Publications by authors named "Raffaele De Caterina"

Over the past decades, there have been great advancements in the antithrombotic management of patients undergoing percutaneous interventions, but most of the available evidence derives from studies conducted in the setting of cardiac interventions. Antithrombotic treatment regimens used in patients undergoing percutaneous cardiac interventions, in particular coronary, are frequently extrapolated to patients undergoing noncardiac interventions. However, the differences in risk profile of the population treated and the types of interventions performed may translate into differences is the safety and efficacy associated with antithrombotic therapy.

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Background: The prospective, single-arm, observational, phase 4 ETNA-AF Europe study collected real-world data about safety, effectiveness and therapeutic adherence in European patients with non-valvular atrial fibrillation newly prescribed with edoxaban and followed up for 4 years.

Methods: Overall, 13 164 patients were included in the full-analysis set, which means that they had at least one documentation after baseline at 4 years. The current paper reports about the 3329 Italian patients out of the whole European population.

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Article Synopsis
  • Cardiac sarcoidosis is a complex condition that can mimic other diseases, making diagnosis difficult and requiring careful evaluation and imaging techniques.
  • A case study highlights a patient with cardiac sarcoidosis who also had coronary artery disease and colon cancer, illustrating the need to consider multiple potential diagnoses.
  • Late gadolinium enhancement is important for assessing arrhythmic risk and guiding treatment, emphasizing that clinical scenarios shouldn't be oversimplified by focusing solely on one condition.
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In the period of increasing prevalence of metabolic disorders such as obesity and diabetes, healthcare professionals are facing significant challenges. Therefore, an accurate global assessment of insulin resistance is of utmost importance. Current medical research is focused on identifying an easily accessible and reproducible gold-standard surrogate marker for insulin resistance.

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Antithrombotic therapy after cardiac percutaneous interventions is key for the prevention of thrombotic events but is inevitably associated with increased bleeding, proportional to the number, duration, and potency of the antithrombotic agents used. Bleeding complications have important clinical implications, which in some cases may outweigh the expected benefit of reducing thrombotic events. Because the response to antithrombotic agents varies widely among patients, there has been a relentless effort toward the identification of patients at high bleeding risk (HBR), in whom modulation of antithrombotic therapy may be needed to optimize the balance between safety and efficacy.

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With the increasing burden of diabetes as a cause of macro- and microvascular disease linked to the epidemics of obesity, attention is being paid to dysglycaemic states that predict and precede the development of type 2 diabetes. Such conditions, termed pre-diabetes, are characterized by fasting plasma glucose, or plasma glucose levels on an oral glucose tolerance test, or values of glycated haemoglobin intermediate between 'normal' values and those characterizing diabetes. These last are by definition associated, in epidemiological terms, with a higher incidence of microvascular disease-mostly retinopathy.

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Mendelian Randomization (MR) studies have emerged as a powerful tool for investigating causal relationships between modifiable risk factors and clinical outcomes, using genetic variants as instrumental variables. In the context of vitamin D research, MR is a promising approach to elucidate the effects of vitamin D on various health outcomes, including adverse cardiovascular events. However, the validity of MR analyses relies heavily on the strength of the genetic associations found.

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Article Synopsis
  • - *This study investigates myocardial T1 and T2 values in patients with beta-thalassemia intermedia (β-TI) to understand the heart's condition in these patients using advanced imaging techniques.* - *A total of 42 β-TI patients and 42 matched healthy volunteers participated, with measurements focusing on left ventricular T2* values, T1 and T2 mapping, ejection fractions, and myocardial fibrosis presence.* - *Results show that β-TI patients have higher LV T2 values compared to healthy individuals and higher LV T1 values than those with thalassemia major, with certain factors like gender and transfusion history influencing these values.*
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Background: Stroke prevention with direct-acting oral anticoagulant agents in patients with atrial fibrillation confers a risk of bleeding and limits their use. Asundexian, an activated factor XI (XIa) inhibitor, is an oral anticoagulant that may prevent strokes with less bleeding.

Methods: In a phase 3, international, double-blind trial, we randomly assigned high-risk patients with atrial fibrillation in a 1:1 ratio to receive asundexian at a dose of 50 mg once daily or standard-dose apixaban.

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Background: While surgery still remains the gold standard treatment for mechanical prosthetic valve thrombosis (MPVT) by many guidelines, the ultraslow low-dose thrombolytic regimen has been reported as a promising alternative.

Methods: In this prospective single-center cohort, patients with acute MPVT were treated with an ultraslow low-dose thrombolytic regimen consisting of 25 mg infusion of recombinant tissue-type plasminogen activator (rtPA) over 25 h. The regimen could be repeated in case of failure until resolution/occurrence of adverse events or a maximum cumulative dose of 150 mg.

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Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischaemia, various classifications have emerged over time, often with conflicting terminology-e.g.

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Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischemia, various classifications have emerged over time, often with conflicting terminology-eg, "stable coronary artery disease" (CAD), "stable ischemic heart disease," and "chronic coronary syndromes" (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with "acute coronary syndromes" (ACS), the 2023 American guidelines endorsed the alternative term "chronic coronary disease.

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Article Synopsis
  • Empagliflozin (EMPA) is a medicine that helps heart function and might reduce heart problems caused by another drug called Ponatinib (PON).
  • In experiments with mice, using EMPA alongside PON showed improvements in heart health compared to just using PON alone.
  • The study suggests that EMPA helps protect the heart by fixing important proteins (called connexins) that are crucial for keeping heart cells healthy.
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Background: Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known.

Methods: We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS.

Results: Among 270 patients admitted for ACS (mean age 67 years, 80% males), 41 (15%) had an ABI ≤0.

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  • Multivessel coronary artery disease affects about half of acute coronary syndrome patients and carries a higher risk of complications compared to single-vessel disease, emphasizing the need for thorough treatment.
  • Research indicates that complete revascularization (treating all affected vessels) is better than just addressing the main problem area, but there's limited evidence for a combined approach (PCI followed by CABG).
  • Challenges arise with dual antiplatelet therapy management before CABG surgery, with possible strategies including timing surgery after safely stopping the therapy or using short-acting antithrombotic agents, along with minimally invasive techniques to reduce bleeding risks.
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  • The optimal management of patients with atrial fibrillation (AF) requiring oral anticoagulation (OAC) during percutaneous coronary intervention (PCI) is debated, with current guidelines suggesting a temporary triple therapy regimen that includes aspirin, which raises bleeding risks.
  • A new study, the WOEST-3 trial, seeks to compare a 30-day dual antiplatelet therapy (DAPT) strategy that temporarily omits OAC against guideline-directed therapy post-PCI for AF patients, aiming to reduce bleeding without sacrificing efficacy.
  • With a sample of 2,000 patients, the trial will evaluate the rates of major bleeding and adverse ischemic events, making it the first randomized controlled trial to explore the omission of OAC
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