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Article ; Online: Successful manual thrombus aspiration in anterior ST-segment elevation myocardial infarction due to cardioembolic obstruction of the left main coronary artery.

Della Riva, Diego / Bruno, Matteo / Taglieri, Nevio

Journal of cardiology cases

2019 Volume 21, Issue 2, Page(s) 46–49

Abstract: Large clinical trials and meta-analyses have shown that thrombus aspiration (TA) in the setting of ST-T segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) does not improve clinical outcome, whilst ...

Abstract	Large clinical trials and meta-analyses have shown that thrombus aspiration (TA) in the setting of ST-T segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) does not improve clinical outcome, whilst it may be associated with an increased risk of stroke. Accordingly, in the most recent European Society of Cardiology guidelines the role of routine TA during PPCI has been downgraded to a class III recommendation with level A of evidence. On the other hand, it has been suggested that in case of high thrombus burden a selective use of TA may still play a role. STEMI due to cardioembolism (CE) definitely represents one of these situations. In the present case of an 81-year-old woman presenting with STEMI due to a cardioembolic obstruction of left main coronary artery, we show that TA succeeded, whereas classical angioplasty failed, in promoting a prompt coronary flow restoration in a life-threatening condition. Further, it allowed us not to upgrade the procedure with stent implantation that would have required a triple antithrombotic therapy, significantly increasing the bleeding risk. Visual examination of thrombi retrieved suggested the diagnosis of CE. Finally, we clearly show which is the mechanism linking TA with the risk of stroke. <
Language	English
Publishing date	2019-12-05
Publishing country	Japan
Document type	Case Reports
ISSN	1878-5409
ISSN (online)	1878-5409
DOI	10.1016/j.jccase.2019.06.008
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Article: Healthcare needs in elderly patients with chronic heart failure in view of a personalized blended collaborative care intervention: a cross sectional study.

Gostoli, Sara / Bernardini, Francesco / Subach, Regina / Engelmann, Petra / Jaarsma, Tiny / Andréasson, Frida / Rasmussen, Sanne / Thilsing, Trine / Eilerskov, Natasja / Bordoni, Barbara / Della Riva, Diego / Urbinati, Stefano / Kohlmann, Sebastian / Rafanelli, Chiara

Frontiers in cardiovascular medicine

2024 Volume 11, Page(s) 1332356

Abstract: Introduction: Few studies explored healthcare needs of elderly heart failure (HF) patients with comorbidities in view of a personalized intervention conducted by Care Managers (CM) in the framework of Blended Collaborative Care (BCC). The aims of the ... ...

Abstract	Introduction: Few studies explored healthcare needs of elderly heart failure (HF) patients with comorbidities in view of a personalized intervention conducted by Care Managers (CM) in the framework of Blended Collaborative Care (BCC). The aims of the present study were to: (1) identify perceived healthcare needs/preferences in elderly patients with HF prior to a CM intervention; (2) investigate possible associations between healthcare needs/preferences, sociodemographic variables (age; sex) and number of comorbidities. Method: Patients aged 65 years or more affected by HF with at least 2 medical comorbidities were enrolled in the study. They were assessed by structured interviewing with colored cue cards that represented six main topics including education, individual tailoring of treatment, monitoring, support, coordination, and communication, related to healthcare needs and preferences. Results: Thirty-three patients (Italy = 21, Denmark = 7, Germany = 5; mean age = 75.2 ± 7.7 years; males 63.6%) were enrolled from June 2021 to February 2022. Major identified needs included: HF information (education), patients' involvement in treatment-related management (individual tailoring of treatment), regular checks of HF symptoms (monitoring), general practitioner update by a CM about progression of symptoms and health behaviors (coordination), and telephone contacts with the CM (communication). Regarding communication modalities with a CM, males preferred phone calls ( Discussion: The findings highlight specific healthcare needs and preferences in older HF multimorbid patients, allowing a more personalized intervention delivered by CM in the framework of BCC.
Language	English
Publishing date	2024-03-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2024.1332356
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Article ; Online: Reply: Meta-Analyses on DAPT Length: Chasing the Calm After the (Perfect) Storm.

