Publications by authors named "Antonio Manari"
Background: In ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary angioplasty (PPCI) the index of microcirculatory resistance (IMR) correlates to the extent of myocardial damage and left ventricular (LV) function recovery. Data on the IMR time-course and impact on clinical outcome in STEMI patients with multi-vessel disease (MVD) are scarce.
Aims: We designed a prospective, multicenter clinical trial to assess the infarct-related artery (IRA)-IMR in STEMI patients with MVD undergoing PPCI and to explore its potential in relationship with outcome and LV remodeling.
The main objective of cardiovascular disease prevention is to reduce morbidity and mortality by promoting a healthy lifestyle, reducing risk factors, and improving adherence to medications. Secondary prevention after an acute coronary syndrome has proved to be effective in reducing new cardiovascular events, but its limited use in everyday clinical practice suggests that there is considerable room for improvement. The short-term results of evidence-based studies of nurse-coordinated secondary prevention programs have been positive, but there is a lack of long-term outcome data.
View Article and Find Full Text PDFBackground: In STEMI patients treated with primary percutaneous coronary angioplasty (PPCI) the evaluation of coronary microcirculatory resistance index (IMR) predict the extent of microvascular damage and left ventricular (LV) remodeling. However, the impact of IMR on the clinical outcome after PPCI in patients with multivessel disease (MVD) remains unsettled.
Aim: We designed a prospective multicenter controlled clinical trial to evaluate the prognostic value of IMR in terms of clinical outcome and left ventricular remodeling in STEMI patients with MVD undergoing PPCI.
Objectives: To establish if the presence of chronic kidney disease (CKD) influences fractional flow reserve (FFR) value in patients with intermediate coronary stenosis.
Background: FFR-guided coronary revascularization reduces cardiac adverse events in patients with coronary artery disease. CKD impairs microcirculation and increases cardiovascular risk.
Same-day transfer for the invasive strategy of patients with non-ST-segment elevation acute coronary syndrome admitted to spoke hospitals: Data from the Emilia-Romagna Regional Network.
Eur Heart J Acute Cardiovasc Care
October 2016
Article Synopsis
- The study analyzed the implementation of a service strategy for managing patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) through same-day transfers from spoke hospitals to specialized centers with cath-lab facilities.
- Results showed that 60% of the patients who underwent this service had quicker access to catheterization lab services and a significantly shorter hospital stay, saving an average of €1590 per patient.
- The outcomes of adverse events within 30 days were similar between patients treated with and without the service strategy, indicating its effectiveness without increasing risk.
Background: The aim of this study was to compare 7-year rates of all-cause death, cardiac death, myocardial infarction, target vessel revascularization, and stroke in a large cohort of octogenarians with left main coronary artery or multivessel disease, treated with coronary artery bypass grafting or percutaneous coronary intervention.
Methods: Two propensity score-matched cohorts of patients undergoing revascularization procedures at regional public and private centers of Emilia-Romagna, Italy, from July 2002 to December 2008 were used to compare long-term outcomes of percutaneous coronary intervention (947 patients) and coronary artery bypass grafting (441 patients).
Results: There were no significant differences between groups in 30-day mortality.
New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction: a propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna).
Catheter Cardiovasc Interv
April 2015
Objectives: The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry.
Background: New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification.
Article Synopsis
- The study investigates the differences in bleeding and mortality between women and men undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) based on a cohort of 1686 patients.
- Results reveal that while women have a higher incidence of in-hospital bleeding (8.6%) compared to men (5.8%), their short and long-term mortality rates are not significantly worse than those of men after adjusting for various factors.
- The findings suggest that bleeding is a key predictor of short-term mortality, but female sex does not independently increase the risk of mortality in the long term.
Background: The concept of a single-lead dual-chamber implantable cardioverter defibrillator (ICD) with floating sensing atrial dipole has been proven safe and functional. We report a single-center experience with this ICD system; the major focus of the work is on the recorded atrial activation and its stability on a medium term follow-up.
Methods: Thirteen patients received a DX ICD (BIOTRONIK SE & Co, Berlin, Germany) with the Linox Smart S DX(ProMRI) ICD lead; the implantation data were reported.
Acute kidney injury after primary angioplasty: effect of different hydration treatments.
