Marcello Galvani - Academia.edu (original) (raw)
Papers by Marcello Galvani
After an episode of unstable angina or myo- cardial infarction, a high proportion of pa- tients s... more After an episode of unstable angina or myo- cardial infarction, a high proportion of pa- tients show biochemical signs of coagula- tion activation, expressed as persistently elevated thrombin generation, in their blood. It is not known whether this has any influ- ence on long-term outcome. In this prospec- tive multicenter cohort study, we assessed the relation of persistently elevated throm-
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
Recommendations for the clinical use of cardiac natriuretic peptides. ... Emdin M, Clerico A, Cle... more Recommendations for the clinical use of cardiac natriuretic peptides. ... Emdin M, Clerico A, Clemenza F, Galvani M, Latini R, Masson S, Mulè P, Panteghini M, Valle R, Zaninotto M, Ganau A, Mariotti R, Volpe M, Aspromonte N, Cacciatore G, Cappelletti P, L'Abbate A, Miglio F, ...
Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PH... more Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PHD," DONATELLA FERRINI, MD, FILIPPO OTTANI, MD, FRANC0 RUSTICALI, MD, PAUL R. EISENBERG, MD, MPH, FACC" F&L ltoiy and Saint Lor,rs Mssouti
Only a few data are available on the survival rate following out-of-hospital cardiac arrest in di... more Only a few data are available on the survival rate following out-of-hospital cardiac arrest in different Italian settings. We report an analysis of a 10-year experience in a mixed rural/urban setting, the main variables associated with survival, and the preliminary results of the implementation of an automated external defibrillator (AED) programme operated by lay volunteers on the effectiveness of the existing Emergency Medical Service (EMS). We report data from an observational cohort study on all adults, resuscitated from witnessed cardiac arrest between 1994 and 2004 in the district area of Forlì (Italy). The AED programme was introduced in 2002. Entry variables, time intervals and nodal events were tested according to Utstein recommendations. The predictors of favourable outcomes (Overall Performance Category 1-2) were identified by logistic regression analysis. The witnessed cardiac arrest rate was 27/100,000 population per year (95% confidence interval, 18-38). The initial rhythm was shockable in 241/479 cases (50.3%). After resuscitation, 55 (11.5%) subjects had a favourable outcome at discharge and 38 (7.9%) at 1 year. Time-to-treatment was longer for EMS than for AED-equipped units (median, 8 min interquartile range, 6-10 (467 cases) versus 6 min interquartile range, 4-8 (13 cases); P<0.013), but the final results of the AED programme were poor, with only 1 subject saved/171,000 inhabitants in 2 years. Positive outcome predictors were male sex, younger age, shockable rhythms, low number of defibrillations, and no history of hypertension, diabetes, myocardial infarction or congestive heart failure. Even in a mixed urban/rural setting, survival from out-of-hospital cardiac arrest is dependent on well-known predictors. In our setting, the number of cases saved by an AED programme is limited when accompanied by an efficient traditional EMS. The allocation of resources to an AED programme should be reconsidered in a mixed rural/urban setting.
Acc Current Journal Review, 2004
Transient ST segment elevation (STE) in lead aVR during an acute coronary syndrome (ACS) is assoc... more Transient ST segment elevation (STE) in lead aVR during an acute coronary syndrome (ACS) is associated with severe multivessel coronary disease but few studies have assessed the prognostic impact of this finding.
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
The Joint European Society of Cardiology and the American College of Cardiology Committee has rec... more The Joint European Society of Cardiology and the American College of Cardiology Committee has recently reviewed the criteria to diagnose myocardial infarction, focusing on the central role of biochemical criterium and indicating the cardiac troponins as the reference marker. However, at present, little is known upon how "old" and "new" biochemical markers of myocardial damage are utilized in daily clinical practice. We performed a survey across the whole set of Italian coronary care units (CCUs) to evaluate the actual behavior of the clinicians in detecting myocardial necrosis with the biomarkers. A simple and brief questionnaire was used to pursue such purpose. The feedback from CCUs was positive in 87.6% (303/346). The creatine kinase-MB is the most frequently used biomarker, however the "mass concentration" method was utilized in a minority of centers (38%). More than 60% of the CCUs are still measuring obsolete biomarkers as lactic dehydrogenase or ...
