The aim of this study was to evaluate clinical characteristics, procedural details, and outcomes ... more The aim of this study was to evaluate clinical characteristics, procedural details, and outcomes of patients undergoing elective multivessel percutaneous coronary intervention (MV-PCI) in Europe. A total of 7113 patients with stable coronary artery disease and at least two major epicardial vessels with C70% stenosis were included in this analysis of the contemporary Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 3376, 47.5%) were compared with those with single-vessel PCI (SV-PCI) (n = 3737, 52.5%). Patients with MV-PCI were more likely to have congestive heart failure, whereas those with SV-PCI more often suffered from noncardiac comorbidities. Hospital mortality (0.1% vs 0.3%) and the incidence of nonfatal postprocedural myocardial infarction (1.0% vs 0.7%) were low in patients with MV-PCI and SV-PCI. In the multivariate analysis, no significant difference in the incidence of hospital death (odds ratio (OR) 0.44, 95% confidence interval (CI) 0.15-1.27) could be observed between the two groups. However, the risk for postprocedural myocardial infarction (OR 1.57, 95% CI 0.93-2.67) tended to be higher among patients undergoing MV-PCI. Independent determinants for performing MV-PCI were age, comorbidities, and coronary anatomy. In Europe almost half of all patients with multivessel disease were treated with MV-PCI. Hospital complications were low, but a trend toward a higher rate of postprocedural myocardial infarctions was seen in patients with MV-PCI.
Clinical cardiology and cardiovascular interventions, Oct 19, 2022
Background: Spontaneous coronary dissection (SCAD) and non-traditional risk factors (NT-RF) have ... more Background: Spontaneous coronary dissection (SCAD) and non-traditional risk factors (NT-RF) have assumed increasing interest. Aim: To assess NT-RF in the Parma SCAD registry population. Methods: 62 patients with SCAD, enrolled between January 2013 through November 2021, were divided in two groups: NT-RF (n=51) and T-RF (n = 11). Clinical, echocardiographic and angiographic features were compared between the two study populations; finally, the occurrence of major adverse cardiovascular events was assessed at follow-up. Results: At least one NT-RF among sex related, sex prevalent and gender specific risk factors was present in 82% of patients, while TRF for atherosclerotic disease were less common with hypertension being the most prevalent (40.3%) and diabetes the most seldom (3.2%). Patients with NT-RF were significantly younger (p=0.027) and mostly female compared to those without NT-RF (p=0.004). Type 2 (second Yip/Saw classification) dissection was the prevailing phenotype (54.8%) with a higher prevalence in the NT-RF group (63%, p=0.035). Major Adverse Cardiovascular Events (MACEs) occurred in 17.7% in all patients at a median follow-up of 23 months. When comparing the incidence of cardiovascular events in the 2 study groups, we did not find any significant differences (p=0.4) between groups. Conclusion: SCAD occurs more often in younger women without the traditional RF. Risk estimation does not include these factors and tailored prediction models are lacking. Clinicians and researchers should establish targeted interventions for primary prevention, early diagnosis and secondary prevention in younger women.
The Journal of Clinical Endocrinology & Metabolism
Context Coronary collateral (CC) vessel development appears to be protective with regard to adver... more Context Coronary collateral (CC) vessel development appears to be protective with regard to adverse cardiovascular events and survival in patients with coronary chronic total occlusion (CTO). The influence of type 2 diabetes mellitus (T2DM) on CC growth has been controversial. In particular, the role of diabetic microvascular complications (DMC) in determining coronary collateralization has not been elucidated. Objective To investigate whether patients with DMC presented differences in CC vessel presence and grading as compared with patients without DMC. Methods We conducted a single-center observational study, including consecutive T2DM patients, without previous cardiovascular history, undergoing a clinically indicated coronary angiography for chronic coronary syndrome (CCS) and angiographic evidence of at least one CTO. Patients were subdivided into 2 study groups according to the presence/absence of at least one DMC (neuropathy, nephropathy, or retinopathy). The presence and gra...
