Publications by authors named "Alessandra Scoccia"
Fractional Flow Reserve Directed Percutaneous Coronary Intervention Optimization Using High-Definition Intravascular Ultrasound in Non-ST-Segment Elevation Acute Coronary Syndrome Versus Chronic Coronary Syndrome.
Catheter Cardiovasc Interv
December 2024
Background: Intravascular ultrasound (IVUS)-guided optimization of suboptimal fractional flow reserve (FFR) following percutaneous coronary intervention (PCI) results in a significant increase in both post-PCI FFR and minimal lumen and stent areas (MLA and MSA, respectively). However, the impact of clinical presentation with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) versus chronic coronary syndrome (CCS) on the efficacy of PCI optimization remains unknown.
Methods: This was a prespecified subgroup analysis of the FFR REACT trial comparing IVUS-guided PCI optimization versus no further treatment in 291 patients with a post-PCI FFR < 0.
Background And Aim: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic.
Methods And Results: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020.
Article Synopsis
- The P2Y12 receptor is crucial for platelet activation and has been a focus of research, particularly in the context of treating acute coronary syndromes (ACS) with dual therapy of aspirin and clopidogrel, as shown in the landmark CURE trial from 2001.
- Advances in interventional cardiology, including drug-eluting stents and new P2Y12 inhibitors like ticagrelor and prasugrel, have significantly changed ACS treatment but challenges still exist, particularly with ST-elevation myocardial infarction (STEMI).
- The review highlights the efficacy and safety of using P2Y12 receptor antagonists as a pretreatment strategy for STEMI, stressing the need for personalized treatment plans and the future
Background: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.
View Article and Find Full Text PDFAssociation of vessel fractional flow reserve (vFFR) with luminal obstruction and plaque characteristics as detected by optical coherence tomography (OCT) in patients with NSTE-ACS: the FAST OCT study.
Eur Heart J Cardiovasc Imaging
December 2024
Aims: There is a paucity of data on the performance of angiography-derived vessel fractional flow reserve (vFFR) in coronary artery lesions of patients presenting with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Optical coherence tomography (OCT) allows for visualization of lumen dimensions and plaque integrity with high resolution. The aim of this study was to define the association between vFFR and OCT findings in intermediate coronary artery lesions in patients presenting with NSTE-ACS.
View Article and Find Full Text PDFArticle Synopsis
- - Resistant hypertension (RHT) occurs when blood pressure remains high despite lifestyle changes and at least three antihypertensive medications, including a diuretic, raising the risk of organ damage and serious cardiovascular events.
- - Treatment guidelines recommend a combination therapy that includes a renin-angiotensin system blocker, a diuretic, and a calcium-channel blocker for RHT patients, with possible additional medication depending on their specific health conditions.
- - Recent clinical trials have explored new drug classes, such as non-steroid mineralocorticoid receptor antagonists and selective aldosterone synthase inhibitors, which show promise in further lowering blood pressure in RHT patients who haven't responded to standard therapies.
Background: Stent implantation represents the standard of care in coronary intervention. While a short stent implanted on a focal lesion located on the left anterior descending artery (LAD) seems a reasonable alternative to an internal mammary implant, the same for long stents is still debated.
Methods: We reported the long-term data of 531 consecutive patients who underwent Percutaneous Coronary Intervention (PCI) with long stents in two highly specialized centres.
Intravascular imaging-derived physiology is emerging as a promising tool allowing simultaneous anatomic and functional lesion assessment. Recently, several optical coherence tomography-based and intravascular ultrasound-based fractional flow reserve (FFR) indices have been developed that compute FFR through computational fluid dynamics, fluid dynamics equations, or machine-learning methods. This review aims to provide an overview of the currently available intravascular imaging-based physiologic indices, their diagnostic performance, and clinical application.
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- Non-hyperemic pressure ratios (NHPRs) have shown potential as a reliable alternative to fractional flow reserve (FFR), but there's a significant discrepancy between the two in about 20-25% of cases.
- The study analyzed 813 patients with intermediate coronary lesions and found that discordance between FFR and diastolic pressure ratio (dPR) occurred in 22.1% of patients, with specific correlations to certain arterial lesions and overall lower pressure values.
- The only independent predictor of this discordance was the absolute difference in dPR values, indicating its importance in assessing these patients.
Background: Segmental postpercutaneous coronary intervention (PCI) pressure gradients may detect residual disease and potential targets for optimization. However, universal definitions of relevant segmental gradients are lacking.
Objectives: This study sought to evaluate the diagnostic performance of post-PCI fractional flow reserve (FFR), distal coronary pressure-to-aortic pressure ratio (Pd/Pa), and diastolic pressure ratio (dPR) gradients to detect residual focal lesions and stent underexpansion as observed by intravascular ultrasound (IVUS).
Culprit lesion plaque characterization and thrombus grading by high-definition intravascular ultrasound in patients with ST-segment elevation myocardial infarction.
