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Coronary Artery Disease: HELP
Articles by Sergio Berti
Based on 15 articles published since 2008
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Between 2008 and 2019, Sergio Berti wrote the following 15 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline [SICI-GISE Position paper: Use of Absorb BVS in clinical practice]. 2016

Tarantini, Giuseppe / Saia, Francesco / Capranzano, Piera / Cortese, Bernardo / Mojoli, Marco / Boccuzzi, Giacomo / Cuculo, Andrea / Geraci, Salvatore / Mattesini, Alessio / Oreglia, Jacopo / Summaria, Francesco / Testa, Luca / Berti, Sergio / Esposito, Giovanni / La Manna, Alessio / Limbruno, Ugo / Marchese, Alfredo / Mauro, Ciro / Tarantino, Fabio / Salvi, Alessandro / Santoro, Gennaro / Varbella, Ferdinando / Violini, Roberto / Musumeci, Giuseppe. ·Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova. · Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna. · Dipartimento Cardiovascolare, Ospedale Ferrarotto, Università degli Studi, Catania. · Cardiologia Interventistica, A.O. Fatebenefratelli, Milano. · Cardiologia Interventistica, Azienda Sanitaria Locale Torino 2, Torino. · Dipartimento di Cardiologia, A.O. Ospedali Riuniti, Foggia. · Cardiologia Interventistica, Ospedale S. Giovanni di Dio, Agrigento. · Cardiologia Interventistica, Ospedale Moriggia Pelascini, Gravedona (CO). · Emodinamica, ASST Grande Ospedale Metropolitano Niguarda, Milano. · Dipartimento di Cardiologia, Policlinico Casilino, Roma. · Dipartimento di Cardiologia, IRCCS Policlinico S. Donato, S. Donato Milanese (MI). · U.O. Cardiologia Diagnostica ed Interventistica, Fondazione Toscana "Gabriele Monasterio", Ospedale del Cuore, Massa. · Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli. · U.O.C. Cardiologia, Azienda USL Toscana Sudest, Grosseto. · U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari. · Dipartimento Cardiovascolare, Ospedale Cardarelli, Napoli. · Laboratorio di Emodinamica, U.O. Cardiologia, Ospedale G.B. Morgagni-L. Pierantoni, Forlì. · Dipartimento Cardiovascolare, Ospedali Riuniti, Università degli Studi, Trieste. · Cardiologia Interventistica, AOU Careggi, Firenze. · Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO). · Cardiologia Interventistica, Ospedale S. Camillo-Forlanini, Roma. · Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo. ·G Ital Cardiol (Rome) · Pubmed #27729667.

ABSTRACT: Drug-eluting stents (DES) are the current gold standard for percutaneous treatment of coronary artery disease. However, DES are associated with a non-negligible risk of long-term adverse events related to persistence of foreign material in the coronary artery wall. In addition, DES implantation causes permanent caging of the native vessel, thus impairing normal vasomotricity and the possibility of using non-invasive coronary imaging or preforming subsequent bypass surgery. On the contrary, coronary bioresorbable stents (BRS) may provide temporary mechanical support to coronary wall without compromising the subsequent recovery of normal vascular physiology, and have the potential to prevent late adverse events related to permanent elements. Several types of BRS have been introduced into clinical practice in Europe or are being tested. However, most of available clinical data relate to a single BRS, the Absorb bioresorbable Vascular Scaffold (Absorb BVS) (Abbott Vascular, Santa Clara, CA). Despite encouraging clinical results, no societal guidelines are available on the use of BRS in clinical practice.A panel of Italian expert cardiologists assembled under the auspices of the Italian Society of Interventional Cardiology (SICI-GISE) for comprehensive discussion and consensus development, with the aim to provide recommendations on the use of bioresorbable stents in terms of clinical indications, procedural aspects, post-percutaneous coronary angioplasty pharmacologic treatment and follow-up. Based on current evidence and BRS availability in Italian cath-labs, the panel decided unanimously to provide specific recommendations for the Absorb BVS device. These recommendations do not necessarily extend to other BRS, unless specified, although significant overlap may exist with Absorb BVS, particularly in terms of clinical rationale.

