Corrado Lettieri - Academia.edu (original) (raw)
Papers by Corrado Lettieri
Giornale italiano di cardiologia, Oct 1, 2015
Background. Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI)... more Background. Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not well defined and standard protocols have been not established. The purpose of this study was to assess: a) the frequency and patterns of cardiology visits, echocardiographic examinations and stress tests after PCI in clinical practice; b) the impact of a multidisciplinary protocol of long-term follow-up after PCI shared with general practitioners on the appropriateness and reduction in healthcare costs. Methods. A total of 780 patients who underwent PCI in 2010 in two Italian hospitals were analyzed. The number of cardiological examinations (total, routine and clinically driven) performed during 2 years of followup were recorded and stratified according to the patient's risk profile. The latter was defined according to the multidisciplinary protocol. In addition, a simulation of the spread between provided and necessary tests (according to the multidisciplinary protocol) was carried out. Results. The mean number of cardiological examinations per patient provided during follow-up was 5, of which 4.4 were routine tests in asymptomatic patients. Routine tests were performed more frequently in patients at low risk compared to those at higher risk. By applying the multidisciplinary protocol to the case mix and by merging clinical visit and stress test or echocardiographic examination, a reduction of 0.87 tests per patient/year would be expected. This reduction would result in a 39% decrease in follow-up examinations in this specific clinical setting. Conclusions. This observational study demonstrates that unnecessary cardiological clinical and functional tests are often performed in long-term follow-up of patients submitted to PCI. The application of a standard protocol of follow-up shared with general practitioners may help avoiding unnecessary consultations, thus reducing healthcare costs.
![Research paper thumbnail of [Coronary stenting and surgery: perioperative management of antiplatelet therapy in patients undergoing surgery after coronary stent implantation]](https://attachments.academia-assets.com/110645632/thumbnails/1.jpg)
](PubMed, Jul 12, 2012
The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a g... more The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.
Eurointervention, May 1, 2014
Optimal perioperative antiplatelet therapy in patients with coronary stents undergoing surgery st... more Optimal perioperative antiplatelet therapy in patients with coronary stents undergoing surgery still remains poorly defined and a matter of debate among cardiologists, surgeons and anaesthesiologists. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. Clinical practice guidelines provide little support with regard to managing antiplatelet therapy in the perioperative phase in the case of patients with non-deferrable surgical interventions and/or high haemorrhagic risk. Moreover, a standard definition of ischaemic and haemorrhagic risk has never been determined. Finally, recommendations shared by cardiologists, surgeons and anaesthesiologists are lacking. The present consensus document provides practical recommendations on the perioperative management of antiplatelet therapy in patients with coronary stents undergoing surgery. Cardiologists, surgeons and anaesthesiologists have contributed equally to its creation. On the basis of clinical and angiographic data, the individual thrombotic risk has been defined. All surgical interventions have been classified according to their inherent haemorrhagic risk. A consensus on the optimal antiplatelet regimen in the perioperative phase has been reached on the basis of the ischaemic and haemorrhagic risk. Aspirin should be continued perioperatively in the majority of surgical operations, whereas dual antiplatelet therapy should not be withdrawn for surgery in the case of low bleeding risk. In selected patients at high risk for both bleeding and ischaemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be taken into consideration.
American Heart Journal, Mar 1, 2009
Background The role of emergency reperfusion therapy in patients with ST-elevation myocardial inf... more Background The role of emergency reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) resuscitated after an out-of-hospital cardiac arrest (OHCA) has not been clearly established yet. The aim of this study was to evaluate the in-hospital and ...
Catheterization and Cardiovascular Interventions
BackgroundA multidisciplinary consensus document (MCD) provided a follow‐up strategy after percut... more BackgroundA multidisciplinary consensus document (MCD) provided a follow‐up strategy after percutaneous coronary intervention (PCI) based on individual risk profiles: A, high; B, intermediate; and C, low.AimTo assess patterns of follow‐up after PCI and to evaluate the potential reduction of cardiologic examinations with the application of the MCD.MethodsThe post‐PCI registry was carried out at 31 Italian Hospitals and included consecutive patients undergoing PCI. We collected cardiologic consults (CC), noninvasive stress tests (ST), and echocardiograms (EC) actually performed at 12 months and we compared them with the expected by the MCD.ResultsWe included 1,113 patients (58% with acute coronary syndrome) that underwent 1,567 CC, 398 ST, and 612 EC. The performed CC and ST were significantly lower compared to the expected, respectively [1.6 (95% CI, 1.5–1.7) vs. 1.9 (95% CI, 1.8–2.0), and 0.40 (95% CI, 0.4–0.5) vs. 0.61 (95% CI, 0.6–0.7), p < .001]; the performed EC were signific...