Palmerini, Tullio / Della Riva, Diego / Stone, Gregg W

Journal of the American College of Cardiology

2017 Volume 70, Issue 10, Page(s) 1305–1306

MeSH term(s)	Drug-Eluting Stents ; Hemorrhage ; Humans ; Platelet Aggregation Inhibitors
Chemical Substances	Platelet Aggregation Inhibitors
Language	English
Publishing date	2017-08-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2017.06.063
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Article ; Online: Response to letter by Messeri et al.

Palmerini, Tullio / Biondi-Zoccai, Giuseppe / Della Riva, Diego / Mariani, Andrea / Stone, Gregg W

American heart journal

2013 Volume 166, Issue 3, Page(s) e19

MeSH term(s)	Coronary Artery Bypass, Off-Pump ; Humans ; Percutaneous Coronary Intervention ; Risk Assessment ; Stroke/epidemiology ; Stroke/etiology
Language	English
Publishing date	2013-09
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2013.06.017
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Article ; Online: Efficacy and safety of thrombus aspiration in ST-segment elevation myocardial infarction: an updated systematic review and meta-analysis of randomised clinical trials.

Taglieri, Nevio / Bacchi Reggiani, Maria Letizia / Ghetti, Gabriele / Saia, Francesco / Compagnone, Miriam / Lanati, Gianluca / Di Dio, Maria Teresa / Bruno, Antonio / Bruno, Matteo / Della Riva, Diego / Corsini, Anna / Narducci, Riccardo / Rapezzi, Claudio

European heart journal. Acute cardiovascular care

2018 Volume 8, Issue 1, Page(s) 24–38

Abstract: Background:: The role of thrombus aspiration plus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction remains controversial.: Methods:: We performed a meta-analysis of 25 randomised controlled trials in which 21, ... ...

Abstract	Background:: The role of thrombus aspiration plus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction remains controversial. Methods:: We performed a meta-analysis of 25 randomised controlled trials in which 21,740 ST-segment elevation myocardial infarction patients were randomly assigned to thrombus aspiration plus primary percutaneous coronary intervention or primary percutaneous coronary intervention. Study endpoints were: death, myocardial infarction, stent thrombosis and stroke. Results:: On pooled analysis, the risk of death (4.3% vs. 4.8%, odds ratio (OR) 0.90, 95% confidence interval (CI) 0.79-1.03; P=0.123), myocardial infarction (2.4% vs. 2.5%, OR 0.95, 95% CI 0.80-1.13; P=0.57) and stent thrombosis (1.3% vs. 1.6%, OR 0.80, 95% CI 0.63-1.01; P=0.066) was similar between thrombus aspiration plus primary percutaneous coronary intervention and primary percutaneous coronary intervention. The risk of stroke was higher in the thrombus aspiration plus primary percutaneous coronary intervention than the primary percutaneous coronary intervention group (0.84% vs. 0.59%, OR 1.401, 95% CI 1.004-1.954; P=0.047). However, on sensitivity analysis after removing the TOTAL trial, thrombus aspiration plus primary percutaneous coronary intervention was not associated with an increased risk of stroke (OR 1.01, 95% CI 0.58-1.78). The weak association between thrombus aspiration and stroke was also confirmed by the fact that the lower bound of the 95% CI was slightly below unity after removing either the study by Kaltoft or the ITTI trial. There was no interaction between the main study results and follow-up, evidence of coronary thrombus, or study sample size. Conclusions:: In patients with ST-segment elevation myocardial infarction, thrombus aspiration plus primary percutaneous coronary intervention does not reduce the risk of death, myocardial infarction or stent thrombosis. Thrombus aspiration plus primary percutaneous coronary intervention is associated with an increased risk of stroke; however, this latter finding appears weak.
MeSH term(s)	Coronary Angiography ; Coronary Thrombosis/complications ; Coronary Thrombosis/diagnosis ; Coronary Thrombosis/surgery ; Electrocardiography ; Humans ; Percutaneous Coronary Intervention ; Randomized Controlled Trials as Topic ; ST Elevation Myocardial Infarction/diagnosis ; ST Elevation Myocardial Infarction/etiology ; ST Elevation Myocardial Infarction/surgery ; Thrombectomy/methods
Language	English
Publishing date	2018-08-30
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2663340-1
ISSN	2048-8734 ; 2048-8726
ISSN (online)	2048-8734
ISSN	2048-8726
DOI	10.1177/2048872618795512
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Article ; Online: Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention: An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients.