Despite evidence-based therapies, patients presenting with atherosclerosis involving more than on... more Despite evidence-based therapies, patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particular vulnerable group characterized by enhanced residual long-term risk for major adverse cardiac events (MACE), as well as major adverse limb events (MALE). The latter are progressively emerging as a hard outcome to be targeted, being correlated with increased mortality. Antithrombotic therapy is the mainstay of secondary prevention in both patients with PAD or CAD however, the optimal intensity of such therapy is still topic of debate, particularly in the post-acute and long-term setting. Recent well powered randomized clinical trials (RCTs) have provided data in favor of a more intense antithrombotic therapy, such as prolonged dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor or a therapy with aspirin combined with an anticoagulant drug...
Background Transcatheter patent foramen ovale (PFO) closure is an effective therapy in patients w... more Background Transcatheter patent foramen ovale (PFO) closure is an effective therapy in patients with cryptogenic stroke (CS) or transient ischemic attack (TIA) and evidence of PFO. However, the incidence of recurrent cerebral ischemia is not negligible and underlying pathogenic mechanisms remain largely unknown. We sought to evaluate the magnitude of the problem and to assess predictors of recurrent stroke/TIA after transcatheter PFO closure. Methods We enrolled non-randomized consecutive patients who underwent PFO closure for secondary prevention of neurological ischemic events at the University Hospital of Parma between 2004 and 2021. Clinical, echocardiographic and procedure-related features were collected for each patient. The incidence of recurrent ischemic neurological events was assessed at follow-up. Results We enrolled a total of 154 patients. The primary indication for PFO closure was previous stroke (85 [55.2%] subjects) and a third of patients (51 [33.1%]) suffered from ...
The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional ri... more The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional risk factors (NT-RF) have assumed increasing interest, but few data are available. NT-RF include three categories: Sex-related (SR-NT-FR), Sex-predominant (SP-NT-RF) and Gender-related (GR-NT-RF). (Table 1) Aim of the Study: The objective of our analysis was to evaluate the incidence of NT-RF in Parma SCAD registry population. Material and methods: We reviewed 62 patients with SCAD enrolled between January 2013 through November 2021 Results: Traditional risk factors were less common: hypertension was the most prevalent (39 pts, 62.9%). When considering NT-RF, 51 patients (82%) had at least one of all, with at least one SR-RF (66%) or GR-RF (64,5%). Patients with NT-RF were younger at time of SCAD (mean age 53 vs 66; p ¼ 0.027) and they were predominantly females (48 vs 7 pts, p ¼ 0.004) (Table 2). No differences were found among NT-RF SCAD and nNT-RF SCAD patients by fibromuscular dysplasia, peripheral arterial disease and chronic kidney disease. Patients with SCAD more often presented with non ST-segment elevation myocardial infarction (43 pts, 72.6%) vs ST-segment elevation (17 pts, 27.4%). No differences in clinical presentation and angiographic characteristics were found among NT-RF and nNT-RF patients group. MACE occurred in 17.7% of patients of the overall study population, at a median follow-up of 23 (interquartile range: 11;57) months. When comparing the incidence of cardiovascular events in the 2 study groups there was a trend toward a higher prevalence of MACE in NT-RF group without statistical significance (NT-RF SCAD 19.6%-nNT-RF SCAD 9.1%; p ¼ 0.4). (Table 3) Conclusion: SCAD is an emerging cause of myocardial infarction in young and middleaged women without the traditional cardiovascular risk profile. Although overall survival seems good, SCAD is a potentially malignant disease which can present with ventricular arrhythmias and sudden cardiac death. Risk estimation is difficult in women, due to the scarce validity of prediction models, therefore a great effort must be made by the clinical community for the widespread diffusion and use of models incorporating NT-RF. Acknowledgement of peculiar features of this disease could help clinicians and researchers to establish targeted interventions for cardiovascular primary prevention, early diagnosis and secondary prevention in women, including rehabilitation and stress management programmes.
