M. Dominici - Academia.edu (original) (raw)
Papers by M. Dominici
Journal of Interventional Cardiology, 2012
Despite several advantages of the transradial over the transfemoral approach, the use of transrad... more Despite several advantages of the transradial over the transfemoral approach, the use of transradial access for coronary interventions in daily practice is still low. Major limitations are the technical and anatomical issues related with right radial artery access. The left radial approach may have an advantage from the point of view of the vascular anatomy. The aim of this study was to evaluate the safety and feasibility of routinely using the left radial compared to the right radial approach. This is a prospective single center study comparing left radial to right radial access for coronary artery catheterization. The overall in-hospital major adverse cardiac and cerebral events (MACCE), procedural success rate, bleeding, vascular and procedural complications, fluoroscopy time, number of catheters, and amount of contrast agent used were assessed. A total of 1,032 coronary angiograms were performed: 420 were performed using the right radial artery and 612 the left radial artery. No differences were observed in MACCE and success rate between the two groups. No cases of major or minor bleeding and vascular complications requiring surgical intervention were reported. Fluoroscopy time and the number of catheters used were significantly less in the left radial group (P = 0.001 and P = 0.007, respectively), while the volume of contrast was similar (P = 0.264). The left radial approach in our series was demonstrated to be safe and feasible in daily practice, and in this study was associated with a reduction in fluoroscopy time and number of catheters used.
European Heart Journal Supplements
Cardiac tumors can be primary (benign or malignant) or metastatic (malignant) and can arise in an... more Cardiac tumors can be primary (benign or malignant) or metastatic (malignant) and can arise in any part of the heart tissue, causing obstruction in the inflow or outflow tract of the valves, thromboembolism, arrhythmias and pericardial disorders. Diagnosis is made by echocardiography and, frequently, by cardiac MRI. The treatment of metastatic malignancies depends on the type and origin of the tumor; however, the prognosis is generally poor.73–year–old patient, he reaches echocardiographic control after having started, 5 months earlier, chemotherapy with weekly carboplatin–paclitaxel scheme for the diagnosis of primary left hilar pulmonary heteroplasia. In medical history: systemic arterial hypertension, iron deficiency anemia and thrombocytopenia in a patient with a history of alcohol–related liver cirrhosis and esophageal varices.On transthoracic echocardiogram (Figures 1 and 2): normal size and bi–ventricular systolic function; mild aortic and mitral insufficiency. Presence of no...
The introduction of Bioresorbable Vascular Scaffolds (BVS) represents the most important novelty ... more The introduction of Bioresorbable Vascular Scaffolds (BVS) represents the most important novelty in coronary intervention. The relation between BVS and coronary spasm, a potential fatal condition in the subset of endothelial dysfunction, is poorly understood yet. Nowadays no correlation with bioresorbable scaffolds is demonstrated yet. We describe a case of a young man who experimented an ECG documented acute coronary spasm leading to ventricular ibrillation after 2 years from the BVS' implantation.
Atherosclerosis, 2020
Background and aims The impact of endothelial shear stress (ESS) on vessel remodeling in vessels ... more Background and aims The impact of endothelial shear stress (ESS) on vessel remodeling in vessels implanted with bioresorbable scaffold (BRS) as compared to metallic drug-eluting stent (DES) remains elusive. The aim of this study was to determine whether the relationship between ESS and remodeling patterns differs in BRS from those seen in metallic DES at 3-year follow-up. Methods In the ABSORB II randomized trial, lesions were investigated by serial coronary angiography and intravascular ultrasound (IVUS). Three-dimensional reconstructions of coronary arteries postprocedure and at 3 years were performed. ESS was quantified using non-Newtonian steady flow simulation. IVUS cross-sections in device segment were matched using identical landmarks. Results Paired ESS calculations post-procedure and at 3 years were feasible in 57 lesions in 56 patients. Postprocedure, median ESS at frame level was higher in BRS than in DES, with marginal statistical significance (0.97 ± 0.48 vs. 0.75 ± 0.39 Pa, p = 0.063). In the BRS arm, vessel area and lumen area showed larger increases in the highest tercile of median ESS post-procedure as compared to the lowest tercile. In contrast, in DES, no significant relationship between median ESS post-procedure and remodeling was observed. In multivariate analysis, smaller vessel area, larger lumen area, higher plaque burden post-procedure, and higher median ESS post-procedure were independently associated with expansive remodeling in matched frames. Only in BRS, younger age was an additional significant predictor of expansive remodeling. Conclusions In a subset of lesions with large plaque burden, shear stress could be associated with expansive remodeling and late lumen enlargement in BRS, while ESS had no impact on vessel dimension in metallic DES.
