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Coronary Artery Disease: HELP
Articles by Giovanni B. Pedrazzini
Based on 16 articles published since 2010
(Why 16 articles?)
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Between 2010 and 2020, Giovanni Pedrazzini wrote the following 16 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline Heart Team: Joint Position of the Swiss Society of Cardiology and the Swiss Society of Cardiac Surgery. 2017

Pedrazzini, Giovanni B / Ferrari, Enrico / Zellweger, Michael / Genoni, Michele. ·Swiss Society of Cardiology (SSC), Ticino, Switzerland. · Swiss Society of Cardiac Surgery (SGHC), Zurich, Switzerland. ·Thorac Cardiovasc Surg · Pubmed #28922674.

ABSTRACT: The Swiss Society of Cardiology (SSC) and the Swiss Society of Cardiac and ThoracicVascular Surgery (SSCTVS) have formulated their mutual intent of a close, patient-oriented, and expertise-based collaboration in the Heart Team Paper. The interdisciplinary dialogue between the SSC and SSCTVS reflects an attitude in decision making, which guarantees the best possible therapy for the individual patient. At the same time, it is a cornerstone of optimized process quality, placing individual interests into the background. Evaluation of the correct indication for a treatment is indeed very challenging and almost impossible to verify retrospectively. Quality in this very important health policy process can therefore only be assured by the use of mutually recognized indications, agreed upon by all involved physicians and medical specialties, whereby the capacity of those involved in the process is not important but rather their competence. These two medical societies recognize their responsibility and have incorporated international guidelines as well as specified regulations for Switzerland. Former competitors now form an integrative consulting team able to deliver a comprehensive evaluation for patients. Naturally, implementation rests with the individual caregiver. The Heart Team Paperof the SGK and SGHC, has defined guide boards within which the involved specialists maintain sufficient room to maneuver, and patients have certainty of receiving the best possible therapy they require.

2 Clinical Trial Newest-generation drug-eluting and bare-metal stents combined with prasugrel-based antiplatelet therapy in large coronary arteries: the BAsel Stent Kosten Effektivitäts Trial PROspective Validation Examination part II (BASKET-PROVE II) trial design. 2012

Jeger, Raban / Pfisterer, Matthias / Alber, Hannes / Eberli, Franz / Galatius, Søren / Naber, Christoph / Pedrazzini, Giovanni / Rickli, Hans / Jensen, Jan Skov / Vuilliomenet, André / Gilgen, Nicole / Kaiser, Christoph. ·Department of Cardiology, University Hospital, Basel, Switzerland. ·Am Heart J · Pubmed #22305828.

ABSTRACT: BACKGROUND: In the BAsel Stent Kosten Effektivitäts Trial PROspective Validation Examination (BASKET-PROVE), drug-eluting stents (DESs) had similar 2-year rates of death and myocardial infarction but lower rates of target vessel revascularization and major adverse cardiac events compared with bare-metal stents (BMSs). However, comparative clinical effects of newest-generation DES with biodegradable polymers vs second-generation DES or newest-generation BMS with biocompatible coatings, all combined with a prasugrel-based antiplatelet therapy, on 2-year outcomes are not known. METHODS: In BASKET-PROVE II, 2,400 patients with de novo lesions in native vessels ≥3 mm in diameter are randomized 1:1:1 to receive a conventional DES, a DES with a biodegradable polymer, or a BMS with biocompatible coating. In addition to aspirin, stable patients with BMS will receive prasugrel for 1 month, whereas all others will receive prasugrel for 12 months. The primary end point will be combined cardiac death, nonfatal myocardial infarction, and target vessel revascularization up to 2 years. Secondary end points include stent thrombosis and major bleeding. The primary aim is to test (1) the noninferiority of a biodegradable-polymer DES to a conventional DES and (2) the superiority of both DESs to BMS. A secondary aim is to compare the outcomes with those of BASKET-PROVE regarding the effects of prasugrel-based vs clopidogrel-based antiplatelet therapy. RESULTS: By the end of 2010, 878 patients (37% of those planned) were enrolled. CONCLUSIONS: This study will test the comparative long-term safety and efficacy of newest-generation stents on the background of contemporary antiplatelet therapy in a large all-comer population undergoing large native coronary artery stenting.