J Cardiovasc Med (Hagerstown)
January 2014
Aims: We evaluated the effect of different dose hydration protocols, with normal saline or bicarbonate, on the incidence of contrast-induced acute kidney injury (CI-AKI) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI).
Methods: We considered 592 STEMI patients treated with PPCI in 5 Italian centers. Patients were randomized to receive standard or high-dose infusions of normal saline or sodium bicarbonate started immediately before contrast medium administration and continued for the following 12 h.
Article Synopsis
- The study assessed cardiac outcomes for STEMI patients with multivessel disease based on whether they received culprit-only primary percutaneous coronary intervention (PPCI) or multivessel PCI, either during the initial procedure or later as a staged approach.
- Approximately 40% of STEMI patients have multivessel disease, which is linked to poorer outcomes, highlighting the need for effective strategies in addressing nonculprit lesions.
- Results showed that culprit-only PPCI had higher short-term mortality rates compared to staged multivessel PCI, but no significant differences were found at the 2-year follow-up, supporting the guideline recommendation for the initial culprit-only approach followed by staging.
High residual platelet reactivity (RPR) on clopidogrel treatment has been associated with increased risk for ischemic events during follow-up in patients with acute coronary syndromes. The aim of this study was to assess the incidence, predictors, and clinical consequences of high RPR in a large population of patients with non-ST-segment elevation acute coronary syndromes who underwent percutaneous coronary intervention and stenting. Overall, 833 patients received point-of-care testing of platelet inhibition 30 days after percutaneous coronary intervention.
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- - The study assessed five-year clinical outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary disease to determine which method is more effective.
- - Researchers followed 2885 patients in Italy who underwent either CABG (1466 patients) or PCI (1419 patients) from 2002 to 2008, analyzing complications like mortality, heart attack, and repeat procedures over time.
- - Results indicated that PCI had significantly higher risks of mortality, heart attack, and repeat procedures compared to CABG, suggesting that diabetes management should influence the choice of revascularization strategy for these patients.
Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting.
View Article and Find Full Text PDFEarly aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial.
JACC Cardiovasc Interv
September 2012
Objectives: This study sought to determine the risk versus benefit ratio of an early aggressive (EA) approach in elderly patients with non-ST-segment elevation acute coronary syndromes (NSTEACS).
Background: Elderly patients have been scarcely represented in trials comparing treatment strategies in NSTEACS.
Methods: A total of 313 patients ≥ 75 years of age (mean 82 years) with NSTEACS within 48 h from qualifying symptoms were randomly allocated to an EA strategy (coronary angiography and, when indicated, revascularization within 72 h) or an initially conservative (IC) strategy (angiography and revascularization only for recurrent ischemia).
Article Synopsis
- - The study aimed to assess gender differences in outcomes after acute myocardial infarction (AMI) for patients who underwent coronary revascularization procedures using a large registry of over 18,000 patients from Italy.
- - Results indicated that women initially had higher mortality rates than men within the first 30 days post-AMI, but this trend reversed after. Notably, younger women (<50 years) faced a significantly higher risk of death than their male counterparts, while older women had similar or better survival rates compared to men.
- - The findings suggest that there are age-dependent and temporal differences in mortality based on gender among AMI patients, potentially pointing to biological factors influencing these outcomes.
A situs inversus with dextrocardia (DC) is a rare condition in adults. Usually, patients have structurally normal hearts and normal life expectancy. The incidence of coronary artery disease in this setting is similar to that in the general population.
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- Current guidelines for treating patients on oral anticoagulation (OAC) during percutaneous coronary intervention with stent implantation (PCI-S) rely on weak data, prompting a study to evaluate outcomes in a multicenter registry from 2003 to 2007.
- The study included 632 OAC patients, primarily with atrial fibrillation, showing that dual antiplatelet therapy was the most common treatment at discharge, with choices reflecting the patients' thromboembolic risk.
- The 1-year follow-up revealed a high occurrence of major adverse cardiovascular events (27%) across treatment groups, low rates of stroke (2%) and stent thrombosis (3%), and reinforced the effectiveness of triple therapy in managing these patients
Objectives: This study sought to assess whether transradial intervention, by minimizing access-site bleeding and vascular events, improves outcomes in patients with ST-segment elevation myocardial infarction compared with the transfemoral approach.