2 Guideline [Position paper of the Italian Society of Invasive Cardiology (SICI-GISE) on indications for coronary angiography in patients with stable angina]. 2015

Marchese, Alfredo / Rossini, Roberta / Basile, Marco / Bedogni, Francesco / Danzi, Gian Battista / Musumeci, Giuseppe / Paradies, Valeria / Piccaluga, Emanuela / Sardella, Gennaro / Varbella, Ferdinando / Giordano, Arturo / Berti, Sergio / Anonymous8140844. ·U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari. · Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo. · Dipartimento di Cardiologia, IRCCS Policlinico San Donato, San Donato Milanese (MI). · U.O. Cardiologia, Ospedale Santa Corona, Pietra Ligure (SV). · Cardiologia 1-Emodinamica, A.O. Ospedale Niguarda Ca' Granda, Milano. · Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma, Roma. · Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO). · U.O.C. Cardiologia Interventistica, Clinica Pineta Grande, Castel Volturno (CE). · U.O. Cardiologia Diagnostica ed Interventistica, Fondazione Toscana "Gabriele Monasterio", Ospedale del Cuore, Massa. ·G Ital Cardiol (Rome) · Pubmed #26444218.

ABSTRACT: Available data suggest a steep increase in stable coronary artery disease with age. Its prevalence reaches a peak of almost 12-14% in men aged 65-84 years with an annual mortality ranging from 1.2% to 2.4%. The diagnosis of stable angina is primarily based on history and therefore relies on clinical judgment. In addition, its diagnosis can be extremely challenging because of the frequent transition from unstable to stable angina. Current European guidelines on the management of stable coronary artery disease give increased importance to the pre-test probability, which strongly affects the diagnostic algorithms. Imaging techniques play a greater role in the diagnosis of stable angina than in the past. Conversely, despite recent advances in technology and in the physiological assessment of coronary stenosis, an ever decreasing relevance is conferred to coronary angiography. Another difficult and controversial issue relates to the prognostic benefit of myocardial revascularization. The aim of this position paper is to review the most relevant clinical aspects of the European guidelines on the management of stable coronary artery disease.

3 Guideline Drug-coated balloon treatment of coronary artery disease: a position paper of the Italian Society of Interventional Cardiology. 2014

Cortese, Bernardo / Berti, Sergio / Biondi-Zoccai, Giuseppe / Colombo, Antonio / Limbruno, Ugo / Bedogni, Francesco / Cremonesi, Alberto / Silva, Pedro Leon / Sgueglia, Gregory A / Anonymous3690766. ·Interventional Cardiology, A.O. Fatebenefratelli Milano, Italy. ·Catheter Cardiovasc Interv · Pubmed #23934956.

ABSTRACT: Drug-coated balloons are a new tool for the treatment of patients with coronary artery disease. The main feature of this technology is a rapid and homogenous transfer of an antiproliferative drug (paclitaxel) to the vessel wall just at the time of balloon inflation, when neointimal proliferation, in response to angioplasty, is the highest. Moreover, drug-coated balloons share adjuntive advantages over stents: the absence of permanent scaffold and polymer, the respect of the original coronary anatomy, and limited inflammatory stimuli, thereby allowing for short-term dual antiplatelet therapy. To this day, a lot of devices are available in the market, with limited scientific data for the vast majority of them. Thus, the Italian scientific society of interventional cardiologists GISE decided to coordinate the efforts of a group of reknown experts on the field, in order to obtain a Position Paper on the correct use of drug-coated balloons in all the settings of coronary artery disease, giving a class of indication to each one, based on the clinical evidence. This Position Paper represents a quick reference for operators, investigators, and manufactures to promote the understanding and the correct use of the drug-coated balloon technology in everyday clinical practice.

4 Guideline [SICI-GISE position paper on drug-coated balloon use in the coronary district]. 2013

Cortese, Bernardo / Sgueglia, Gregory A / Berti, Sergio / Biondi-Zoccai, Giuseppe / Colombo, Antonio / Limbruno, Ugo / Bedogni, Francesco / Cremonesi, Alberto / Anonymous1860772. · ·G Ital Cardiol (Rome) · Pubmed #24121894.

