Publications by authors named "Paolo Guastaroba"
Article Synopsis
- The study aimed to compare four different dual antiplatelet therapy (DAPT) strategies in patients with acute coronary syndromes (ACS) who underwent percutaneous coronary intervention (PCI).
- A total of 2,404 patients were analyzed over a median follow-up of one year, focusing on the incidence of net adverse cardiovascular events (NACE) such as all-cause death and myocardial infarction among different treatment groups.
- Results indicated that the A-C (ASA + Clopidogrel) and A-PLx (ASA + Plavix) treatments had higher rates of NACE compared to A-T (ASA + Ticagrelor) and A-P (ASA + Prasugrel), suggesting that A-T
Aims: In accordance with current guidelines, patients discharged after acute myocardial infarction (AMI) are usually prescribed agents acting on the renin-angiotensin system (ACE-I/ARB). However, adherence to prescribing medications is a recognized problem and most studies demonstrating the value of adherence were limited by their non-randomized design and by 'healthy-adherer' bias. Herein we sought to evaluate the relationship between adherence to ACE-I/ARB and risk of subsequent AMIs, by using the self-controlled case-series design which virtually eliminates interpersonal confounding, being based on intrapersonal comparisons.
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- Kawasaki disease (KD) is a systemic vasculitis primarily affecting children, with higher incidence rates among Asian populations; this study focuses on its epidemiology in Tuscany and Emilia Romagna, Italy, from 2008-2013.
- The research utilized hospital discharge codes to analyze KD cases in children under 14 and found a peak incidence at age two, with an overall rate of 17.6 cases per 100,000 children under five and a slight increase in incidence during the study years.
- This study is the first of its kind in Italy using administrative data and found incidence rates that are slightly higher than those reported in other European countries.
Background: Epidemiology and consequences of surgery in patients with coronary stents are not clearly defined, as well as the impact of different stent types in relationship with timing of surgery.
Methods And Results: Among 39 362 patients with previous coronary stenting enrolled in a multicenter prospective registry and followed for 5 years, 13 128 patients underwent 17 226 surgical procedures. The cumulative incidence of surgery at 30 days, 6 months, 1 year, and 5 years was 3.
Article Synopsis
- - The study evaluated the effectiveness of three bleeding risk scores (CRUSADE, ACUITY, and HAS-BLED) to help guide the duration of dual antiplatelet therapy in patients from the PRODIGY trial, focusing on their ability to predict bleeding and ischemic events.
- - Results showed that CRUSADE outperformed HAS-BLED in terms of reclassification and discrimination for major bleeding risks, while the performances of CRUSADE and ACUITY were relatively close overall.
- - Patients with CRUSADE scores above 40 experienced significantly higher rates of major bleeding and transfusions when on a longer dual antiplatelet therapy, indicating that the score can help identify those at greater 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.
Article Synopsis
- The study evaluates the integration of emergency department (ED) and emergency medical system (EMS) data with hospital discharge records (HDR) to improve the assessment of STEMI (ST-segment elevation myocardial infarction) treatment quality in Italy.
- It analyzes data from 2793 STEMI patients admitted in 2013, revealing key quality indicators such as EMS activation rates and median time spent in ED.
- The findings highlight the importance of integrated data for identifying quality indicators, which can help in comparing performance and enhancing the quality of STEMI care locally and internationally.
Aims: A sizable group of patients with symptomatic aortic stenosis can undergo neither surgical aortic valve replacement nor transcatheter aortic valve implantation. The aim of this study was to assess the potential role of repeated balloon aortic valvuloplasty (BAV) in these patients.
Methods: Within our local prospective BAV registry, we retrospectively selected 105 patients who underwent ≥2 BAV procedures between 2005 and 2012 because of persisting contraindications to definitive treatment after first BAV.
Background: Beta-blockers (BB) are recommended in secondary prevention of acute myocardial infarction (AMI), but adherence to prescription medication is a recognized problem. Most literature on the consequences of poor adherence to prescribed BB is limited by the possibility of "healthy adherer bias" and better-designed studies have been advocated.
