Publications by authors named "Biscaglia S"
Aims: To investigate the influence of index of microcirculatory resistance (IMR) on fractional flow reserve (FFR) and adenosine-induced hyperemia (ΔPd/Pa-FFR) in patients with chronic (CCS) or stabilized acute coronary syndromes (ACS), utilizing various IMR threshold values.
Methods: Data were extracted from two ongoing Italian registries involving patients with CCS or stabilized ACS who underwent a #FullPhysiology approach [Pd/Pa, FFR, IMR, coronary flow reserve (CFR)] by bolus thermodilution technique in the left anterior descending artery. Correlations between IMR and both FFR and ΔPd/Pa-FFR were analyzed both globally and within three IMR-defined groups: Group 1 (IMR <25), Group 2 (25 ≤ IMR <40), and Group 3 (IMR ≥40).
Background: Few data are available on polymer-free drug-eluting stents in patients undergoing percutaneous coronary intervention (PCI).
Aims: We aimed to determine the efficacy and safety of a polymer-free amphilimus-eluting stent (AES), using a reservoir-based technology for drug delivery, compared with a biodegradable-polymer everolimus-eluting stent (EES).
Methods: This was a randomised, investigator-initiated, assessor-blind, non-inferiority trial conducted at 14 hospitals in Italy (ClinicalTrials.
Traditionally, coronary angiography was restricted to visual estimation of contrast-filled lumen in coronary obstructive diseases. Over the previous decades, considerable development has been made in quantitatively analyzing coronary angiography, significantly improving its accuracy and reproducibility. Notably, the integration of artificial intelligence (AI) and machine learning into quantitative coronary angiography (QCA) holds promise for further enhancing diagnostic accuracy and predictive capabilities.
View Article and Find Full Text PDFBackground: Older adults with non-ST-segment-elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions.
Methods And Results: We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non-ST-segment-elevation acute coronary syndrome.
Background: Fractional flow reserve (FFR) or non-hyperaemic pressure ratios are recommended to assess functional relevance of intermediate coronary stenosis. Both diagnostic methods require the placement of a pressure wire in the coronary artery during invasive coronary angiography. Quantitative flow ratio (QFR) is an angiography-based computational method for the estimation of FFR that does not require the use of pressure wires.
View Article and Find Full Text PDFArticle Synopsis
- Complete revascularization is the standard treatment for older STEMI patients with multivessel disease, offering benefits shown in the FIRE trial, though long-term effects remain uncertain.
- A meta-analysis of several randomized clinical trials analyzed data from 1733 patients aged 75 and older, comparing complete versus culprit-only revascularization strategies.
- Results indicated that complete revascularization significantly reduced the risk of cardiovascular death or myocardial infarction in the long term, but did not show a difference in overall death rates compared to culprit-only revascularization.
Background: The effectiveness of complete revascularization is well established in patients with ST-segment elevation myocardial infarction (STEMI), but it is less investigated in those with non-ST-segment elevation myocardial infarction (NSTEMI).
Objectives: This study aimed to assess whether complete revascularization, compared with culprit-only revascularization, was associated with consistent outcomes in older patients with STEMI and NSTEMI.
Methods: In the FIRE (Functional Assessment in Elderly MI Patients with Multivessel Disease) trial, 1,445 older patients with myocardial infarction (MI) were randomized to culprit-only or physiology-guided complete revascularization, stratified by STEMI (n = 256 culprit-only vs n = 253 complete) and NSTEMI (n = 469 culprit-only vs n = 467 complete).
The mean age of patients with coronary artery disease (CAD) is steadily increasing. In older patients, there is a tendency to underutilize invasive approach, coronary revascularization, up-to-date pharmacological therapies, and secondary prevention strategies, including cardiac rehabilitation. Older adults with CAD commonly exhibit atypical symptoms, multi-vessel disease involvement, complex coronary anatomy, and a higher presence of risk factors and comorbidities.
View Article and Find Full Text PDFCombination of mechanical circulatory devices in cardiogenic shock.
