Papers by Pietro Paolo Elia
Pharmacological Research, 1995
Journal of the American College of Cardiology, 2002
Prophylactic acetylcysteine along with hydration seems to be better than hydration alone in preve... more Prophylactic acetylcysteine along with hydration seems to be better than hydration alone in preventing the reduction in renal function induced by a contrast dye. BACKGROUND Contrast media can lead to acute renal failure that may occasionally require hemodialysis. METHODS One hundred eighty-three consecutive patients with impairment of renal function, undergoing coronary and/or peripheral angiography and/or angioplasty, were randomly assigned to receive 0.45% saline intravenously and acetylcysteine (600 mg orally twice daily; group A, n ϭ 92) or 0.45% saline intravenously alone (group B, n ϭ 91) before and after nonionic, low-osmolality contrast dye administration. RESULTS The baseline serum creatinine concentrations were similar (1.5 Ϯ 0.4 mg/dl in group A vs. 1.5 Ϯ 0.4 mg/dl in group B; p ϭ 0.37). An increase of Ն25% in the baseline creatinine level 48 h after the procedure occurred in 6 (6.5%) of 92 patients in group A and in 10 (11%) of 91 patients in group B (p ϭ 0.22). In the subgroup with a low (Ͻ140 ml) contrast dose, renal function deterioration occurred in 5 (8.5%) of 60 patients in group B and in 0 of 60 patients in group A (p ϭ 0.02; odds ratio [OR] 0.44, 95% confidence interval [CI] 0.35 to 0.54). In the subgroup with a high contrast dose, no difference was found (5/31 vs. 6/32 patients, p ϭ 0.78). By multivariate analysis, the amount of contrast agent, but not the treatment strategy, was a predictor of the occurrence of contrast dye-associated nephrotoxicity (OR 2.58, 95% CI 1.1 to 4.9; p ϭ 0.035). CONCLUSIONS In patients with reduced renal function undergoing angiography and/or angioplasty, the amount of contrast agent, but not the administration of prophylactic acetylcysteine, was a predictor of renal function deterioration. Prophylactic acetylcysteine might provide better protection than hydration alone, only when a small volume of contrast agent is used.
Journal of the American College of Cardiology, 2004
We performed a study to assess the efficacy of fenoldopam mesylate (a specific agonist of the dop... more We performed a study to assess the efficacy of fenoldopam mesylate (a specific agonist of the dopamine-1 receptor) as compared with N-acetylcysteine (NAC) in preventing contrast agent-associated nephrotoxicity (CAN). BACKGROUND Prophylactic administration of NAC, along with hydration, prevents CAN in patients with chronic renal insufficiency who are undergoing contrast media administration. Preliminary data support the hypothesis that fenoldopam might be as effective as NAC. METHODS One hundred ninety-two consecutive patients with chronic renal insufficiency, referred to our institution for coronary and/or peripheral procedures, were assigned randomly to receive 0.45% saline intravenously and NAC (1,200 mg orally twice daily; NAC group; n ϭ 97) or fenoldopam (0.10 g/kg/min; fenoldopam group; n ϭ 95) before and after a nonionic, iso-osmolality contrast dye administration. RESULTS Baseline creatinine levels were similar in the two groups: NAC group ϭ 1.72 mg/dl (interquartile range, 1.55 to 1.90 mg/dl) and fenoldopam group ϭ 1.75 mg/dl (interquartile range, 1.62 to 2.01 mg/dl) (p ϭ 0.17). An increase of at least 0.5 mg/dl of the creatinine concentration 48 h after the procedure occurred in 4 of 97 patients (4.1%) in the NAC group and in 13 of 95 patients (13.7%) in the fenoldopam group (p ϭ 0.019; odds ratio 0.27; 95% confidence interval 0.08 to 0.85). The amount of contrast media administration was similar in the two groups (NAC group ϭ 160 Ϯ 82 ml; fenoldopam group ϭ 168 Ϯ 104 ml; p ϭ 0.54). CONCLUSIONS N-acetylcysteine seems to be more effective than fenoldopam in preventing CAN.