Giornale italiano di cardiologia, 2015
Corrado Lettieri1, Paola Colombo2, Renato Rosiello1, Nuccia Morici2, Pierpaolo Parogni3, Giuseppe... more Corrado Lettieri1, Paola Colombo2, Renato Rosiello1, Nuccia Morici2, Pierpaolo Parogni3, Giuseppe Musumeci4, Erminio Tabaglio5, Alessandro Zadra5, Maria Grazia Cattaneo6, Francesco Soriano2, Maria Cristiana Brunazzi1, Maurizio Galavotti7, Silvio Klugmann2, Michele Senni4, Orazio Valsecchi4, Roberto Zanini1, Roberta Rossini4 1Dipartimento Cardio-Toraco-Vascolare, A.O. Carlo Poma, Mantova 2Dipartimento Cardiotoracovascolare “A. De Gasperis”, A.O. Ospedale Niguarda Ca’ Granda, Milano 3Dipartimento Emergenza-Urgenza, A.O. Carlo Poma, Mantova 4Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo 5Azienda Sanitaria Locale di Brescia, Brescia 6Ufficio Qualità, A.O. Papa Giovanni XXIII, Bergamo 7Azienda Sanitaria Locale di Mantova, Mantova
Giornale italiano di cardiologia, 2017
Roberta Rossini,* MD, PhD, Luigi Oltrona Visconti, MD, Giuseppe Musumeci, MD, Alessandro Filippi,... more Roberta Rossini,* MD, PhD, Luigi Oltrona Visconti, MD, Giuseppe Musumeci, MD, Alessandro Filippi, MD, Roberto Pedretti, MD, Corrado Lettieri, MD, Francesca Buffoli, MD, Marco Campana, MD, Davide Capodanno, MD, PhD, Battistina Castiglioni, MD, Maria Grazia Cattaneo, MD, Paola Colombo, MD, Leonardo De Luca, MD, Stefano De Servi, MD, Marco Ferlini, MD, Ugo Limbruno, MD, Daniele Nassiacos, MD, Emanuela Piccaluga, MD, Arturo Raisaro, MD, PierFranco Ravizza, MD, Michele Senni, MD, Erminio Tabaglio, MD, Giuseppe Tarantini, MD, Daniela Trabattoni, MD, Alessandro Zadra, MD, Carmine Riccio, MD, Francesco Bedogni, MD, Oreste Febo, MD, Ovidio Brignoli, MD, Roberto Ceravolo, MD, Gennaro Sardella, MD, Sante Bongo, MD, Pompilio Faggiano, MD, Claudio Cricelli, MD, Cesare Greco, MD, Michele Massimo Gulizia, MD, Sergio Berti, MD, and Francesco Bovenzi, MD, on behalf of the Italian Society of Invasive Cardiology (SICI-GISE), National Association of Hospital Cardiologists (ANMCO), Italian Association f...
IJC Heart & Vasculature, 2020
Background: During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regiona... more Background: During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regional network concerning time-dependent emergencies. Specifically, 13 Macro-Hubs were identified to deliver timely optimal care to patients with acute coronary syndromes (ACS). Aim of this paper is to present the results of this experience. Methods and Results: This is a multicenter, observational study. A total of 953 patients were included, presenting with STEMI in 57.7% of the cases. About 98% of patients received coronary angiography with a median since first medical contact to angiography of 79 (IQR 45-124) minutes for STEMI and 1262 (IQR 643-2481) minutes for NSTEMI. A total of 107 patients (11.2%) had SARS-CoV2 infection, mostly with STEMI (74.8%). The time interval from first medical contact to cath-lab was significant shorter in patients with COVID-19, both in the overall population and in STEMI patients (87 (IQR 41-310) versus 160 (IQR 67-1220) minutes, P = 0.001, and 61 (IQR 23-98) versus 80 (IQR 47-126) minutes, P = 0.01, respectively). In-hospital mortality and cardiogenic shock rates were higher among patients with COVID-19 compared to patients without (32% vs 6%, P < 0.0001, and 16.8% vs 6.7%, P < 0.0003, respectively). Conclusions: During the COVID-19 outbreak in Lombardy, the redefinition of ACS network according to enlarged Macro-Hubs allowed to continue with timely ACS management, while reserving a high number of intensive care beds for the pandemic. Patients with ACS and COVID-19 presented a worst outcome, particularly in case of STEMI.