BMJ Open, 2019
IntroductionThe GLOBAL LEADERS is an open-label, pragmatic and superiority randomised controlled ... more IntroductionThe GLOBAL LEADERS is an open-label, pragmatic and superiority randomised controlled trial designed to challenge the current treatment paradigm of dual antiplatelet therapy (DAPT) for 12 months followed by aspirin monotherapy among patients undergoing percutaneous coronary intervention. By design, all study endpoints are investigator reported (IR) and not subject to formal adjudication by an independent Clinical Event Committee (CEC), which may introduce detection, reporting or ascertainment bias.Methods and analysisWe designed the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY) to prospectively implement, in a large sample of patients enrolled within the GLOBAL LEADERS trial (7585 of 15 991, 47.5%), an independent adjudication process of reported and unreported potential endpoints, using standardised CEC procedures, in order to assess whether 23-month ticagrelor monotherapy (90 mg twice daily) after 1-month DAPT is non-inferior to a standard regimen of DAPT for 12 months...
Circulation: Cardiovascular Interventions, 2014
Background— Microvascular obstruction seems to predict poor outcome in patients undergoing electi... more Background— Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B 2 , a stable metabolite of thromboxane A 2 , may be implicated in post-PCI microvascular obstruction. Methods and Results— We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B 2 , reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B 2 significantly increased after 120 minutes ( P =0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a stati...
Case Reports in Vascular Medicine, 2013
Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, nowadays poorly underst... more Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, nowadays poorly understood yet. The lack of firm recommendations about this issue is a great limitation which makes any therapeutic decision controversial. The case described is that of a young, otherwise healthy woman, who presented with an ostial dissection of the left anterior descending (LAD) artery. Due to patient’s stable clinical and hemodynamic parameters, we used a cautious approach based on watchful waiting and medical therapy, postponing stenting in order to achieve a partial vessel reopening with a more comfortable access to PCI.
Background: Incomplete aspirin (ASA) platelet inhibition and interventional microvascular obstruc... more Background: Incomplete aspirin (ASA) platelet inhibition and interventional microvascular obstruction (MVO) have been suggested as putative mechanisms of adverse clinical outcome in patients undergoing elective percutaneous coronary intervention (PCI) despite optimal dual antiplatelet therapy. Thromboxane (TX) A2 might be involved as a key mediator of platelet activation and as a potent coronary vasoconstrictor. Aim and Methods: Pre-procedural Aspirin reload for Native coronary disease Treated by Angioplasty: Reperfusion indexes Evaluation and Improvement of clinical outcome (PANTAREI) study is an interventional, multicenter, randomized study planned to evaluate the effect of ASA reload (325 mg orally at-least 1 hour before elective PCI) on: (i) serum TxB2 levels (stable metabolite of TxA2) changes after 60 and 120 min; (ii) changes of reperfusion indexes, evaluated by corrected TIMI Frame Count (cTFC) and myocardial blush grade (MBG); (iii) modifications of myocardial injury indexes expressed by serum cardiac Troponin I (TnI) tested at 6, 12 and 24 hours after PCI. Results: We enrolled 91 patients (74 M and 17 F, 66 ± 10 yrs.), already on chronic low-dose ASA therapy, scheduled for elective PCI and randomly assigned to receive ASA reload (N=46) or no-reload (N=45) before the procedure. Compared to no-reload group, TxB2 significantly decreased after 120’ from PCI in ASA reload group. After procedure, both groups showed a statistically significant reduction in cTFC and in percentage of patients with MBG≤2 (Reload= 39%; No-Reload=69%). Moreover, at the end of procedure, both reperfusion indexes were lower in the ASA reload group compared with the no-reload group (p Conclusions: The present study shows that 325-mg ASA loading dose, before elective PCI, would provide a significant clinical benefit. These findings suggest a possible physiopathological role of serum thromboxane complete inhibition in the prevention of “interventional MVO”.