Giornale italiano di cardiologia
Giornale italiano di cardiologia
Cardiology, 2007
Background: Intravenous unfractionated heparin (UFH) is recommended in ST-elevation acute myocard... more Background: Intravenous unfractionated heparin (UFH) is recommended in ST-elevation acute myocardial infarction (STEMI), following thrombolysis with fibrin-specific agents. Subcutaneous low-molecular-weight heparins (LMWH), previously proven effective in non-ST-elevation acute coronary syndromes, have been recently investigated in the setting of STEMI. We aimed at evaluating the current level of evidence supporting the use of LMWH in STEMI. Methods: A Medline search of
Clinical Pharmacology and Therapeutics, 1985
Vasodilators of resistive vessels may induce ischemia in patients with coronary artery disease. T... more Vasodilators of resistive vessels may induce ischemia in patients with coronary artery disease. To evaluate this possibility during prostacyclin (PGI2; scalar doses up to 10 ng/kg/min) and prostacyclin analog (iloprost; scalar doses up to 6 ng/kg/min) infusions, we studied 33 patients with angina pectoris and proved coronary artery disease. Patients were also submitted to dipyridamole (0.15 mg/kg/min for 4 minutes) and exercise stress testing (starting at 25 W and increasing 25 W every 2 minutes). In a preliminary study the hemodynamic and side effects of iloprost were studied in seven healthy subjects. At an iloprost dose of 4 to 6 ng/kg/min, these subjects had a significant decrease in mean arterial pressure and total peripheral and pulmonary vascular resistances. Side effects were limited to facial flushing and slight headache and were readily reversible. PGI, induced typical chest pain and significant ST segment depression in six patients with severe coronary artery disease (three with left main and three with triple vessel disease) and poor exercise tolerance (X SD = 362 -± 99 seconds). All six patients had had angina during the dipyridamole infusion. Similar findings were observed after iloprost infusion in four of these.
![Research paper thumbnail of [New definition of myocardial infarction: analysis of the consensus document ESC/ACC and thoughts about applicability to the Italian health situation]](https://attachments.academia-assets.com/45024833/thumbnails/1.jpg)
](Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2002
The recent document of the ESC/ACC Committee for the redefinition of myocardial infarction (MI) h... more The recent document of the ESC/ACC Committee for the redefinition of myocardial infarction (MI) has introduced the measurement of cardiac troponin as the biochemical standard for the diagnosis of MI. This change has been mainly driven by the demonstration that any amount of myocardial damage, as detected by cardiac troponins, implies a worse long-term outcome of the patient. The results of several studies consistently show that there is a continuous relationship between the degree of troponin elevation and the patient's prognosis. The new definition has important consequences on the diagnostic and therapeutic approaches to patients with acute coronary syndromes; in fact, patients with increased troponins, i.e. patients with MI, necessitate more aggressive treatment than those without troponin elevations, i.e. patients with unstable angina. The application of the new definition is expected to increase the number of cases of MI by about 30% and to decrease mortality. We believe th...
Dronedarone is the antiarrhythmic drug with the most complete and wide literature preceding its m... more Dronedarone is the antiarrhythmic drug with the most complete and wide literature preceding its marketing. Most of these studies showed a good efficacy along with an excellent risk profile, especially in low-and medium-risk patients. Recently, updates of European, American and even Italian guidelines gave dronedarone its own spot into the antiarrhythmic armamentarium, recommending its use both for rhythm control and rate control in non-permanent atrial fibrillation. In Italy, however, dronedarone prescription is still possible only when amiodarone is not tolerated, making dronedarone a mere second choice of its older "relative". Moreover, patients taking dronedarone must undergo a strict alanine aminotransferase and bilirubin follow-up, which usefulness in predicting drug-induced liver damage (probably idiosyncratic in nature and therefore unpredictable) is far from demonstrated.
