Publications by authors named "Alessandro Sionis"
Objective: To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction (NSTEMI) from the MOSCA-FRAIL clinical trial.
Methods: The MOSCA-FRAIL trial randomized 167 frail patients, defined by a Clinical Frailty Scale (CFS) ≥ 4, with NSTEMI to an invasive or conservative strategy. The primary endpoint was the number of days alive and out of hospital (DAOH) one year after discharge.
Article Synopsis
- The Shock-CAT study aimed to assess in-hospital mortality and prognosis in cardiogenic shock (CS) patients, comparing those with acute myocardial infarction (AMI) to those without it.
- Out of 382 patients studied, AMI-CS exhibited higher in-hospital mortality rates (37.1%) compared to non-AMI-CS (26.7%), with AMI-CS patients requiring more mechanical circulatory support.
- The IABP-SHOCK II score was found to be more accurate than the CardShock score in predicting 90-day mortality for AMI-CS patients, while both scores performed similarly for non-AMI-CS patients.
Background: Lung ultrasound (LUS) has emerged as a useful tool in the acute phase of patients admitted for ST-segment-elevation myocardial infarction. However, its long-term significance remains uncertain, and risk scores do not include LUS findings as a predictor. This study aims to assess the 1-year prognostic value of LUS and its ability to enhance existing risk scores.
View Article and Find Full Text PDFBackground: Takotsubo syndrome (TTS) is a form of transient left ventricular (LV) dysfunction that usually resolves within days to weeks.
Objectives: We aimed to assess the predictors and prognostic impact of time-to-LV recovery after TTS.
Methods: Prospective serial imaging data from the nationwide, multicenter RETAKO (REgistry on TAKOtsubo Syndrome) were comprehensively reviewed to assess the timing of LV recovery.
Article Synopsis
- The MOSCA-FRAIL trial examined the effects of invasive versus conservative treatment strategies in frail patients aged 70 and older with non-ST-segment elevation myocardial infarction (NSTEMI).
- The study included 167 participants and focused on various geriatric conditions, finding that invasive management had a notable survival benefit primarily for those with lower frailty levels (CFS=4).
- Results suggested that frailty, as indicated by the Clinical Frailty Scale (CFS), is an important factor in determining the risks and benefits of treatment, with a CFS score greater than 4 potentially signaling a need for more cautious decision-making.
Article Synopsis
- Recent guidelines advocate for quick initiation of lipid-lowering therapy (LLT) in patients with acute coronary syndromes (ACS) to achieve significant reductions in LDL cholesterol levels.
- A European study involving 286 ACS patients evaluated the effectiveness of two LLT strategies: high-intensity statin monotherapy (mono-HIS) and a combination of high-intensity statins with ezetimibe (combo-HIS).
- Findings showed that while LDL-c targets were met in under half of the patients, combo-HIS was linked to a significantly greater reduction in LDL-c levels compared to mono-HIS, suggesting its potential for more effective management in post-ACS care.*
Killip scale reclassification according to lung ultrasound: Killip pLUS.
Eur Heart J Acute Cardiovasc Care
July 2024
Aims: The Killip scale remains a fundamental tool for prognostic assessment in ST-segment elevation myocardial infarction (STEMI) due to its simplicity and predictive value. Lung ultrasound (LUS) has emerged as a valuable adjunct for diagnosing and predicting outcomes in heart failure (HF) and STEMI patients, even those with subclinical congestion. We created a new classification (Killip pLUS), which reclassifies Killip I and II patients into an intermediate category (Killip I pLUS) based on LUS results.
View Article and Find Full Text PDFKey Clinical Message: An interesting case that shows an infrequent cause of cardiorespiratory arrest such as coronary vasospasm due to intravenous amiodarone induced Kounis syndrome. It highlights the usefulness of circulatory support with ECMO in the scenario of CPR.
Abstract: A patient with atrial fibrillation was admitted for an elective electrical cardioversion.
This review aims to enhance the comprehension and management of cardiopulmonary interactions in critically ill patients with cardiovascular disease undergoing mechanical ventilation. Highlighting the significance of maintaining a delicate balance, this article emphasizes the crucial role of adjusting ventilation parameters based on both invasive and noninvasive monitoring. It provides recommendations for the induction and liberation from mechanical ventilation.
View Article and Find Full Text PDFBackground: Recently, abnormal thyroid function was shown to be common in patients with Takotsubo syndrome (TTS), being classified into "endocrine-type" and "stress-type" responses. The aim of this study was to investigate the association between thyroid homeostasis and TTS in a larger international registry.
Methods: In total 288 patients with TTS were enrolled through the GEIST multicentre registry from Germany, Italy and Spain.
Introduction: Data on the association between kidney function and Takotsubo syndrome (TTS) outcomes are scarce and conflictive.
Objective: To assess the impact of chronic kidney disease (CKD) and acute renal failure (ARF) in patients with TTS.