Minerva cardioangiologica, Jan 7, 2015
The purpose of this registry is to report the immediate and long-term safety and efficacy of the ... more The purpose of this registry is to report the immediate and long-term safety and efficacy of the Orsiro®- Biotronik stent in an unselected population during everyday practice. Between May 2012 and June 2013, 246 consecutive coronary angioplasty were performed using at least one Orsiro DES, in 225 patients and 303 lesions. Diabetes was present in 34.7% of patients. Procedures were non-elective PCI in 17.1% of cases and Acute Coronary Syndromes were 55.1%. Radial vascular access was used in 78% of cases, multivessel PCI was performed in 19.5% of the procedures. In 81.6% of cases lesions were B2/C type, 20.7% of procedures have bifurcation lesions. Procedural success was 99.6%. No acute thrombosis occurred. Clinical follow up median period is 24.3 (± 8.28) months and FU was available in 93.7% of patients. Death for any cause occurred in 11 patients (5.2%), 6 of them were non cardiac-related. Cardiac Related death rate was 2.4%. Two patients had intrastent restenosis. The overall TLF ra...
Medical Hypotheses, 2017
Timely recanalization of infarct related artery along with effective myocardial cell reperfusion ... more Timely recanalization of infarct related artery along with effective myocardial cell reperfusion represents a major challenge in the management of STEMI. The reperfusion of coronary arteries can induce further cardiomyocyte death by generating oxidative stress, which itself can mediate myocardial damage through a number of different mechanisms. Based on experimental and clinical studies, interventions to treat reperfusion injury by antioxidants were considered to be an appropriate therapeutic option. We emphasize the hypothesis that glutathione sodium salt, a physiologic antioxidant, may be of value when administered to STEMI patients both at an early stage of myocardial reperfusion by primary angioplasty and for up to three days after the procedure, in addition to standard treatment.
European Heart Journal, 2019
Background The efficacy and safety of ticagrelor monotherapy in elderly patients undergoing percu... more Background The efficacy and safety of ticagrelor monotherapy in elderly patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) or stable coronary artery disease (CAD) has not been evaluated. Purpose To evaluate the efficacy and safety of ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI in relation to age and clinical presentation in the GLOBAL LEADERS study cohort. Methods This is a subanalysis of the randomized multicentre GLOBAL LEADERS study, comparing the experimental strategy of 23-month ticagrelor monotherapy after 1 month of ticagrelor and aspirin with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy in 15991 patients undergoing PCI. Patients were categorized into elderly and very elderly according to a pre-specified cut-off of 75 years and a post-hoc defined cut-off of 80 years. Impact of age and clinical presentation (ACS versus stable CAD) on clinical outcome at 2 ye...
Case Reports in Vascular Medicine, 2012
Spontaneous coronary artery dissection (SCAD) is a very rare disease, associated with high mortal... more Spontaneous coronary artery dissection (SCAD) is a very rare disease, associated with high mortality rate, whose etiology and pathogenesis are poorly understood. Its sporadic nature and the varied angiographic extent make firm recommendations regarding revascularization impossible. The case described is that of a young, otherwise healthy woman, without a known underlying condition which may lead to SCAD, but with a history of intense psychological stress. We managed the patient with a conservative approach based on watchful waiting, medical therapy, and plain old balloon angioplasty (POBA) with low inflation atmospheres.
ilgiornale.gise.it
Introduzione L'arteria femorale è l'approccio di scelta per l'angiografia coronari... more Introduzione L'arteria femorale è l'approccio di scelta per l'angiografia coronarica. Tuttavia è gravato da una percentuale di complicanze vascolari compresa tra il 2% el'8%(1), che comportano un aumento della morbilità e mortalità, della durata del ricovero e dei costi ospedalieri, e ...