[
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2000
For many years creatine kinase (CK) and CK-MB isoenzymes were used together with the ECG to confi... more For many years creatine kinase (CK) and CK-MB isoenzymes were used together with the ECG to confirm the presence of myocardial infarction. During the last decade newer cardiac markers have been introduced and immunological test systems developed for their quantification. Among these new markers, a prominent role has emerged for cardiac troponins (T or I). These technological advanced assays have shown greater sensitivity compared to "conventional cardiac enzymes;, thereby identifying patients with small--at times, microscopic--infarcts who would not have met defining criteria for myocardial infarction in an earlier era. Another major advantage shown by both cardiac troponins with respect to "conventional cardiac enzymes" is their ability to predict clinical outcome over a short- or long-term follow-up in patients with acute coronary syndromes, and this appears to be particularly relevant in patients with micronecrosis, who constitute a high-risk subgroup of unstable a...
Resuscitation, 2006
Only a few data are available on the survival rate following out-of-hospital cardiac arrest in di... more Only a few data are available on the survival rate following out-of-hospital cardiac arrest in different Italian settings. We report an analysis of a 10-year experience in a mixed rural/urban setting, the main variables associated with survival, and the preliminary results of the implementation of an automated external defibrillator (AED) programme operated by lay volunteers on the effectiveness of the existing Emergency Medical Service (EMS). We report data from an observational cohort study on all adults, resuscitated from witnessed cardiac arrest between 1994 and 2004 in the district area of Forlì (Italy). The AED programme was introduced in 2002. Entry variables, time intervals and nodal events were tested according to Utstein recommendations. The predictors of favourable outcomes (Overall Performance Category 1-2) were identified by logistic regression analysis. The witnessed cardiac arrest rate was 27/100,000 population per year (95% confidence interval, 18-38). The initial rhythm was shockable in 241/479 cases (50.3%). After resuscitation, 55 (11.5%) subjects had a favourable outcome at discharge and 38 (7.9%) at 1 year. Time-to-treatment was longer for EMS than for AED-equipped units (median, 8 min interquartile range, 6-10 (467 cases) versus 6 min interquartile range, 4-8 (13 cases); P<0.013), but the final results of the AED programme were poor, with only 1 subject saved/171,000 inhabitants in 2 years. Positive outcome predictors were male sex, younger age, shockable rhythms, low number of defibrillations, and no history of hypertension, diabetes, myocardial infarction or congestive heart failure. Even in a mixed urban/rural setting, survival from out-of-hospital cardiac arrest is dependent on well-known predictors. In our setting, the number of cases saved by an AED programme is limited when accompanied by an efficient traditional EMS. The allocation of resources to an AED programme should be reconsidered in a mixed rural/urban setting.
Journal of the American College of Cardiology, 1994
Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PH... more Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PHD," DONATELLA FERRINI, MD, FILIPPO OTTANI, MD, FRANC0 RUSTICALI, MD, PAUL R. EISENBERG, MD, MPH, FACC" F&L ltoiy and Saint Lor,rs Mssouti
Journal of the American College of Cardiology, 2002
The study investigated the relationship among creatine kinase (CK) elevations, clinical character... more The study investigated the relationship among creatine kinase (CK) elevations, clinical characteristics and cardiac events across the whole spectrum of acute coronary syndromes (ACS). BACKGROUND Elevated serum levels of cardiac enzymes have been shown to be a major prognostic determinant in acute myocardial ischemia. Yet prior to this report, the relation between cardiac enzyme levels and other prognostic determinants across the entire spectrum of ACS has not been explored by a large clinical study.
Journal of the American College of Cardiology, 1998
International Journal of Cardiology, 1998
The availability of 'new' biochemical markers of myocardial injury such as creati... more The availability of 'new' biochemical markers of myocardial injury such as creatine kinase isoforms and troponins has renewed the interest for rapid confirmation/exclusion of myocardial infarction in patients presented to the hospital for suspected acute myocardial ischemia. Many of these protein markers have the potential to allow the diagnosis of acute myocardial infarction at a time from the onset of symptoms when the activity of creatine kinase MB is still within the reference range. However, the exclusion of classical myocardial infarction as defined by WHO criteria does not allow to conclude that the patient is at low-risk and can be safely sent home since he may have high-risk unstable angina. The sensitivity for the detection of myocardial damage of troponins is such that a substantial proportion of patients with unstable angina develop elevations of troponins in the absence of creatine kinase MB increases. It is now clear that such patients have an increased risk of cardiac events over the short and long-term similar to that of patients with definite myocardial infarction. Such finding may help in developing selective admission policies and deciding which patients deserve aggressive treatment.