ABSTRACT: Drug-coated balloons are a new tool for the treatment of patients with coronary artery disease. The main feature of this technology is a rapid and homogeneous transfer of an antiproliferative drug (paclitaxel) to the vessel wall just at the time of balloon inflation, when neointimal proliferation, in response to angioplasty, is the highest. Moreover, drug-coated balloons share adjunctive advantages over stents: the absence of permanent scaffold and polymer, the respect of the original coronary anatomy, and limited inflammatory stimuli, thereby allowing for short-term dual antiplatelet therapy. At present, a variety of devices are available in the market, with limited scientific data for the vast majority of them. Thus, the Italian Society of Interventional Cardiology (SICI-GISE) decided to coordinate the efforts of a group of renowned experts in this field, in order to produce a position paper on the correct use of drug-coated balloons in all settings of coronary artery disease, giving a class of indication to each one, based on clinical evidence. This position paper represents a quick reference for operators, investigators and manufacturers to promote the understanding and the correct use of the drug-coated balloon technology in everyday clinical practice.

5 Review A multidisciplinary consensus document on follow-up strategies for patients treated with percutaneous coronary intervention. 2015

Rossini, Roberta / Oltrona Visconti, Luigi / Musumeci, Giuseppe / Filippi, Alessandro / Pedretti, Roberto / Lettieri, Corrado / Buffoli, Francesca / Campana, Marco / Capodanno, Davide / Castiglioni, Battistina / Cattaneo, Maria Grazia / Colombo, Paola / De Luca, Leonardo / De Servi, Stefano / Ferlini, Marco / Limbruno, Ugo / Nassiacos, Daniele / Piccaluga, Emanuela / Raisaro, Arturo / Ravizza, PierFranco / Senni, Michele / Tabaglio, Erminio / Tarantini, Giuseppe / Trabattoni, Daniela / Zadra, Alessandro / Riccio, Carmine / Bedogni, Francesco / Febo, Oreste / Brignoli, Ovidio / Ceravolo, Roberto / Sardella, Gennaro / Bongo, Sante / Faggiano, Pompilio / Cricelli, Claudio / Greco, Cesare / Gulizia, Michele Massimo / Berti, Sergio / Bovenzi, Francesco / Anonymous3470811 / Anonymous3480811 / Anonymous3490811 / Anonymous3500811. ·Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italia. ·Catheter Cardiovasc Interv · Pubmed #25380511.

ABSTRACT: The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. Of note, clinical evaluations and non-invasive exams are often performed to low risk patients. In the present consensus document, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Three strategies follow-up have been defined and types and timing of clinical and instrumental evaluations are reported. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners, who are in charge to manage post-PCI patients, equally contributed to the creation of the present document.

6 Clinical Trial Osteopontin plasma levels and accelerated atherosclerosis in patients with CAD undergoing PCI: a prospective clinical study. 2011

Mazzone, Annamaria / Parri, Maria Serena / Giannessi, Daniela / Ravani, Marcello / Vaghetti, Marco / Altieri, Paola / Casalino, Laura / Maltinti, Maristella / Balbi, Manrico / Barsotti, Antonio / Berti, Sergio. ·Department of Cardiology, Heart Hospital, Fondazione Toscana G. Monasterio/CNR, Massa, Italy. mazzone@ifc.cnr.it ·Coron Artery Dis · Pubmed #21407077.

ABSTRACT: OBJECTIVES: Growing evidence supports the role played by inflammation in atherosclerosis. Identifying sensitive biomarkers is useful in predicting accelerated atherosclerosis. We investigated prospectively the relationship between plasma levels of inflammatory biomarkers [osteopontin, C-reactive protein (CRP), interleukin-6 (IL-6)] and instent restenosis, and rapid coronary plaque progression in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). METHODS: We studied 77 patients with CAD: 45 affected by unstable angina/non-ST elevation myocardial infarction [acute coronary syndrome (ACS)], and 32 by chronic coronary syndrome (CCS). Plasma osteopontin, IL-6, and CRP levels were measured before intervention in all patients; measurements were carried out on the basis of the following time course at 1,15, 30, 90, and 180 days follow-up in a subgroup of 39 consenting patients. Clinical and biohumoral data were correlated with baseline and 6-month PCI follow-up angiography. RESULTS: Osteopontin, IL-6, and CRP were higher in patients with ACS than in those with CCS (analysis of variance: P<0.001, 0.05, and 0.05, respectively). Baseline osteopontin levels proved to be associated with rapid coronary plaque progression (P=0.005) and instent restenosis (P=0.05). The highest osteopontin levels were found in patients with CAD with both rapid plaque progression and instent restenosis (P=0.003). PCI increased inflammatory markers acutely, and osteopontin remained elevated in patients with ACS. Patients with ACS showed a higher percentage (74%) of rapid plaque progression than those with CCS (26%) (P<0.05). CONCLUSION: The study prospectively shows the link between inflammatory status and accelerated atherosclerosis in patients with CAD undergoing PCI. The baseline and persistent rise of osteopontin is an expression of its contribution to the accelerated plaque progression, and therefore osteopontin may be a useful prognostic biomarker.