3 Article A patient-centered multidisciplinary cardiac rehabilitation program improves glycemic control and functional outcome in coronary artery disease after percutaneous and surgical revascularization. 2020

Denegri, Andrea / Rossi, Valentina A / Vaghi, Fabrizio / Di Muro, Paolo / Regazzi, Martino / Moccetti, Tiziano / Pasotti, Elena / Pedrazzini, Giovanni B / Capoferri, Mauro / Moccetti, Marco. ·Department of Cardiology, ASST Mantova, Strada Lago Paiolo 10, 46100 Mantova, Italy. denegriandrea@msn.com. · Department of Cardiology, University Hospital, Zurich CH-8091, Switzerland. · Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland. ·Cardiol J · Pubmed #32037504.

ABSTRACT: BACKGROUND: Cardiac rehabilitation (CR) is strongly associated with all-cause mortality reduction in patients with coronary artery disease (CAD). The impact of CR on pathological risk factors, such as impaired glucose tolerance (IGT), and functional recovery remains under debate. The aim of the present study is to determine whether CR has a positive effect on physical exercise improvement and on pathological risk factors in IGT and diabetic patients with CAD. METHODS: One hundred and seventy-one consecutive patients participating in a 3-month CR from January 2014 to June 2015 were enrolled. The primary endpoint was defined as an improvement of peak workload and VO2-peak; glycated hemoglobin (HbA1c) reduction was considered as a secondary endpoint. RESULTS: Euglycemic patients presented a significant improvement in peak workload compared to diabetic patients (from 5.75 ± 1.45 to 6.65 ± 1.84 METs, p = 0.018 vs. 4.8 ± 0.8 to 4.9 ± 1.4 METs). VO2-peak improved in euglycemic patients (VO2-peak from 19.3 ± 5.3 mL/min/kg to 22.5 ± 5.9, p = 0.003), while diabetic patients did not present a statistically significant trend (VO2-peak from 16.9 ± 4.4 mL/min/kg to 18.0 ± 3.8, p < 0.056). Diabetic patients have benefited more in terms of blood glucose control compared to IGT patients (HbA1c from 7.7 ± 1.0 to 7.4 ± 1.1 compared to 5.6 ± 0.4 to 5.9 ± 0.5, p = 0.02, respectively). CONCLUSIONS: A multidisciplinary CR program improves physical functional capacity in CAD setting, particularly in euglycemic patients. IGT patients as well as diabetic patients may benefit from a CR program, but long-term outcome needs to be clarified in larger studies.

4 Article Five-year clinical outcomes and intracoronary imaging findings of the COMFORTABLE AMI trial: randomized comparison of biodegradable polymer-based biolimus-eluting stents with bare-metal stents in patients with acute ST-segment elevation myocardial infarction. 2019

Räber, Lorenz / Yamaji, Kyohei / Kelbæk, Henning / Engstrøm, Thomas / Baumbach, Andreas / Roffi, Marco / von Birgelen, Clemens / Taniwaki, Masanori / Moschovitis, Aris / Zaugg, Serge / Ostojic, Miodrag / Pedrazzini, Giovanni / Karagiannis-Voules, Dimitrios-Alexios / Lüscher, Thomas F / Kornowski, Ran / Tüller, David / Vukcevic, Vladan / Heg, Dik / Windecker, Stephan. ·Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, Bern, Switzerland. · Department of Cardiology, Zealand University Hospital, Sygehusvej 10, Roskilde, Denmark. · Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark. · Department of Cardiology, Barts Heart Centre, Queen Mary University of London, London, UK. · Division of Cardiology, University Hospital, Rue Gabrielle Perret-Gentil 4, Geneva, Switzerland. · Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Koningsplein 1, Enschede, the Netherlands. · Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7500 AE, Enschede, the Netherlands. · Clinical Trials Unit, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland. · Cardiology Clinic, Clinical Center of Serbia, Visegradska 26, Belgrade, Serbia. · Department of Cardiology, Cardiocentro, Via Tesserete 46, Lugano, Switzerland. · Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland. · Royal Brompton and Harefield Hospitals, Trust and Imperial College, London, UK. · Cardiology Department, Rabin Medical Center, Petach Tikva, Tel Aviv University, Jabotinsky Street 39, Petah Tikwa, Israel. · Cardiology Department, Triemlispital, Birmensdorferstrasse 497, Zurich, Switzerland. ·Eur Heart J · Pubmed #30851032.