Case Reports in Vascular Medicine, 2013
Circulation: Cardiovascular Interventions, 2014
Background-Microvascular obstruction seems to predict poor outcome in patients undergoing electiv... more Background-Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B 2 , a stable metabolite of thromboxane A 2 , may be implicated in post-PCI microvascular obstruction. Methods and Results-We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B 2 , reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B 2 significantly increased after 120 minutes (P=0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a statistically significant reduction in corrected Thrombolysis In Myocardial Infarction frame count more evident in aspirin reload group (P=0.0023). Moreover, after PCI, 61% of patients allocated to aspirin reload and only 32% of patients allocated to control group reached normal microcirculatory reperfusion (myocardial blush grade=3); patients with myocardial blush grade=3 exhibited lower values of serum thromboxane B 2 compared with those with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I significantly increased (F=3.64; P=0.01334) and correlated with serum thromboxane B 2 (ρ=0.31; P=0.0413) in control but not in aspirin reload group. In addition, left ventricular ejection fraction significantly increased after PCI only in the aspirin reload group (P=0.0005).
Circulation, 2008
The online-only Data Supplement, which contains Movies I through V, is available with this articl... more The online-only Data Supplement, which contains Movies I through V, is available with this article at http://circ.ahajournals.org/cgi/content/full/117/ 24/e485/DC1.
Lancet, Jan 3, 2015
Despite rapid dissemination of an everolimus-eluting bioresorbable scaffold for treatment for cor... more Despite rapid dissemination of an everolimus-eluting bioresorbable scaffold for treatment for coronary artery disease, no data from comparisons with its metallic stent counterpart are available. In a randomised controlled trial we aimed to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent. Here we report secondary clinical and procedural outcomes after 1 year of follow-up. In a single-blind, multicentre, randomised trial, we enrolled eligible patients aged 18-85 years with evidence of myocardial ischaemia and one or two de-novo native lesions in different epicardial vessels. We randomly assigned patients in a 2:1 ratio to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb, Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (Xience, Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetes status and number of planned target lesions. The co-primary e...
Journal of Interventional Cardiology, 2012
Despite several advantages of the transradial over the transfemoral approach, the use of transrad... more Despite several advantages of the transradial over the transfemoral approach, the use of transradial access for coronary interventions in daily practice is still low. Major limitations are the technical and anatomical issues related with right radial artery access. The left radial approach may have an advantage from the point of view of the vascular anatomy. The aim of this study was to evaluate the safety and feasibility of routinely using the left radial compared to the right radial approach. This is a prospective single center study comparing left radial to right radial access for coronary artery catheterization. The overall in-hospital major adverse cardiac and cerebral events (MACCE), procedural success rate, bleeding, vascular and procedural complications, fluoroscopy time, number of catheters, and amount of contrast agent used were assessed. A total of 1,032 coronary angiograms were performed: 420 were performed using the right radial artery and 612 the left radial artery. No differences were observed in MACCE and success rate between the two groups. No cases of major or minor bleeding and vascular complications requiring surgical intervention were reported. Fluoroscopy time and the number of catheters used were significantly less in the left radial group (P = 0.001 and P = 0.007, respectively), while the volume of contrast was similar (P = 0.264). The left radial approach in our series was demonstrated to be safe and feasible in daily practice, and in this study was associated with a reduction in fluoroscopy time and number of catheters used.
European Heart Journal Supplements
Cardiac tumors can be primary (benign or malignant) or metastatic (malignant) and can arise in an... more Cardiac tumors can be primary (benign or malignant) or metastatic (malignant) and can arise in any part of the heart tissue, causing obstruction in the inflow or outflow tract of the valves, thromboembolism, arrhythmias and pericardial disorders. Diagnosis is made by echocardiography and, frequently, by cardiac MRI. The treatment of metastatic malignancies depends on the type and origin of the tumor; however, the prognosis is generally poor.73–year–old patient, he reaches echocardiographic control after having started, 5 months earlier, chemotherapy with weekly carboplatin–paclitaxel scheme for the diagnosis of primary left hilar pulmonary heteroplasia. In medical history: systemic arterial hypertension, iron deficiency anemia and thrombocytopenia in a patient with a history of alcohol–related liver cirrhosis and esophageal varices.On transthoracic echocardiogram (Figures 1 and 2): normal size and bi–ventricular systolic function; mild aortic and mitral insufficiency. Presence of no...