Methods And Results: We investigated the association between adherence to BB prescription and risk of subsequent AMIs using the self-controlled case series design, which allows improved control of interpersonal confounding, being based on intrapersonal comparisons.
Background: Aggressive post-resuscitation care, in particular combining mild therapeutic hypothermia (MTH) with early coronary angiography (CAG) and percutaneous coronary intervention (PCI), may improve prognosis after out-of-hospital cardiac arrest (OHCA).
Objectives: The study aims to assess the value of immediate CAG or PCI in comatose survivors after OHCA treated with MTH and their association with outcomes.
Methods: Observational, prospective analysis of all comatose, resuscitated patients treated with MTH at a tertiary centre and undergoing CAG or PCI ≤6 hours after OHCA, or non-invasively managed.
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.
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.
Association of bleeding, mortality and sex in acute coronary syndromes: the missing triangle.
J Cardiovasc Med (Hagerstown)
May 2015
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.
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.
Article Synopsis
- The study analyzed trends from 2002-2009 regarding acute myocardial infarction (heart attacks) in Emilia-Romagna, Italy, focusing on incidence rates, treatment methods, and patient outcomes.
- The incidence of heart attacks peaked in 2004 but saw a decline by 2009, while the use of medical procedures such as coronary angiography and angioplasty increased significantly during the study period.
- Although early mortality rates for hospitalizations decreased, there was a notable rise in post-treatment bleeding complications, indicating a shift towards more aggressive treatment strategies.
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.
View Article and Find Full Text PDFAims: The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the treatment of high-risk patients with severe aortic stenosis. This study describes the indications and long-term outcome of balloon aortic valvuloplasty (BAV) in recent years.
Methods And Results: Between 2000 and 2010, 415 consecutive patients at our institution underwent BAV.
Objectives: Most studies comparing coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) showed that fewer patients who had undergone CABG required repeat revascularizations , but no difference in survival, with the exception of some subgroups of patients. However, long-term real-world evidence on patients in whom both procedures are technically feasible is yet not available. The aim of this study was to compare 5-year rates of death, myocardial infarction (MI), target vessel revascularization (TVR) and stroke in a large cohort of patients with left main coronary artery (LMCA) or multivessel disease, treated with CABG or PCI (with or without DES) or PCI with DES only.
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- * It found that 18.2% of the patients had COPD, and these individuals had higher mortality rates and hospital readmissions for various cardiovascular issues compared to their non-COPD counterparts.
- * Specifically, patients with COPD who were readmitted for COPD had a significantly increased risk of death and were more likely to experience recurrent heart attacks, heart failure, and serious bleeding.
Baseline white blood cell count is an independent predictor of long-term cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome, but it does not improve the risk classification of the GRACE score.
Cardiology
August 2013
Article Synopsis
- The study aimed to determine the importance of baseline white blood cell count (WBCc) for predicting cardiovascular death in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), particularly comparing its effectiveness to the established GRACE score.
- Involving 1,315 NSTE-ACS patients, the results indicated that a higher WBCc is linked to an increased risk of cardiovascular death, specifically showing worse outcomes for patients in the highest quartile (Q4).
- Despite WBCc being a significant independent risk factor, incorporating it into the GRACE score didn’t enhance its predictive accuracy or classification capabilities for assessing patient risk.
Article Synopsis
- - 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.
Relevance of gender in patients with acute myocardial infarction undergoing coronary interventions.
J Cardiovasc Med (Hagerstown)
June 2013
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.
Article Synopsis
- 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
Background: Transcatheter aortic valve implantation (TAVI) represents a promising therapeutic option for patients affected by severe aortic stenosis, but it is currently associated with high costs. Therefore, the assessment of its economic impact becomes urgent to support decision-makers' choices about its use, patient access to treatment and reimbursement mechanisms.
Methods: A retrospective, observational, single-center (the teaching hospital located in Bologna, Italy) study was conducted.