ABSTRACT: AIMS: The long-term outcomes of biolimus-eluting stents (BESs) with biodegradable polymer as compared with bare-metal stent (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) remain unknown. METHODS AND RESULTS: We performed a 5-year clinical follow-up of 1157 patients (BES: N = 575 and BMS: N = 582) included in the randomized COMFORTABLE AMI trial. Serial intracoronary imaging of stented segments using both intravascular ultrasound (IVUS) and optical coherence tomography performed at baseline and 13 months follow-up were analysed in 103 patients. At 5 years, BES reduced the risk of major adverse cardiac events [MACE; hazard ratio (HR) 0.56, 95% confidence interval (CI): 0.39-0.79, P = 0.001], driven by lower risks for target vessel-related reinfarction (HR 0.44, 95% CI: 0.22-0.87, P = 0.02) and ischaemia-driven target lesion revascularization (HR 0.41, 95% CI: 0.25-0.66, P < 0.001). Definite stent thrombosis (ST) was recorded in 2.2% and 3.9% (HR 0.57, 95% CI: 0.28-1.16, P = 0.12) with no differences in rates of very late definite ST (1.3% vs. 1.6%, P = 0.77). Optical coherence tomography showed no difference in the frequency of malapposed stent struts at follow-up (BES 0.08% vs. BMS 0.02%, P = 0.10). Uncovered stent struts were rarely observed but more frequent in BES (2.1% vs. 0.15%, P < 0.001). In the IVUS analysis, there was no positive remodelling in either group (external elastic membrane area change BES: -0.63 mm2, 95% CI: -1.44 to 0.39 vs. BMS -1.11 mm2, 95% CI: -2.27 to 0.04, P = 0.07). CONCLUSION: Compared with BMS, the implantation of biodegradable polymer-coated BES resulted in a lower 5-year rate of MACE in patients with STEMI undergoing primary percutaneous coronary intervention. At 13 months, vascular healing in treated culprit lesions was almost complete irrespective of stent type. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT00962416.

5 Article Changes in Coronary Plaque Composition in Patients With Acute Myocardial Infarction Treated With High-Intensity Statin Therapy (IBIS-4): A Serial Optical Coherence Tomography Study. 2019

Räber, Lorenz / Koskinas, Konstantinos C / Yamaji, Kyohei / Taniwaki, Masanori / Roffi, Marco / Holmvang, Lene / Garcia Garcia, Hector M / Zanchin, Thomas / Maldonado, Rafaela / Moschovitis, Aris / Pedrazzini, Giovanni / Zaugg, Serge / Dijkstra, Jouke / Matter, Christian M / Serruys, Patrick W / Lüscher, Thomas F / Kelbaek, Henning / Karagiannis, Alexios / Radu, Maria D / Windecker, Stephan. ·Department of Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: lorenz.raeber@insel.ch. · Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. · Department of Cardiology, Bern University Hospital, Bern, Switzerland; Tokorozawa Heart Center, Saitama, Japan. · Division of Cardiology, University Hospital Geneva, Geneva, Switzerland. · Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. · MedStar Cardiovacular Research Network, MedStar Washington Hospital Center, Washington. · Cardiocentro, Lugano, Switzerland. · Clinical Trials Unit (CTU), Bern, and Institute of Social and Preventive Medicine, University of Bern, Bern Switzerland. · Leiden University Medical Center, Leiden, the Netherlands. · Department of Cardiology, Zurich University Hospital, Zurich, Switzerland. · International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, London, United Kingdom. · Royal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom. · Department of Cardiology, Zealand University Hospital, Roskilde, Denmark. ·JACC Cardiovasc Imaging · Pubmed #30553686.