7 Article Usefulness of High-Sensitivity Cardiac Troponin T for the Identification of Outlier Patients With Diffuse Coronary Atherosclerosis and Low-Risk Factors. 2016

Magnoni, Marco / Masson, Serge / Andreini, Daniele / Moccetti, Tiziano / Modena, Maria Grazia / Canestrari, Mauro / Berti, Sergio / Casolo, Giancarlo / Gabrielli, Domenico / Marraccini, Paolo / Pontone, Gianluca / Latini, Roberto / Maggioni, Aldo Pietro / Maseri, Attilio / Anonymous4760861. ·Heart Care Foundation Onlus, Florence, Italy. Electronic address: magnoni.marco@tiscali.it. · Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. · Centro Cardiologico Monzino, Milan, Italy. · Servizio di Ricerca Cardiovascolare, Cardiocentro Ticino, Lugano, Switzerland. · Department of Cardiology, Ospedale Policlinico, Modena, Italy. · Department of Cardiology, Santa Croce Hospital, Fano, Italy. · Fondazione Toscana Gabriele Monasterio, Stabilimento di Massa, Unità Operativa Adult Cardiology, Massa, Italy. · Department of Cardiology, Nuovo Ospedale Versilia, Lido di Camaiore, Italy. · Department of Cardiology, Ospedale Civile A. Murri, Fermo, Italy. · Istituto di Fisiologia Clinica-Consiglio Nazionale delle Ricerche, Fondazione Toscana G. Monasterio, S.A. Emodinamica, Pisa, Italy. · Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy. · Heart Care Foundation Onlus, Florence, Italy. ·Am J Cardiol · Pubmed #26976791.

ABSTRACT: Novel high-sensitivity assay can detect very low levels of circulating cardiac troponin (hs-cTnT) in apparently healthy subjects. Within normal range, higher levels are associated with coronary artery disease (CAD) and cardiac abnormalities commonly associated to traditional risk factors (RFs) for CAD. Therefore, we investigated the relation between circulating hs-cTnT and CAD in patients with a spectrum of RF burden aiming to assess the added value of hs-cTnT to identify "outlier" patients with CAD despite a low RF burden. Hs-cTnT was measured in 525 stable patients without previous diagnosis of ischemic heart disease with 0 to 1 RF, excluded diabetes, (low-RF group, n = 263) or ≥2 RFs (multiple-RF group, n = 262) and without CAD (segment involvement score = 0) or diffuse CAD (segment involvement score >5) at coronary computed tomography angiography. Outlier patients with diffuse CAD despite low-RF burden had similar extent, severity, and plaque composition than patients with multiple RFs. Overall, hs-cTnT was measurable in 81% of patients with median value of 6.0 ng/L. In both groups, hs-cTnT concentration was higher in patients with CAD than in patients with normal coronary arteries (p <0.0001). Hs-cTnT was more accurate to detect patients with CAD in the low-RF group than in the multiple-RF group (p = 0.04). In multivariate analysis, higher level of hs-cTnT (>6 ng/L) was independently associated with CAD in low-RF group only. Despite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse CAD despite low-RF burden.

8 Article Self-expanding stent for complex percutaneous coronary interventions: A real life experience. 2016

Pastormerlo, Luigi Emilio / Ciardetti, Marco / Coceani, Michele / Trianni, Giuseppe / Ravani, Marcello / Vaghetti, Marco / Rizza, Antonio / De Caterina, Alberto / Berti, Sergio / Palmieri, Cataldo. ·Division of Interventional Cardiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa-Massa, Italy; Life Sciences Institute - Scuola Superiore Sant'Anna, Pisa, Italy. Electronic address: pastormerlo@ftgm.it. · Division of Interventional Cardiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa-Massa, Italy. ·Cardiovasc Revasc Med · Pubmed #26944852.