The introduction of Bioresorbable Vascular Scaffolds (BVS) represents the most important novelty ... more The introduction of Bioresorbable Vascular Scaffolds (BVS) represents the most important novelty in coronary intervention. The relation between BVS and coronary spasm, a potential fatal condition in the subset of endothelial dysfunction, is poorly understood yet. Nowadays no correlation with bioresorbable scaffolds is demonstrated yet. We describe a case of a young man who experimented an ECG documented acute coronary spasm leading to ventricular ibrillation after 2 years from the BVS' implantation.
Atherosclerosis, 2020
Background and aims The impact of endothelial shear stress (ESS) on vessel remodeling in vessels ... more Background and aims The impact of endothelial shear stress (ESS) on vessel remodeling in vessels implanted with bioresorbable scaffold (BRS) as compared to metallic drug-eluting stent (DES) remains elusive. The aim of this study was to determine whether the relationship between ESS and remodeling patterns differs in BRS from those seen in metallic DES at 3-year follow-up. Methods In the ABSORB II randomized trial, lesions were investigated by serial coronary angiography and intravascular ultrasound (IVUS). Three-dimensional reconstructions of coronary arteries postprocedure and at 3 years were performed. ESS was quantified using non-Newtonian steady flow simulation. IVUS cross-sections in device segment were matched using identical landmarks. Results Paired ESS calculations post-procedure and at 3 years were feasible in 57 lesions in 56 patients. Postprocedure, median ESS at frame level was higher in BRS than in DES, with marginal statistical significance (0.97 ± 0.48 vs. 0.75 ± 0.39 Pa, p = 0.063). In the BRS arm, vessel area and lumen area showed larger increases in the highest tercile of median ESS post-procedure as compared to the lowest tercile. In contrast, in DES, no significant relationship between median ESS post-procedure and remodeling was observed. In multivariate analysis, smaller vessel area, larger lumen area, higher plaque burden post-procedure, and higher median ESS post-procedure were independently associated with expansive remodeling in matched frames. Only in BRS, younger age was an additional significant predictor of expansive remodeling. Conclusions In a subset of lesions with large plaque burden, shear stress could be associated with expansive remodeling and late lumen enlargement in BRS, while ESS had no impact on vessel dimension in metallic DES.
BMJ Open, 2019
IntroductionThe GLOBAL LEADERS is an open-label, pragmatic and superiority randomised controlled ... more IntroductionThe GLOBAL LEADERS is an open-label, pragmatic and superiority randomised controlled trial designed to challenge the current treatment paradigm of dual antiplatelet therapy (DAPT) for 12 months followed by aspirin monotherapy among patients undergoing percutaneous coronary intervention. By design, all study endpoints are investigator reported (IR) and not subject to formal adjudication by an independent Clinical Event Committee (CEC), which may introduce detection, reporting or ascertainment bias.Methods and analysisWe designed the GLOBAL LEADERS Adjudication Sub-StudY (GLASSY) to prospectively implement, in a large sample of patients enrolled within the GLOBAL LEADERS trial (7585 of 15 991, 47.5%), an independent adjudication process of reported and unreported potential endpoints, using standardised CEC procedures, in order to assess whether 23-month ticagrelor monotherapy (90 mg twice daily) after 1-month DAPT is non-inferior to a standard regimen of DAPT for 12 months...
Circulation: Cardiovascular Interventions, 2014
Background— Microvascular obstruction seems to predict poor outcome in patients undergoing electi... more Background— Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B 2 , a stable metabolite of thromboxane A 2 , may be implicated in post-PCI microvascular obstruction. Methods and Results— We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B 2 , reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B 2 significantly increased after 120 minutes ( P =0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a stati...
Case Reports in Vascular Medicine, 2013
Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, nowadays poorly underst... more Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, nowadays poorly understood yet. The lack of firm recommendations about this issue is a great limitation which makes any therapeutic decision controversial. The case described is that of a young, otherwise healthy woman, who presented with an ostial dissection of the left anterior descending (LAD) artery. Due to patient’s stable clinical and hemodynamic parameters, we used a cautious approach based on watchful waiting and medical therapy, postponing stenting in order to achieve a partial vessel reopening with a more comfortable access to PCI.