Palmerini, Tullio / Della Riva, Diego / Biondi-Zoccai, Giuseppe / Leon, Martin B / Serruys, Patrick W / Smits, Pieter C / von Birgelen, Clemens / Ben-Yehuda, Ori / Généreux, Philippe / Bruno, Antonio G / Jenkins, Paul / Stone, Gregg W

JACC. Cardiovascular interventions

2018 Volume 11, Issue 9, Page(s) 892–902

Abstract: Objectives: This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI).: Background: Restenosis requiring TLR after ...

Abstract	Objectives: This study sought to investigate the impact of nonemergent, uncomplicated target lesion revascularization (TLR) on the risk of long-term mortality after percutaneous coronary intervention (PCI). Background: Restenosis requiring TLR after PCI is generally considered a benign event. Methods: The study pooled patient-level data from 21 randomized trials. Subjects dying the same day as or the day after the TLR procedure as well as those with myocardial infarction (MI) the day before, the same day as or the day after TLR were excluded. The primary endpoint of the study was all-cause mortality. Results: The dataset included 32,524 patients who were stratified according to whether repeat TLR was performed during follow-up. During a median follow-up of 37 months, 2,330 (7.2%) patients underwent a nonemergent, uncomplicated TLR procedure. After adjusting for potential confounders, TLR was an independent predictor of mortality (hazard ratio: 1.23, 95% confidence interval: 1.04 to 1.45; p = 0.02). Patients undergoing nonemergent, uncomplicated TLR had significantly higher rates of non-procedure-related MI compared with those without TVR. Among patients undergoing elective TLR, MI occurring after TLR was an independent predictor of mortality (hazard ratio: 3.82; 95% confidence interval: 2.44 to 5.99; p < 0.0001). Conclusions: Nonemergent, uncomplicated TLR after PCI is an independent predictor of long-term mortality, an association in part explained by higher rates of MI occurring after TLR. Efforts aimed at reducing TLR risk may translate into prognostic benefits including reduced rates of MI and survival.
MeSH term(s)	Aged ; Cause of Death ; Coronary Artery Bypass/adverse effects ; Coronary Artery Bypass/mortality ; Coronary Artery Disease/mortality ; Coronary Artery Disease/therapy ; Coronary Restenosis/etiology ; Coronary Restenosis/mortality ; Coronary Restenosis/therapy ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Infarction/mortality ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/instrumentation ; Percutaneous Coronary Intervention/mortality ; Randomized Controlled Trials as Topic ; Retreatment/mortality ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2018-04-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2018.01.277
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Article ; Online: Risk-Benefit Profile of Longer-Than-1-Year Dual-Antiplatelet Therapy Duration After Drug-Eluting Stent Implantation in Relation to Clinical Presentation.

Palmerini, Tullio / Bruno, Antonio G / Gilard, Martine / Morice, Marie-Claude / Valgimigli, Marco / Montalescot, Gilles / Collet, Jean-Philippe / Della Riva, Diego / Bacchi-Reggiani, Maria Letizia / Steg, Philippe Gabriel / Diallo, Abdourahmane / Vicaut, Eric / Helft, Gerard / Nakamura, Masato / Généreux, Philippe / Vahl, Torsten P / Stone, Gregg W

Circulation. Cardiovascular interventions

2019 Volume 12, Issue 3, Page(s) e007541

Abstract: Background: We sought to determine whether the risks and benefits of prolonging dual-antiplatelet therapy (DAPT) beyond 1 year after drug-eluting stent implantation depend on clinical presentation in a meta-analysis of randomized controlled trials.: ... ...

