Sara Giolitto

Ospedale di Rivoli

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Emanuele Tizzani

Ospedale degli Infermi

Francesco Tomassini

Ospedale San Luigi Gonzaga

Ferdinando Varbella

Ospedale San Luigi Gonzaga

Antonella Corleto

Ospedale di Rivoli

Enrico Cerrato

Ospedale San Luigi Gonzaga

Andrea Gagnor

Ospedale Maria Vittoria

Giorgio Quadri

Ospedale di Rivoli

Matteo Bianco

Ospedale San Luigi Gonzaga

Cristina Rolfo

Ospedale degli Infermi

Luca Lo Savio

Ospedale di Rivoli

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Ospedale degli Infermi

Ospedale San Luigi Gonzaga

University of Turin

Ospedale di Rivoli

Ospedale Maggiore

Gonzaga University

Ospedale Santa Corona

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Istituti di Ricovero e Cura a Carattere Scientifico

Hospital Clínico San Carlos

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Acute interventional management of spontaneous coronary artery dissection: case series and literature review

Global Cardiology (2024)

Enrico Cerrato Ilaria Meynet Giorgio Quadri Federico Giacobbe Cristina Rolfo

Spontaneous coronary artery dissection (SCAD) treatment is currently a matter of debate as scarce data are available for the interventional cardiologists. In the present review, we introduce 4 representative clinical scenarios in which different interventional strategies were carried out. Subsequently, we discuss different tools and useful techniques for the treatment of SCAD, presenting the advantages and drawbacks of the conservative approach versus percutaneous coronary intervention with drug eluting stent or bioresorbable scaffolds implantation, and/or cutting balloon angioplasty.

Artery dissection

10.4081/cardio.2024.22

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Citations (1)

Chronic total occlusion treatment as a health insurance

Journal of Cardiovascular Medicine (2012)

Andrea Gagnor Francesco Tomassini Nicolò Montali Emanuele Tizzani Sara Giolitto

Gagnor, Andrea; Tomassini, Francesco; Montali, Nicolò; Tizzani, Emanuele; Giolitto, Sara; Infantino, Vincenzo; Favro, Elisa; Varbella, Ferdinando Author Information

10.2459/jcm.0b013e3283528fcb

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REC interventional cardiology (English Edition) (2019)

Francesco Tomassini Enrico Cerrato Cristina Rolfo Matteo Bianco Luca Lo Savio

Introduction and objectives:Female sex is believed to be a significant risk factor for mortality among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI).Methods: We collected data on all consecutive STEMI patients treated with pPCI within 12 hours and compared the males vs the females.The primary endpoint was long-term mortality one month after hospital discharge.The secondary endpoint was 30-days mortality.Results : From March 2006 to December 2016, 1981 patients underwent pPCI at our hospital, 484 (24.4%) were females.Compared with men, women were older (mean age 71.3 ± 11.6 vs 62.9 ± 11.8 years, P < .001),less smokers (26.7% vs 72.7%; P < .001),more diabetic (28.0%vs 22.3%; P < .002),more hypertensive (69.6% vs 61.3%; P < .001),presented more often with shock at baseline (13.2% vs 9.0%; P = .006),had longer symptoms-to-balloon time frames (5.36 ± 3.97 vs 4.47 ± 3.67 hours; P < .001).Also, women were less likely to receive glycoprotein IIb-IIIa inhibitors (59.5% vs 71.4%; P < .001)and stents (79.5% vs 86.6%; P = .01).During the 30-day and long-term follow-up (mean 4.9 ± 3.2 years) the female sex was associated with a higher mortality rate (8.9% vs 4.0%, P < .001and 23.8% vs 18.4%, P = .01,respectively).After propensity score matching, 379 men and 379 women were selected.Female sex continued to be associated with a higher death rate at 30 days (9.5% vs 5.5%; P = .039)but not in the long term among survivors (25.6% vs 21.4%; P = .170).Conclusions: Compared to men, women with STEMI undergoing pPCI had higher 30-day mortality rates.However, among survivors, the long-term mortality rate was similar.Even if residual confounding cannot be ruled out, this difference in the outcomes may be partially explained by biological sex-related differences.

10.24875/recice.m19000061

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P489 A VERY DIFFICULT PATIENT

European Heart Journal Supplements (2023)