Background: Incomplete aspirin (ASA) platelet inhibition and interventional microvascular obstruc... more Background: Incomplete aspirin (ASA) platelet inhibition and interventional microvascular obstruction (MVO) have been suggested as putative mechanisms of adverse clinical outcome in patients undergoing elective percutaneous coronary intervention (PCI) despite optimal dual antiplatelet therapy. Thromboxane (TX) A2 might be involved as a key mediator of platelet activation and as a potent coronary vasoconstrictor. Aim and Methods: Pre-procedural Aspirin reload for Native coronary disease Treated by Angioplasty: Reperfusion indexes Evaluation and Improvement of clinical outcome (PANTAREI) study is an interventional, multicenter, randomized study planned to evaluate the effect of ASA reload (325 mg orally at-least 1 hour before elective PCI) on: (i) serum TxB2 levels (stable metabolite of TxA2) changes after 60 and 120 min; (ii) changes of reperfusion indexes, evaluated by corrected TIMI Frame Count (cTFC) and myocardial blush grade (MBG); (iii) modifications of myocardial injury indexes expressed by serum cardiac Troponin I (TnI) tested at 6, 12 and 24 hours after PCI. Results: We enrolled 91 patients (74 M and 17 F, 66 ± 10 yrs.), already on chronic low-dose ASA therapy, scheduled for elective PCI and randomly assigned to receive ASA reload (N=46) or no-reload (N=45) before the procedure. Compared to no-reload group, TxB2 significantly decreased after 120’ from PCI in ASA reload group. After procedure, both groups showed a statistically significant reduction in cTFC and in percentage of patients with MBG≤2 (Reload= 39%; No-Reload=69%). Moreover, at the end of procedure, both reperfusion indexes were lower in the ASA reload group compared with the no-reload group (p Conclusions: The present study shows that 325-mg ASA loading dose, before elective PCI, would provide a significant clinical benefit. These findings suggest a possible physiopathological role of serum thromboxane complete inhibition in the prevention of “interventional MVO”.
Minerva cardioangiologica, Jan 7, 2015
The purpose of this registry is to report the immediate and long-term safety and efficacy of the ... more The purpose of this registry is to report the immediate and long-term safety and efficacy of the Orsiro®- Biotronik stent in an unselected population during everyday practice. Between May 2012 and June 2013, 246 consecutive coronary angioplasty were performed using at least one Orsiro DES, in 225 patients and 303 lesions. Diabetes was present in 34.7% of patients. Procedures were non-elective PCI in 17.1% of cases and Acute Coronary Syndromes were 55.1%. Radial vascular access was used in 78% of cases, multivessel PCI was performed in 19.5% of the procedures. In 81.6% of cases lesions were B2/C type, 20.7% of procedures have bifurcation lesions. Procedural success was 99.6%. No acute thrombosis occurred. Clinical follow up median period is 24.3 (± 8.28) months and FU was available in 93.7% of patients. Death for any cause occurred in 11 patients (5.2%), 6 of them were non cardiac-related. Cardiac Related death rate was 2.4%. Two patients had intrastent restenosis. The overall TLF ra...
Medical Hypotheses, 2017
Timely recanalization of infarct related artery along with effective myocardial cell reperfusion ... more Timely recanalization of infarct related artery along with effective myocardial cell reperfusion represents a major challenge in the management of STEMI. The reperfusion of coronary arteries can induce further cardiomyocyte death by generating oxidative stress, which itself can mediate myocardial damage through a number of different mechanisms. Based on experimental and clinical studies, interventions to treat reperfusion injury by antioxidants were considered to be an appropriate therapeutic option. We emphasize the hypothesis that glutathione sodium salt, a physiologic antioxidant, may be of value when administered to STEMI patients both at an early stage of myocardial reperfusion by primary angioplasty and for up to three days after the procedure, in addition to standard treatment.
European Heart Journal, 2019
Background The efficacy and safety of ticagrelor monotherapy in elderly patients undergoing percu... more Background The efficacy and safety of ticagrelor monotherapy in elderly patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) or stable coronary artery disease (CAD) has not been evaluated. Purpose To evaluate the efficacy and safety of ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI in relation to age and clinical presentation in the GLOBAL LEADERS study cohort. Methods This is a subanalysis of the randomized multicentre GLOBAL LEADERS study, comparing the experimental strategy of 23-month ticagrelor monotherapy after 1 month of ticagrelor and aspirin with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy in 15991 patients undergoing PCI. Patients were categorized into elderly and very elderly according to a pre-specified cut-off of 75 years and a post-hoc defined cut-off of 80 years. Impact of age and clinical presentation (ACS versus stable CAD) on clinical outcome at 2 ye...