ABSTRACT: OBJECTIVES: This study assessed changes in optical coherence tomography (OCT)-defined plaque composition in patients with ST-elevation myocardial infarction (STEMI) receiving high-intensity statin treatment. BACKGROUND: OCT is a high-resolution modality capable of measuring plaque characteristics including fibrous cap thickness (FCT) and macrophage infiltration. There is limited in vivo evidence regarding the effects of statins on OCT-defined coronary atheroma composition and no evidence in the context of STEMI. METHODS: In the IBIS-4 (Integrated Biomarker Imaging Study-4), 103 patients underwent intravascular ultrasonography and OCT of 2 noninfarct-related coronary arteries in the acute phase of STEMI. Patients were treated with high-dose rosuvastatin for 13 months. Serial OCT imaging was available in 153 arteries from 83 patients. We measured FCT by using a semi-automated method. Co-primary endpoints consisted of the change in minimum FCT (measured in fibroatheromas) and change in macrophage line arc. RESULTS: At 13 months, median low-density lipoprotein cholesterol had decreased from 128 mg/dl to 73.6 mg/dl. Minimum FCT, measured in 31 lesions from 27 patients, increased from 64.9 ± 19.9 μm to 87.9 ± 38.1 μm (p = 0.008). Macrophage line arc decreased from 9.6° ± 12.8° to 6.4° ± 9.6° (p < 0.0001). The secondary endpoint, mean lipid arc, decreased from 55.9° ± 37° to 43.5° ± 33.5°. In lesion-level analyses (n = 191), 9 of 13 thin-cap fibroatheromata (TCFAs) at baseline (69.2%) regressed to non-TCFA morphology, whereas 2 of 178 non-TCFA lesions (1.1%) progressed to TCFAs. CONCLUSIONS: In this observational study, we found significant increase in minimum FCT, reduction in macrophage accumulation, and frequent regression of TCFAs to other plaque phenotypes in nonculprit lesions of patients with STEMI treated with high-intensity statin therapy.

6 Article Rehospitalizations Following Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Multi-Center Randomized Trial. 2017

Spitzer, Ernest / Frei, Martina / Zaugg, Serge / Hadorn, Susanne / Kelbaek, Henning / Ostojic, Miodrag / Baumbach, Andreas / Tüller, David / Roffi, Marco / Engstrom, Thomas / Pedrazzini, Giovanni / Vukcevic, Vladan / Magro, Michael / Kornowski, Ran / Lüscher, Thomas F / von Birgelen, Clemens / Heg, Dik / Windecker, Stephan / Räber, Lorenz. ·Department of Cardiology, Bern University Hospital, Bern, Switzerland. · Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands. · Clinical Trials Unit, University of Bern, Switzerland. · Institute of Social and Preventive Medicine, University of Bern, Switzerland. · Department of Cardiology, Zealand University Hospital, Roskilde, Denmark. · Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia. · William Harvey Research Institute, Queen Mary University and Barts Heart Centre, London, United Kingdom. · Cardiology Department, Triemlispital, Zurich, Switzerland. · Cardiocentro, Lugano, Switzerland. · Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. · Division of Cardiology, University Hospital, Geneva, Switzerland. · Department of Cardiology, TweeSteden Ziekenhuis, Tilburg, The Netherlands. · Rabin Medical Center, Petach Tikva, Israel. · Tel Aviv University, Tel Aviv, Israel. · Cardiology Department, University Hospital Zurich, Zurich, Switzerland. · Thoraxcentrum Twente, Twente University, Enschede, The Netherlands. · Department of Cardiology, Bern University Hospital, Bern, Switzerland lorenz.raeber@insel.ch. ·J Am Heart Assoc · Pubmed #28780509.