Journal of the American College of Cardiology, 2003
tic endografl positioning using RMRI in animal model of AAA. Methods and Results. For rtMRl we us... more tic endografl positioning using RMRI in animal model of AAA. Methods and Results. For rtMRl we used a clinical 1.5T MRI scanner customized with a rapid external image reconstruction system, in-lab consoles, phased-array surface coils, and interactive Interventional features such as independent channel coloring and gain, magnetization preparation, and interleaved multiplanar acquisition. Typical parameters using steady state free precession ("FISP') were 258x128 matrix, 3/4 partial phase Fourier, flip angle 80", field of view 3&m, and bandwidth * 82.5kH.z. Stable infrarenal abdominal aortic aneurysm was created in 50-70kg Yorkshire swine by transfemoral 1.8-2.0-fold balloon overstretch under rtMRI. Clinical intravascular 0.030" MRI guidewire recewer coils (lnterceptTM, Surgi-Vision) guided percutaneous device placement. Clinical tubular stent-grafts were positioned to exclude the AAA under simultaneous multiplanar rtMRl guidance. Conventional MRI and MRA demonstrated appropriate aneurysm exclusion. Conclusion. rtMRl successfully guides AAA endografl delivery in a pig model, and is a promising guidance modality for clinical procedures. Simple customization of endografts and delivery systems can be expected to facilitate accurate device placement in patients with complex aneurysm disease.
Journal of the American College of Cardiology, 2004
Background: Studies of Percutaneous Coronary Intervention (PCI) have focused on mortality and res... more Background: Studies of Percutaneous Coronary Intervention (PCI) have focused on mortality and restenosis. Little is known about the hospital cost of treating acute PCI complications. We studied the incremental hospital resource consumption (cost and length of stay (LOS)) due to acute PCI complications. Methods: A retrospective analysis was conducted using the Medicare Provider Analysis and Review (MedPar) Files from 2002. This consists of 313,517 admissions whose primary procedure was PCI. Procedures, complications, and comorbidities were identified using ICD-9 codes. Hospital costs were estimated from billed charges using the hospital's cost-to charge ratio. Multivariate regression analysis was used to estimate the incremental hospital resources associated with complications, after controlling for age, gender, and 26 comorbiditites. Results: Complications of PCI procedures occur in less than 3.3% of admissions. The hospital cost (unadjusted for morbidities) of PCI with at least one major complication was $29,440 (mean LOS of 9.4 days) compared to $14,046 (mean LOS 2.9 days) for those without a complication. The table reports estimated incremental cost and LOS after control for age, gender, and comorbidities. Conclusion: This retrospective study of Medicare beneficiaries indicates that complications significantly increase cost. Quality improvement efforts to reduce complications, could not only result in improved patient outcomes, but could also prove to be cost-effective.
Journal of Molecular and Cellular Cardiology, 1990
Journal of Molecular and Cellular Cardiology, 1990
Journal of Clinical Investigation, 1991
To test whether generation of oxygen radicals during postischemic reperfusion might promote perox... more To test whether generation of oxygen radicals during postischemic reperfusion might promote peroxidation of cardiac membrane lipids, four groups of Langendorff-perfused rabbit hearts were processed at the end of (a) control perfusion, (b) 30 min of total global ischemia at 370C without reperfusion, (c) 30 min of ischemia followed by reperfusion with standard perfusate, (d) 30 min of ischemia followed by reperfusion with the oxygen radical scavenger human recombinant superoxide dismutase (h-SOD). The left ventricle was homogenized and tissue content of malonyldialdehyde (MDA), an end product of lipid peroxidation, was measured on the whole homogenate as well as on various subcellular fractions. Reperfusion was accompanied by a significant increase in MDA content of the whole homogenate and of the fraction enriched in mitochondria and lysosomes. This phenomenon was not observed in hearts subjected to ischemia but not reperfused, and was similarly absent in those hearts which received h-SOD at reflow. Reperfused hearts also had significantly greater levels of conjugated dienes (another marker of lipid peroxidation) in the mitochondrial-lysosomal fraction. Again, this phenomenon did not occur in ischemic hearts or in reperfused hearts treated with h-SOD. Unlike the effect on tissue MDA and conjugated dienes, reperfusion did not significantly stimulate release of MDA in the cardiac effluent. Treatment with h-SOD was also associated with significant improvement in the recovery ofcardiac function. In conclusion, these data directly demonstrate that postischemic reperfusion results in enhanced lipid peroxidation of cardiac membranes, which can be blocked by h-SOD, and therefore is most likely secondary to oxygen radical generation at reflow.