Transcatheter left atrial appendage occlusion (LAAO) has emerged as a reliable tool to prevent th... more Transcatheter left atrial appendage occlusion (LAAO) has emerged as a reliable tool to prevent thromboembolic events, in particular ischemic stroke, in patients with atrial fibrillation (AF) in the absence of mitral stenosis/valve prosthesis and contraindication to oral anticoagulation (OAC). Antiplatelet therapy (APT) is required after device implantation to prevent device–related thrombus (DRT). Previous studies provided conflicting results on the optimal APT regimen after LAAO. Thus, herein we aimed at assessing the comparative effectiveness and safety of distinct APT regimens. We conducted a real–world single–center observational study including consecutive AF patients that underwent LAAO at the University Hospital of Parma between October 2010 and June 2021. Clinical follow–up included all successfully implanted patients. Primary endpoint was net efficacy outcome, a composite of any ischemic or hemorrhagic event. Secondary endpoints were ischemic (any of the following: ischemic...
ImportanceThere is growing awareness of sex-related differences in cardiovascular risk profiles, ... more ImportanceThere is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure.MethodsA nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1–22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).ResultsST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a ...
BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is f... more BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
Oral anticoagulation (OAC) is the cornerstone therapy for stroke prevention in patients with atri... more Oral anticoagulation (OAC) is the cornerstone therapy for stroke prevention in patients with atrial fibrillation (AF). However, a not negligible proportion of AF patients experiences major bleeding events or is affected by concomitant disorders that represent a contraindication for OAC. Left atrial appendage occlusion (LAAO) has emerged as an effective strategy to minimize the risk of thromboembolism in AF patients (without moderate/severe mitral stenosis or mechanical prosthetic heart valves) that are poor candidates for OAC. After the procedure variable regimens of antithrombotic therapy are prescribed, in order to provide protection and prevent device-related thrombus (DRT). The optimal post-procedural antithrombotic strategy remains to be assessed. Therefore, we aim to evaluate the safety and efficacy of LAAO procedure and the relationship between antiplatelet therapy and outcomes at long-term follow-up. We conducted a retrospective observational study including consecutive AF p...
Data regarding long-term prognosis of MINOCA are very limited and conflicting. The Italian Geneti... more Data regarding long-term prognosis of MINOCA are very limited and conflicting. The Italian Genetic Study on early-onset MI enrolled 2000 patients who had a first MI before they were 45. The median follow-up was 19.9 years, the equivalent of 39 535 person-years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalization for coronary revascularization. MINOCA was experienced by 317 patients (15.9%). The risk of MACE was not significantly different between MINOCA patients and those with obstructive coronary artery disease (MICAD, 27.8% vs. 37.5%; adj. HR: 0.79, 95% CI: 0.57–1.09; P = 0.15, Figure 1). There was no between-group difference in the rate of non-fatal MI (17.3% vs. 25.4%; adj. HR: 0.76, 95% CI: 0.52–1.13; P = 0.18), non-fatal ischaemic stroke (9.5% vs. 3.7%; adj. HR: 1.79, 95% CI: 0.87–3.70; P = 0.12), or all-cause mortality (14.1% vs. 20.7%; adj. HR: 0.73, 95% CI: 0.43–1.25; P = 0.26)...
Aims Sex-differences have been demonstrated in the acute phase of COVID-19 infection; females (f)... more Aims Sex-differences have been demonstrated in the acute phase of COVID-19 infection; females (f) were found to be less prone to develop a severe disease than males (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome. Methods and results The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection from a sex-perspective. For this purpose, we enrolled 223 patients (89 F and 134 M) who experienced a SARS-CoV-2 infection. In the acute phase of the illness, females reported more frequently than males: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhoea, and myalgia without significant differences in breathlessness, cough, and sleep disturbance. After a mean follow-up time of 5 months after the acute phase, females were significantly more likely than males to report weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, wo...