ABSTRACT: BACKGROUND: Rehospitalizations (RHs) after ST-elevation myocardial infarction carry a high economic burden and may deteriorate quality of life. Characterizing patients at higher risk may allow the design of preventive measures. We studied the frequency, reasons, and predictors for unplanned cardiac and noncardiac RHs in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. METHODS AND RESULTS: In this post-hoc analysis of the COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction; NCT00962416) trial including 1137 patients, unplanned cardiac and noncardiac RHs occurred in 133 (11.7%) and in 79 patients (6.9%), respectively, at 1 year. The most frequent reasons for unplanned cardiac RHs were recurrent chest pain without evidence of ischemia (20.4%), recurrent chest pain with ischemia and coronary intervention (16.9%), and ischemic events (16.9%). Unplanned noncardiac RHs occurred most frequently attributed to bleeding (24.5%), infections (14.3%), and cancer (9.1%). On multivariate analysis, left ventricular ejection fraction (22% increase in the rate of RHs per 10% decrease; CONCLUSIONS: Among ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention in the setting of a randomized, clinical trial, unplanned cardiac RHs occurred in 12% with recurrent chest pain being the foremost reason. Unplanned noncardiac RHs occurred in 7% with bleeding as the leading cause. Left ventricular ejection fraction and Syntax score were independent predictors of unplanned cardiac RHs and identified patient subgroups in need for improved secondary prevention. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00962416.

7 Article Coronary artery bypass graft surgery versus percutaneous coronary intervention with drug-eluting stents for left main coronary artery disease: A meta-analysis of randomized trials. 2017

Putzu, Alessandro / Gallo, Michele / Martino, Enrico Antonio / Ferrari, Enrico / Pedrazzini, Giovanni / Moccetti, Tiziano / Cassina, Tiziano. ·Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: alessandroputzu@ymail.com. · Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: michelegallo@hotmail.co.uk. · Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza, Italy. Electronic address: enri.martino@gmail.com. · Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: enrico.ferrari@cardiocentro.org. · Department of Cardiology, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: giovanni.pedrazzini@cardiocentro.org. · Department of Cardiology, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: tiziano.moccetti@cardiocentro.org. · Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. Electronic address: tiziano.cassina@cardiocentro.org. ·Int J Cardiol · Pubmed #28438354.

ABSTRACT: BACKGROUND: Despite several clinical studies, efficacy of coronary artery bypass grafting (CABG) surgery versus percutaneous coronary intervention (PCI) in patients with left main (LM) disease remains controversial. The objective of this meta-analysis of randomized trials was to evaluate the clinical outcome of CABG versus PCI with drug-eluting stents in LM coronary disease. METHODS: We systematically searched online databases up to March 2017 for randomized trials comparing CABG to PCI with drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We included data from 5 randomized trials and 4595 patients. At 30days, CABG was associated with higher stroke (OR 2.54 [95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45 [95% CI, 1.00-2.10]), with no other significant differences compared to PCI. At 1year, CABG reduced repeat revascularization (OR 0.56 [95% CI, 0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67]) and non-periprocedural myocardial infarction (OR 0.45 [95% CI, 0.29-0.70]), without significant differences on other outcomes. CONCLUSIONS: From the present updated meta-analysis of available studies on LM coronary disease treatment, there were no differences in mortality, myocardial infarction, and stroke rate at 3-5years follow-up after CABG or PCI, but CABG decreased the rate of repeat revascularization and non-periprocedural infarction. However, at short-term follow-up, CABG showed higher rate of stroke and periprocedural myocardial infarction, but these effects attenuated over time. These findings merit further investigation at longer follow-up.

8 Article Evaluation of a protocol for same-day discharge after radial lounge monitoring in a southern Swiss referral percutaneous coronary intervention centre. 2017

Biasco, Luigi / Pedrazzini, Giovanni B / Araco, Marco / Petracca, Francesco / Del Monte, Daniele / Sürder, Daniel / Bomio, Fulvio / Berto, Martina Boscolo / Montrasio, Giulia / Del Bufalo, Alessandro / Pasotti, Elena / Moccetti, Tiziano / Moccetti, Marco. ·Fondazione Cardiocentro Ticino, Lugano, Switzerland. ·J Cardiovasc Med (Hagerstown) · Pubmed #28319532.

