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Coronary Artery Disease: HELP
Articles by Gianni Dall'Ara
Based on 5 articles published since 2010
(Why 5 articles?)

Between 2010 and 2020, G. Dall'ara wrote the following 5 articles about Coronary Artery Disease.
+ Citations + Abstracts
1 Review Risk of Stroke in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention versus Optimal Medical Therapy: Systematic Review and Meta-Analysis of Randomized Controlled Trials. 2016

Taglieri, Nevio / Bacchi Reggiani, Maria Letizia / Ghetti, Gabriele / Saia, Francesco / Dall'Ara, Gianni / Gallo, Pamela / Moretti, Carolina / Palmerini, Tullio / Marrozzini, Cinzia / Marzocchi, Antonio / Rapezzi, Claudio. ·Istituto di Cardiologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Alma Mater Studiorum Università di Bologna, Bologna, Italy. ·PLoS One · Pubmed #27391212.

ABSTRACT: BACKGROUND: Stroke is a rare but serious adverse event associated with percutaneous coronary intervention (PCI). However, the relative risk of stroke between stable patients undergoing a direct PCI strategy and those undergoing an initial optimal medical therapy (OMT) strategy has not been established yet. This study sought to investigate if, in patients with stable coronary artery disease (SCAD), an initial strategy PCI is associated with a higher risk of stroke than a strategy based on OMT alone. METHODS: We performed a meta-analysis of 6 contemporary randomized control trials in which 5673 patients with SCAD were randomized to initial PCI or OMT. Only trials with stent utilization more than 50% were included. Study endpoint was the rate of stroke during follow up. RESULTS: Mean age of patients ranged from 60 to 65 years and stent utilization ranged from 72% to 100%. Rate of stroke was 2.0% at a weighted mean follow up of 55.3 months. On pooled analysis, the risk of stroke was similar between patients undergoing a PCI plus OMT and those receiving only OMT (2.2% vs. 1.8%, OR on fixed effect = 1.24 95%CI: 0.85-1.79). There was no heterogeneity among the studies (I2 = 0.0%, P = 0.15). On sensitivity analysis after removing each individual study the pooled effect estimate remains unchanged. CONCLUSIONS: In patients with SCAD an initial strategy based on a direct PCI is not associated with an increased risk of stroke during long-term follow up compared to an initial strategy based on OMT alone.

2 Review Optical coherence tomography in bioabsorbable stents: mechanism of vascular response and guidance of stent implantation. 2014

Mattesini, A / Pighi, M / Konstantinidis, N / Ghione, M / Kilic, D / Foin, N / Dall'ara, G / Secco, G G / Valente, S / Di Mario, C. ·NIHR Biomedical Research Unit Royal Brompton & Harefield NHS Foundation Trust, London, UK2 Interventional Cardiology Unit Department of Heart and Vessels Florence University AOU Careggi, Florence, Italy3 National Heart Centre Singapore, Singapore4 University of Eastern Piedmont "Maggiore della Carità" Hospital, Novara, Italy - c.dimario@rbht.nhs.uk. ·Minerva Cardioangiol · Pubmed #24500218.

ABSTRACT: Fully biodegradable L-polylactic acid stents (biodegradable vascular scaffold, BVS), the latest breakthrough in the area of coronary implants, entered clinical trials in 2005 and became commercially available in 2011. Optical coherence tomography (OCT) was used from the first implants to study the vessel wall response and the timing of the resorption process in man. Analysis of BVS with OCT has several advantages over that of metallic stents. BVS polymeric struts are transparent to the light so that scaffold integrity, apposition to the underlying wall, presence of thrombus and hyperplasia, and changes in the strut characteristics over time can be easily studied. We present a comprehensive review of the findings OCT provided when used as a research tool in serial examination up to five years for investigation of the mechanism of resorption, neointimal coverage, shrinkage and late lumen enlargement. We also report our experience with OCT in 47 lesions of various complexity as a practical means of percutaneous coronary intervention guidance during BVS implantation.