Single coronary artery (SCA) is a rare coronary anomaly that occurs with an incidence of 0.024%. ... more Single coronary artery (SCA) is a rare coronary anomaly that occurs with an incidence of 0.024%. We report the case of an 83-year-old woman with a Lipton’s type 3 SCA, which is the rarest anomaly within this group, occurring only in the 0.004% of general population. The clinical presentation of this patient was chest pain at rest with multifocal transient ST segment elevation as a marker of multifocal ischemia secondary to severe three vessels coronary artery disease (CAD). This patient was proposed for coronary artery bypass grafting (CABG) with an excellent mid-term outcome. (www.actabiomedica.it)
Introduction Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represen... more Introduction Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represents a challenging scenario. It deserves specific considerations due to the dramatic presentation and the need for secondary sudden cardiac death prevention. Methods We collected clinical data of four women admitted during the last two years in the Coronary Care Unit of Parma University Hospital, whose presentation of SCAD were cardiac arrest due to ventricular fibrillation. Results Three patients survived the acute phases. One patient, being considered at high risk of SCAD recurrence, received a subcutaneous implantable cardioverter-defibrillator (S-ICD). Acute management of cardiac arrest related to SCAD deserves specific considerations. Our case series illustrates the importance of prompt resuscitation manoeuvres and early defibrillation. We propose a flow chart of management of cardiac arrest in patient with suspect of SCAD. Evaluating risk of SCAD recurrence and sudden cardiac death T...
Aims To evaluate whether gender differences in terms of up to 4-year outcome still persist within... more Aims To evaluate whether gender differences in terms of up to 4-year outcome still persist within patients with acute myocardial infarction (AMI) who uniformly underwent coronary revascularization, we performed a gender comparison in a large contemporary multicentre percutaneous intervention (PCI) registry.
The aim of this study was to evaluate clinical characteristics, procedural details, and outcomes ... more The aim of this study was to evaluate clinical characteristics, procedural details, and outcomes of patients undergoing elective multivessel percutaneous coronary intervention (MV-PCI) in Europe. A total of 7113 patients with stable coronary artery disease and at least two major epicardial vessels with C70% stenosis were included in this analysis of the contemporary Euro Heart Survey PCI registry. Patients undergoing MV-PCI (n = 3376, 47.5%) were compared with those with single-vessel PCI (SV-PCI) (n = 3737, 52.5%). Patients with MV-PCI were more likely to have congestive heart failure, whereas those with SV-PCI more often suffered from noncardiac comorbidities. Hospital mortality (0.1% vs 0.3%) and the incidence of nonfatal postprocedural myocardial infarction (1.0% vs 0.7%) were low in patients with MV-PCI and SV-PCI. In the multivariate analysis, no significant difference in the incidence of hospital death (odds ratio (OR) 0.44, 95% confidence interval (CI) 0.15-1.27) could be observed between the two groups. However, the risk for postprocedural myocardial infarction (OR 1.57, 95% CI 0.93-2.67) tended to be higher among patients undergoing MV-PCI. Independent determinants for performing MV-PCI were age, comorbidities, and coronary anatomy. In Europe almost half of all patients with multivessel disease were treated with MV-PCI. Hospital complications were low, but a trend toward a higher rate of postprocedural myocardial infarctions was seen in patients with MV-PCI.