International Journal of Cardiology, 1999
Coronary thrombosis is an important determinant of prognosis in patients with acute coronary synd... more Coronary thrombosis is an important determinant of prognosis in patients with acute coronary syndromes (ACS). However, the identification of patients at high-risk for progression of coronary thrombosis is difficult partly because we currently lack clinically meaningful laboratory methods for its detection. The most promising approaches involve the measurement in plasma of markers of fibrin formation and degradation. Thrombin activity, as reflected by plasma or urine concentrations of fibrinopeptide A, is increased in patients with ACS and is associated with adverse outcome. However, the use of fibrinopeptide A as a marker of fibrin formation is limited by the very short half-life of the compound, by artifact due to sample acquisition, and by extremely long turnaround times. To overcome these limitations, measurement of soluble fibrin has been proposed. We have recently explored the prognostic value of a new fibrin-specific ELISA assay for soluble fibrin in patients with ACS and found that patients with the highest levels had a 2-fold increased risk of early and late cardiac events. Increases in plasma concentrations of cross-linked fibrin degradation products (XL-FDPs), which reflect increased fibrin turn-over, are a marker of risk for complications of myocardial infarction. However, until recently, assays for XL-FDPs lacked specificity, because they did not distinguish between fibrin and fibrinogen degradation products. Recently, fibrin-specific ELISAs have been described and a rapid whole blood assay for D-dimer has been developed. We recently validated the prognostic value of this whole blood agglutination assay in patients with ACS. These results suggest that: (1) The detection of significant activation of the coagulation and/or fibrinolytic system may be important for rapid risk stratification of patients with ACS; (2) patients with biochemical evidence of ongoing coronary thrombosis may particularly benefit from aggressive antithrombotic strategies; (3) sequential measurement of these markers may be useful to guide antithrombotic treatment during the unstable phase of coronary artery disease.
After an episode of unstable angina or myo- cardial infarction, a high proportion of pa- tients s... more After an episode of unstable angina or myo- cardial infarction, a high proportion of pa- tients show biochemical signs of coagula- tion activation, expressed as persistently elevated thrombin generation, in their blood. It is not known whether this has any influ- ence on long-term outcome. In this prospec- tive multicenter cohort study, we assessed the relation of persistently elevated throm-
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
Recommendations for the clinical use of cardiac natriuretic peptides. ... Emdin M, Clerico A, Cle... more Recommendations for the clinical use of cardiac natriuretic peptides. ... Emdin M, Clerico A, Clemenza F, Galvani M, Latini R, Masson S, Mulè P, Panteghini M, Valle R, Zaninotto M, Ganau A, Mariotti R, Volpe M, Aspromonte N, Cacciatore G, Cappelletti P, L'Abbate A, Miglio F, ...
Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PH... more Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PHD," DONATELLA FERRINI, MD, FILIPPO OTTANI, MD, FRANC0 RUSTICALI, MD, PAUL R. EISENBERG, MD, MPH, FACC" F&L ltoiy and Saint Lor,rs Mssouti
Only a few data are available on the survival rate following out-of-hospital cardiac arrest in di... more Only a few data are available on the survival rate following out-of-hospital cardiac arrest in different Italian settings. We report an analysis of a 10-year experience in a mixed rural/urban setting, the main variables associated with survival, and the preliminary results of the implementation of an automated external defibrillator (AED) programme operated by lay volunteers on the effectiveness of the existing Emergency Medical Service (EMS). We report data from an observational cohort study on all adults, resuscitated from witnessed cardiac arrest between 1994 and 2004 in the district area of Forlì (Italy). The AED programme was introduced in 2002. Entry variables, time intervals and nodal events were tested according to Utstein recommendations. The predictors of favourable outcomes (Overall Performance Category 1-2) were identified by logistic regression analysis. The witnessed cardiac arrest rate was 27/100,000 population per year (95% confidence interval, 18-38). The initial rhythm was shockable in 241/479 cases (50.3%). After resuscitation, 55 (11.5%) subjects had a favourable outcome at discharge and 38 (7.9%) at 1 year. Time-to-treatment was longer for EMS than for AED-equipped units (median, 8 min interquartile range, 6-10 (467 cases) versus 6 min interquartile range, 4-8 (13 cases); P<0.013), but the final results of the AED programme were poor, with only 1 subject saved/171,000 inhabitants in 2 years. Positive outcome predictors were male sex, younger age, shockable rhythms, low number of defibrillations, and no history of hypertension, diabetes, myocardial infarction or congestive heart failure. Even in a mixed urban/rural setting, survival from out-of-hospital cardiac arrest is dependent on well-known predictors. In our setting, the number of cases saved by an AED programme is limited when accompanied by an efficient traditional EMS. The allocation of resources to an AED programme should be reconsidered in a mixed rural/urban setting.