3 Article [Bioresorbable vascular scaffolds: clinical experience of the Emilia-Romagna Region, Italy]. 2017

Menozzi, Alberto / Campo, Gianluca Calogero / Guiducci, Vincenzo / Dall'Ara, Gianni / Santarelli, Andrea / Sbarzaglia, Paolo / Balducelli, Marco / Magnavacchi, Paolo / Sgura, Fabio / Losi, Luciano / Vignali, Luigi / Casella, Gianni / Steffanon, Luigi / Tarantino, Fabio / Saia, Francesco. ·U.O. Cardiologia, Azienda Ospedaliero-Universitaria di Parma. · U.O. Cardiologia, Azienda Ospedaliera Universitaria di Ferrara. · U.O. Cardiologia Interventistica, IRCCS S. Maria Nuova, Reggio Emilia. · U.O. Cardiologia, Ospedale Morgagni-Pierantoni, Forlì. · U.O. Cardiologia, Ospedale degli Infermi, Rimini. · Laboratorio di Cardio-Angiologia Diagnostica ed Interventistica, Maria Cecilia Hospital - GVM Care & Research, Cotignola (RA). · U.O. Cardiologia, Ospedale Santa Maria delle Croci, Ravenna. · U.O. Cardiologia, Ospedale di Baggiovara, Modena. · U.O. Cardiologia, Azienda Policlinico, Modena. · U.O. Cardiologia, Ospedale Guglielmo da Saliceto, Piacenza. · U.O. Cardiologia, Ospedale Maggiore, Bologna. · U.O. Cardiologia, Hesperia Hospital, Modena. · U.O. Cardiologia, Policlinico S. Orsola-Malpighi, Bologna. ·G Ital Cardiol (Rome) · Pubmed #28398396.

ABSTRACT: BACKGROUND: The bioresorbable vascular scaffold (BRS) technology constitutes the new revolution of the coronary artery disease interventional treatment. Currently, three distinct types of BRSs are available but only one, the Absorb BVS, was on the market in 2013 when the Regional Commission for Medical Devices and the Cardiology and Cardiac Surgery Commission of the Emilia-Romagna Region drew up a technical and scientific essay to provide guidance for the introduction of BRS in public and affiliated health facilities. Five preferential indications were given for use: long coronary lesions (>28 mm), ostial lesions (left main stem excluded), complete revascularization in patients aged <50 years, diffuse disease (>40 mm) or involving the mid/distal left anterior descending (LAD) branch in patients <70 years, spontaneous coronary artery dissection. METHODS: This survey analyzed data from all the catheterization laboratories in the Emilia-Romagna Region, merged in a unified database. RESULTS: In a 3-year study period, 546 BRS were implanted in 328 patients, corresponding to 1.5% of the drug-eluting stents (DES) used, with a trend towards a progressive increase over time. Initial indications were followed in 200/328 (61.0%) patients (about one third fitting more indications), mainly for treatment of long lesions in vessels >2.5 mm (67%), young patients (31.5%) and mid/distal LAD (28%). In 22.6% of cases the clinical scenario was a ST-segment elevation myocardial infarction, in 39.3% a non-ST-segment elevation acute coronary syndrome. Intracoronary imaging was infrequently used (intravascular ultrasound in 24.7% of cases). In 85 patients (25.9%) a hybrid procedure (BVS/DES) was performed. CONCLUSIONS: BRS use has resulted lower than expected, with discrete variability among centers, but according to the initial indications of the Emilia-Romagna Region in the majority of cases. The underuse might have been due to operators' caution in their initial experience. However, the increasing trend may reveal a greater confidence in the implantation technique and the whole amount of safety and efficacy data.

4 Article ABSORB biodegradable stents versus second-generation metal stents: a comparison study of 100 complex lesions treated under OCT guidance. 2014

Mattesini, Alessio / Secco, Gioel G / Dall'Ara, Gianni / Ghione, Matteo / Rama-Merchan, Juan C / Lupi, Alessandro / Viceconte, Nicola / Lindsay, Alistair C / De Silva, Ranil / Foin, Nicolas / Naganuma, Toru / Valente, Serafina / Colombo, Antonio / Di Mario, Carlo. ·NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Heart and Vessels, AOUC Careggi, Florence, Italy. · NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy. · NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. · Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy. · National Heart Centre Singapore, Singapore. · Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. · Department of Heart and Vessels, AOUC Careggi, Florence, Italy. · NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. Electronic address: c.dimario@rbht.nhs.uk. ·JACC Cardiovasc Interv · Pubmed #25060016.