Clinical cardiology and cardiovascular interventions, Oct 19, 2022
Background: Spontaneous coronary dissection (SCAD) and non-traditional risk factors (NT-RF) have ... more Background: Spontaneous coronary dissection (SCAD) and non-traditional risk factors (NT-RF) have assumed increasing interest. Aim: To assess NT-RF in the Parma SCAD registry population. Methods: 62 patients with SCAD, enrolled between January 2013 through November 2021, were divided in two groups: NT-RF (n=51) and T-RF (n = 11). Clinical, echocardiographic and angiographic features were compared between the two study populations; finally, the occurrence of major adverse cardiovascular events was assessed at follow-up. Results: At least one NT-RF among sex related, sex prevalent and gender specific risk factors was present in 82% of patients, while TRF for atherosclerotic disease were less common with hypertension being the most prevalent (40.3%) and diabetes the most seldom (3.2%). Patients with NT-RF were significantly younger (p=0.027) and mostly female compared to those without NT-RF (p=0.004). Type 2 (second Yip/Saw classification) dissection was the prevailing phenotype (54.8%) with a higher prevalence in the NT-RF group (63%, p=0.035). Major Adverse Cardiovascular Events (MACEs) occurred in 17.7% in all patients at a median follow-up of 23 months. When comparing the incidence of cardiovascular events in the 2 study groups, we did not find any significant differences (p=0.4) between groups. Conclusion: SCAD occurs more often in younger women without the traditional RF. Risk estimation does not include these factors and tailored prediction models are lacking. Clinicians and researchers should establish targeted interventions for primary prevention, early diagnosis and secondary prevention in younger women.
The Journal of Clinical Endocrinology & Metabolism
Context Coronary collateral (CC) vessel development appears to be protective with regard to adver... more Context Coronary collateral (CC) vessel development appears to be protective with regard to adverse cardiovascular events and survival in patients with coronary chronic total occlusion (CTO). The influence of type 2 diabetes mellitus (T2DM) on CC growth has been controversial. In particular, the role of diabetic microvascular complications (DMC) in determining coronary collateralization has not been elucidated. Objective To investigate whether patients with DMC presented differences in CC vessel presence and grading as compared with patients without DMC. Methods We conducted a single-center observational study, including consecutive T2DM patients, without previous cardiovascular history, undergoing a clinically indicated coronary angiography for chronic coronary syndrome (CCS) and angiographic evidence of at least one CTO. Patients were subdivided into 2 study groups according to the presence/absence of at least one DMC (neuropathy, nephropathy, or retinopathy). The presence and gra...
Despite evidence-based therapies, patients presenting with atherosclerosis involving more than on... more Despite evidence-based therapies, patients presenting with atherosclerosis involving more than one vascular bed, such as those with peripheral artery disease (PAD) and concomitant coronary artery disease (CAD), constitute a particular vulnerable group characterized by enhanced residual long-term risk for major adverse cardiac events (MACE), as well as major adverse limb events (MALE). The latter are progressively emerging as a hard outcome to be targeted, being correlated with increased mortality. Antithrombotic therapy is the mainstay of secondary prevention in both patients with PAD or CAD however, the optimal intensity of such therapy is still topic of debate, particularly in the post-acute and long-term setting. Recent well powered randomized clinical trials (RCTs) have provided data in favor of a more intense antithrombotic therapy, such as prolonged dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor or a therapy with aspirin combined with an anticoagulant drug...
Background Transcatheter patent foramen ovale (PFO) closure is an effective therapy in patients w... more Background Transcatheter patent foramen ovale (PFO) closure is an effective therapy in patients with cryptogenic stroke (CS) or transient ischemic attack (TIA) and evidence of PFO. However, the incidence of recurrent cerebral ischemia is not negligible and underlying pathogenic mechanisms remain largely unknown. We sought to evaluate the magnitude of the problem and to assess predictors of recurrent stroke/TIA after transcatheter PFO closure. Methods We enrolled non-randomized consecutive patients who underwent PFO closure for secondary prevention of neurological ischemic events at the University Hospital of Parma between 2004 and 2021. Clinical, echocardiographic and procedure-related features were collected for each patient. The incidence of recurrent ischemic neurological events was assessed at follow-up. Results We enrolled a total of 154 patients. The primary indication for PFO closure was previous stroke (85 [55.2%] subjects) and a third of patients (51 [33.1%]) suffered from ...