Case Reports in Vascular Medicine, 2012
Spontaneous coronary artery dissection (SCAD) is a very rare disease, associated with high mortal... more Spontaneous coronary artery dissection (SCAD) is a very rare disease, associated with high mortality rate, whose etiology and pathogenesis are poorly understood. Its sporadic nature and the varied angiographic extent make firm recommendations regarding revascularization impossible. The case described is that of a young, otherwise healthy woman, without a known underlying condition which may lead to SCAD, but with a history of intense psychological stress. We managed the patient with a conservative approach based on watchful waiting, medical therapy, and plain old balloon angioplasty (POBA) with low inflation atmospheres.
ilgiornale.gise.it
Introduzione L'arteria femorale è l'approccio di scelta per l'angiografia coronari... more Introduzione L'arteria femorale è l'approccio di scelta per l'angiografia coronarica. Tuttavia è gravato da una percentuale di complicanze vascolari compresa tra il 2% el'8%(1), che comportano un aumento della morbilità e mortalità, della durata del ricovero e dei costi ospedalieri, e ...
Case Reports in Vascular Medicine, 2013
Circulation: Cardiovascular Interventions, 2014
Background-Microvascular obstruction seems to predict poor outcome in patients undergoing electiv... more Background-Microvascular obstruction seems to predict poor outcome in patients undergoing elective percutaneous coronary intervention (PCI), but the underlying mechanism is still unclear. We analyzed whether serum thromboxane B 2 , a stable metabolite of thromboxane A 2 , may be implicated in post-PCI microvascular obstruction. Methods and Results-We enrolled 91 patients (74 males, 66±10 years) on chronic low-dose aspirin therapy (aspirin, 100 mg daily) scheduled for elective PCI and randomly assigned to receive aspirin reload (325 mg orally, n=46) or no reload (control group, n=45) ≥1 hour before elective PCI. Serum levels of thromboxane B 2 , reperfusion indexes (corrected Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), and serum cardiac troponin I were assessed before and after PCI. Serum thromboxane B 2 significantly increased after 120 minutes (P=0.0447) from PCI in control but not in aspirin reload group. After PCI, both groups showed a statistically significant reduction in corrected Thrombolysis In Myocardial Infarction frame count more evident in aspirin reload group (P=0.0023). Moreover, after PCI, 61% of patients allocated to aspirin reload and only 32% of patients allocated to control group reached normal microcirculatory reperfusion (myocardial blush grade=3); patients with myocardial blush grade=3 exhibited lower values of serum thromboxane B 2 compared with those with myocardial blush grade <3 (P=0.05). Periprocedural cardiac troponin I significantly increased (F=3.64; P=0.01334) and correlated with serum thromboxane B 2 (ρ=0.31; P=0.0413) in control but not in aspirin reload group. In addition, left ventricular ejection fraction significantly increased after PCI only in the aspirin reload group (P=0.0005).
Circulation, 2008
The online-only Data Supplement, which contains Movies I through V, is available with this articl... more The online-only Data Supplement, which contains Movies I through V, is available with this article at http://circ.ahajournals.org/cgi/content/full/117/ 24/e485/DC1.
Lancet, Jan 3, 2015
Despite rapid dissemination of an everolimus-eluting bioresorbable scaffold for treatment for cor... more Despite rapid dissemination of an everolimus-eluting bioresorbable scaffold for treatment for coronary artery disease, no data from comparisons with its metallic stent counterpart are available. In a randomised controlled trial we aimed to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent. Here we report secondary clinical and procedural outcomes after 1 year of follow-up. In a single-blind, multicentre, randomised trial, we enrolled eligible patients aged 18-85 years with evidence of myocardial ischaemia and one or two de-novo native lesions in different epicardial vessels. We randomly assigned patients in a 2:1 ratio to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb, Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (Xience, Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetes status and number of planned target lesions. The co-primary e...