Acc Current Journal Review, 2004
Transient ST segment elevation (STE) in lead aVR during an acute coronary syndrome (ACS) is assoc... more Transient ST segment elevation (STE) in lead aVR during an acute coronary syndrome (ACS) is associated with severe multivessel coronary disease but few studies have assessed the prognostic impact of this finding.
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology
The Joint European Society of Cardiology and the American College of Cardiology Committee has rec... more The Joint European Society of Cardiology and the American College of Cardiology Committee has recently reviewed the criteria to diagnose myocardial infarction, focusing on the central role of biochemical criterium and indicating the cardiac troponins as the reference marker. However, at present, little is known upon how "old" and "new" biochemical markers of myocardial damage are utilized in daily clinical practice. We performed a survey across the whole set of Italian coronary care units (CCUs) to evaluate the actual behavior of the clinicians in detecting myocardial necrosis with the biomarkers. A simple and brief questionnaire was used to pursue such purpose. The feedback from CCUs was positive in 87.6% (303/346). The creatine kinase-MB is the most frequently used biomarker, however the "mass concentration" method was utilized in a minority of centers (38%). More than 60% of the CCUs are still measuring obsolete biomarkers as lactic dehydrogenase or ...
Giornale italiano di cardiologia
Giornale italiano di cardiologia
Cardiology, 2007
Background: Intravenous unfractionated heparin (UFH) is recommended in ST-elevation acute myocard... more Background: Intravenous unfractionated heparin (UFH) is recommended in ST-elevation acute myocardial infarction (STEMI), following thrombolysis with fibrin-specific agents. Subcutaneous low-molecular-weight heparins (LMWH), previously proven effective in non-ST-elevation acute coronary syndromes, have been recently investigated in the setting of STEMI. We aimed at evaluating the current level of evidence supporting the use of LMWH in STEMI. Methods: A Medline search of
Clinical Pharmacology and Therapeutics, 1985
Vasodilators of resistive vessels may induce ischemia in patients with coronary artery disease. T... more Vasodilators of resistive vessels may induce ischemia in patients with coronary artery disease. To evaluate this possibility during prostacyclin (PGI2; scalar doses up to 10 ng/kg/min) and prostacyclin analog (iloprost; scalar doses up to 6 ng/kg/min) infusions, we studied 33 patients with angina pectoris and proved coronary artery disease. Patients were also submitted to dipyridamole (0.15 mg/kg/min for 4 minutes) and exercise stress testing (starting at 25 W and increasing 25 W every 2 minutes). In a preliminary study the hemodynamic and side effects of iloprost were studied in seven healthy subjects. At an iloprost dose of 4 to 6 ng/kg/min, these subjects had a significant decrease in mean arterial pressure and total peripheral and pulmonary vascular resistances. Side effects were limited to facial flushing and slight headache and were readily reversible. PGI, induced typical chest pain and significant ST segment depression in six patients with severe coronary artery disease (three with left main and three with triple vessel disease) and poor exercise tolerance (X SD = 362 -± 99 seconds). All six patients had had angina during the dipyridamole infusion. Similar findings were observed after iloprost infusion in four of these.