Journal of Cardiovascular Medicine, 2020
Background Patients surviving a myocardial infarction (MI) are at a heightened risk for recurrent... more Background Patients surviving a myocardial infarction (MI) are at a heightened risk for recurrent ischemic events that can be reduced with the long-term addition of a second antithrombotic drug to aspirin. However, data about real prescription of this therapy are lacking and sometimes controversial. Methods We aimed to describe the incidence and the determinants of a dual antiplatelet therapy (DAPT) prolongation beyond 12 months in a cohort of consecutive patients undergoing percutaneous coronary intervention (PCI) with prior MI undergoing PCI and features of high ischemic risk intended as age more than 65 years, second MI, type 2 diabetes mellitus, multivessel coronary artery disease (MVCAD) and chronic kidney disease (CKD). We analysed patients enrolled in the prospective ‘Post-PCI’ registry that included patients treated with PCI for stable coronary artery disease (CAD) or acute coronary syndromes. At 12 months' follow-up, we collected data about DAPT prolongation in patients...
International Journal of Cardiology, 2020
European Heart Journal, 2019
Background Redundant clinical and non-invasive examinations after percutaneous coronary intervent... more Background Redundant clinical and non-invasive examinations after percutaneous coronary intervention (PCI) increase the cost of medical care with no outcome improve. A multidisciplinary consensus document (MCD) providing a follow-up (FU) strategy based on 3 clinical and angiographic risk profile (A high, B intermediate, and C low) has been recently proposed. Aim To evaluate the potential reduction of cardiologic consults (CC), stress tests (ST), and echocardiograms (EC) with the application of the MCD after PCI. Methods The Post-PCI registry is a multicenter, observational, prospective data collection carried out during a four-week period that included consecutive patients undergoing PCI at 31 Italian Hospitals both for acute coronary syndromes (ACS) or stable coronary artery disease (SCAD). FU strategies were left at investigator's discretion. A comparison between the CC, ST and EC performed in the first 12-months with the potential suggested by the MCD was evaluated. Results A...
Circulation: Cardiovascular Interventions, 2019
June 2019 1
Giornale italiano di cardiologia (2006), 2018
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic coronary artery pathology ... more Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic coronary artery pathology and an important cause of coronary artery disease in young women with an average age of 40 to 50 years with few or no cardiovascular risk factors. There has been a surge in the diagnosis of SCAD due to an increased use of coronary angiography and the clinical availability and application of high-resolution intracoronary imaging. SCAD is due to the separation of coronary wall layers with the formation of intramural hematoma, compression of the true lumen and secondary myocardial ischemia. Coronary angiography is the first-line imaging, also useful are intravascular ultrasound and optical coherence tomography. Therapy is conservative in most cases because of the high percentage of spontaneous healing of the vascular wall. The prognosis is good, although the disease is burdened by a high prevalence of major adverse coronary events, including recurrence of coronary dissection, thus making ca...
Giornale italiano di cardiologia (2006), 2018
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with... more Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.
Giornale Italiano Di Cardiologia, Jul 1, 2012
Or tu a Cariddi Non t'accostar, mentre il mar negro inghiotte: Chè mal sapria dalla ruina estrema... more Or tu a Cariddi Non t'accostar, mentre il mar negro inghiotte: Chè mal sapria dalla ruina estrema Nettuno stesso dilivrarti. A Scilla Tienti vicino, e rapido trascorri. Perder sei de' compagni entro la nave Torna più assai, che perir tutti a un tempo." Omero, Odissea, libro XII PROLOGO: TRE SCENARI Scenario 1 "Buongiorno Signor X, la chiamo dalla Cardiochirurgia per il suo ricovero. L'intervento è previsto mercoledì mattina per cui il ricovero sarà lunedì [...]. Ah, mi raccomando di sospendere l'aspirina da sabato." Sospendere l'aspirina da sabato. Cinque giorni prima dell'intervento. Una frase standard pronunciata a memoria, come un salmo, come l'incipit di una telefonata pubblicitaria. Peccato che il paziente avesse ricevuto 2 mesi prima uno stent coronarico (fortunatamente non medicato) per una sindrome coronarica acuta e presentasse una malattia aterosclerotica di altri rami coronarici ...