ABSTRACT: OBJECTIVES: The aim of this study was to compare the acute performance of the PLLA ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) with second-generation metal drug-eluting stents (DES) in complex coronary artery lesions. BACKGROUND: Thick polymer-based BVS have different mechanical properties than thin second-generation DES. Data on the acute performance of BVS are limited to simple coronary lesions treated in trials with strict inclusion criteria. METHODS: Fifty complex coronary lesions (all type American College of Cardiology/American Heart Association B2-C) treated with a BVS undergoing a final optical coherence tomography (OCT) examination were compared with an equal number of matched lesions treated with second-generation DES. The following stent performance indexes were assessed with OCT: mean and minimal area, residual area stenosis (RAS), incomplete strut apposition (ISA), tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection. RESULTS: One hundred lesions from 73 patients were analyzed. A higher balloon diameter/reference vessel diameter ratio was used for predilation in the BVS group (p < 0.01). Most of the BVS and DES were post-dilated with short noncompliant (NC) balloons of similar diameter. OCT showed in the BVS group a higher tissue prolapse area (p = 0.08) and greater incidence of ISA at the proximal edge (p = 0.04) with no difference in the overall ISA. The RAS was 20.2% in the BVS group and 21.7% in the DES group (p = 0.32). There was no difference in the eccentricity index. The minimal and mean lumen areas were similar in the 2 groups. Two cases of strut fractures occurred after the BVS, whereas none was observed in the DES. CONCLUSIONS: Based on OCT, the BVS showed similar post-procedure area stenosis, minimal lumen area, and eccentricity index as second-generation DES. The different approach for lesion preparation and routine use of OCT guidance during BVS expansion may have contributed to these results.

5 Article Predictors of complicated athero-thrombotic lesions in non-ST segment acute coronary syndrome. 2013

Taglieri, Nevio / Dall'Ara, Gianni / Rapezzi, Claudio / Saia, Francesco / Cinti, Laura / Rosmini, Stefania / Alessi, Laura / Vagnarelli, Fabio / Moretti, Carolina / Palmerini, Tullio / Marrozzini, Cinzia / Montefiori, Michela / Branzi, Angelo / Marzocchi, Antonio. ·Institute of Cardiology, St. Orsola/Malpighi Hospital, Bologna University, Bologna, Italy. neviotaglieri@hotmail.it ·J Cardiovasc Med (Hagerstown) · Pubmed #22772600.

ABSTRACT: AIMS: Non-ST segment elevation acute coronary syndrome (NSTE-ACS) is a heterogeneous syndrome in terms of patho-physiological mechanisms and prognosis. We sought to investigate the clinical features associated with complicated athero-thrombotic (CAT) coronary lesions and their prognostic relevance in NSTE-ACS. METHODS: We enrolled 701 consecutive NSTE-ACS patients without previous coronary bypass undergoing coronary angiography. The study population was divided into two groups according to the presence/absence of angiographic signs of endoluminal thrombi and/or plaque rupture, defined as CAT lesions. Multivariable analyses were used to identify predictors of CAT lesions. Their relation to composite endpoint of death, re-myocardial infarction, and re-unstable angina was investigated with the use of multivariable logistic regression. RESULTS: Patients with CAT lesions (n = 279, 40%) had a higher incidence of the combined endpoint (11.5 vs. 4.3%; P < 0.001). On multivariable analysis male sex [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.17-2.30, P = 0.004], previous percutaneous coronary intervention (PCI) (OR 0.48, 95% CI 0.32-0.72, P < 0.001), severe angina (OR 1.72, 95% CI 1.18-2.52, P = 0.005) and anterior (i.e. V1-V4) ST segment depression (STD) were independently associated with CAT lesions (OR 1.71, 95% CI 1.14-2.57, P = 0.01). After adjustment for the Global Registry of Acute Coronary Events (GRACE) score only the presence of anterior STD emerged as an independent predictor of the clinical endpoint (OR 2.68, 95% CI 1.38-5.20, P = 0.003). The incorporation of anterior STD into the GRACE risk score showed an important trend toward improving prediction of endpoint as assessed by c-statistic (0.72 vs. 0.67; P = 0.08). CONCLUSION: In patients with NSTE-ACS male sex, severe angina and anterior STD were associated with an increased risk of CAT lesions. Patients with anterior STD were also at increased risk of in-hospital clinical events.