Catheter Cardiovasc Interv
August 2023
Background: Dedicated prospective studies investigating high-definition intravascular ultrasound (HD-IVUS)-guided primary percutaneous coronary intervention (PCI) are lacking. The aim of this study was to qualify and quantify culprit lesion plaque characteristics and thrombus using HD-IVUS in patients presenting with ST-segment elevation myocardial infarction (STEMI).
Methods: The SPECTRUM study is a prospective, single-center, observational cohort study investigating the impact of HD-IVUS-guided primary PCI in 200 STEMI patients (NCT05007535).
Article Synopsis
- The study investigates how severe coronary artery calcification affects stent expansion and identifies optical coherence tomography (OCT) indicators for stent success.
- Researchers analyzed data from 361 lesions in 336 patients who had percutaneous coronary interventions with OCT assessments before and after stenting.
- Findings revealed that stent expansion was significantly less in calcified lesions compared to noncalcified ones, with total stent length being the key predictor of stent expansion, while calcium length significantly predicted minimal stent area (MSA).
Article Synopsis
- A systematic review and meta-analysis examined the effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft surgery (CABG) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD).
- The study analyzed data from four observational studies involving over 3,000 patients, looking primarily at one-year all-cause mortality and secondary outcomes like myocardial infarction (MI) and stroke.
- Results showed no significant differences in mortality, MI, or stroke rates between PCI and CABG, but repeat revascularization was significantly lower for patients who underwent CABG.
Article Synopsis
- * A study involving over 16,600 STEMI patients found a 16% reduction in PPCI procedures in 2020 compared to 2019, with the elderly experiencing the most significant delays.
- * Consequently, there was a notable increase in 30-day mortality rates during the pandemic, particularly among older patients, attributed to longer ischemia times and treatment delays.
Background: Physiological assessment of intermediate coronary lesions to guide coronary revascularization is currently recommended by international guidelines. Vessel fractional flow reserve (vFFR) has emerged as a new approach to derive fractional flow reserve (FFR) from 3D-quantitative coronary angiography (3D-QCA) without the need for hyperemic agents or pressure wires.
Study Design And Objectives: The FAST III is an investigator-initiated, open label, multicenter randomized trial comparing vFFR guided versus FFR guided coronary revascularization in approximately 2228 patients with intermediate coronary lesions (defined as 30%-80% stenosis by visual assessment or QCA).
Background: Recently, questions around the efficacy and effectiveness of Fractional Flow Reserve (FFR) have arisen in various clinical settings.
Methods: The Clinical Outcome of FFR-guided Revascularization Strategy of Coronary Lesions (HALE-BOPP) study is an investigator-initiated, multicentre, international prospective study enrolling patients who underwent FFR measurement on at least one vessel. In accordance with the decision-making workflow and treatment, the vessels were classified in three subgroups: (i) angio-revascularized, (ii) FFR-revascularized, (iii) FFR-deferred.
Article Synopsis
- The COVID-19 pandemic significantly reduced the number of primary percutaneous coronary interventions (PPCIs) for ST-segment elevation myocardial infarction (STEMI) patients by 16% in 2020 compared to 2019.
- Despite this reduction affecting both genders equally, 30-day mortality rates increased notably for female patients during the pandemic, while male patients did not show a significant change.
- The analysis highlights the importance of addressing gender-specific outcomes in cardiac care during public health crises.
Background: In order to facilitate fractional flow reserve (FFR)-guided lesion assessment, several 3-dimensional (3D)-angiography-based physiological indices have been recently validated. Thus far, limited data are available on the association of these indices with conventional forms of ischemia testing.
Aim: The aim of the study was to determine the association between 3D-angiography-based vessel-FFR (vFFR) and myocardial ischemia as assessed by exercise electrocardiography (ECG) testing, dobutamine stress echocardiography, single photon emission computed tomography myocardial perfusion imaging (SPECTMPI), and stress cardiovascular magnetic resonance imaging (stress CMR).
Background: Complete revascularization in patients with ST-segment elevation myocardial (STEMI) improves clinical outcome. Vessel fractional flow reserve (vFFR) has been validated as a non-invasive physiological technology to evaluate hemodynamic lesion significance without need for a dedicated pressure wire or hyperemic agent. This study aimed to assess discordance between vFFR reclassification and treatment strategy in intermediate non-culprit lesions of STEMI patients and to assess the clinical impact of this discordance.
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- The "smoking paradox" refers to lower mortality rates in smokers among STEMI patients, particularly in the context of modern primary PCI protocols during the COVID-19 pandemic.
- A large retrospective study revealed that among 16,083 STEMI patients, active smokers had better postprocedural blood flow and lower mortality rates compared to both non-smokers and previous smokers.
- The findings suggest that despite initial challenges in treatment, active smoking was linked to improved heart health outcomes in this patient population, indicating the need for further investigation into this unexpected relationship.
Article Synopsis
- Intravascular imaging-derived physiology is a new technique that helps evaluate both the structure and function of blood vessel lesions at the same time.
- Recent advancements have introduced optical coherence tomography and intravascular ultrasound methods to calculate fractional flow reserve (FFR) using various computational techniques.
- The review discusses the available imaging-based FFR indices, how well they work in diagnosing issues, and their potential uses in clinical settings.*