Giornale italiano di cardiologia (2006), 2015
Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not wel... more Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not well defined and standard protocols have been not established. The purpose of this study was to assess: a) the frequency and patterns of cardiology visits, echocardiographic examinations and stress tests after PCI in clinical practice; b) the impact of a multidisciplinary protocol of long-term follow-up after PCI shared with general practitioners on the appropriateness and reduction in healthcare costs. A total of 780 patients who underwent PCI in 2010 in two Italian hospitals were analyzed. The number of cardiological examinations (total, routine and clinically driven) performed during 2 years of follow-up were recorded and stratified according to the patient's risk profile. The latter was defined according to the multidisciplinary protocol. In addition, a simulation of the spread between provided and necessary tests (according to the multidisciplinary protocol) was carried out. The me...
JACC: Cardiovascular Interventions, 2015
Giornale Italiano di Cardiologia, 2012
STENT CORONARICO E CHIRURGIA D'altra parte, la terapia antiaggregante aumenta notevolmente il ris... more STENT CORONARICO E CHIRURGIA D'altra parte, la terapia antiaggregante aumenta notevolmente il rischio emorragico in corso di procedure chirurgiche o endoscopiche. La gestione perioperatoria della terapia antiaggregante è spesso individuale e non necessariamente condivisa tra cardiologi e chirurghi. Le attuali linee guida non forniscono protocolli operativi chiari in relazione al rischio trombotico del paziente ed alle diverse tipologie di interventi chirurgici e rimandano, per lo più, ad una valutazione dei singoli casi 1,2. INTRODUZIONE Il numero di pazienti portatori di stent coronarico che hanno necessità di effettuare un intervento chirurgico è in costante aumento. È noto che il paziente portatore di stent necessita di una duplice terapia antiaggregante orale per un tempo, ad oggi, non ben definito, e che la sospensione di uno o entrambi i farmaci antiaggreganti comporta, specie nei primi mesi dopo la procedura, un rischio significativo di trombosi di stent (ST), evento potenzialmente mortale 1-6 .
Giornale italiano di cardiologia, Oct 1, 2015
Background. Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI)... more Background. Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not well defined and standard protocols have been not established. The purpose of this study was to assess: a) the frequency and patterns of cardiology visits, echocardiographic examinations and stress tests after PCI in clinical practice; b) the impact of a multidisciplinary protocol of long-term follow-up after PCI shared with general practitioners on the appropriateness and reduction in healthcare costs. Methods. A total of 780 patients who underwent PCI in 2010 in two Italian hospitals were analyzed. The number of cardiological examinations (total, routine and clinically driven) performed during 2 years of followup were recorded and stratified according to the patient's risk profile. The latter was defined according to the multidisciplinary protocol. In addition, a simulation of the spread between provided and necessary tests (according to the multidisciplinary protocol) was carried out. Results. The mean number of cardiological examinations per patient provided during follow-up was 5, of which 4.4 were routine tests in asymptomatic patients. Routine tests were performed more frequently in patients at low risk compared to those at higher risk. By applying the multidisciplinary protocol to the case mix and by merging clinical visit and stress test or echocardiographic examination, a reduction of 0.87 tests per patient/year would be expected. This reduction would result in a 39% decrease in follow-up examinations in this specific clinical setting. Conclusions. This observational study demonstrates that unnecessary cardiological clinical and functional tests are often performed in long-term follow-up of patients submitted to PCI. The application of a standard protocol of follow-up shared with general practitioners may help avoiding unnecessary consultations, thus reducing healthcare costs.
PubMed, Jul 12, 2012
The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a g... more The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.
Eurointervention, May 1, 2014
Optimal perioperative antiplatelet therapy in patients with coronary stents undergoing surgery st... more Optimal perioperative antiplatelet therapy in patients with coronary stents undergoing surgery still remains poorly defined and a matter of debate among cardiologists, surgeons and anaesthesiologists. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. Clinical practice guidelines provide little support with regard to managing antiplatelet therapy in the perioperative phase in the case of patients with non-deferrable surgical interventions and/or high haemorrhagic risk. Moreover, a standard definition of ischaemic and haemorrhagic risk has never been determined. Finally, recommendations shared by cardiologists, surgeons and anaesthesiologists are lacking. The present consensus document provides practical recommendations on the perioperative management of antiplatelet therapy in patients with coronary stents undergoing surgery. Cardiologists, surgeons and anaesthesiologists have contributed equally to its creation. On the basis of clinical and angiographic data, the individual thrombotic risk has been defined. All surgical interventions have been classified according to their inherent haemorrhagic risk. A consensus on the optimal antiplatelet regimen in the perioperative phase has been reached on the basis of the ischaemic and haemorrhagic risk. Aspirin should be continued perioperatively in the majority of surgical operations, whereas dual antiplatelet therapy should not be withdrawn for surgery in the case of low bleeding risk. In selected patients at high risk for both bleeding and ischaemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be taken into consideration.
American Heart Journal, Mar 1, 2009
Background The role of emergency reperfusion therapy in patients with ST-elevation myocardial inf... more Background The role of emergency reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) resuscitated after an out-of-hospital cardiac arrest (OHCA) has not been clearly established yet. The aim of this study was to evaluate the in-hospital and ...
Catheterization and Cardiovascular Interventions
BackgroundA multidisciplinary consensus document (MCD) provided a follow‐up strategy after percut... more BackgroundA multidisciplinary consensus document (MCD) provided a follow‐up strategy after percutaneous coronary intervention (PCI) based on individual risk profiles: A, high; B, intermediate; and C, low.AimTo assess patterns of follow‐up after PCI and to evaluate the potential reduction of cardiologic examinations with the application of the MCD.MethodsThe post‐PCI registry was carried out at 31 Italian Hospitals and included consecutive patients undergoing PCI. We collected cardiologic consults (CC), noninvasive stress tests (ST), and echocardiograms (EC) actually performed at 12 months and we compared them with the expected by the MCD.ResultsWe included 1,113 patients (58% with acute coronary syndrome) that underwent 1,567 CC, 398 ST, and 612 EC. The performed CC and ST were significantly lower compared to the expected, respectively [1.6 (95% CI, 1.5–1.7) vs. 1.9 (95% CI, 1.8–2.0), and 0.40 (95% CI, 0.4–0.5) vs. 0.61 (95% CI, 0.6–0.7), p < .001]; the performed EC were signific...
Giornale italiano di cardiologia, 2015
Corrado Lettieri1, Paola Colombo2, Renato Rosiello1, Nuccia Morici2, Pierpaolo Parogni3, Giuseppe... more Corrado Lettieri1, Paola Colombo2, Renato Rosiello1, Nuccia Morici2, Pierpaolo Parogni3, Giuseppe Musumeci4, Erminio Tabaglio5, Alessandro Zadra5, Maria Grazia Cattaneo6, Francesco Soriano2, Maria Cristiana Brunazzi1, Maurizio Galavotti7, Silvio Klugmann2, Michele Senni4, Orazio Valsecchi4, Roberto Zanini1, Roberta Rossini4 1Dipartimento Cardio-Toraco-Vascolare, A.O. Carlo Poma, Mantova 2Dipartimento Cardiotoracovascolare “A. De Gasperis”, A.O. Ospedale Niguarda Ca’ Granda, Milano 3Dipartimento Emergenza-Urgenza, A.O. Carlo Poma, Mantova 4Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo 5Azienda Sanitaria Locale di Brescia, Brescia 6Ufficio Qualità, A.O. Papa Giovanni XXIII, Bergamo 7Azienda Sanitaria Locale di Mantova, Mantova
Giornale italiano di cardiologia, 2017
Roberta Rossini,* MD, PhD, Luigi Oltrona Visconti, MD, Giuseppe Musumeci, MD, Alessandro Filippi,... more Roberta Rossini,* MD, PhD, Luigi Oltrona Visconti, MD, Giuseppe Musumeci, MD, Alessandro Filippi, MD, Roberto Pedretti, MD, Corrado Lettieri, MD, Francesca Buffoli, MD, Marco Campana, MD, Davide Capodanno, MD, PhD, Battistina Castiglioni, MD, Maria Grazia Cattaneo, MD, Paola Colombo, MD, Leonardo De Luca, MD, Stefano De Servi, MD, Marco Ferlini, MD, Ugo Limbruno, MD, Daniele Nassiacos, MD, Emanuela Piccaluga, MD, Arturo Raisaro, MD, PierFranco Ravizza, MD, Michele Senni, MD, Erminio Tabaglio, MD, Giuseppe Tarantini, MD, Daniela Trabattoni, MD, Alessandro Zadra, MD, Carmine Riccio, MD, Francesco Bedogni, MD, Oreste Febo, MD, Ovidio Brignoli, MD, Roberto Ceravolo, MD, Gennaro Sardella, MD, Sante Bongo, MD, Pompilio Faggiano, MD, Claudio Cricelli, MD, Cesare Greco, MD, Michele Massimo Gulizia, MD, Sergio Berti, MD, and Francesco Bovenzi, MD, on behalf of the Italian Society of Invasive Cardiology (SICI-GISE), National Association of Hospital Cardiologists (ANMCO), Italian Association f...
