibly preventing this phenomenon. Several mechanisms have already been advocated to explain why ISA occurs more frequently in patients with ST-segment elevation myocardial tent implantation in the setting of primary percutaneous coronary intervention (p-PCI) has been linked with an increased risk of early and late incomplete stent apposition (ISA). 1,2 Importantly, despite the lack of a compelling evidence, multiple studies have highlighted the putative asso-S
Springer eBooks, Nov 1, 2014
Journal of the American College of Cardiology, Nov 1, 2021
Heart, May 1, 2012
in the BMS group. There was no difference in death, MI or stroke between the stent types. Age-adj... more in the BMS group. There was no difference in death, MI or stroke between the stent types. Age-adjusted Cox analysis showed an decrease in the hazard of events for DES compared to BMS (HR 0.60, 95% CIs 0.03 to 0.69) and this was maintained with multiple adjustment (HR 0.52, 95% CIs 0.05 to 0.89). Conclusions In our cohort of patients who had PCI for treatment of SVG disease the use of DES resulted in lower MACE rate compared to BMS over a 5-year follow-up.
Eurointervention, Nov 1, 2015
Catheterization and Cardiovascular Interventions
BackgroundUncovered struts are a determinant of stent failure. The impact of plaque composition a... more BackgroundUncovered struts are a determinant of stent failure. The impact of plaque composition and procedural factors on the occurrence, evolution, and outcomes of uncovered struts in a high‐risk setting has not been investigated.ObjectiveTo investigate the determinants and long‐term clinical impact of largely uncovered struts (LUS) in thin‐struts drug‐eluting stents (DES) implanted in complex lesions by intracoronary optical coherence tomography (OCT).MethodsNinety patients with multivessel disease undergoing staged complete revascularization were randomly assigned to bioabsorbable or durable polymer DES. OCT were serially performed during the index procedure, at 3‐ and 18‐month follow‐up, and analyzed by an independent core lab. Struts were defined uncovered by OCT if no tissue was visible above the struts. LUS were defined as ≥30% of uncovered struts at 3‐month follow‐up. Clinical outcomes were the occurrence of target vessel failure (TVF) and major adverse cardiac and cerebrova...
European Heart Journal - Case Reports, Mar 1, 2022
A 60-year-old male was referred to the emergency department after a European snake bite (Vipera A... more A 60-year-old male was referred to the emergency department after a European snake bite (Vipera Aspis Francisciredi) (Panel A), complaining of vomiting, and mouth's dryness. The first electocardiogram (ECG) was unremarkable. However, during observation patient developed five episodes of ventricular fibrillation (VT), treated with Direct-Current Defibrillation (DC) shock and Advanced Cardiovascular Life Support (ACLS). Repeated ECG demonstrated anterolateral STelevation myocardial infarction (MI) (Panel B). In 2018, for an acute coronary syndrome, he underwent everolimus-eluting-stent (EES) implantation on the left anterior descending artery (LAD) and first diagonal (D1) branch with a T-modified-stent-technique, and he was discharged with ticagrelor 180 mg/day for 1 year. Coronary angiograms revealed a very late EES thrombosis in mid-LAD-D1 (Panel D) which was satisfactorily treated with mechanical thrombectomy and kissing balloon inflations with non-compliant balloons (Panel A). Intracoronary imaging was not performed to assess the potential mechanisms underlying ST due to refractory VT episodes. The patient was treated with bolus and infusion and integrilin. Ticagrelor 90 mg/b.i.d. followed by 60 mg/b.i.d. after 1 year plus aspirin was planned. He was treated with anti-snake venom
European Heart Journal Supplements, 2021
Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial con... more Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial conservative management or immediate revascularization through percutaneous coronary intervention (PCI) remains debated. To investigate the frequency and predictors of choosing a strategy of immediate PCI for SCAD, and to compare the clinical outcomes of immediate PCI patients with those undergoing an initial strategy of medical management. 369 patients enrolled in the multicentre international DIssezioni Spontanee COronariche (DISCO) registry between January 2009 and December 2020 were included. The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction (MI) and any PCI. 240 (65%) patients underwent initial medical management, whereas 129 (35%) had immediate PCI. PCI patients presented more frequently with ST segment-elevation myocardial infarction (STEMI) (68.2% vs. 35%, P < 0.001) and had higher frequency of proxi...
