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1.
J Clin Med ; 11(17)2022 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-36079018

RESUMO

Background: Treatment delays are the most easily audited index of quality of care in the setting of ST-segment elevation myocardial infarction; among the components of ischemia time, system delay has been demonstrated to be a predictor of outcomes, and in a mountainous region it relies mostly upon helicopter rescue service. Aim: The aim of the study is to analyze the impact of the activation of helicopter rescue service for the nighttime for urgent transportation of patients on the time to revascularization and on the outcomes of STEMI patients. Methods: Data were prospectively collected in a database and retrospectively split into two different cohorts, based on the presentation date in the 18 months before, or after, the first day of implementation of the new organizational model. The patients were also split into two groups based on the place of STEMI diagnosis, either the chief town territory or the rest of the region, and retrospectively evaluated for vital status at 30 days and 2 years after index event. Results: The number of patients included was 751. For patients coming from outside Trento, an improvement in ST-segment resolution was shown (ST-segment elevation reduction >50% in 54.0% of the patients vs. 36.4%, p < 0.01). Moreover, a reduction in diagnosis-to-reperfusion median time has been demonstrated (from 105 to 97 min, p < 0.01), mainly driven by a reduction during the night shift (from 119 to 100 min, p = 0.02). With regard to 30-day and 2-year mortality, no statistically significant differences were achieved. Discussion: The organizational effort has translated into a significant reduction in the treatment delay for patients coming from outside the chief town. However, although a longer diagnosis to reperfusion time has been related to a higher mortality, a significant reduction in mortality was not demonstrated in our study. However, an improvement in ST-segment elevation resolution was shown for patients coming from outside the city of Trento, a result that could have other potential clinical benefits. Conclusions: Implementation of night flight proved to be effective in reducing the time between the diagnosis and the treatment of patients in the setting of STEMI, improving ST-segment elevation resolution, although no impact was shown on short- and long-term mortality.

2.
Minerva Cardiol Angiol ; 70(4): 468-475, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33703854

RESUMO

BACKGROUND: Northern Italy has been one of the most affected area in the world by the novel severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The healthcare system has been overwhelmed by the huge number of patients in need of mechanical ventilation or intensive care, resulting in a delay of treatment of patients with acute coronary syndrome (ACS), due to a crash in STEMI networks and closure of a certain number of hub centers, and to a delay in patients' seeking for medical evaluation for chest pain or angina-equivalent symptoms. METHODS: In the Trentino region, a mountainous area with about 500,000 inhabitants, very close to Lombardy that was the epicenter of the pandemic in Italy, to avoid these dramatic consequences, we developed a new protocol tailored to our specificity to keep our institution, and above all the cath-lab, clean from the SARS-CoV-2 infection, to ensure full operativity for cardiologic emergencies. RESULTS: Applying this protocol during the two months of the peak of the infection in Italy no one of the staff members of the cath-lab, the ICCU or the cardiology ward tested positive to nasal swab for SARS-CoV-2 and the same result was obtained for all the patients admitted to our units. CONCLUSIONS: Our real-world experience shows that during the COVID-19 pandemic, quick activation of an appropriate protocol defining specific pathways for patients with a medical urgency is effective in minimizing healthcare personnel exposure and to preserve full operativity of the hub centers. This issue will be of a crucial importance, now that we are facing the second wave of the pandemic.


Assuntos
COVID-19 , Cardiologia , Infarto do Miocárdio com Supradesnível do Segmento ST , COVID-19/epidemiologia , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
3.
G Ital Cardiol (Rome) ; 22(1): 62-67, 2021 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-33470244

RESUMO

BACKGROUND: In patients with an indication for oral anticoagulation (OAC) with warfarin, the management of OAC peri-procedure of percutaneous coronary intervention (PCI) is still not fully defined. To investigate clinical practice and outcomes associated with continuation vs interruption of OAC, with or without bridging with low-molecular-weight heparin (LMWH), we examined the database of the observational, prospective, multicenter Italian WAR-STENT registry. METHODS: The WAR-STENT registry was conducted in 2008-2010 in 37 Italian centers and included 411 consecutive patients in 157 of whom the peri-procedural international normalized ratio (INR) value was available. In relation to the continuation vs interruption of OAC, patients were divided into group 1 (n = 106) and group 2 (n = 51) respectively, and compared. RESULTS: The basal characteristics of the two groups were similar. The most frequent indication for OAC was atrial fibrillation and for PCI acute coronary syndromes, respectively. The pre-procedural mean value of INR was significantly different in group 1 vs group 2 (2.3 ± 0.4 vs 1.5 ± 0.2; p <0.001), while the use of antithrombotic drugs did not differ, except for LMWH which, albeit limited to only 14% of cases, was used significantly more frequently in group 2 (14% vs 2%; p=0.006). The radial approach was used significantly more often in group 1 vs group 2 (72% vs 45%; p=0.002). The in-hospital incidence of major bleeding complications was similar in groups 1 and 2 (4% vs 8%; p=0.27), as well as the occurrence of major adverse cardio-cerebrovascular events, including cardiovascular death, non-fatal myocardial infarction, re-revascularization of the treated vessel, stent thrombosis, stroke and venous thromboembolism (6% vs 6%; p=0.95). There was a tendency towards a higher incidence of minor access-site bleeding complications in group 1 patients treated by the femoral route. CONCLUSIONS: In unselected patients with an indication for OAC with warfarin and undergoing PCI, the continuation vs interruption of OAC (essentially without LMWH bridging) strategies appears similar in terms of efficacy and safety. In consideration of the superior convenience, peri-procedural continuation of OAC should therefore generally be preferred, with the possible exception of patients in whom the femoral approach is required for the procedure.


Assuntos
Fibrilação Atrial , Intervenção Coronária Percutânea , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Heparina de Baixo Peso Molecular , Hospitais , Humanos , Estudos Prospectivos , Sistema de Registros , Stents , Resultado do Tratamento , Varfarina
4.
Future Cardiol ; 17(4): 669-675, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33078958

RESUMO

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, mostly in women; however, differences between the sexes should be investigated. Materials & methods: Hundred consecutive patients affected by SCAD were identified; coronary lesions were classified according to the most recent classification and clinical and angiographic data of men and women were compared. Results: Men were significantly younger than women, with more cardiovascular risk factors. Lesions were prevalently classified as type 2A, type 2B or type 1; an angiographic pattern compatible with the presence of an intimal tear (types 1 and 1/2) was more represented in males. Conclusion: Sex-related differences in clinical and angiographic characteristics could help in shedding light on mechanisms that contribute to SCAD.


Assuntos
Anomalias dos Vasos Coronários , Caracteres Sexuais , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/epidemiologia , Dissecação , Feminino , Humanos , Masculino
5.
G Ital Cardiol (Rome) ; 21(8): 647-653, 2020 Aug.
Artigo em Italiano | MEDLINE | ID: mdl-32686792

RESUMO

BACKGROUND: Early prognostication of patients experiencing out-of-hospital cardiac arrest (OHCA) remains difficult, with no recommended risk assessment tool. The aim of this study was to determine and assess the association between available variables with survival at discharge of patients with OHCA in our regional reality. METHODS: We conducted a retrospective observational study in a single-center cohort of 236 consecutive patients with OHCA and return of spontaneous circulation admitted to the S. Chiara Hospital (Trento, Italy) from 2012 to 2015. We applied a backward stepwise multivariable logistic regression performed on 26 variables significantly related to outcome to identify predictors. The final model was evaluated for discrimination with area under the curve (AUC) of a receiver operating characteristic curve and for calibration with Hosmer-Lemeshow test and with calibration belt. RESULTS: We identified four independent factors predictive of outcome: age, arterial blood pH, coronary angiography execution and intervention of helicopter. The final model presented good discrimination with an average AUC of 0.78 (95% confidence interval 0.72-0.84) and was well calibrated, as confirmed by the Hosmer-Lemeshow test (p=0.45) and the calibration belt plot (p=0.597). CONCLUSIONS: Age, arterial blood pH, coronary angiography execution and intervention of helicopter were variables predictive of outcome. Identified predictors are in agreement with the literature and relate to local reality. Accurate prognostic assessment would facilitate an earlier identification of patients who may benefit from intensive advanced post-resuscitation care.


Assuntos
Resgate Aéreo , Reanimação Cardiopulmonar/métodos , Angiografia Coronária , Parada Cardíaca Extra-Hospitalar/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hospitalização , Humanos , Concentração de Íons de Hidrogênio , Itália , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Sobrevida
6.
Phys Med Biol ; 64(8): 085014, 2019 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-30884468

RESUMO

The success of transcatheter aortic valve implantation (TAVI) is highly dependent on the prediction of the interaction between the prosthesis and the aortic root anatomy. The simulation of the surgical procedure may be useful to guide artificial valve selection and delivery, nevertheless the introduction of simulation models into the clinical workflow is often hindered by model complexity and computational burden. To address this point, we introduced a patient-specific mass-spring model (MSM) with viscous damping, as a good trade-off between simulation accuracy and time-efficiency. The anatomical model consisted of a hexahedral mesh, segmented from pre-procedural patient-specific cardiac computer tomographic (CT) images of the aortic root, including valve leaflets and attached calcifications. Nodal forces were represented by linear-elastic springs acting on edges and angles. A fast integration approach based on the modulation of nodal masses was also tested. The model was validated on seven patients, comparing simulation results with post-procedural CT images with respect to calcification and aortic wall position. The validation showed that the MSM was able to predict calcification displacement with an average accuracy of 1.72 mm and 1.54 mm for the normal and fast integration approaches, respectively. Wall displacement root mean squared error after valve expansion was about 1 mm for both approaches, showing an improved matching with respect to the pre-procedural configuration. In terms of computational burden, the fast integration approach allowed a consistent reduction of the computational times, which decreased from 36 h to 21.8 min per 100 K hexahedra. Our findings suggest that the proposed linear-elastic MSM model may provide good accuracy and reduced computational times for TAVI simulations, fostering its inclusion in clinical routines.


Assuntos
Modelagem Computacional Específica para o Paciente , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Aorta/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Modelos Anatômicos
7.
Cardiovasc Revasc Med ; 18(6): 425-430, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28363682

RESUMO

PURPOSE: To evaluate the outcome of patients with an established indication for oral anticoagulation (OAC) undergoing coronary stent implantation (PCI-S) and stratified by the baseline risk of bleeding. MATERIAL AND METHODS: The database of the prospective, multicentre, observational WAR-STENT registry (ClinicalTrials.gov identifier NCT00722319) was analyzed and patients with atrial fibrillation and CHA2DS2-VASc score ≥2, mechanical heart valve, prior cardiac embolism, intra-cardiac thrombus and recent venous thromboembolism who were treated with either triple (warfarin, aspirin and clopidogrel) or dual (warfarin and clopidogrel) or dual antiplatelet (aspirin and clopidogrel) therapy, identified. Patients were then sorted into two groups at non-low and low risk of bleeding, as defined by an ATRIA score >3 and ≤3 respectively, and compared regarding major adverse cardiac and vascular events (MACVE) and bleeding. RESULTS: At 12-month follow up, MACVE were comparable in the two groups, whereas total, major and minor bleeding, as well as combined MACVE and total bleeding, were significantly more frequent in the non-low bleeding risk group. Upon Cox univariate and multivariable analysis, non-low bleeding risk category confirmed as an independent predictor of major bleeding. The choice of antithrombotic therapy however, appeared not to be influenced by the bleeding risk category at baseline. CONCLUSIONS: In patients with an established indication for OAC undergoing PCI-S, non-low bleeding risk category is the most potent independent predictor of major bleeding. Stratification of the bleeding risk at baseline should therefore be regarded as an indispensable process to be carried out before selection of the antithrombotic therapy.


Assuntos
Anticoagulantes/uso terapêutico , Doença da Artéria Coronariana/cirurgia , Hemorragia/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêutico , Stents , Ticlopidina/análogos & derivados , Varfarina/uso terapêutico , Administração Oral , Adulto , Idoso , Anticoagulantes/administração & dosagem , Clopidogrel , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Stents/efeitos adversos , Terapia Trombolítica , Ticlopidina/administração & dosagem , Ticlopidina/uso terapêutico , Resultado do Tratamento , Varfarina/administração & dosagem , Adulto Jovem
8.
Int J Cardiol ; 233: 52-60, 2017 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-28188002

RESUMO

OBJECTIVE: The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes. METHODS AND RESULTS: We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate-severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9-2.05, p=0.012 for mild PVL, HR 1.36, CI 95% 0.9-2.05, p<0.001 for PVL≥moderate and OR 1.04, p=0.97 respectively). Patients with moderate-severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi>75ml/m2) showed better survival than those without dilatation (HR 8.63, p=0.001). CONCLUSIONS: In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.


Assuntos
Insuficiência da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Sistema de Registros , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida/tendências
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