IJC Heart & Vasculature, 2020
Background: During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regiona... more Background: During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regional network concerning time-dependent emergencies. Specifically, 13 Macro-Hubs were identified to deliver timely optimal care to patients with acute coronary syndromes (ACS). Aim of this paper is to present the results of this experience. Methods and Results: This is a multicenter, observational study. A total of 953 patients were included, presenting with STEMI in 57.7% of the cases. About 98% of patients received coronary angiography with a median since first medical contact to angiography of 79 (IQR 45-124) minutes for STEMI and 1262 (IQR 643-2481) minutes for NSTEMI. A total of 107 patients (11.2%) had SARS-CoV2 infection, mostly with STEMI (74.8%). The time interval from first medical contact to cath-lab was significant shorter in patients with COVID-19, both in the overall population and in STEMI patients (87 (IQR 41-310) versus 160 (IQR 67-1220) minutes, P = 0.001, and 61 (IQR 23-98) versus 80 (IQR 47-126) minutes, P = 0.01, respectively). In-hospital mortality and cardiogenic shock rates were higher among patients with COVID-19 compared to patients without (32% vs 6%, P < 0.0001, and 16.8% vs 6.7%, P < 0.0003, respectively). Conclusions: During the COVID-19 outbreak in Lombardy, the redefinition of ACS network according to enlarged Macro-Hubs allowed to continue with timely ACS management, while reserving a high number of intensive care beds for the pandemic. Patients with ACS and COVID-19 presented a worst outcome, particularly in case of STEMI.
Journal of Cardiovascular Medicine, 2020
Background Patients surviving a myocardial infarction (MI) are at a heightened risk for recurrent... more Background Patients surviving a myocardial infarction (MI) are at a heightened risk for recurrent ischemic events that can be reduced with the long-term addition of a second antithrombotic drug to aspirin. However, data about real prescription of this therapy are lacking and sometimes controversial. Methods We aimed to describe the incidence and the determinants of a dual antiplatelet therapy (DAPT) prolongation beyond 12 months in a cohort of consecutive patients undergoing percutaneous coronary intervention (PCI) with prior MI undergoing PCI and features of high ischemic risk intended as age more than 65 years, second MI, type 2 diabetes mellitus, multivessel coronary artery disease (MVCAD) and chronic kidney disease (CKD). We analysed patients enrolled in the prospective ‘Post-PCI’ registry that included patients treated with PCI for stable coronary artery disease (CAD) or acute coronary syndromes. At 12 months' follow-up, we collected data about DAPT prolongation in patients...
International Journal of Cardiology, 2020
European Heart Journal, 2019
Background Redundant clinical and non-invasive examinations after percutaneous coronary intervent... more Background Redundant clinical and non-invasive examinations after percutaneous coronary intervention (PCI) increase the cost of medical care with no outcome improve. A multidisciplinary consensus document (MCD) providing a follow-up (FU) strategy based on 3 clinical and angiographic risk profile (A high, B intermediate, and C low) has been recently proposed. Aim To evaluate the potential reduction of cardiologic consults (CC), stress tests (ST), and echocardiograms (EC) with the application of the MCD after PCI. Methods The Post-PCI registry is a multicenter, observational, prospective data collection carried out during a four-week period that included consecutive patients undergoing PCI at 31 Italian Hospitals both for acute coronary syndromes (ACS) or stable coronary artery disease (SCAD). FU strategies were left at investigator's discretion. A comparison between the CC, ST and EC performed in the first 12-months with the potential suggested by the MCD was evaluated. Results A...