European Heart Journal, 2013
Background: Transcatheter aortic valve implantation (TAVI) is an accepted alternative to conventi... more Background: Transcatheter aortic valve implantation (TAVI) is an accepted alternative to conventional surgical aortic valve replacement in high risk patients with aortic stenosis. Identifying patients at high risk of short/mid-term mortality remains difficult. We aimed to assess the prognostic value of pre-procedural anemia in patients undergoing TAVI. Methods and results: We studied 150 consecutive patients undergoing TAVI (transfemoral n=96, transapical n=54) (age 81±7 years; logistic EuroSCORE 24±15%). Pre-procedural anemia was defined as a hemoglobin (Hb)<12 in females and<13 mg/dL in males. Severe anemia was defined as a Hb<11.5 in males and <10.5 mg/dL in females. Baseline EuroSCORE was not significantly different between anemic and non-anemic patients (p=0.67). Baseline Hb was significantly related to 30-day mortality independently of age, baseline glomerular filtration rate, type of procedure and left ventricular ejection fraction (OR 0.60, 95% CI 0.42-0.87 per g/dL Hb, p=0.006). Severe anemia was associated with a 3.4-fold higher risk of 30-day mortality compared to the remaining patients. During a median follow-up period of 3.4 months, 45 patients died. Hb emerged as an independent predictor of mortality (HR 0.78, p=0.007) on Cox analysis independently of GFR (HR 0.98, p=0.002), transfemoral or transapical access (HR 1.87, p=0.04), age (p=NS) and left ventricular ejection fraction (p=NS). Kaplan-Meier curves were constructed to illustrate the association between baseline anemia and outcome (Figure). Conclusion: Pre-interventional anemia is a powerful predictor of adverse outcome after TAVI. This association was found to be independent of renal function. The presence of severe anemia should be considered a significant risk factor for mortality in patients undergoing TAVI.
European Heart Journal, 2021
Aims The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SC... more Aims The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SCAD) undergoing initial conservative management is still a matter of debate, with theoretical arguments in favour and against its use. The aims of this article are to assess the use of antiplatelet drugs in medically treated SCAD patients and to investigate the relationship between single (SAPT) and dual (DAPT) antiplatelet regimens and 1-year patient outcomes. Methods and results We investigated the 1-year outcome of patients with SCAD managed with initial conservative treatment included in the DIssezioni Spontanee COronariche (DISCO) multicentre international registry. Patients were divided into two groups according to SAPT or DAPT prescription. Primary endpoint was 12-month incidence of major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction (MI), and any unplanned percutaneous coronary intervention (PCI). Out of 314 patie...
European Heart Journal, 2020
Background Thin-strut drug-eluting stents (DES) and optimal implantation technique reduce the rat... more Background Thin-strut drug-eluting stents (DES) and optimal implantation technique reduce the rate of stent failure significantly. Nevertheless, uncovered struts (US) have been observed as a key factor for stent thrombosis regardless of stent generation and time of follow-up. Associated factors and temporal evolution are currently unknown. Purpose To evaluate the prevalence, mechanisms and long-term clinical impact of largely-US after state-of-the-art DES implantation in complex coronary clinical/lesion cohorts Methods The study was a pre-specified analysis of TRASFORM-OCT, a randomized controlled trial comparing bioabsorbable or durable polymer DES by serial optical coherence tomography (OCT), obtained at baseline, immediately after procedure, at 3 and 18 months follow-up. Methods and results were published previously. For the current analysis enrolled patients (n=90) were divided in 2 groups according to the amount of US identified by OCT at 3 months: a largely US (LUS ≥30%) group...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Jan 22, 2015
Circulation journal : official journal of the Japanese Circulation Society, Jan 8, 2016
The role of culprit plaque and related atherothrombotic components on incomplete stent apposition... more The role of culprit plaque and related atherothrombotic components on incomplete stent apposition (ISA) occurrence after primary percutaneous coronary intervention (p-PCI) is unknown.Methods and Results:ST-segment elevation myocardial infarction (STEMI) patients undergoing p-PCI with an everolimus-eluting stent were prospectively investigated with optical coherence tomography (OCT) of the infarct-related artery before, after stenting and at 9 months. OCT data, aspirated thrombus and serum inflammatory biomarkers were analyzed. 114 patients with 114 lesions were evaluated. Acute ISA occurred in 82 lesions (71.9%), preferentially in larger vessels with a median area of 0.2 mm(2). The presence of thrombus before stent implantation (odds ratio (OR) 5.5, 95% confidence interval (CI) [1.1-26.9], P=0.04) and the lipid content in the target segment (OR 1.3, 95% CI [1.0-1.5], P=0.04) independently predicted acute ISA. At 9-month follow-up, ISA persisted in 46 lesions (56.1%). The volume of a...
Circulation: Cardiovascular Interventions, 2013
Background— The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in pat... more Background— The presence of chronic total occlusion of the right coronary artery (CTO-RCA) in patients undergoing percutaneous interventions for unprotected left main (ULM) disease may affect the prognosis. In this study, we evaluated the immediate results and follow-up of patients with ULM-percutaneous interventions and with or without associated CTO-RCA. Methods and Results— Between March 2002 and December 2008, a total of 568 consecutive patients with ULM stenosis treated with drug-eluting stent were included in this analysis. The mean EuroScore and SYNTAX scores were 4.05±2.62 and 28.12±10.82, respectively. Of these, 522 had ULM lesions without residual CTO-RCA (493 ULM without CTO-RCA+29 ULM with treated CTO-RCA), and 46 patients had residual CTO-RCA. At 1466 days (interquartile range, 1150–1917) follow-up, the cardiac-death occurred in 41 patients (7.2%). Cardiac-death was more frequently observed in patients with ULM and residual CTO-RCA as compared with those without residua...
