Publications by authors named "Alice Sacco"

Background: The clinical governance of patients with acute myocardial infarction (AMI) has markedly changed in the last few years. We sought to assess the contemporary in-hospital management patterns of patients with AMI at a country level.

Methods: EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units)-2 was a nationwide, prospective registry aimed to evaluate the current management of patients admitted to intensive cardiac care units (CCUs) for an AMI in Italy.

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  • Pregnancy-Associated Spontaneous Coronary Artery Dissection (P-SCAD) is the leading cause of heart attacks during and after pregnancy, with the study examining its presentation, treatment, and outcomes based on a review of 253 studies involving 316 patients.
  • Most patients were postpartum (79.6%), with common symptoms including ST-elevation myocardial infarction, and severe complications like cardiac arrest occurring in a significant number.
  • The study found a relatively low mortality rate of 4.1%, but a notable recurrence rate (23.4%) after initial treatment, suggesting a need for better diagnostic methods and treatment guidelines for this complex condition.
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Aims: To describe the use and the relation to outcome of different ventilation strategies in a contemporary, large, prospective registry of cardiogenic shock patients.

Methods And Results: Among 657 patients enrolled from March 2020 to November 2023, 198 (30.1%) received oxygen therapy (OT), 96 (14.

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There is an unmet need for new treatment options for patients with acute myocardial infarction (AMI) as progress in patients' outcomes has plateaued over the past 15 years. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated cardio-renal benefits in various disease states, encompassing diabetes mellitus, chronic kidney disease, and heart failure. Experimental studies further support their use in AMI, demonstrating beneficial effects in animal models by reducing infarct size and mitigating adverse cardiac remodelling.

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  • * This study assesses the effectiveness, safety, and adherence to NW in obese and overweight diabetic patients compared to standard rehabilitation and counseling over 6 and 12 months after a 3-month intervention.
  • * Results will indicate how NW stacks up against other methods in improving cardiovascular performance and will provide insights for developing personalized exercise programs for better health outcomes in this patient group.
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Background: Recent data indicate that end-of-life management for patients affected by acute decompensated heart failure in cardiac intensive care units is aggressive, with late or no engagement of palliative care teams.

Objective: To assess current palliative care and end-of-life practices in a contemporary Italian multicenter registry of patients with cardiogenic shock due to acute decompensated heart failure.

Methods: A survey-based approach was used to collect data on palliative care and end-of-life management practices.

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Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this study. The primary endpoint was the incidence of pulmonary hypertension (PH) at follow-up.

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Cardiogenic shock (CS) portends a dismal prognosis if hypoperfusion triggers uncontrolled inflammatory and metabolic derangements. We sought to investigate metabolomic profiles and temporal changes in IL6, Ang-2, and markers of glycocalyx perturbation from admission to discharge in eighteen patients with heart failure complicated by CS (HF-CS). Biological samples were collected from 18 consecutive HF-CS patients at admission (T0), 48 h after admission (T1), and at discharge (T2).

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  • This study investigates the role of organ perfusion pressure (OPP) as a prognostic marker in acute heart failure (AHF), comparing it to mean arterial pressure (MAP) alone.
  • It utilizes data from 200 patients in the SNIP-AHF study, focusing on those with both MAP and central venous pressure (CVP) measurements, to analyze OPP's effectiveness in predicting worsening heart failure within 48 hours.
  • Results indicate that OPP is a strong predictor for worsening heart failure, with an optimal cut-off value identified, suggesting that monitoring OPP could improve patient outcomes in AHF management.
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  • 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.
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  • Anemia, whether existing before hospitalization or developed during the hospital stay, impacts mortality rates in patients with acute coronary syndromes, but its role remains ambiguous.
  • A study conducted at Niguarda Hospital analyzed 1294 patients, categorizing them into three groups: those with pre-existing anemia, those who developed anemia during their stay, and those who maintained normal hemoglobin levels.
  • Findings indicated that while pre-existing anemia was linked to a higher risk of death, hospital-acquired anemia did not significantly increase long-term mortality risk, suggesting different implications for patient health management.
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  • Advanced heart failure (AHF) is a severe stage of heart failure with a generally poor prognosis, even with medical advancements.
  • The review emphasizes the importance of quickly referring patients to specialized AHF facilities for better management and outcomes.
  • It discusses the diagnostic and treatment processes at an Italian AHF center, focusing on assessing patient eligibility for top treatments like heart transplantation (HTx) and left ventricular assist devices (LVAD).
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Background: Cardiogenic shock (CS) includes several phenotypes with heterogenous hemodynamic features. Timely prognostication is warranted to identify patients requiring treatment escalation. We explored the association of the updated Society for Cardiovascular Angiography and Interventions (SCAI) stages classification with in-hospital mortality using a prospective national registry.

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Cardiogenic shock remains a deadly complication of acute on chronic decompensated heart failure (ADHF-CS). Despite its increasing prevalence, it is incompletely understood and therefore often misdiagnosed in the early phase. Precise diagnosis of the underlying cause of CS is fundamental for undertaking the correct therapeutic strategy.

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Aims: Despite evidence of hemodynamic benefit of sodium nitroprusside (SNP) treatment for acute heart failure (AHF), there are limited data about its efficacy and safety. This study aimed to assess the effectiveness and safety of SNP treatment, to explore the impact of N-terminal pro-B natriuretic peptide (NT-proBNP) reduction on clinical endpoints and to identify possible predictors of clinical response.

Methods And Results: Multicenter retrospective cohort study of 200 patients consecutively admitted for AHF in 2 Italian Centers.

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Background: Systemic capillary leak syndrome (SCLS) is a potentially fatal disorder characterized by relapses of hypovolemic shock episodes.

Case Summary: We present a case of a 58-year-old man who presented to the Emergency Department with a history of recurrent episodes of syncope in the last hours. A few days before medical contact the patient complained of sore throat, fever, and flu-like symptoms.

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Cardiogenic shock represents one of the most dramatic scenarios to deal with in intensive cardiology care and is burdened by substantial short-term mortality. An integrated approach, including timely diagnosis and phenotyping, along with a well-established shock team and management protocol, may improve survival. The use of the Swan-Ganz catheter could play a pivotal role in various phases of cardiogenic shock management, encompassing diagnosis and haemodynamic characterisation to treatment selection, titration and weaning.

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Purpose: To investigate the impact of pulmonary artery catheter (PAC) monitoring on survival of cardiogenic shock(CS), in the light of the controversies in available evidence.

Materials And Methods: MEDLINE, EMBASE, Cochrane library and Web of Science were systematically screened to identify most relevant studies on patients with CS comparing PAC use to non-use during hospital stay. Short-term mortality was the primary endpoint and the use of Mechanical Circulatory Support (MCS) devices was the secondary one.

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Out-of-hospital cardiac arrest (OHCA) is still associated with high mortality and severe complications, despite major treatment advances in this field. Ischemic heart disease is a common cause of OHCA, and current guidelines clearly recommend performing immediate coronary angiography (CAG) in patients whose post-resuscitation electrocardiogram shows ST-segment elevation (STE). Contrarily, the optimal approach and the advantage of early revascularization in cases of no STE is less clear, and decisions are often based on the individual experience of the center.

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Background: The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD).

Methods: We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers.

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We focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcomes were acute HF and cardiogenic shock at admission, secondary outcomes were the use of Non Invasive Ventilation (NIV) and the admission Left Ventricular Ejection Fraction (LVEF). We consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019.

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