Free Radical Biology and Medicine, 1998
Oxygen radical generation induced by postischemic reperfusion can overwhelm endogenous radical sc... more Oxygen radical generation induced by postischemic reperfusion can overwhelm endogenous radical scavenging systems, resulting in "oxidative stress." Release of oxidized glutathione (GSSG) upon reflow has been taken as evidence for the occurrence of oxidative stress in postischemic hearts. However, demonstration that GSSG release is due to oxygen radicals and not to other consequences of ischemia/reperfusion is lacking. To address this issue, isolated rabbit hearts underwent 30 min of global ischemia at 37 degrees C. At reflow, control hearts were perfused with standard buffer for 45 min (n = 8); treated hearts received the oxygen radical scavenger superoxide dismutase (hSOD) for 15 min, followed by 30 min of standard perfusion (n = 8). During reperfusion control hearts showed a prominent release of GSSG, which peaked 5 min after reflow. Interestingly, GSSG release was still significantly elevated 45 min into reperfusion, at a time when oxygen radical generation has long ceased. In contrast, in hSOD-treated hearts GSSG release was negligible. Prevention of oxidative stress was also associated with significantly greater recovery of function. Thus, GSSG release occurs in postischemic hearts as a direct consequence of oxygen radical generation, and it may outlast the initial oxidant load.
European Heart Journal, 2004
Aims Prophylactic administration of N-acetylcysteine (NAC) (600 mg orally twice daily), along wit... more Aims Prophylactic administration of N-acetylcysteine (NAC) (600 mg orally twice daily), along with hydration, prevents contrast agent-associated nephrotoxicity (CAN) induced by a low dose of non-ionic, low-osmolality contrast dye. We tested whether a double dose of NAC is more effective to prevent CAN. Methods and results Two-hundred-twenty-four consecutive patients with chronic renal insufficiency (creatinine level ≥1.5 mg/dl and/or creatinine clearance <60 ml/ min), referred to our institution for coronary and/or peripheral procedures, were randomly assigned to receive 0.45% saline intravenously and NAC at the standard dose (600 mg orally twice daily; SD Group; n=110) or at a double dose (1200 mg orally twice daily; DD Group; n=114) before and after a non-ionic, low-osmolality contrast dye administration. Increase of at least 0.5 mg/dl of the creatinine concentration 48 h after the procedure occurred in 12/109 patients (11%) in the SD Group and 4/114 patients (3.5%) in the DD Group (P=0.038; OR=0.29; 95% CI=0.09-0.94). In the subgroup with low (<140 ml, or contrast ratio ≤1) contrast dose, no significant difference in renal function deterioration occurred between the 2 groups. In the subgroup with high (≥140 ml, or contrast ratio >1) contrast dose, the event was significantly more frequent in the SD Group. Conclusions Double dose of NAC seems to be more effective than the standard dose in preventing CAN, especially with high volumes of non-ionic, low-osmolality contrast agent.
European Heart Journal, 2004
Aims Peri-procedural non-Q-wave myocardial infarction is a frequent and prognostically important ... more Aims Peri-procedural non-Q-wave myocardial infarction is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). It has been postulated that statins may reduce the rate of myocardial injury after PCI. Methods and Results Four hundred and fifty-one patients scheduled for elective PCI and not on statins were randomly assigned to either no treatment or to statin treatment. Statin administration was started at least 3 days before the procedure.Incidence of periprocedural myocardial injury was assessed by analysis of creatinine kinase myocardial isoenzyme (CK-MB: upper limit of normal [ULN] 3.5 ng/ml) and cardiac troponin I (cTn I, ULN 0.10 ng/ml) before, 6 and 12 h after the intervention. A large non-Q-wave myocardial infarction was defined as a CK-MB elevation >5 times ULN alone or associated with chest pain or ST segment or T wave abnormalities. Median CK-MB peak after PCI was 1.70 (interquartile ranges 1.10-3.70) ng/ml in the Statin group and 2.20 (1.30-5.60) ng/ml in the Control group (p = 0.015). Median peak of cTnI after PCI was 0.13 (0.05-0.45) ng/ml in the Statin group and 0.21 (0.06-0.85) ng/ml in the Control group (p = 0.033). The incidence of a large non-Q-wave myocardial infarction was 8.0% in the Statin group and 15.6% in the Control group (p = 0.012: OR = 0.47; 95% CI = 0.26-0.86). The incidence of cTnI elevation >5 times ULN was 23.5% in the Statin group and 32% in the Control group (p = 0.043: OR = 0.65; 95% CI = 0.42-0.98). By logistic regression analysis, the independent predictors of CK-MB
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Papers by Pietro Paolo Elia