Cardiovascular OCT Imaging, 2014
Journal of the American College of Cardiology, 2012
Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patie... more Background: Transcatheter aortic valve implantation (TAVI) is a viable option for high-risk patients with severe symptomatic tricuspid aortic valve stenosis. However, the role of TAVI in the treatment of the stenosed bicuspid aortic valve has not been clearly demonstrated. Methods: Consecutive patients with bicuspid aortic valve disease in our center treated with TAVI from November 2007 to May 2012 were included. All data was collected from a comprehensive prospective database and events were adjudicated according to the Valve Academic Research Consortium (VARC) definitions. Results: In total, 8 patients undergoing TAVI were identified to have an anatomical bicuspid aortic valve. The mean age was 75.8 Ϯ 5.5 years and 75.0% were female. The patients were deemed high risk for surgery, with a median STS score of 6.5 (interquartile range [IQR] 3.7-13.8). Of the patients nϭ5 (62.5%) underwent implantation of the Medtronic CoreValve® ReValving system device (Medtronic Inc., Minneapolis, MN) and nϭ3 (37.5%) the Edwards SAPIEN™/SAPIEN XT™ (Edwards Lifesciences, Irvine, California). At 30 days, there were 2 deaths, both secondary to aortic dissection (one peri-procedural and one 24 hours post-procedure). There were no events of myocardial infarction or stroke. With regards to the procedure, there were no cases of device embolization. The overall VARC device success was nϭ6 (75.0%), with both failures due to residual significant aortic regurgitation. At a median of 435 (IQR 399-507) days follow-up, there was one further death secondary to hepatic failure. One other patient was readmitted to hospital at day 75 due to acute cardiac compensation. This resulted in a combined efficacy endpoint of 50.0% at follow-up. Conclusions: Despite small numbers, the outcomes of TAVI for the stenosed bicuspid aortic valve may not be optimal and hence require further investigation prior to this becoming an acceptable treatment option in this group of patients.
Journal of the American College of Cardiology, 2012
Background: To compare the incidence and clinical significance of new bundle branch block in pati... more Background: To compare the incidence and clinical significance of new bundle branch block in patients undergoing transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve and Edwards-Sapien prosthesis. Methods: We analyzed data from 336 patients (pts) with no prior pacemaker who underwent TAVI with CoreValve (nϭ130) or Edwards (nϭ206) prosthesis between 2007 and 2011 in our centre. We examined the 12-lead ECGs and documented the conduction disturbances after TAVI and before discharge as compared to baseline. Results: Mean age was similar in CoreValve (79.4Ϯ7.3 years) vs. Edwards group (79.7Ϯ8.1 years, pϭ0.43). New onset of left bundle branch block (LBBB) was documented in 65 (19.3%) pts: 21 (32.2%) in Edwards vs. 44 (67.7%) in CoreValve pts (pϭ0.001). Of them 18 (27.7%) pts showed also a 1st atrioventricular block (AVB): 3 in Edwards and 16 in CoreValve pts (pϭ0.001). Permanent Pacemaker implantation (PPM) was required in 9 (13.8%) pts because of 3rd AVB (Edwards nϭ3; CoreValve nϭ4), LBBB and 1st AVB (CoreValve nϭ1) and LBBB with sinus bradycardia (CoreValve nϭ1). In 14 (21.5%) pts, LBBB was temporary (5 pts, 23.8% Edwards vs. 9pts, 20.4% CoreValve), whereas LBBB persisted in 61.9% of Edwards and in 65.9% of CoreValve pts (pϭ0.5) at discharge. On multivariable analysis, the predictors of LBBB were: CoreValve prosthesis (OR:5.3 95%-CI:2.9-9.8, pϽ0.001), and previous CABG (OR:1.9, 95%-CI:0.9-4, pϽ0.064). New onset of LBBB was not a predictor of overall (log rank pϭ0.56) and cardiovascular mortality (log rank pϭ0.61). A new onset of right bundle branch block (RBBB) was documented in 12 (3.6%) pts (6 both in Edwards and in CoreValve pts): 1.5% with left anterior hemiblock (LAH), 0.3% with 1st AVB and 0,6% with both LAH and 1st AVB. There were no statistically significant differences between Edwards and CoreValve prosthesis. 9 pts developed a new isolated 1st AVB. Conclusions: New LBBB and RBBB are frequent intraventricular conduction disturbances after TAVI with a higher incidence in CoreValve prosthesis. In the majority of pts, the LBBB persists but is not a predictor of overall and cardiovascular mortality. These preliminary conclusions needs to be confirmed in a lorger cohort of patients.
Journal of the American College of Cardiology, 2012
Journal of the American College of Cardiology, 2012