ABSTRACT: AIM: Self-expanding stents represent a re-emerging option for percutaneous coronary interventions. Their application covers a wide spectrum of angiographic situations, i.e., coronary bifurcations, acute coronary syndromes with large thrombotic burden and stenosis of ectatic coronaries. We review our experience with self-expanding stents for different clinical and angiographic indications, with long clinical follow-up. METHODS: From 2011 to 2013 we used self-expanding STENTYS® stents in 40 consecutive patients followed-up for death from any cause and from cardiovascular cause, myocardial infarction, target lesion revascularization (TLR), stent thrombosis (mean 21±13months). We also revised rate of procedural outcomes, acute stent thrombosis and TLR in patients treated with conventional stents for similar clinical/angiographic situations, in the same period at our institution. RESULTS: We identified three anatomical settings of STENTYS® use: coronary bifurcations with proximal/distal main branch diameter discrepancy (55% of cases), massive thrombotic burden in the setting of acute coronary syndrome (35% of cases) and stenosis of ectatic coronaries (15%). We observed one death related to acute heart failure and 1 case (2.5%) of acute stent thrombosis (2.5% in the control group). During follow-up 2 cases of stent restenosis leading to TLR (5%) occurred (6.25% in the control group). CONCLUSIONS: According to our real life experience, self-expanding STENTYS® stents appear to be an effective tool for different angiographic situations in which they may be preferable to balloon-expandable stents, showing a low rate of complications and good results at long term follow-up.

9 Article Coronary atherosclerosis in outlier subjects at the opposite extremes of traditional risk factors: Rationale and preliminary results of the Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation (CAPIRE) study. 2016

Magnoni, Marco / Andreini, Daniele / Gorini, Marco / Moccetti, Tiziano / Modena, Maria Grazia / Canestrari, Mauro / Berti, Sergio / Casolo, Giancarlo / Gabrielli, Domenico / Marraccini, Paolo / Pontone, Gianluca / Masson, Serge / Latini, Roberto / Maggioni, Aldo Pietro / Maseri, Attilio / Anonymous6040859. ·Heart Care Foundation Onlus, Florence, Italy. Electronic address: magnoni.marco@tiscali.it. · Department of Radiology, Centro Cardiologico Monzino, Milan, Italy. · ANMCO Research Center, Florence, Italy. · SRC, Cardiocentro Ticino, Lugano, Switzerland. · Department of Cardiology, Ospedale Policlinico, Modena, Italy. · Department of Cardiology, Santa Croce Hospital, Fano, Italy. · FTGM-Stabilimento di Massa, UO Adult Cardiology, Massa, Italy. · Department of Cardiology, Nuovo Ospedale Versilia, Lido di Camaiore, Italy. · Department of Cardiology, Ospedale Civile A. Murri, Fermo, Italy. · IFC CNR-Fondazione Toscana G. Monasterio, S.A. Emodinamica, Pisa, Italy. · Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. · Heart Care Foundation Onlus, Florence, Italy. ·Am Heart J · Pubmed #26920592.

ABSTRACT: Although it is generally accepted that cardiac ischemic events develop when coronary atherosclerosis (coronary artery disease [CAD]) has reached a critical threshold, this is true only to a first approximation. Indeed, there are patients with severe CAD who do not develop ischemic events; conversely, at the other extreme, individuals with minimal CAD may do. Similar exceptions to this paradigm include patients with diffuse CAD with a low risk factor (RF) profile and others with multiple RFs who develop only mild or no CAD. Therefore, the CAPIRE project was designed to investigate whether the specific study of these extreme outlier populations could provide clues for identification of yet unknown risk or protective factors for CAD and ischemic events. In the CAPIRE study, 481 subjects without previous symptoms or history of ischemic heart disease and normal left ventricular systolic function undergoing coronary computed tomography angiography have been selected based on coronary computed tomography angiography findings and cardiovascular RF profile. Therefore, in the whole population, 2 extreme outlier populations have been identified: (1) subjects with no CAD despite multiple RFs, and (2) at the opposite extreme, subjects with diffuse CAD despite a low-risk profile. Each subject has been characterized by clinical, anatomical imaging variables of CAD and baseline circulating biomarkers. Blood samples were collected and stored in a biological bank for further advanced investigations. The project is designed as a prospective, observational, international multicenter study with an initial cross-sectional analysis of clinical, imaging, and biomolecular variables in the selected groups and a longitudinal 5-year follow-up.

10 Article Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised controlled trials. 2015

Kowalewski, Mariusz / Schulze, Volker / Berti, Sergio / Waksman, Ron / Kubica, Jacek / Kołodziejczak, Michalina / Buffon, Antonino / Suryapranata, Harry / Gurbel, Paul Alfred / Kelm, Malte / Pawliszak, Wojciech / Anisimowicz, Lech / Navarese, Eliano Pio. ·Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany. · Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany. · Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany Department of Invasive Cardiology, Institute of Clinical Physiology, National Research Council, Pisa, Italy. · MedStar Washington Hospital Center, Washington, DC, USA. · Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland. · Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy. · Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. · Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland, USA. · Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland. ·Heart · Pubmed #26037102.

ABSTRACT: BACKGROUND: Current guidelines recommend culprit-only revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled trials (RCTs) demonstrates improved outcomes with complete MV-percutaneous coronary intervention (PCI). METHODS AND RESULTS: We performed a meta-analysis of RCTs comparing complete MV-PCI with non-complete MV-PCI in STEMI and MV disease. Complete MV-PCI was defined as revascularisation to non-infarct-related artery lesions during index procedure, non-complete MV-PCI-encompassed COR and staged approaches. Multiple databases and congress proceedings from major cardiovascular societies' meetings were screened for relevant studies. Primary endpoint was the composite of major adverse cardiac events (MACE) typically defined as death, recurrent myocardial infarction (MI) and repeat revascularisation. Secondary endpoints were cardiovascular mortality, recurrent MI and repeat revascularisation. Outcomes were analysed at longest available follow-up with differences accounted for with adjusted models by person-years. Seven RCTs (N=1303) were included. The median follow-up was 12 months. Complete MV-PCI reduced the odds of MACE compared with non-complete MV-PCI (OR (95% CIs) 0.59 (0.36 to 0.97), p=0.04) driven by reduction in recurrent MI (0.48 (0.27 to 0.85), p=0.01) and repeat revascularisation (0.51 (0.31 to 0.84), p=0.008). Complete MV-PCI was associated with a non-significant trend towards reduced cardiovascular mortality (0.54 (0.26 to 1.10), p=0.09) as well. In a sensitivity analysis, none of the baseline clinical variables significantly influenced overall estimates. CONCLUSIONS: In STEMI and MV disease, complete MV-PCI as compared with non-complete strategy reduces MACE by 41%, driven by a 52% reduction in recurrent MI and 49% reduction in repeat revascularisation.

11 Article In-vivo segmentation and quantification of coronary lesions by optical coherence tomography images for a lesion type definition and stenosis grading. 2014

Celi, Simona / Berti, Sergio. ·Scuola Superiore Sant'Anna, Heart Hospital, Massa, Italy; Fondazione CNR/Regione Toscana Gabriele Monasterio FTGM, Heart Hospital, Adult Cardiology Unit, Massa, Italy. Electronic address: s.celi@sssup.it. · Fondazione CNR/Regione Toscana Gabriele Monasterio FTGM, Heart Hospital, Adult Cardiology Unit, Massa, Italy. ·Med Image Anal · Pubmed #25077844.

ABSTRACT: Optical coherence tomography (OCT) is a catheter-based medical imaging technique that produces cross-sectional images of blood vessels. This technique is particularly useful for studying coronary atherosclerosis. In this paper, we present a new framework that allows a segmentation and quantification of OCT images of coronary arteries to define the plaque type and stenosis grading. These analyses are usually carried out on-line on the OCT-workstation where measuring is mainly operator-dependent and mouse-based. The aim of this program is to simplify and improve the processing of OCT images for morphometric investigations and to present a fast procedure to obtain 3D geometrical models that can also be used for external purposes such as for finite element simulations. The main phases of our toolbox are the lumen segmentation and the identification of the main tissues in the artery wall. We validated the proposed method with identification and segmentation manually performed by expert OCT readers. The method was evaluated on ten datasets from clinical routine and the validation was performed on 210 images randomly extracted from the pullbacks. Our results show that automated segmentation of the vessel and of the tissue components are possible off-line with a precision that is comparable to manual segmentation for the tissue component and to the proprietary-OCT-console for the lumen segmentation. Several OCT sections have been processed to provide clinical outcome.

12 Article A multicenter randomized trial comparing amphilimus- with paclitaxel-eluting stents in de novo native coronary artery lesions. 2012

Carrié, Didier / Berland, Jacques / Verheye, Stefan / Hauptmann, Karl Eugen / Vrolix, Mathias / Violini, Roberto / Dibie, Alain / Berti, Sergio / Maupas, Eric / Antoniucci, David / Schofer, Joachim. ·Service de Cardiologie, Centre Hospitalier Universitaire Rangueil, Toulouse, France. carrie.didier@chu-toulouse.fr ·J Am Coll Cardiol · Pubmed #22284328.

ABSTRACT: OBJECTIVES: This study sought to demonstrate the noninferiority of polymer-free amphilimus-eluting stents (Cre8, CID, Saluggia, Italy) versus permanent-polymer paclitaxel-eluting stents (Taxus Liberté, Boston Scientific, Natick, Massachusetts) in de novo percutaneous coronary intervention. BACKGROUND: Although the efficacy of the drug-eluting stent has been well established, the risk-benefit balance is still suboptimal, and the safety of polymers remains uncertain. METHODS: Patients undergoing percutaneous coronary intervention for de novo lesions were randomly assigned 1:1 to Cre8 or Taxus Liberté stents. Primary endpoint was 6-month angiographic in-stent late lumen loss (LLL) within a noninferiority scope. Six-month intravascular ultrasound was performed in 20% of the patients. All patients will be clinically followed up to 5 years. RESULTS: Out of 323 patients enrolled, 162 received Cre8 and 161 Taxus Liberté stents. In-stent LLL was significantly lower in Cre8 group (0.14 ± 0.36 mm vs. 0.34 ± 0.40 mm, p noninferiority <0.0001, p superiority <0.0001). Clinical endpoints (cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis) up to 12 months did not differ significantly between the groups. CONCLUSIONS: The Cre8 stent in de novo lesions showed significantly lower in-stent LLL at 6 months than the Taxus Liberté stent did, with a trend toward better 12-month clinical safety and efficacy results. (International Randomized Comparison Between DES Limus Carbostent and Taxus Drug-Eluting Stents in the Treatment of De Novo Coronary Lesions [NEXT]; NCT01373502).

13 Article Reduced antiplatelet therapy after drug-eluting stenting: multicenter Janus Flex carbostent implantation with short dual antiplatelet treatment for 2 or 6 months-MATRIX study. 2012

Cassese, Salvatore / De Luca, Giuseppe / Villari, Bruno / Berti, Sergio / Bellone, Pietro / Alfieri, Alfonso / Montinaro, Antonio / Quaranta, Gaetano / Marraccini, Paolo / Piscione, Federico / Anonymous4160699. ·Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University of Naples, Italy. ·Catheter Cardiovasc Interv · Pubmed #21735531.

ABSTRACT: OBJECTIVES: The Multicentre registry with Antiplatelet TReatment two-sIX months (MATRIX) evaluated safety and efficacy at 12-month follow-up of Janus Flex stenting with 2- or 6-month dual antiplatelet therapy (DAT) period. BACKGROUND: There are no data of Janus Flex stent (Carbostent and Implantable Devices-CID, Saluggia, Italy), a polymer-free, tacrolimus-eluting coronary stent, followed by short-term DAT, in daily practice. METHODS: Patients were prospectively enrolled at 12 high-volume procedures centres. After stenting, four sites prescribed 2-month DAT, eight sites 6-month DAT. Major adverse cardiac events (MACE) and stent thrombosis (ST) rate was evaluated at 12-month follow-up, for entire population, as well as for 2- and 6-month DAT groups, distinctly. MACE included cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). RESULTS: From March 2007 to June 2008, 572 patients (mean age 64.91 ± 11 years, 77.45% males) were enrolled. After successful stenting, 12-month follow-up showed a 12.74% MACE occurrence (cardiac death 0.98%; MI 3.13%; TLR 8.62%), with good Janus Flex safety profile confirmed by only two (0.39%) ST. After adjustment for potential confounding, no significant differences were noted at 12-month follow-up among 2- or 6-month DAT groups (MACE-8.99% versus 12.47%, P = 0.16; cardiac death-0.54% versus 1.14%, P = 0.52; MI-2.38% versus 2.71%, P = 0.83; TLR-5.66% versus 10.60%, P = 0.20; ST-0% versus 0.55%, P = 0.99). At multivariable analysis, DAT time duration was not an independent risk factor for adverse events (adjusted HR 0.47, 95% confidence interval 0.16-1.35, P = 0.16). CONCLUSIONS: Janus Flex coronary stenting, followed by short DAT, is safe and feasible, without differences between 2- and 6-month DAT groups. A randomized trial confirming these encouraging data is needed.

14 Article Diabetic and nondiabetic patients with left main and/or 3-vessel coronary artery disease: comparison of outcomes with cardiac surgery and paclitaxel-eluting stents. 2010

Banning, Adrian P / Westaby, Stephen / Morice, Marie-Claude / Kappetein, A Pieter / Mohr, Friedrich W / Berti, Sergio / Glauber, Mattia / Kellett, Mirle A / Kramer, Robert S / Leadley, Katrin / Dawkins, Keith D / Serruys, Patrick W. ·Cardiology Department, John Radcliffe Hospital, Oxford, UK. adrian.banning@orh.nhs.uk ·J Am Coll Cardiol · Pubmed #20079596.

ABSTRACT: OBJECTIVES: This study was designed to compare contemporary surgical revascularization (coronary artery bypass graft surgery [CABG]) versus TAXUS Express (Boston Scientific, Natick, Massachusetts) paclitaxel-eluting stents (PES) in diabetic and nondiabetic patients with left main and/or 3-vessel disease. BACKGROUND: Although the prevalence of diabetes mellitus is increasing, the optimal coronary revascularization strategy in diabetic patients with complex multivessel disease remains controversial. METHODS: The SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) study randomly assigned 1,800 patients (452 with medically treated diabetes) to receive PES or CABG. RESULTS: The overall 1-year major adverse cardiac and cerebrovascular event rate was higher among diabetic patients treated with PES compared with CABG, but the revascularization method did not impact the death/stroke/myocardial infarction rate for nondiabetic patients (6.8% CABG vs. 6.8% PES, p = 0.97) or for diabetic patients (10.3% CABG vs. 10.1% PES, p = 0.96). The presence of diabetes was associated with significantly increased mortality after either revascularization treatment. The incidence of stroke was higher among nondiabetic patients after CABG (2.2% vs. PES 0.5%, p = 0.006). Compared with CABG, mortality was higher after PES use for diabetic patients with highly complex lesions (4.1% vs. 13.5%, p = 0.04). Revascularization with PES resulted in higher repeat revascularization for nondiabetic patients (5.7% vs. 11.1%, p < 0.001) and diabetic patients (6.4% vs. 20.3%, p < 0.001). CONCLUSIONS: Subgroup analyses suggest that the 1-year major adverse cardiac and cerebrovascular event rate is higher among diabetic patients with left main and/or 3-vessel disease treated with PES compared with CABG, driven by an increase in repeat revascularization. However, the composite safety end point (death/stroke/myocardial infarction) is comparable between the 2 treatment options for diabetic and nondiabetic patients. Although further study is needed, these exploratory results may extend the evidence for PES use in selected patients with less complex left main and/or 3-vessel lesions. (SYNergy Between PCI With TAXus and Cardiac Surgery [SYNTAX]; NCT00114972).

15 Minor Superficial coronary calcium analysis by OCT: looking forward an imaging algorithm for an automatic 3D quantification. 2013

Celi, Simona / Vaghetti, Marco / Palmieri, Cataldo / Berti, Sergio. ·Scuola Superiore Sant'Anna, "G. Pasquinucci" Heart Hospital, Massa, Italy; Fondazione Gabriele Monasterio CNR-Toscana, "G. Pasquinucci" Heart Hospital, Massa, Italy. Electronic address: s.celi@sssup.it. ·Int J Cardiol · Pubmed #23611743.

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