Background: Bleeding and consequent blood product transfusions have been causally associated with a higher mortality rate in patients with myocardial infarction undergoing coronary angioplasty.
Methods: We identified all adults undergoing percutaneous intervention for acute myocardial infarction in Emilia-Romagna, a region in the north of Italy of 4 million residents, between January 1, 2003, and July 30, 2009, at 12 referral hospitals using a region-mandated database of percutaneous coronary intervention procedures.
Off-hour primary percutaneous coronary angioplasty does not affect outcome of patients with ST-Segment elevation acute myocardial infarction treated within a regional network for reperfusion: The REAL (Registro Regionale Angioplastiche dell'Emilia-Romagna) registry.
JACC Cardiovasc Interv
March 2011
Objectives: This study aims to evaluate whether results of "off-hours" and "regular-hours" primary angioplasty (primary percutaneous coronary intervention [pPCI]) are comparable in an unselected population of patients with ST-segment elevation acute myocardial infarction treated within a regional network organization.
Background: Conflicting results exist on the outcome of off-hours pPCI.
Methods: We analyzed in-hospital and 1-year cardiac mortality among 3,072 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with pPCI between January 1, 2004, and June 30, 2006, during regular-hours (weekdays 8:00 AM to 8:00 PM) and off-hours (weekdays 8:01 PM to 7:59 AM, weekends, and holidays) within the STEMI Network of the Italian Region Emilia-Romagna (28 hospitals: 19 spoke and 9 hub interventional centers).
Timing of events in STEMI patients treated with immediate PCI or standard medical therapy: implications on optimisation of timing of treatment from the CARESS-in-AMI trial.
Int J Cardiol
February 2012
Objectives: Early angioplasty after thrombolysis is now recommended for ST-elevation myocardial infarction, but the current guidelines propose a wide time-window ranging between 3 and 24h after lytic administration. To identify the optimal timing for PCI after thrombolysis, we analyzed frequency and time course of the adverse events in patients randomized in the multicenter CARESS-in-AMI trial.
Methods: 598 high-risk patients with STEMI recruited in the CARESS-in-AMI study, were divided into the Immediate PCI group (IMM, n=298), Rescue PCI group (RES, n=107) and Standard Treatment Arm without rescue PCI (STA, n=193).
Article Synopsis
- The study aimed to compare the long-term effectiveness of cobalt-chromium bare-metal stents (CCSs) versus first-generation drug-eluting stents (DESs) in a large group of patients after a percutaneous coronary intervention over two years.
- Patients treated with DESs showed greater complications such as diabetes and longer lesions compared to those with CCSs, yet CCS patients were typically older and had more hypertension and heart failure.
- Overall, while the rates of serious adverse events were similar for both stent types, DESs significantly reduced the need for target-vessel revascularization (TVR) in patients at intermediate to high risk of restenosis, highlighting their effectiveness over CCSs in
Long-term clinical outcomes and cost-effectiveness analysis in multivessel percutaneous coronary interventions: comparison of drug-eluting stents, bare-metal stents and a mixed approach in patients at high and low risk of repeat revascularisation.
EuroIntervention
April 2010
Article Synopsis
- The study aims to assess the long-term effectiveness and cost-efficacy of drug-eluting stents (DES) in patients undergoing multivessel coronary interventions, focusing on real-world data over a 2-year period.
- Results showed that patients using DES experienced fewer major adverse cardiac events and complications compared to those using bare-metal stents (BMS), particularly in high-risk patients, but there was no significant difference when comparing DES alone to a mixed approach.
- The conclusion highlights that while DES are more costly, they provide better clinical outcomes and are cost-effective for high-risk patients, particularly when compared to BMS, in a real-world setting.
Article Synopsis
- The study evaluates the long-term effectiveness of drug eluting stents (DESs) compared to bare metal stents (BMSs) in female patients over a 3-year follow-up period.
- Among 3549 women in a multicenter registry, DESs were linked to a lower incidence of major adverse cardiac events (MACE) and target vessel revascularization (TVR) compared to BMSs.
- However, there was a noted non-significant increase in the risk of late acute myocardial infarction (AMI) and stent thrombosis in the DES group, suggesting the need for larger studies to assess long-term safety.