Circulation: Cardiovascular Interventions, 2019
June 2019 1
Giornale italiano di cardiologia (2006), 2018
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic coronary artery pathology ... more Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic coronary artery pathology and an important cause of coronary artery disease in young women with an average age of 40 to 50 years with few or no cardiovascular risk factors. There has been a surge in the diagnosis of SCAD due to an increased use of coronary angiography and the clinical availability and application of high-resolution intracoronary imaging. SCAD is due to the separation of coronary wall layers with the formation of intramural hematoma, compression of the true lumen and secondary myocardial ischemia. Coronary angiography is the first-line imaging, also useful are intravascular ultrasound and optical coherence tomography. Therapy is conservative in most cases because of the high percentage of spontaneous healing of the vascular wall. The prognosis is good, although the disease is burdened by a high prevalence of major adverse coronary events, including recurrence of coronary dissection, thus making ca...
Giornale italiano di cardiologia (2006), 2018
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with... more Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.
Giornale Italiano Di Cardiologia, Jul 1, 2012
Or tu a Cariddi Non t'accostar, mentre il mar negro inghiotte: Chè mal sapria dalla ruina estrema... more Or tu a Cariddi Non t'accostar, mentre il mar negro inghiotte: Chè mal sapria dalla ruina estrema Nettuno stesso dilivrarti. A Scilla Tienti vicino, e rapido trascorri. Perder sei de' compagni entro la nave Torna più assai, che perir tutti a un tempo." Omero, Odissea, libro XII PROLOGO: TRE SCENARI Scenario 1 "Buongiorno Signor X, la chiamo dalla Cardiochirurgia per il suo ricovero. L'intervento è previsto mercoledì mattina per cui il ricovero sarà lunedì [...]. Ah, mi raccomando di sospendere l'aspirina da sabato." Sospendere l'aspirina da sabato. Cinque giorni prima dell'intervento. Una frase standard pronunciata a memoria, come un salmo, come l'incipit di una telefonata pubblicitaria. Peccato che il paziente avesse ricevuto 2 mesi prima uno stent coronarico (fortunatamente non medicato) per una sindrome coronarica acuta e presentasse una malattia aterosclerotica di altri rami coronarici ...
Giornale italiano di cardiologia (2006), 2015
Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not wel... more Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not well defined and standard protocols have been not established. The purpose of this study was to assess: a) the frequency and patterns of cardiology visits, echocardiographic examinations and stress tests after PCI in clinical practice; b) the impact of a multidisciplinary protocol of long-term follow-up after PCI shared with general practitioners on the appropriateness and reduction in healthcare costs. A total of 780 patients who underwent PCI in 2010 in two Italian hospitals were analyzed. The number of cardiological examinations (total, routine and clinically driven) performed during 2 years of follow-up were recorded and stratified according to the patient's risk profile. The latter was defined according to the multidisciplinary protocol. In addition, a simulation of the spread between provided and necessary tests (according to the multidisciplinary protocol) was carried out. The me...
JACC: Cardiovascular Interventions, 2015
Giornale Italiano di Cardiologia, 2012
STENT CORONARICO E CHIRURGIA D'altra parte, la terapia antiaggregante aumenta notevolmente il ris... more STENT CORONARICO E CHIRURGIA D'altra parte, la terapia antiaggregante aumenta notevolmente il rischio emorragico in corso di procedure chirurgiche o endoscopiche. La gestione perioperatoria della terapia antiaggregante è spesso individuale e non necessariamente condivisa tra cardiologi e chirurghi. Le attuali linee guida non forniscono protocolli operativi chiari in relazione al rischio trombotico del paziente ed alle diverse tipologie di interventi chirurgici e rimandano, per lo più, ad una valutazione dei singoli casi 1,2. INTRODUZIONE Il numero di pazienti portatori di stent coronarico che hanno necessità di effettuare un intervento chirurgico è in costante aumento. È noto che il paziente portatore di stent necessita di una duplice terapia antiaggregante orale per un tempo, ad oggi, non ben definito, e che la sospensione di uno o entrambi i farmaci antiaggreganti comporta, specie nei primi mesi dopo la procedura, un rischio significativo di trombosi di stent (ST), evento potenzialmente mortale 1-6 .