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2002
The recent document of the ESC/ACC Committee for the redefinition of myocardial infarction (MI) h... more The recent document of the ESC/ACC Committee for the redefinition of myocardial infarction (MI) has introduced the measurement of cardiac troponin as the biochemical standard for the diagnosis of MI. This change has been mainly driven by the demonstration that any amount of myocardial damage, as detected by cardiac troponins, implies a worse long-term outcome of the patient. The results of several studies consistently show that there is a continuous relationship between the degree of troponin elevation and the patient's prognosis. The new definition has important consequences on the diagnostic and therapeutic approaches to patients with acute coronary syndromes; in fact, patients with increased troponins, i.e. patients with MI, necessitate more aggressive treatment than those without troponin elevations, i.e. patients with unstable angina. The application of the new definition is expected to increase the number of cases of MI by about 30% and to decrease mortality. We believe th...
Dronedarone is the antiarrhythmic drug with the most complete and wide literature preceding its m... more Dronedarone is the antiarrhythmic drug with the most complete and wide literature preceding its marketing. Most of these studies showed a good efficacy along with an excellent risk profile, especially in low-and medium-risk patients. Recently, updates of European, American and even Italian guidelines gave dronedarone its own spot into the antiarrhythmic armamentarium, recommending its use both for rhythm control and rate control in non-permanent atrial fibrillation. In Italy, however, dronedarone prescription is still possible only when amiodarone is not tolerated, making dronedarone a mere second choice of its older "relative". Moreover, patients taking dronedarone must undergo a strict alanine aminotransferase and bilirubin follow-up, which usefulness in predicting drug-induced liver damage (probably idiosyncratic in nature and therefore unpredictable) is far from demonstrated.
[
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2000
For many years creatine kinase (CK) and CK-MB isoenzymes were used together with the ECG to confi... more For many years creatine kinase (CK) and CK-MB isoenzymes were used together with the ECG to confirm the presence of myocardial infarction. During the last decade newer cardiac markers have been introduced and immunological test systems developed for their quantification. Among these new markers, a prominent role has emerged for cardiac troponins (T or I). These technological advanced assays have shown greater sensitivity compared to "conventional cardiac enzymes;, thereby identifying patients with small--at times, microscopic--infarcts who would not have met defining criteria for myocardial infarction in an earlier era. Another major advantage shown by both cardiac troponins with respect to "conventional cardiac enzymes" is their ability to predict clinical outcome over a short- or long-term follow-up in patients with acute coronary syndromes, and this appears to be particularly relevant in patients with micronecrosis, who constitute a high-risk subgroup of unstable a...
Resuscitation, 2006
Only a few data are available on the survival rate following out-of-hospital cardiac arrest in di... more Only a few data are available on the survival rate following out-of-hospital cardiac arrest in different Italian settings. We report an analysis of a 10-year experience in a mixed rural/urban setting, the main variables associated with survival, and the preliminary results of the implementation of an automated external defibrillator (AED) programme operated by lay volunteers on the effectiveness of the existing Emergency Medical Service (EMS). We report data from an observational cohort study on all adults, resuscitated from witnessed cardiac arrest between 1994 and 2004 in the district area of Forlì (Italy). The AED programme was introduced in 2002. Entry variables, time intervals and nodal events were tested according to Utstein recommendations. The predictors of favourable outcomes (Overall Performance Category 1-2) were identified by logistic regression analysis. The witnessed cardiac arrest rate was 27/100,000 population per year (95% confidence interval, 18-38). The initial rhythm was shockable in 241/479 cases (50.3%). After resuscitation, 55 (11.5%) subjects had a favourable outcome at discharge and 38 (7.9%) at 1 year. Time-to-treatment was longer for EMS than for AED-equipped units (median, 8 min interquartile range, 6-10 (467 cases) versus 6 min interquartile range, 4-8 (13 cases); P<0.013), but the final results of the AED programme were poor, with only 1 subject saved/171,000 inhabitants in 2 years. Positive outcome predictors were male sex, younger age, shockable rhythms, low number of defibrillations, and no history of hypertension, diabetes, myocardial infarction or congestive heart failure. Even in a mixed urban/rural setting, survival from out-of-hospital cardiac arrest is dependent on well-known predictors. In our setting, the number of cases saved by an AED programme is limited when accompanied by an efficient traditional EMS. The allocation of resources to an AED programme should be reconsidered in a mixed rural/urban setting.