The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional ri... more The etiology of spontaneous coronary dissection (SCAD) is not well defined and Non traditional risk factors (NT-RF) have assumed increasing interest, but few data are available. NT-RF include three categories: Sex-related (SR-NT-FR), Sex-predominant (SP-NT-RF) and Gender-related (GR-NT-RF). (Table 1) Aim of the Study: The objective of our analysis was to evaluate the incidence of NT-RF in Parma SCAD registry population. Material and methods: We reviewed 62 patients with SCAD enrolled between January 2013 through November 2021 Results: Traditional risk factors were less common: hypertension was the most prevalent (39 pts, 62.9%). When considering NT-RF, 51 patients (82%) had at least one of all, with at least one SR-RF (66%) or GR-RF (64,5%). Patients with NT-RF were younger at time of SCAD (mean age 53 vs 66; p ¼ 0.027) and they were predominantly females (48 vs 7 pts, p ¼ 0.004) (Table 2). No differences were found among NT-RF SCAD and nNT-RF SCAD patients by fibromuscular dysplasia, peripheral arterial disease and chronic kidney disease. Patients with SCAD more often presented with non ST-segment elevation myocardial infarction (43 pts, 72.6%) vs ST-segment elevation (17 pts, 27.4%). No differences in clinical presentation and angiographic characteristics were found among NT-RF and nNT-RF patients group. MACE occurred in 17.7% of patients of the overall study population, at a median follow-up of 23 (interquartile range: 11;57) months. When comparing the incidence of cardiovascular events in the 2 study groups there was a trend toward a higher prevalence of MACE in NT-RF group without statistical significance (NT-RF SCAD 19.6%-nNT-RF SCAD 9.1%; p ¼ 0.4). (Table 3) Conclusion: SCAD is an emerging cause of myocardial infarction in young and middleaged women without the traditional cardiovascular risk profile. Although overall survival seems good, SCAD is a potentially malignant disease which can present with ventricular arrhythmias and sudden cardiac death. Risk estimation is difficult in women, due to the scarce validity of prediction models, therefore a great effort must be made by the clinical community for the widespread diffusion and use of models incorporating NT-RF. Acknowledgement of peculiar features of this disease could help clinicians and researchers to establish targeted interventions for cardiovascular primary prevention, early diagnosis and secondary prevention in women, including rehabilitation and stress management programmes.
Transcatheter left atrial appendage occlusion (LAAO) has emerged as a reliable tool to prevent th... more Transcatheter left atrial appendage occlusion (LAAO) has emerged as a reliable tool to prevent thromboembolic events, in particular ischemic stroke, in patients with atrial fibrillation (AF) in the absence of mitral stenosis/valve prosthesis and contraindication to oral anticoagulation (OAC). Antiplatelet therapy (APT) is required after device implantation to prevent device–related thrombus (DRT). Previous studies provided conflicting results on the optimal APT regimen after LAAO. Thus, herein we aimed at assessing the comparative effectiveness and safety of distinct APT regimens. We conducted a real–world single–center observational study including consecutive AF patients that underwent LAAO at the University Hospital of Parma between October 2010 and June 2021. Clinical follow–up included all successfully implanted patients. Primary endpoint was net efficacy outcome, a composite of any ischemic or hemorrhagic event. Secondary endpoints were ischemic (any of the following: ischemic...
ImportanceThere is growing awareness of sex-related differences in cardiovascular risk profiles, ... more ImportanceThere is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure.MethodsA nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1–22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).ResultsST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a ...
BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is f... more BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
Oral anticoagulation (OAC) is the cornerstone therapy for stroke prevention in patients with atri... more Oral anticoagulation (OAC) is the cornerstone therapy for stroke prevention in patients with atrial fibrillation (AF). However, a not negligible proportion of AF patients experiences major bleeding events or is affected by concomitant disorders that represent a contraindication for OAC. Left atrial appendage occlusion (LAAO) has emerged as an effective strategy to minimize the risk of thromboembolism in AF patients (without moderate/severe mitral stenosis or mechanical prosthetic heart valves) that are poor candidates for OAC. After the procedure variable regimens of antithrombotic therapy are prescribed, in order to provide protection and prevent device-related thrombus (DRT). The optimal post-procedural antithrombotic strategy remains to be assessed. Therefore, we aim to evaluate the safety and efficacy of LAAO procedure and the relationship between antiplatelet therapy and outcomes at long-term follow-up. We conducted a retrospective observational study including consecutive AF p...