Abstract	Background: We sought to determine whether the risks and benefits of prolonging dual-antiplatelet therapy (DAPT) beyond 1 year after drug-eluting stent implantation depend on clinical presentation in a meta-analysis of randomized controlled trials. Methods and results: Randomized controlled trials comparing ≤1- versus >1-year DAPT after drug-eluting stent placement were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. The primary efficacy end point was myocardial infarction, whereas the primary safety end point was major bleeding. Net clinical benefit was defined as the composite of myocardial infarction or major bleeding. Outcomes were analyzed according to patient presentation with stable ischemic heart disease versus acute coronary syndromes. The meta-analysis included 6 trials with a total of 21 457 patients, including 14 132 with stable ischemic heart disease and 7325 with acute coronary syndrome. After a median follow-up of 19.5 months, ≤1-year DAPT was associated with higher rates of myocardial infarction compared with >1-year DAPT (hazard ratio [HR], 1.63; 95% CI, 1.37-1.95), with no interaction apparent between treatment effect and clinical presentation. Shorter DAPT was associated with reduced rates of major bleeding compared with longer DAPT (HR, 0.64; 95% CI, 0.42-0.99) with no significant interaction between treatment effect and clinical presentation. However, a net clinical benefit of >1-year DAPT was present in patients with acute coronary syndrome (HR of shorter versus longer DAPT, 1.59; 95% CI, 1.24-2.02) but not in those with stable ischemic heart disease (HR, 1.15; 95% CI, 0.89-1.51; P Conclusions: Compared with ≤1-year DAPT, >1-year DAPT reduces the risk of myocardial infarction but increases the risk of major bleeding and noncardiac mortality. A net clinical benefit of extended DAPT was apparent for patients with acute coronary syndrome but not for those with stable ischemic heart disease.
MeSH term(s)	Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/mortality ; Acute Coronary Syndrome/therapy ; Drug Administration Schedule ; Drug Therapy, Combination ; Drug-Eluting Stents ; Hemorrhage/chemically induced ; Hemorrhage/epidemiology ; Humans ; Myocardial Infarction/epidemiology ; Myocardial Ischemia/diagnosis ; Myocardial Ischemia/mortality ; Myocardial Ischemia/therapy ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/instrumentation ; Percutaneous Coronary Intervention/mortality ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/adverse effects ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Chemical Substances	Platelet Aggregation Inhibitors
Language	English
Publishing date	2019-03-14
Publishing country	United States
Document type	Journal Article ; Meta-Analysis
ZDB-ID	2450797-0
ISSN	1941-7632 ; 1941-7640
ISSN (online)	1941-7632
ISSN	1941-7640
DOI	10.1161/CIRCINTERVENTIONS.118.007541
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Article ; Online: Prodromal angina and risk of 2-year cardiac mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous intervention.

Ghetti, Gabriele / Bacchi Reggiani, Maria Letizia / Rosetti, Claudia / Battistini, Paola / Lanati, Gianluca / Di Dio, Maria Teresa / Corsini, Anna / Bruno, Matteo / Della Riva, Diego / Bruno, Antonio Giulio / Compagnone, Miriam / Narducci, Riccardo / Saia, Francesco / Rapezzi, Claudio / Taglieri, Nevio

Medicine

2018 Volume 97, Issue 37, Page(s) e12332

Abstract: We sought to investigate the prognostic significance of prodromal angina (PA) in unselected patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) and its additive predictive value to ...