Journal of the American College of Cardiology, 1994
Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PH... more Thrombin Activity After ~~ro~a~ lysis With Stre nase MARCEL0 GALVANI, MD, DANA R. ABENDSCHEIN. PHD," DONATELLA FERRINI, MD, FILIPPO OTTANI, MD, FRANC0 RUSTICALI, MD, PAUL R. EISENBERG, MD, MPH, FACC" F&L ltoiy and Saint Lor,rs Mssouti
Journal of the American College of Cardiology, 2002
The study investigated the relationship among creatine kinase (CK) elevations, clinical character... more The study investigated the relationship among creatine kinase (CK) elevations, clinical characteristics and cardiac events across the whole spectrum of acute coronary syndromes (ACS). BACKGROUND Elevated serum levels of cardiac enzymes have been shown to be a major prognostic determinant in acute myocardial ischemia. Yet prior to this report, the relation between cardiac enzyme levels and other prognostic determinants across the entire spectrum of ACS has not been explored by a large clinical study.
Journal of the American College of Cardiology, 1998
International Journal of Cardiology, 1998
The availability of 'new' biochemical markers of myocardial injury such as creati... more The availability of 'new' biochemical markers of myocardial injury such as creatine kinase isoforms and troponins has renewed the interest for rapid confirmation/exclusion of myocardial infarction in patients presented to the hospital for suspected acute myocardial ischemia. Many of these protein markers have the potential to allow the diagnosis of acute myocardial infarction at a time from the onset of symptoms when the activity of creatine kinase MB is still within the reference range. However, the exclusion of classical myocardial infarction as defined by WHO criteria does not allow to conclude that the patient is at low-risk and can be safely sent home since he may have high-risk unstable angina. The sensitivity for the detection of myocardial damage of troponins is such that a substantial proportion of patients with unstable angina develop elevations of troponins in the absence of creatine kinase MB increases. It is now clear that such patients have an increased risk of cardiac events over the short and long-term similar to that of patients with definite myocardial infarction. Such finding may help in developing selective admission policies and deciding which patients deserve aggressive treatment.
International Journal of Cardiology, 1999
Coronary thrombosis is an important determinant of prognosis in patients with acute coronary synd... more Coronary thrombosis is an important determinant of prognosis in patients with acute coronary syndromes (ACS). However, the identification of patients at high-risk for progression of coronary thrombosis is difficult partly because we currently lack clinically meaningful laboratory methods for its detection. The most promising approaches involve the measurement in plasma of markers of fibrin formation and degradation. Thrombin activity, as reflected by plasma or urine concentrations of fibrinopeptide A, is increased in patients with ACS and is associated with adverse outcome. However, the use of fibrinopeptide A as a marker of fibrin formation is limited by the very short half-life of the compound, by artifact due to sample acquisition, and by extremely long turnaround times. To overcome these limitations, measurement of soluble fibrin has been proposed. We have recently explored the prognostic value of a new fibrin-specific ELISA assay for soluble fibrin in patients with ACS and found that patients with the highest levels had a 2-fold increased risk of early and late cardiac events. Increases in plasma concentrations of cross-linked fibrin degradation products (XL-FDPs), which reflect increased fibrin turn-over, are a marker of risk for complications of myocardial infarction. However, until recently, assays for XL-FDPs lacked specificity, because they did not distinguish between fibrin and fibrinogen degradation products. Recently, fibrin-specific ELISAs have been described and a rapid whole blood assay for D-dimer has been developed. We recently validated the prognostic value of this whole blood agglutination assay in patients with ACS. These results suggest that: (1) The detection of significant activation of the coagulation and/or fibrinolytic system may be important for rapid risk stratification of patients with ACS; (2) patients with biochemical evidence of ongoing coronary thrombosis may particularly benefit from aggressive antithrombotic strategies; (3) sequential measurement of these markers may be useful to guide antithrombotic treatment during the unstable phase of coronary artery disease.