Antonella Corleto Sara Giolitto F Varbella

Abstract 68–year–old woman, normal weight, dyslipidemic, with family history of ischemic heart disease. Hypothyroidism in treatment. Peripheral vascular disease: bilateral carotid artery disease. She reported adverse effects on muscle (pain with rise in CPK) and on liver (ALT elevation clinically relevant) during simvastatin/ezetimib 10/10 mg taking March 2020 hospitalized for myocardial infarction without ST–segment elevation. Coronary angiography revealed three–vessel disease with subocclusive stenosis of the medium tract of circumflex, medium tract of anterior descending and medium tract of right coronary artery, all treated with angioplasty and drug–eluting stents. Preserved left ventricular ejection fraction on echocardiograpy. Blood LDL 216 mg/dl so we started therapy with Evolocumab 140 mg every 15 days. After 6 months of therapy LDL was 137 mg/dl. Non–target LDL values so Evolocumab 140mg was stopped and Alirocumab 150 mg started. January 2021 hospitalized for suspected recurrence angina. Coronary angiography unchanged. LDL 194 mg/dl so ezetimib 10 mg was associated to alirocumab (statin intolerance). September 2022 cardiology visit for alirocumab PT renewal. LDL 92 mg/dl. Patient wanted to stop PCSK9 inhibitory monoclonal antibodies therapy due to intolerance to drug self–administration. For this reason, we suggested Inclisiran 300 mg administration in association with ezetimibe 10 mg. The administration took place in cardiology outpatient clinic with patient satisfaction. At one month, dosage LDL 78 mg/dl, at 3 months LDL 72 mg/dl. Conclusions The innovative mechanism of action, with only two administrations per year, and the healthcare professional administration, allow Inclisiran to obtain a rapid and sustained LDL reduction over time even in conditions of poorly adherent patients to lipid–lowering therapies. Inclisiran is the first siRNA that reduces LDL levels by silencing the mRNA of the PCSK9 protein, involved in the degradation of R–LDL receptors on hepatocytes. Inclisiran allows, in combination with statin and ezetimib, to reach the target levels of LDL–C with two administrations a year. We wait for LDL value in the coming months to confirm its effectiveness over time.

Alirocumab

Evolocumab

Unstable angina

10.1093/eurheartjsupp/suad111.550

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Primary angioplasty in ST-elevation myocardial infarction due to unprotected left-main coronary disease in a high-volume catheterization center without on-site surgery facilities: immediate and medium-term outcome: the STEMI-Placet Registry.

PubMed (2012)

Andrea Gagnor Francesco Tomassini Enrico Romagnoli Nicolò Montali Sara Giolitto

Very few data have been published for ST-elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) and very little is known about the results in this subgroup of patients in a hospital with high-volume catheterization laboratories (cath labs) without on-site cardiosurgery.From January 2004 to December 2009, a total of 38 patients with evolving STEMI and ULMCA as the culprit lesion treated with primary angioplasty were enrolled in our registry. Despite dramatic clinical presentation (73.7% cardiogenic shock, 15.8% cardiac arrest and resuscitation maneuvers, 81.6% additive EuroSCORE >13, and 89.5% distal bifurcation involvement), angiographic success was obtained in 84.2% and final TIMI 3 flow was achieved in 34 (89.5%), while target lesion failure occurred in 47.4% (mostly [42.1%] during the in-hospital phase). Most of the patients discharged from hospital had no events at follow-up (47.4%), and notably no target lesion revascularization was required during the follow-up phase.Primary angioplasty in patients presenting with ULMCA as the culprit lesion in a STEMI setting appears to be technically feasible and a good alternative to surgical revascularization. Mortality in this group of patients tends to be high, but lower than mortality of untreated patients; the majority of events are concentrated during the in-hospital phase. Procedural delay related to activation of operator's staff in off-duty hours doesn't correlate with a worse prognosis.

TIMI

Cardiac catheterization

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Management of aspirin intolerance in patients undergoing percutaneous coronary intervention. The role of mono-antiplatelet therapy: a retrospective, multicenter, study

Minerva Cardioangiologica (2019)

Matteo Bianco Carol Gravinese Enrico Cerrato Iván J. Núñez‐Gil P. Destefanis

The optimal management of patients with aspirin intolerance undergoing stent implantation represents a challenge for physicians. The aim of this study was to assess the overall number of patients discharged with mono antiplatelet therapy after percutaneous coronary intervention (PCI). The most frequent aspirin intolerance symptoms in this population and the overall incidence of patient-oriented composite endpoints (POCE).From January 2006 to June 2016 all patients discharged with mono-antiplatelet therapy because of aspirin intolerance/hypersensitivity/allergy and treated by means of PCI were included. Data about percutaneous treatments and aspirin intolerance were collected. POCE were evaluated at a twelve-month clinical follow-up comparing safety and efficacy of clopidogrel monotherapy versus new P2Y12 inhibitors.We collected 70 patients, that is 0.3% of the total amount of PCI in the considered period, 25 (35%) of them were women and the remaining 45 (65%) were men. An acute coronary syndrome (ACS) was the clinical presentation in 47 (67.1%) patients, with NSTEMI in 19 (27.1%) of them. Forty-six patients (65.7%) were treated with clopidogrel and 24 (34.3%) with new P2Y12 inhibitors. At one-year follow-up, 18 (25.7%) patients suffered a new clinically relevant adverse event, 5 (7.1%) died, 3 (4.3%) required a target vessel revascularization and 10 (14.3%) patients a target lesion revascularization.Our study evaluated patients with ACS or stable coronary artery disease undergoing PCI and treated with mono-antiplatelet therapy with P2Y12 inhibitors due to aspirin intolerance shows a 25% incidence of POCE at one year. Further studies with adequate sample size are required to evaluate the efficacy and safety of mono antiplatelet therapy in this clinical scenario.