Abstract	We sought to investigate the prognostic significance of prodromal angina (PA) in unselected patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) and its additive predictive value to the GRACE score.We prospectively enrolled 3015 consecutive STEMI patients undergoing PPCI. Patients were divided in 2 groups according to the presence or absence of PA. Multivariable Cox regression was used to establish the relation to 2-year cardiac mortality of PA.The mean age of the study population was 68 (±14) years; 2178 patients (72%) were male. During follow-up, 395 (13%) patients died with 278 of these (9.2%) suffering from cardiac mortality. Kaplan-Meier estimates showed a survival rate of 95% and 87% for patients with PA and no PA, respectively (log rank test < 0.001). After multivariable analysis, patients with PA had still a lower risk of 2 years' cardiac mortality compared with patients without PA (adjusted hazard ratio = 0.50; 95% confidence interval [CI] 1.06-1.81, P = .001). Evaluation of net reclassification improvement showed that reclassification improved by 0.16% in case patients, whereas classification worsened in control patients by 1.08% leading to a net reclassification improvement of -0.93% (95% CI: -0.98, -0.88).In patients with STEMI undergoing PPCI the presence of PA is independently associated with a lower risk of 2-year cardiac mortality. However, the incorporation of this variable to the GRACE score slightly worsened the classification of risk. Accordingly, it seems unlikely that the evaluation of PA may be useful in clinical practice.
MeSH term(s)	Aged ; Angina Pectoris/etiology ; Angina Pectoris/mortality ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Percutaneous Coronary Intervention/mortality ; Predictive Value of Tests ; Prodromal Symptoms ; Proportional Hazards Models ; Prospective Studies ; Regression Analysis ; Risk Assessment/methods ; Risk Factors ; ST Elevation Myocardial Infarction/complications ; ST Elevation Myocardial Infarction/mortality ; ST Elevation Myocardial Infarction/therapy ; Severity of Illness Index ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2018-09-12
Publishing country	United States
Document type	Evaluation Study ; Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000012332
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Article ; Online: Stent thrombosis with drug-eluting stents: is the paradigm shifting?

Palmerini, Tullio / Biondi-Zoccai, Giuseppe / Della Riva, Diego / Mariani, Andrea / Genereux, Philippe / Branzi, Angelo / Stone, Gregg W

Journal of the American College of Cardiology

2013 Volume 62, Issue 21, Page(s) 1915–1921

Abstract: First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization ... ...

Abstract	First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared with bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first-generation DES early after their adoption in clinical practice, requiring prolonged dual antiplatelet therapy. Pathological studies have shown that first-generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second-generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer-coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES and, unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of DES being safer than BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer-coated CoCr-EES, DES with bioabsorbable polymers, and fully bioresorbable scaffolds are the subject of numerous ongoing large-scale trials.
MeSH term(s)	Coronary Angiography ; Coronary Restenosis/diagnostic imaging ; Coronary Restenosis/etiology ; Drug-Eluting Stents ; Humans ; Percutaneous Coronary Intervention/methods ; Postoperative Complications
Language	English
Publishing date	2013-11-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2013.08.725
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Article ; Online: Effects of statin therapy on platelet reactivity after percutaneous coronary revascularization in patients with acute coronary syndrome.

Toso, Anna / De Servi, Stefano / Leoncini, Mario / Angiolillo, Dominick J / Calabrò, Paolo / Piscione, Federico / Cattaneo, Marco / Maffeo, Diego / Bartorelli, Antonio / Palmieri, Cataldo / De Carlo, Marco / Capodanno, Davide / Genereux, Philippe / Bellandi, Francesco / Barozzi, Chiara / Tomasi, Luciana / Della Riva, Diego / Palmerini, Tullio

Journal of thrombosis and thrombolysis

2017 Volume 44, Issue 3, Page(s) 355–361

Abstract: Statin use is associated with enhanced pharmacodynamic response to clopidogrel in patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI). However, the impact of statin therapy on clopidogrel response profiles in ... ...

Abstract	Statin use is associated with enhanced pharmacodynamic response to clopidogrel in patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI). However, the impact of statin therapy on clopidogrel response profiles in patients with acute coronary syndrome (ACS) undergoing PCI has not been established and represents the objective of this investigation. On-treatment P2Y
MeSH term(s)	Acute Coronary Syndrome/drug therapy ; Acute Coronary Syndrome/surgery ; Acute Coronary Syndrome/therapy ; Aged ; Aged, 80 and over ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Middle Aged ; Percutaneous Coronary Intervention ; Platelet Activation/drug effects ; Ticlopidine/analogs & derivatives ; Ticlopidine/pharmacokinetics
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; clopidogrel (A74586SNO7) ; Ticlopidine (OM90ZUW7M1)
Language	English
Publishing date	2017-10
Publishing country	Netherlands
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	1230645-9
ISSN	1573-742X ; 0929-5305
ISSN (online)	1573-742X
ISSN	0929-5305
DOI	10.1007/s11239-017-1541-x
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