Material And Methods: Patients from the prospective nation-wide (RETAKO) registry were included and divided into quartiles of maximum creatinine (Cr) level during hospitalization.
Article Synopsis
- The MOSCA-FRAIL trial investigated treatment approaches for frail patients (aged ≥70) with non-ST-segment elevation myocardial infarction (NSTEMI) and found no significant difference in health outcomes after one year between invasive and conservative strategies.
- Following extended follow-up until January 2023, the analysis of 167 patients indicated similar survival times and readmission rates, revealing that neither treatment significantly outperformed the other.
- Overall, while initial outcomes suggested that invasive treatment might lead to shorter survival in the first year, the long-term results demonstrated inconclusive differences, highlighting the need for personalized treatment decisions in frail older adults.
Article Synopsis
- - Takotsubo syndrome (TTS) during the peripartum period is a significant health issue, with unclear prognosis compared to the general TTS population, prompting a study utilizing a nationwide registry.
- - Analysis showed that peripartum TTS patients commonly experience atypical symptoms like dyspnea, have different echocardiographic findings, and less ST-segment elevation than other TTS patients.
- - Despite presenting with higher Killip status upon admission, peripartum TTS patients often have good long-term prognoses, even though their conditions are mainly secondary and linked to physical stressors.
Article Synopsis
- Cardiogenic shock (CS) is a life-threatening condition linked to severe heart issues, particularly in patients with ST-segment elevation myocardial infarction (STEMI), where the role of epigenetic factors, like miRNAs, is not well understood.
- In a study involving 49 STEMI patients, researchers found that miR-619-5p levels were significantly higher in those experiencing CS compared to those without, indicating its potential as a biomarker for assessing risk and mortality outcomes.
- The study concluded that miR-619-5p not only correlates with inflammatory responses but also serves as a critical indicator for predicting patient mortality within a 30-day follow-up in CS patients.
Background: The role of age in the short- and long-term prognosis of takotsubo syndrome (TTS) is controversial. The aim of the present study was to evaluate age-related differences and prognostic implications among patients with TTS.
Methods And Results: In total, 2492 consecutive patients with TTS enrolled in an international registry were stratified into 4 groups (<45, 45-64, 65-74, and ≥75 years).
Introduction: Takotsubo syndrome (TTS) encompasses distinct variants, with midventricular (MV) as the most common atypical subtype. While electrocardiogram (ECG) abnormalities are well documented in typical TTS, they are less explored in MV-TTS.
Methods: A retrospective case-control study was conducted where ECGs were reviewed at three time points from symptom onset (within the first 12 h, at 48 h, and at 5-7 days) and compared between patients with typical TTS ( = 33) and those with MV-TTS ( = 27), as classified by ventriculography.
Article Synopsis
- Endomyocardial biopsy (EMB) is important for diagnosing fulminant myocarditis in adults, but its timing and effects on patient outcomes are still being studied.
- In a study involving 419 patients across 36 centers, those who had an early EMB (within 2 days of ICU admission) showed significantly better survival rates (63%) without needing heart transplants or LVAD compared to those with delayed EMB (40%).
- The research suggests that early EMB is associated with lower mortality rates and better overall outcomes, supporting its prompt use in ICU patients suspected of having fulminant myocarditis.
Article Synopsis
- There are significant sex-specific differences in acute heart failure (AHF), indicating a need for separate evaluation of treatments for men and women.
- In a multicenter trial of 781 AHF patients, women were older, less weighted, and had lower kidney function compared to men, with a notable difference in treatment outcomes.
- The study found that the rapid increase of RAAS inhibitors was less effective in women, which may contribute to their higher rates of mortality and rehospitalization due to AHF.
Aims: Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management.
View Article and Find Full Text PDFAims: We performed quality control of lipid-lowering therapy (LLT) in patients with acute coronary syndrome (ACS), with a view to proposing corrective actions.
Methods And Results: Using a Define Measure Analysis Improve Control (DMAIC) approach applied to data from the ACS EuroPath IV survey, we measured attainment of two quality indicators (QIs) related to lipid-lowering treatment: (i) prescription of high-intensity statins (or equipotent treatment) before discharge, and (ii) proportion with LDL-cholesterol <55 mg/dL (1.4 mmol/L) during follow-up.
Article Synopsis
- The analysis from the Altshock-2 registry aimed to compare the clinical features and management of cardiogenic shock due to acutely decompensated heart failure (ADHF-CS) versus that caused by acute myocardial infarction (AMI-CS).
- It found that patients with ADHF-CS were younger but had worse kidney and liver function, leading to longer hospital stays and increased use of heart replacement therapies.
- In terms of treatment, norepinephrine was more common for AMI-CS, while epinephrine was more frequently used for ADHF-CS, and overall in-hospital mortality rates were similar between the two groups.