Data regarding long-term prognosis of MINOCA are very limited and conflicting. The Italian Geneti... more Data regarding long-term prognosis of MINOCA are very limited and conflicting. The Italian Genetic Study on early-onset MI enrolled 2000 patients who had a first MI before they were 45. The median follow-up was 19.9 years, the equivalent of 39 535 person-years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalization for coronary revascularization. MINOCA was experienced by 317 patients (15.9%). The risk of MACE was not significantly different between MINOCA patients and those with obstructive coronary artery disease (MICAD, 27.8% vs. 37.5%; adj. HR: 0.79, 95% CI: 0.57–1.09; P = 0.15, Figure 1). There was no between-group difference in the rate of non-fatal MI (17.3% vs. 25.4%; adj. HR: 0.76, 95% CI: 0.52–1.13; P = 0.18), non-fatal ischaemic stroke (9.5% vs. 3.7%; adj. HR: 1.79, 95% CI: 0.87–3.70; P = 0.12), or all-cause mortality (14.1% vs. 20.7%; adj. HR: 0.73, 95% CI: 0.43–1.25; P = 0.26)...
Aims Sex-differences have been demonstrated in the acute phase of COVID-19 infection; females (f)... more Aims Sex-differences have been demonstrated in the acute phase of COVID-19 infection; females (f) were found to be less prone to develop a severe disease than males (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome. Methods and results The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection from a sex-perspective. For this purpose, we enrolled 223 patients (89 F and 134 M) who experienced a SARS-CoV-2 infection. In the acute phase of the illness, females reported more frequently than males: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhoea, and myalgia without significant differences in breathlessness, cough, and sleep disturbance. After a mean follow-up time of 5 months after the acute phase, females were significantly more likely than males to report weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, wo...
Single coronary artery (SCA) is a rare coronary anomaly that occurs with an incidence of 0.024%. ... more Single coronary artery (SCA) is a rare coronary anomaly that occurs with an incidence of 0.024%. We report the case of an 83-year-old woman with a Lipton’s type 3 SCA, which is the rarest anomaly within this group, occurring only in the 0.004% of general population. The clinical presentation of this patient was chest pain at rest with multifocal transient ST segment elevation as a marker of multifocal ischemia secondary to severe three vessels coronary artery disease (CAD). This patient was proposed for coronary artery bypass grafting (CABG) with an excellent mid-term outcome. (www.actabiomedica.it)
Introduction Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represen... more Introduction Cardiac arrest secondary to a spontaneous coronary artery dissection (SCAD) represents a challenging scenario. It deserves specific considerations due to the dramatic presentation and the need for secondary sudden cardiac death prevention. Methods We collected clinical data of four women admitted during the last two years in the Coronary Care Unit of Parma University Hospital, whose presentation of SCAD were cardiac arrest due to ventricular fibrillation. Results Three patients survived the acute phases. One patient, being considered at high risk of SCAD recurrence, received a subcutaneous implantable cardioverter-defibrillator (S-ICD). Acute management of cardiac arrest related to SCAD deserves specific considerations. Our case series illustrates the importance of prompt resuscitation manoeuvres and early defibrillation. We propose a flow chart of management of cardiac arrest in patient with suspect of SCAD. Evaluating risk of SCAD recurrence and sudden cardiac death T...
Aims To evaluate whether gender differences in terms of up to 4-year outcome still persist within... more Aims To evaluate whether gender differences in terms of up to 4-year outcome still persist within patients with acute myocardial infarction (AMI) who uniformly underwent coronary revascularization, we performed a gender comparison in a large contemporary multicentre percutaneous intervention (PCI) registry.
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Papers by emilia solinas