J Cardiovasc Med (Hagerstown)
August 2024
Background: The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) enrolled 1445 older (aged ≥75 years) patients with myocardial infarction and multivessel disease in Italy, Spain, and Poland. Patients were randomized to physiology-guided complete revascularization or treatment of the only culprit lesion. Physiology-guided complete revascularization significantly reduced ischemic adverse events at 1 year.
View Article and Find Full Text PDFBackground: The role of quantitative flow ratio (QFR) in the treatment of nonculprit vessels of patients with myocardial infarction (MI) is a topic of ongoing discussion.
Objectives: This study aimed to investigate the predictive capability of QFR for adverse events and its noninferiority compared to wire-based functional assessment in nonculprit vessels of MI patients.
Methods: The FIRE (Functional Assessment in Elderly MI Patients With Multivessel Disease) trial randomized 1,445 older MI patients to culprit-only (n = 725) or physiology-guided complete revascularization (n = 720).
Article Synopsis
- Study investigated how well the pullback pressure gradient (PPG) can predict successful outcomes in percutaneous coronary intervention (PCI) for patients with diffuse coronary artery disease.
- PPG was found to have a strong correlation with changes in fractional flow reserve (FFR) post-PCI, significantly better than using FFR alone for predicting optimal revascularization.
- The research highlights that PPG can influence treatment decisions and improve safety during PCI procedures, particularly for patients at risk of complications.
Article Synopsis
- Patients with high bleeding risk (HBR) following a myocardial infarction (MI) face poor outcomes, and it's uncertain if they benefit from complete revascularization.
- The study aimed to compare the outcomes of physiology-guided complete revascularization versus a culprit-only strategy for HBR patients with MI and multivessel disease.
- Results showed that HBR patients had a higher risk of complications, but those who underwent complete revascularization experienced significantly better outcomes, reducing primary endpoint events.
Background: Use of Intra-Aortic Balloon Pump (IABP) in combination with Impella has been described as an alternative strategy for mechanical circulatory support (MCS) in patients with cardiogenic shock (CS). We provide a systematic review aimed to explore the effectiveness of this paired MCS approach.
Methods: We conducted a comprehensive systematic search in MEDLINE, Scopus, and Cochrane databases to identify all studies that investigated dual MCS with IABP and Impella.
Article Synopsis
- - Coronary vasomotor disorders (CVD) involve temporary over-contraction of coronary smooth muscle, contributing to heart issues like ischemia and myocardial infarction, even when arteries are not blocked.
- - The acetylcholine (ACh) test is the main method for diagnosing CVD and offers important insights for treatment and predicting outcomes, but concerns about safety limit its use in everyday medical settings.
- - This review aims to explain the causes of CVD, evaluate the safety and effectiveness of the ACh test, and discuss new management strategies tailored to individual patients with CVD.
Article Synopsis
- The study investigates the effectiveness of high-sensitivity troponin I (TnI) levels in diagnosing myocardial infarction (MI) in patients with heart failure (HF), as traditional methods may be less reliable in this group.
- Data from 562 patients with suspected MI were analyzed, showing that while baseline TnI had moderate predictive capability for MI, the relative change in TnI levels was a much more accurate indicator.
- The findings suggest that monitoring TnI changes is crucial for MI diagnosis in heart failure patients, and baseline TnI accuracy can be affected by the severity of HF, highlighting the need for comprehensive evaluation including BNP levels.
Aims: The present analysis from the Functional Assessment in Elderly Myocardial Infarction Patients with Multivessel Disease (FIRE) trial aims to explore the significance of pre-admission physical activity and assess whether the benefits of physiology-guided complete revascularization apply consistently to sedentary and active older patients.
Methods And Results: Patients aged 75 years or more with myocardial infarction (MI) and multivessel disease were randomized to receive physiology-guided complete revascularization or culprit-only strategy. The primary outcome was a composite of death, MI, stroke, or any revascularization within a year.
Background: Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment.
Methods: NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV).