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Coronary Artery Disease: HELP
Articles by Giuseppe G. L. Biondi-Zoccai
Based on 85 articles published since 2008
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Between 2008 and 2019, G. Biondi Zoccai wrote the following 85 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 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.

2 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.

3 Editorial Hybrid invasive coronary imaging with intravascular ultrasound and optical coherence tomography: Informing research and guiding practice. 2018

Gatto, Laura / Prati, Francesco / Biondi-Zoccai, Giuseppe / Giordano, Arturo. ·Division of Cardiology, S. Giovanni-Addolorata Hospital, Rome, Italy; Centro Per La Lotta Contro L'Infarto, Rome, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. Electronic address: giuseppe.biondizoccai@uniroma1.it. · Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy; Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy. ·Int J Cardiol · Pubmed #30017515.

ABSTRACT: -- No abstract --

4 Editorial Non-HDL-C vs. LDL-C in Predicting the Severity of Coronary Atherosclerosis. 2016

Roever, Leonardo / Biondi-Zoccai, Giuseppe / Chagas, Antonio Carlos Palandri. ·Federal University of Uberlândia, Department of Clinical Research, Uberlândia, Brazil. Electronic address: leonardoroever@hotmail.com. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzill, Italy. · Heart Institute (InCor), HCFMUSP- University of São Paulo Medical School, São Paulo, Brazil; Faculty of Medicine ABC, Santo André, Brazil. ·Heart Lung Circ · Pubmed #27432736.

ABSTRACT: -- No abstract --

5 Editorial Duplicate meta-analyses on coronary bifurcation strategies: when more is less? 2010

Biondi-Zoccai, Giuseppe. · ·EuroIntervention · Pubmed #20597192.

ABSTRACT: -- No abstract --

6 Editorial Last nail in the coffin of late lumen loss? 2008

Biondi-Zoccai, Giuseppe G L / Agostoni, Pierfrancesco / Sheiban, Imad. · ·EuroIntervention · Pubmed #19112773.

ABSTRACT: -- No abstract --

7 Review What We Have Learned from the Recent Meta-analyses on Diagnostic Methods for Atherosclerotic Plaque Regression. 2018

Biondi-Zoccai, Giuseppe / Mastrangeli, Simona / Romagnoli, Enrico / Peruzzi, Mariangela / Frati, Giacomo / Roever, Leonardo / Giordano, Arturo. ·Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy. giuseppe.biondizoccai@uniroma1.it. · Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. giuseppe.biondizoccai@uniroma1.it. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy. · Division of Cardiology, S. Giovanni Hospital, Rome, Italy. · Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil. · Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy. · Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy. ·Curr Atheroscler Rep · Pubmed #29344739.

ABSTRACT: PURPOSE OF REVIEW: Atherosclerosis has major morbidity and mortality implications globally. While it has often been considered an irreversible degenerative process, recent evidence provides compelling proof that atherosclerosis can be reversed. Plaque regression is however difficult to appraise and quantify, with competing diagnostic methods available. Given the potential of evidence synthesis to provide clinical guidance, we aimed to review recent meta-analyses on diagnostic methods for atherosclerotic plaque regression. RECENT FINDINGS: We identified 8 meta-analyses published between 2015 and 2017, including 79 studies and 14,442 patients, followed for a median of 12 months. They reported on atherosclerotic plaque regression appraised with carotid duplex ultrasound, coronary computed tomography, carotid magnetic resonance, coronary intravascular ultrasound, and coronary optical coherence tomography. Overall, all meta-analyses showed significant atherosclerotic plaque regression with lipid-lowering therapy, with the most notable effects on echogenicity, lipid-rich necrotic core volume, wall/plaque volume, dense calcium volume, and fibrous cap thickness. Significant interactions were found with concomitant changes in low density lipoprotein cholesterol, high density lipoprotein cholesterol, and C-reactive protein levels, and with ethnicity. Atherosclerotic plaque regression and conversion to a stable phenotype is possible with intensive medical therapy and can be demonstrated in patients using a variety of non-invasive and invasive imaging modalities.

8 Review Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients. 2017

D'Ascenzo, Fabrizio / Iannaccone, Mario / Saint-Hilary, Gaelle / Bertaina, Maurizio / Schulz-Schüpke, Stefanie / Wahn Lee, Cheol / Chieffo, Alaide / Helft, Gerard / Gili, Sebastiano / Barbero, Umberto / Biondi Zoccai, Giuseppe / Moretti, Claudio / Ugo, Fabrizio / D'Amico, Maurizio / Garbo, Roberto / Stone, Gregg / Rettegno, Sara / Omedè, Pierluigi / Conrotto, Federico / Templin, Christian / Colombo, Antonio / Park, Seung-Jung / Kastrati, Adnan / Hildick-Smith, David / Gasparini, Mauro / Gaita, Fiorenzo. ·Department of Cardiology, Città Della Salute e della Scienza Hospital, Corso Bramante 88/90, 10126 Turin, Italy. · Department of Cardiology, San Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154 Turin, Italy. · Department of Mathematical Sciences "G. L. Lagrange", Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy. · Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München Lazarettstrasse 36, Munich 80636, Germany. · Department of Cardiology, The Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. · Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 60, 20132 Milan, Italy. · Department of Cardiology, Cardiology Institute, Pitié-Salpêtrière Hospital, UPMC, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France. · Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland. · Department of Cardiology, La Sapienza, Piazzale Aldo Moro, 5, 00185 Rome, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso Della Repubblica 79, 04100 Latina, Italy. · Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy. · Department of Cardiology, Columbia University Medical Center, USA Cardiovascular Research Foundation, 161 Ft. Washington Ave. Herbert Irving Pavilion 6th Floor, New York, NY 10032 212.305.7060, USA. · Department of Cardiology, Sussex Cardiac Centre, Barry Building, Eastern Rd, Brighton BN2 5BE, UK. ·Eur Heart J · Pubmed #29020300.

ABSTRACT: Aims: The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined. Methods and results: Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT. Conclusion: Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length.

9 Review Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4,686 patients. 2017

Palmerini, Tullio / Serruys, Patrick / Kappetein, Arie Pieter / Genereux, Philippe / Riva, Diego Della / Reggiani, Letizia Bacchi / Christiansen, Evald Høj / Holm, Niels R / Thuesen, Leif / Makikallio, Timo / Morice, Marie Claude / Ahn, Jung-Min / Park, Seung-Jung / Thiele, Holger / Boudriot, Enno / Sabatino, Mario / Romanello, Mattia / Biondi-Zoccai, Giuseppe / Cavalcante, Raphael / Sabik, Joseph F / Stone, Gregg W. ·Polo Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy. · International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom. · Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Morristown Medical Center, Morristown, NJ. · Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark. · Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. · Department of Cardiology, Oulu University Hospital, Oulu, Finland. · MC Moriec Ramsay Générale de Santé, ICPS, Massy, France. · The Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. · University Heart Center Lübeck and the German Center for Cardiovascular Research (DZHK), Lübeck, Germany. · Department of Internal Medicine/Cardiology, University Heart Center, Leipzig, Germany. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · The Cleveland Clinic Foundation, Cleveland, OH. · Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY. Electronic address: gs2184@columbia.edu. ·Am Heart J · Pubmed #28760214.

ABSTRACT: Some but not all randomized controlled trials (RCT) have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents may be an acceptable alternative to coronary artery bypass grafting (CABG) surgery for the treatment of unprotected left main coronary artery disease (ULMCAD). We therefore aimed to compare the risk of all-cause mortality between PCI and CABG in patients with ULMCAD in a pairwise meta-analysis of RCT. METHODS: Randomized controlled trials comparing PCI vs CABG for the treatment of ULMCAD were searched through MEDLINE, EMBASE, Cochrane databases, and proceedings of international meetings. RESULTS: Six trials including 4,686 randomized patients were identified. After a median follow-up of 39 months, there were no significant differences between PCI vs CABG in the risk of all-cause mortality (hazard ratio [HR] 0.99, 95% CI 0.76-1.30) or cardiac mortality. However, a significant interaction for cardiac mortality (P CONCLUSIONS: In patients undergoing revascularization for ULMCAD, PCI was associated with similar rates of mortality compared with CABG at a median follow-up of 39 months, but with an interaction effect suggesting relatively lower mortality with PCI in patients with low SYNTAX score and relatively lower mortality with CABG in patients with high SYNTAX score. Both procedures resulted in similar long-term composite rates of death, myocardial infarction, or stroke, with PCI offering an early safety advantage and CABG demonstrating greater durability.

10 Review Meta-Analysis of Head-to-Head Comparison of Intracoronary Versus Intravenous Adenosine for the Assessment of Fractional Flow Reserve. 2017

Rigattieri, Stefano / Biondi Zoccai, Giuseppe / Sciahbasi, Alessandro / Di Russo, Cristian / Cera, Maria / Patrizi, Roberto / Fedele, Silvio / Berni, Andrea / Pugliese, Francesco Rocco. ·Interventional Cardiology, Sandro Pertini Hospital, Azienda Sanitaria Locale Roma 2, Rome, Italy. Electronic address: stefanorigattieri@yahoo.it. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of Angio-Cardio-Neurology, Istituto di Ricovero e Cura a Carattere Scientifico Neuromed, Pozzilli, Italy. · Interventional Cardiology, Sandro Pertini Hospital, Azienda Sanitaria Locale Roma 2, Rome, Italy. · Cardiology Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy. · Emergency Department, Sandro Pertini Hospital, Azienda Sanitaria Locale Roma 2, Rome, Italy. ·Am J Cardiol · Pubmed #28651849.

ABSTRACT: Intravenous (IV) infusion of adenosine represents the gold standard for measuring fractional flow reserve (FFR). However, IV adenosine is more expensive and time-consuming compared with intracoronary (IC) boluses of adenosine. We conducted a meta-analysis of studies comparing IC with IV adenosine for FFR assessment in the same coronary lesions. We searched for studies comparing IC with IV adenosine and reporting absolute FFR values or rate of abnormal FFR for both routes. Prespecified subgroup analysis was performed to appraise studies using low-dose (<100 μg) or high-dose IC adenosine (≥100 μg). We retrieved 11 studies amounting to 587 patients and 621 lesions. Six studies evaluated low-dose IC boluses (15 to 80 μg) and 5 studies high-dose boluses (120 to 600 μg). Absolute FFR values were slightly, yet significantly lower with IV adenosine compared with IC adenosine (mean difference 0.02, 95% confidence interval [CI] 0.00 to 0.03, p = 0.02). This difference, however, did not translate into a significant difference in the rate of abnormal FFR between IC and IV adenosine (hazard ratio 0.93, 95% CI 0.76 to 1.13, p = 0.57); moreover, no statistically significant difference was observed between low-dose and high-dose IC adenosine subgroups. Adverse events were less frequent with IC adenosine compared with IV adenosine (risk ratio 0.17, 95% CI 0.07 to 0.43, p <0.001). In conclusion, IC administration of adenosine, although inducing a slightly lower amount of hyperemia compared with IV infusion of adenosine, yields a similar diagnostic accuracy in identifying hemodynamically significant coronary stenosis and is better tolerated by the patients.

11 Review Diagnostic Accuracy of Myocardial Perfusion Imaging With CZT Technology: Systemic Review and Meta-Analysis of Comparison With Invasive Coronary Angiography. 2017

Nudi, Francesco / Iskandrian, Ami E / Schillaci, Orazio / Peruzzi, Mariangela / Frati, Giacomo / Biondi-Zoccai, Giuseppe. ·Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Rome, Italy; Ostia Radiologica, Ostia, Italy; Etisan, Rome, Italy. · Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama. · Department of Nuclear Medicine, Tor Vergata University, Rome, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. Electronic address: giuseppe.biondizoccai@uniroma1.it. ·JACC Cardiovasc Imaging · Pubmed #28330657.

ABSTRACT: OBJECTIVES: This study sought to summarize the evidence on stress myocardial perfusion imaging (MPI) using cadmium-zinc-telluride (CZT) technology for the diagnosis of obstructive coronary artery disease (CAD). The CZT cameras are newly introduced, and comparative data with the conventional Anger technology (Anger-MPI) are lacking. BACKGROUND: The diagnostic accuracy of Anger-MPI for detection of angiographically significant CAD is well established; however, less evidence is available on the diagnostic accuracy of CZT-MPI. METHODS: Clinical studies comparing CZT-MPI and invasive coronary angiography were systematically searched and abstracted. Calculations of diagnostic accuracy, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratio, were obtained with fixed and random effects, reporting point estimates and 95% confidence intervals. RESULTS: Based on our search, a total of 16 studies (N = 2,092) were included. The sensitivity of CZT-MPI was 0.84 (95% confidence interval [CI]: 0.78 to 0.89), whereas the specificity of 0.69 (95% CI: 0.62 to 0.76) was significantly reduced. The positive likelihood ratio was 2.73 (95% CI: 2.21 to 3.39), the negative likelihood ratio was 0.24 (95% CI: 0.17 to 0.31), and the diagnostic odds ratio was 11.93 (95% CI: 7.84 to 17.42). At subgroup and meta-regression analyses, the diagnostic accuracy between D-SPECT and Discovery cameras was similar (p = 0.711) and not impacted upon by smaller sample size studies (p = 0.573). CONCLUSIONS: CZT-MPI has satisfactory sensitivity for angiographically significant CAD, but its suboptimal specificity warrants further development and research.

12 Review Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients. 2017

Palmerini, Tullio / Della Riva, Diego / Benedetto, Umberto / Bacchi Reggiani, Letizia / Feres, Fausto / Abizaid, Alexandre / Gilard, Martine / Morice, Marie-Claude / Valgimigli, Marco / Hong, Myeong-Ki / Kim, Byeong-Keuk / Jang, Yangsoo / Kim, Hyo-Soo / Park, Kyung Woo / Colombo, Antonio / Chieffo, Alaide / Sangiorgi, Diego / Biondi-Zoccai, Giuseppe / Généreux, Philippe / Angelini, Gianni D / Pufulete, Maria / White, Jonathon / Bhatt, Deepak L / Stone, Gregg W. ·Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy. · Bristol Heart Institute, University of Bristol School of Clinical Sciences, Bristol, Bristol, UK. · Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Department of Cardiology, Brest University, Brest, France. · Générale de Santé, Institut Cardiovasculaire Paris Sud, Massy, France. · Swiss Cardiovascular Center, Bern, Switzerland. · Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. · San Raffaele Scientific Institute, Milan, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY. · Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA. ·Eur Heart J · Pubmed #28110296.

ABSTRACT: Aim: We sought to determine whether the optimal dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) placement varies according to clinical presentation. Methods and Results: We performed an individual patient data pairwise and network meta-analysis comparing short-term (≤6-months) versus long-term (1-year) DAPT as well as 3-month vs. 6-month vs 1-year DAPT. The primary study outcome was the 1-year composite risk of myocardial infarction (MI) or definite/probable stent thrombosis (ST). Six trials were included in which DAPT after DES consisted of aspirin and clopidogrel. Among 11 473 randomized patients 6714 (58.5%) had stable CAD and 4758 (41.5%) presented with acute coronary syndrome (ACS), the majority of whom (67.0%) had unstable angina. In ACS patients, ≤6-month DAPT was associated with non-significantly higher 1-year rates of MI or ST compared with 1-year DAPT (Hazard Ratio (HR) 1.48, 95% Confidence interval (CI) 0.98-2.22; P = 0.059), whereas in stable patients rates of MI and ST were similar between the two DAPT strategies (HR 0.93, 95%CI 0.65-1.35; P = 0.71; Pinteraction = 0.09). By network meta-analysis, 3-month DAPT, but not 6-month DAPT, was associated with higher rates of MI or ST in ACS, whereas no significant differences were apparent in stable patients. Short DAPT was associated with lower rates of major bleeding compared with 1-year DAPT, irrespective of clinical presentation. All-cause mortality was not significantly different with short vs. long DAPT in both patients with stable CAD and ACS. Conclusions: Optimal DAPT duration after DES differs according to clinical presentation. In the present meta-analysis, despite the fact that most enrolled ACS patients were relatively low risk, 3-month DAPT was associated with increased ischaemic risk, whereas 3-month DAPT appeared safe in stable CAD. Prolonged DAPT increases bleeding regardless of clinical presentation. Further study is required to identify the optimal duration of DAPT after DES in individual patients based on their relative ischaemic and bleeding risks.

13 Review Comparative safety and effectiveness of coronary computed tomography: Systematic review and meta-analysis including 11 randomized controlled trials and 19,957 patients. 2016

Nudi, Francesco / Lotrionte, Marzia / Biasucci, Luigi M / Peruzzi, Mariangela / Marullo, Antonino G M / Frati, Giacomo / Valenti, Valentina / Giordano, Arturo / Biondi-Zoccai, Giuseppe. ·Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome, Italy; Ostia Radiologica, Rome, Italy; ETISAN, Rome, Italy. · Division of Cardiology, Catholic University, Rome, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. · Division of Radiology, University of Rome, Rome, Italy. · Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy; Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. Electronic address: giuseppe.biondizoccai@uniroma1.it. ·Int J Cardiol · Pubmed #27500763.

ABSTRACT: BACKGROUND/OBJECTIVES: The clinical approach to suspected or established coronary artery disease (CAD) has been revolutionized in the last few decades by coronary computed tomography (coroCT). Yet, uncertainty persists on its comparative diagnostic and clinical effectiveness. We conducted a systematic review on randomized controlled trials (RCTs) of coroCT. METHODS: We searched RCTs in PubMed and The Cochrane Library, extracting as outcomes of interest long-term rates of death, myocardial infarction, revascularization, and invasive coronary angiography. Effects were estimated with risk ratios (RR) and 95% confidence intervals. RESULTS: A total of 11 trials were included, with 19,957 patients followed for a median of 6months. One trial focused on screening, 3 on stable CAD, and 7 on acute CAD. Meta-analysis showed that coroCT was associated with a trend toward fewer deaths or myocardial infarctions (RR=0.84 [0.70-1.01]) whereas no significant difference was found for the risk of death (RR=0.91 [0.71-1.18]). Conversely, the risk of myocardial infarction tended to be lower with coroCT at the overall analysis (RR=0.77 [0.59-1.02]), and this effect reached statistical significance in studies focusing on subjects with stable CAD (RR=0.69 [0.49-0.99]). These potential benefits were offset (or mediated) by a significant albeit modest increase in the need for invasive angiography (RR=1.36 [1.08-1.72]), and ensuing coronary revascularization (RR=1.76 [1.29-2.40]). CONCLUSIONS: According to the current evidence base, coroCT is associated with an increased usage of invasive angiography and coronary revascularization when compared to standard of care, with possible benefits on nonfatal myocardial infarction, but without significant benefits on death or the composite of death or myocardial infarction.

14 Review Coronary surgery is superior to drug eluting stents in multivessel disease. Systematic review and meta-analysis of contemporary randomized controlled trials. 2016

Benedetto, Umberto / Gaudino, Mario / Ng, Colin / Biondi-Zoccai, Giuseppe / D'Ascenzo, Fabrizio / Frati, Giacomo / Girardi, Leonard N / Angelini, Gianni D / Taggart, David P. ·Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, UK. Electronic address: umberto.benedetto@hotmail.com. · Division of Cardio-thoracic Surgery, Cornell University, New York, NY, USA. · Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, UK. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy. · Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy. · Nuffield Department of Surgical Sciences, Oxford University Hospital, Oxford, UK. ·Int J Cardiol · Pubmed #26922707.

ABSTRACT: OBJECTIVE: Current randomized controlled trials (RCTs) comparing percutaneous coronary intervention with drug eluting stent (DES-PCI) with coronary artery bypass grafting (CABG) in multivessel disease are underpowered to detect a difference in hard clinical end-points such as mortality, myocardial infarction and stroke. We aimed to overcome this limitation by conducting a meta-analysis of contemporary RCTs. METHODS: A systematic literature search was conducted for all RCTs comparing DES-PCI versus CABG in multivessel disease published through May 2015. Inverse variance weighting was used to pool data from individual studies (<1 favouring DES-PCI and >1 CABG favouring surgery). RESULTS: A total of five randomized trials including 4563 subjects were analysed. After an average follow-up of 3.4 years, DES-PCI was associated with a significantly increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P<0.001), MI (HR 2.02; 95%CI 1.57-2.58; P<0.001) and repeat revascularization (HR 2.54; 95%CI 2.07-3.11; P=<0.001). CABG marginally increased the risk of stroke (HR 0.70; 95%CI 0.50-0.98; P=0.04). The absolute risk reduction for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG was larger than the absolute risk reduction for stroke (0.9%) with DES-PCI. CONCLUSION: In patients with multivessel coronary disease, CABG was found to be superior to DES-PCI by reducing the risk of mortality and subsequent myocardial infarction at the expense of a marginally increased risk of stroke.

15 Review Prevalence and predictors of culprit plaque rupture at OCT in patients with coronary artery disease: a meta-analysis. 2016

Iannaccone, Mario / Quadri, Giorgio / Taha, Salma / D'Ascenzo, Fabrizio / Montefusco, Antonio / Omede', Pierluigi / Jang, Ik-Kyung / Niccoli, Giampaolo / Souteyrand, Geraud / Yundai, Chen / Toutouzas, Konstantinos / Benedetto, Sara / Barbero, Umberto / Annone, Umberto / Lonni, Enrica / Imori, Yoichi / Biondi-Zoccai, Giuseppe / Templin, Christian / Moretti, Claudio / Luscher, Thomas F / Gaita, Fiorenzo. ·Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy mario.iannaccone@hotmail.it. · Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy. · Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Division of Cardiology, Cattolica del Sacro Cuore, Roma, Italy. · Pole Cardiologie, Centre Hospitalier Universitaire de Clermont-Ferrant, Clermont-Ferrant, France. · Department of Cardiology, Chinese PLA General Hospital, Beijing, China. · Athens Medical School, Hippokration Hospital, Athens, Greece. · Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan University Hospital, Zurich, Switzerland. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. · University Hospital, Zurich, Switzerland. ·Eur Heart J Cardiovasc Imaging · Pubmed #26508517.

ABSTRACT: AIMS: The prevalence of plaque rupture at the culprit lesion identified by optical coherence tomography (OCT) in different clinical subset of patients undergoing coronary angiography and its clinical predictors remain to be defined. METHODS: All studies including patients with OCT evaluation of the culprit coronary plaque were included. The prevalence of culprit plaque rupture (CPR) and thin-cap fibro-atheroma (TCFA) were the primary endpoints. The factors associated with these findings were studied in a subset of patients with different clinical presentations [ST-elevation myocardial (STEMI) vs. nonST-elevation myocardial infarction (NSTEMI) vs. unstable angina (UA) vs. stable angina pectoris (SAP)]. RESULTS: One hundred and fifty citations were initially appraised at the abstract level and 23 full-text studies were assessed. The mean prevalence of CPR and TCFA was 48.1% (40.5-55.8) and 48.7% (37.4-60.1), respectively. The prevalence of CPR and TCFA were higher in STEMI (70.4 and 76.6%) than in NSTEMI (55.6 and 56.3%) and UA (39.1 and 52.9%) or SAP (6.2 and 22.8%). In the overall population at meta-regression analysis, TCFA and current smoking were the only predictors of CPR (B 3.6:2.0-5.1, P < 0.001 and 0.06:0.02-0.1, P = 0.002, respectively). The factors associated with CPR were different depending on clinical presentation. Hypertension was the only clinical predictor for STEMI (B 3.3: 1.2.-5.3 P = 0.001), while advanced age (B 0.12: 0.02-0.22, P = 0.021), diabetes mellitus (B 0.04: 0.01-0.08, P = 0.012), and hyperlipidaemia (B 0.07:0.02-0.11, P = 0.005) were the predictors in NSTEMI and UA. No clinical predictor was found in SA. CONCLUSIONS: Our analysis showed high rates of CPR and TCFA detected by OCT in CAD patients, especially in those with ACS, although their prevalence is not negligible in stable patients. TCFA seems to be a strong predictor of CPR in all the ACS scenarios.

16 Review Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. 2015

Palmerini, Tullio / Benedetto, Umberto / Bacchi-Reggiani, Letizia / Della Riva, Diego / Biondi-Zoccai, Giuseppe / Feres, Fausto / Abizaid, Alexandre / Hong, Myeong-Ki / Kim, Byeong-Keuk / Jang, Yangsoo / Kim, Hyo-Soo / Park, Kyung Woo / Genereux, Philippe / Bhatt, Deepak L / Orlandi, Carlotta / De Servi, Stefano / Petrou, Mario / Rapezzi, Claudio / Stone, Gregg W. ·Dipartimento Cardio-Toraco-Vascolare, University of Bologna, Italy. · Oxford Heart Center, Oxford University, Oxford, UK. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. · Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. · Severance Cardiovascular Hospital and Science Institute, Yonsei University College of Medicine, Seoul, Korea. · Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. · Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA. · Policlinico S Matteo, Pavia, Italy. · Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY, USA. Electronic address: gs2184@columbia.edu. ·Lancet · Pubmed #25777667.

ABSTRACT: BACKGROUND: Despite recent studies, the optimum duration of dual antiplatelet therapy (DAPT) after coronary drug-eluting stent placement remains uncertain. We performed a meta-analysis with several analytical approaches to investigate mortality and other clinical outcomes with different DAPT strategies. METHODS: We searched Medline, Embase, Cochrane databases, and proceedings of international meetings on Nov 20, 2014, for randomised controlled trials comparing different DAPT durations after drug-eluting stent implantation. We extracted study design, inclusion and exclusion criteria, sample characteristics, and clinical outcomes. DAPT duration was categorised in each study as shorter versus longer, and as 6 months or shorter versus 1 year versus longer than 1 year. Analyses were done by both frequentist and Bayesian approaches. FINDINGS: We identified ten trials published between Dec 16, 2011, and Nov 16, 2014, including 31,666 randomly assigned patients. By frequentist pairwise meta-analysis, shorter DAPT was associated with significantly lower all-cause mortality compared with longer DAPT (HR 0·82, 95% CI 0·69-0·98; p=0·02; number needed to treat [NNT]=325), with no significant heterogeneity apparent across trials. The reduced mortality with shorter compared with longer DAPT was attributable to lower non-cardiac mortality (0·67, 0·51-0·89; p=0·006; NNT=347), with similar cardiac mortality (0·93, 0·73-1·17; p=0.52). Shorter DAPT was also associated with a lower risk of major bleeding, but a higher risk of myocardial infarction and stent thrombosis. We noted similar results in a Bayesian framework with non-informative priors. By network meta-analysis, patients treated with 6-month or shorter DAPT and 1-year DAPT had higher risk of myocardial infarction and stent thrombosis but lower risk of mortality compared with patients treated with DAPT for longer than 1 year. Patients treated with DAPT for 6 months or shorter had similar rates of mortality, myocardial infarction, and stent thrombosis, but lower rates of major bleeding than did patients treated with 1-year DAPT. INTERPRETATION: Although treatment with DAPT beyond 1 year after drug-eluting stent implantation reduces myocardial infarction and stent thrombosis, it is associated with increased mortality because of an increased risk of non-cardiovascular mortality not offset by a reduction in cardiac mortality. FUNDING: None.

17 Review Factors associated with progression of coronary artery disease measured by intravascular ultrasound: systematic review and meta-analysis. 2014

Nascimento, Bruno R / de Sousa, Marcos Roberto / Demarqui, Fábio N / Chamié, Daniel / Marcolino, Milena S / Biondi-Zoccai, Giuseppe / Boersma, Eric / Ribeiro, Antônio L P / Costa, Marco A. ·Serviço de Cardiologia e Cirurgia Cardiovascular do Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Departamento de Clínica Médica da Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Programa de Pós-graduação em Ciências Aplicadas à Saúde do Adulto, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. · Serviço de Cardiologia e Cirurgia Cardiovascular do Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Programa de Pós-graduação em Ciências Aplicadas à Saúde do Adulto, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. · Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. · Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Case Western Reserve University, Cleveland, USA. · Serviço de Cardiologia e Cirurgia Cardiovascular do Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Departamento de Clínica Médica da Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy. · Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands. · Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, and Case Western Reserve University, Cleveland, USA. Electronic address: Marco.Costa@UHhospitals.org. ·Int J Cardiol · Pubmed #24801090.

ABSTRACT: -- No abstract --

18 Review Cardiac remote ischaemic preconditioning reduces periprocedural myocardial infarction for patients undergoing percutaneous coronary interventions: a meta-analysis of randomised clinical trials. 2014

D'Ascenzo, Fabrizio / Moretti, Claudio / Omedè, Pierluigi / Cerrato, Enrico / Cavallero, Erika / Er, Fikret / Presutti, Davide Giacomo / Colombo, Francesco / Crimi, Gabriele / Conrotto, Federico / Dinicolantonio, James J / Chen, Shaoliang / Prasad, Abhiram / Biondi Zoccai, Giuseppe / Gaita, Fiorenzo. ·Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza, Turin, Italy. ·EuroIntervention · Pubmed #24755386.

ABSTRACT: AIMS: To establish the cardioprotective effect of remote ischaemic preconditioning (RIPC) in patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: Pubmed (MEDLINE), Cochrane and Embase were systematically searched for randomised controlled trials of RIPC in patients undergoing PCI. Periprocedural myocardial infarction (PMI) was the primary endpoint (defined as troponin elevation >3 times upper reference limit) and C-reactive protein (CRP) was a secondary endpoint. Five studies with 731 patients were included. The median age of the patients was 62 (59-68) years old, 25% were female (23-33), 29% (25-33) had diabetes mellitus, and 26.5% (19-31) presented with multivessel disease. RIPC significantly reduced the incidence of PMI (odds ratio: 0.58 [0.36, 0.93]; I2 43%), with a greater benefit when performed using the lower limb (0.21 [0.07-0.66]) compared to the upper limb (0.67 [0.46-0.99]). This reduction was enhanced for patients with multivessel disease (beta -0.05 [-0.09;-0.01], p=0.01) and with type C lesion (beta -0.014 [-0.04;-0.010], p=0.01) and did not vary according to age, female gender, diabetes mellitus, use of beta-blockers and of angiotensin converting enzyme inhibitors. Absolute risk difference was -0.10 [-0.19, -0.02], with a number needed to treat of 10 [6-50] patients to avoid one event. CRP -0.69 [-1.69, 0.31] was not significantly reduced by RIPC. CONCLUSIONS: RIPC reduced the incidence of PMI following PCI, especially when performed in the lower limb and for patients with multivessel disease and complex lesions.

19 Review Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting. 2014

DiNicolantonio, James J / Beavers, Craig J / Menezes, Arthur R / Lavie, Carl J / O'Keefe, James H / Meier, Pascal / Vorobcsuk, András / Aradi, Dániel / Komócsi, András / Chatterjee, Saurav / D'Ascenzo, Fabrizio / Gasparini, Mauro / Brugts, Jasper / Biondi-Zoccai, Giuseppe. ·Department of Preventive Cardiology, Mid America Heart Institute at Saint Luke's Hospital, University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: jjdinicol@gmail.com. · Department of Pharmacy, Centennial Medical Center, Nashville, Tennessee. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana. · Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana. · Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri. · The Heart Hospital, University College London Hospitals UCLH, London, United Kingdom. · Department of Interventional Cardiology, Heart Centre, University of Pécs, Hungary. · Department of Interventional Cardiology, Heart Centre, University of Pécs, Hungary; Department of Cardiology, Heart Center, Balatonfüred, Hungary. · Cardiovascular Diseases, St. Luke's - Roosevelt Hospital Center, Division of Cardiology, New York, New York. · Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, San Giovanni battista, Turin, Italy. · Department of Mathematical Sciences, Politecnico di Torino. · Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands. · Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. ·Am J Cardiol · Pubmed #24332247.

ABSTRACT: A systematic review and meta-analysis was performed to evaluate the effects of carvedilol versus metoprolol on the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting in randomized controlled trials. Ovid MEDLINE, PubMed, CENTRAL, and Excepta Medica (EMBASE) were searched up to March 2013 for suitable randomized controlled trials. Data were pooled using random-effects model for pairwise analyses. A total of 4 trials with 601 patients were included in this analysis. Pairwise analyses showed that compared with metoprolol, carvedilol significantly reduced the incidence of postoperative atrial fibrillation (odds ratio 0.50, 95% confidence interval 0.32 to 0.80). In conclusion, compared with metoprolol, carvedilol significantly reduces the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

20 Review Right versus left radial artery access for coronary procedures: an international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients. 2013

Biondi-Zoccai, Giuseppe / Sciahbasi, Alessandro / Bodí, Vicente / Fernández-Portales, Javier / Kanei, Yumiko / Romagnoli, Enrico / Agostoni, Pierfrancesco / Sangiorgi, Giuseppe / Lotrionte, Marzia / Modena, Maria Grazia. ·Division of Cardiology, University of Modena and Reggio Emilia, Modena, Italy. gbiondizoccai@gmail.com ·Int J Cardiol · Pubmed #22192284.

ABSTRACT: BACKGROUND: Radial artery access is a mainstay in the diagnosis and treatment of coronary artery disease. However, there is uncertainty on the comparison of right versus left radial access for coronary procedures. We thus undertook a systematic review and meta-analysis comparing right versus left radial access for coronary diagnostic and interventional procedures. METHODS: Pertinent studies were searched in CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus, together with international conference proceedings. Randomized trials comparing right versus left radial (or ulnar) access for coronary diagnostic or interventional procedures were included. Risk ratios (RR) and weighted mean differences (WMD) were computed to generate point estimates (95% confidence intervals). RESULTS: A total of 5 trials (3210 patients) were included. No overall significant differences were found comparing right versus left radial access in terms of procedural time (WMD=0.99 [-0.53; 2.51]min, p=0.20), contrast use (WMD=1.71 [-1.32; 4.74]mL, p=0.27), fluoroscopy time (WMD=-35.79 [-3.54; 75.12]s, p=0.07) or any major complication (RR=2.00 [0.75; 5.31], p=0.49). However, right radial access was fraught with a significantly higher risk of failure leading to cross-over to femoral access (RR=1.65 [1.18; 2.30], p=0.003) in comparison to left radial access. CONCLUSIONS: Right and left radial accesses appear largely similar in their overall procedural and clinical performance during transradial diagnostic or interventional procedures. Nonetheless, left radial access can be recommended especially during the learning curve phase to reduce femoral cross-overs.

21 Review Prevalence and non-invasive predictors of left main or three-vessel coronary disease: evidence from a collaborative international meta-analysis including 22 740 patients. 2012

D'Ascenzo, Fabrizio / Presutti, Davide Giacomo / Picardi, Elisa / Moretti, Claudio / Omedè, Pierluigi / Sciuto, Filippo / Novara, Marco / Yan, Andrew T / Goodman, Shaun / Mahajan, Nitin / Kosuge, Masami / Palazzuoli, Alberto / Jong, Gwo-Ping / Isma'eel, Hussain / Budoff, Matthew J / Rubinshtein, Ronen / Gewirtz, Henry / Reed, Matthew J / Theroux, Pierre / Biondi-Zoccai, Giuseppe / Modena, Maria Grazia / Sheiban, Imad / Gaita, Fiorenzo. ·Division of Cardiology, University of Turin, S Giovanni Battista Molinette Hospital, Corso Bramante 88-90, Turin 10126, Italy. fabrizio.dascenzo@gmail.com ·Heart · Pubmed #22626899.

ABSTRACT: BACKGROUND: Left main disease (LMD) and three-vessel disease (3VD) have important prognostic value in patients with coronary artery disease. However, uncertainties still exist about their prevalence and predictors in patients with acute coronary syndrome (ACS) and also in patients with stable coronary disease. Thus the aim of this study was to perform an international collaborative systematic review and meta-analysis to appraise the prevalence and predictors of LMD and 3VD. METHODS: Medline/PubMed were systematically searched for eligible studies published up to 2010, reporting multivariate predictors of LMD or 3VD. Study features, patient characteristics, and prevalence and predictors of LMD and 3VD were abstracted and pooled with random-effect methods (95% CIs). RESULTS: 17 studies (22 740 patients) were included, 11 focusing on ACS (17 896 patients) and six on stable coronary disease (4844 patients). In the ACS subgroup, LMD or 3VD occurred in 20% (95% CI 7.2% to 33.4%), LMD in 12% (95% CI 10.5% to 13.5%), and 3VD in 25% (95% CI 23.1% to 27.0%). Heart failure at admission and extent of ST-segment elevation in lead aVR on 12-lead ECG were the most powerful predictors of LMD or 3VD. In the stable disease subgroup, LMD or 3VD was found in 36% (95% CI 18.5% to 48.8%), with the most powerful predictors being transient ischaemic dilation during the imaging stress test, extent of ST-segment elevation in aVR and V1 during the stress test, and hyperlipidaemia. CONCLUSIONS: This meta-analysis demonstrated that severe coronary disease-that is, LMD or 3VD-is more common in patients with ACS or stable coronary disease than generally perceived, and that simple and low-cost tools may help in the selection of the most appropriate therapeutic approach.

22 Review Unprotected left main coronary disease and ST-segment elevation myocardial infarction: a contemporary review and argument for percutaneous coronary intervention. 2010

Lee, Michael S / Bokhoor, Pooya / Park, Seung-Jung / Kim, Young-Hak / Stone, Gregg W / Sheiban, Imad / Biondi-Zoccai, Giuseppe / Sillano, Dario / Tobis, Jonathan / Kandzari, David E. ·UCLA Medical Center, Los Angeles, California 90095, USA. mslee@mednet.ucla.edu ·JACC Cardiovasc Interv · Pubmed #20723848.

ABSTRACT: Acute occlusion involving the unprotected left main coronary artery (ULMCA) is a clinically catastrophic event, often leading to abrupt and severe circulatory failure, lethal arrhythmias, and sudden cardiac death. Although coronary artery bypass grafting (CABG) is the standard of care for ULMCA disease in patients with stable ischemic heart disease, uncertainty surrounds the optimal revascularization strategy for patients with ST-elevation myocardial infarction (MI) and ULMCA occlusion who survive to hospitalization, and treatment guidelines in this setting are vague. Percutaneous coronary intervention (PCI) is technically feasible in most patients, has the advantage of providing more rapid reperfusion compared with CABG with acceptable short- and long-term outcomes, and is associated with a lower risk of stroke. PCI of the ULMCA should be considered as a viable alternative to CABG for selected patients with MI, including those with ULMCA occlusion and less than Thrombolysis In Myocardial Infarction flow grade 3, cardiogenic shock, persistent ventricular arrhythmias, and significant comorbidities. The higher risk of target vessel revascularization associated with ULMCA PCI compared with CABG is an acceptable tradeoff given the primary need for rapid reperfusion to enhance survival.

23 Review Percutaneous coronary intervention for small vessel coronary artery disease. 2010

Biondi-Zoccai, Giuseppe / Moretti, Claudio / Abbate, Antonio / Sheiban, Imad. ·Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, 10126 Turin, Italy. gbiondizoccai@gmail.com ·Cardiovasc Revasc Med · Pubmed #20599174.

ABSTRACT: Symptomatic coronary artery disease may be commonly due to significant atherosclerotic disease involving coronary vessels of relatively small caliber (i.e., with reference vessel diameter <2.75 mm). Whenever medical therapy fails and in other selected cases, revascularization by means of percutaneous coronary intervention (PCI) or bypass surgery is indicated even for small vessel coronary disease. However, despite the numerous developments and improvements in devices and techniques, PCI of small coronary vessels is still fraught with a significant risk of midterm restenosis after both balloon-only PCI and bare-metal stent implantation. Drug-eluting stents, especially those associated with very low angiographic late lumen loss (<0.20 mm), appear to significantly improve angiographic and clinical outcomes after PCI of small coronary vessels. The present article provides a concise and updated review on percutaneous coronary revascularization in patients with symptomatic small vessel coronary artery disease.

24 Review Quantitative coronary angiography in the current era: principles and applications. 2009

Garrone, Paolo / Biondi-Zoccai, Giuseppe / Salvetti, Ilaria / Sina, Noemi / Sheiban, Imad / Stella, Peter R / Agostoni, Pierfrancesco. ·Division of Cardiology, University of Turin, San Giovanni Battista Molinette Hospital, Turin, Italy. ·J Interv Cardiol · Pubmed #19627430.

ABSTRACT: Coronary angiography, despite its inherent invasiveness and need for contrast media and radiographic exposure, is still routinely employed every year for the diagnostic and therapeutic management of millions of patients with or at risk for coronary artery disease. Whereas approximate visual estimation is the most common way to evaluate coronary angiography findings, since the late 1980s a number of investigators have developed and investigated methods of quantitative coronary angiography (QCA) analysis exploiting automated or semi-automated edge detection. Despite the inherent drawback of QCA due to its focus on the contrast-filled lumen of the vessel, QCA has offered and continues to offer important insights for clinical research and, in selected cases, clinical practice. This review aims thus to provide a comprehensive and updated viewpoint on the actual role of QCA.

25 Review Long-term effect of chronic oral anticoagulation: focus on coronary artery disease. 2009

Lotrionte, Marzia / Castagno, Davide / Agostoni, Pierfrancesco / Abbate, Antonio / Sangiorgi, Giuseppe / Sheiban, Imad / Biondi-Zoccai, Giuseppe G L. ·Institute of Cardiology, Catholic University, Rome, Italy. mlotrionte@gmail.com ·Future Cardiol · Pubmed #19450052.

ABSTRACT: Coronary artery disease remains one of the most important causes of morbidity and mortality worldwide, with a disease burden that does not seem to have decreased significantly over time. Since their developments, oral drugs that are able to reduce the coagulation properties of blood (i.e., oral anticoagulants such as warfarin or dicoumarol) have been tested in thousands of patients with, or suspected with, coronary artery disease, however they have yielded disparate and conflicting results. The advent of oral antiplatelet agents has further put into a niche the apparent role of oral anticoagulant therapy in subjects with established coronary artery disease (i.e., in the setting of secondary prevention). However, the current and future role of oral anticoagulants in the secondary prevention of coronary artery disease remains very important, as testified to by the ongoing research by several major companies and investigators focusing on the development of novel oral anticoagulants. This review provides a succinct and updated appraisal of the long-term effects of chronic oral anticoagulation in the setting of coronary artery disease.

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