10.23736/s0026-4725.19.04787-x

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Unprotected Left-Main Coronary Angioplasty in the Elderly in a High Volume Catheterization Centre without On-Site Surgery Facilities: Immediate and Medium Term Outcome—The Old-Placet Registry

Advances in Vascular Medicine (2015)

Andrea Gagnor Francesco Tomassini Enrico Cerrato Cristina Rolfo Alfonso Gambino

We aim to assess clinical feasibility and efficacy of unprotected left main (ULM) percutaneous coronary intervention (PCI) in patients older than 75 years over a 6-year period and with 2-year follow-up demonstrating that PCI is a feasible revascularization strategy even in absence of on-site cardiothoracic support. Nevertheless, the outcome of these high-risk patients is still hampered by a sensible in-hospital mortality rate. Older patients have a higher mortality at follow-up (10.0 versus 0.8%, P = 0.014), while younger patients have a low mortality after the acute phase (15.7 versus 8.4%, P = 0.15).

Cardiac catheterization

10.1155/2015/751293

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Antegrade trapping balloon technique to increase support in percutaneous treatment of ‘uncrossable’ lesions

Journal of Cardiovascular Medicine (2011)

Andrea Gagnor Francesco Tomassini Paolo Giay Pron Sara Giolitto Ferdinando Varbella

We describe an antegrade trapping technique to increase support for stent delivery in calcified and tortuous vessels.

10.2459/jcm.0b013e32834ba0bc

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Diferencias relacionadas con el sexo en pacientes con IAMCEST: an�lisis por puntuaci�n de propensi�n

REC, Interventional cardiology (2019)

Francesco Tomassini Enrico Cerrato Cristina Rolfo M. Bianco Luca Lo Savio

RESUMENIntroducción y objetivos: El sexo femenino se considera un importante factor de riesgo de mortalidad en el infarto agudo de miocardio con elevación del segmento ST (IAMCEST) tratado con intervención coronaria percutánea primaria (ICPp).Métodos: Se analizó a todos los pacientes consecutivos con IAMCEST tratados con ICPp dentro de las primeras 12 horas, y se compararon varones y mujeres.El objetivo principal fue la mortalidad a largo plazo en los supervivientes después del primer mes del alta, y el objetivo secundario fue la mortalidad a los 30 días.Resultados: Desde marzo de 2006 hasta diciembre de 2016 se trató con ICPp a 1.981 pacientes, de los cuales 484 (24,4%) eran mujeres.En comparación con los varones, las mujeres tenían mayor edad (edad media 71,3 ± 11,6 frente a 62,9 ± 11,8 años, p < 0,001) y la frecuencia de fumadoras era más baja (26,7 frente a 72,7%; p < 0,001), mientras que era más alta la frecuencia de diabetes (28,0 frente a 22,3%; p < 0,002), hipertensión arterial (69.6 frente a 61,3%, p < 0,001) y shock al ingreso (13,2 frente a 9,0%; p = 0,006), y más largo el tiempo desde el comienzo de los síntomas hasta la intervención con balón (5,36 ± 3,97 frente a 4,47 ± 3,67 horas; p < 0,001).Además, la frecuencia de tratamiento con inhibidores de la glucoproteína IIb-IIIa (59,5 frente a 71,4%; p < 0,001) y stent (79,5 frente a 86,6%, p = 0,01) fue inferior.Tanto a los 30 días como a largo plazo (media 4,9 ± 3,2 años), el sexo femenino se asoció con una mortalidad más alta (8,9 frente a 4,0%, p < 0,001, y 23,8 frente a 18,4%, p = 0,01, res pectivamente).Se seleccionaron 379 mujeres y 379 varones emparejados por puntuación de propensión.Se mantuvo la asociación entre sexo femenino y mayor mortalidad a los 30 días (9,5 frente a 5,5%; p = 0,039), pero no a largo plazo (25,6 frente a 21,4%; p = 0,170).Conclusiones: En comparación con los varones, las mujeres con IAMCEST tratadas con ICPp tuvieron mayor mortalidad a los 30 días.Sin embargo, entre los supervivientes, la mortalidad a largo plazo fue similar.Aunque no puede descartarse el efecto de variables residuales de confusión, las diferencias en el pronóstico podrían explicarse en parte por diferencias biológicas relacionadas con el sexo.Palabras clave: Infarto agudo de miocardio con elevación del segmento ST.Angioplastia

10.24875/recic.m19000072

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TCT-61 Gender-related Differences in 30-day Mortality Among Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Angioplasty

Journal of the American College of Cardiology (2014)

Francesco Tomassini Andrea Gagnor Alfonso Gambino Mario Bollati Emanuele Tizzani

Elevation (ballistics)

10.1016/j.jacc.2014.07.085

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