ABSTRACT: AIMS: The aim of the study was to retrospectively evaluate safety and patient satisfaction of same-day discharge after elective radial coronary angiography/percutaneous coronary intervention (PCI) after the implementation of a radial lounge facility. METHODS: All patients admitted to our radial lounge with a planned same-day discharge after an uncomplicated coronary angiography/PCI, having a co-living caregiver, were day enrolled in the study. Rates of same-day discharge, unplanned overnight stay, and in-hospital and first complications [death, myocardial infarction (MI), unplanned coronary angiography, access site hematoma, bleedings requiring hospitalization] were analysed; satisfaction was also evaluated through a questionnaire. RESULTS: From February 2015 to January 2016, 312 patients with a mean age of 66.6 ± 10.8 years were admitted to the radial lounge (coronary angiography, n = 232; PCIs, n = 80). Of them, 245 (78.5%) were discharged the same day. Mean radial lounge monitoring was 6:35 h (interquartile range 5:30-7:30 h). No episodes of death/MI/unplanned coronary angiography were observed both in same-day discharged and postponed patients. Reasons to postpone discharge were: PCI deemed to need prolonged monitoring in 31, patient's preference in 14, femoral shift in 13, surgery in four, chest pain in four, and bleeding in one. At day 1, 11 access site hematoma and one hospitalization for access site bleeding were reported. Patients reported complete satisfaction in 97% of cases. Unplanned overnight stay was common among PCIs patients (RR 6.2, 95% CI 3.9-9.9, P < 0.001). CONCLUSION: A low rate of minor complications was observed in elective radial coronary angiography and PCIs showing the feasibility and safety of the development of an institutional protocol for same-day discharge after the implementation of a radial lounge facility.

9 Article SYNTAX score II in patients with coronary artery disease undergoing percutaneous mitral repair with the MitraClip. 2017

Obeid, Slayman / Attinger-Toller, Adrian / Taramasso, Maurizio / Pedrazzini, Giovanni / Suetsch, Gabor / Landolt, Fabienne / Karbeyaz, Fatih / Rodriguez, Hector / Sürder, Daniel / Moccetti, Tiziano / Nietlispach, Fabian / Maisano, Francesco. ·University Heart Center, University Hospital Zurich, Switzerland. · Cardiocentro Ticino, Lugano, Switzerland. · University Heart Center, University Hospital Zurich, Switzerland; HerzZentrum Hirslanden Zurich, Switzerland. · University Heart Center, University Hospital Zurich, Switzerland. Electronic address: francesco.maisano@usz.ch. ·Int J Cardiol · Pubmed #28283362.

ABSTRACT: BACKGROUND: Percutaneous mitral valve repair (PMVR) using the MitraClip™ system has become a valuable alternative in patients with severe mitral regurgitation (MR) and high surgical risk. We sought to evaluate the prognostic value of the SYNTAX II score (SSII) in patients with concomitant coronary artery disease (CAD) undergoing a Mitraclip procedure. METHODS: In seventy-five consecutive patients who underwent PMVR at the University Heart Center Zürich and the Cardiocentro Ticino, the SSSII was calculated at baseline. Clinical endpoints comprised of all-cause mortality, mitral valve surgery due to failure of PMVR or reoperation, hospitalization for congestive heart failure, heart transplantation and the composite of all four endpoints. RESULTS: Patients were followed for a median of 271days. And were divided in tertiles of SSII: SSII low ≤46.5 (n=25), SSII mid 46.6-54.4 (n=25) and SSII high ≥54.5 (n=25). Patients in the highest SSII tertile had a lower left ventricular ejection fraction (33% vs. 40% vs. 53%) with a higher log-BNP (3.6 vs. 3.45 vs. 3.16) when compared to SSII mid and SSII low, respectively. However, the anatomical syntax score (SS) did not differ significantly within the tertiles (9.1±6.3 (SSII Low) vs 9.5±7.6 (SSII Mid) vs 10.2±6.7(SSII High), p=0.837). The primary endpoint occurred in 33% of patients (n=25). By multivariate analysis patients in the high SSII tertile (OR=6.12, 95% confidence interval, [CI] 1.45-25.86, p=0.014) and patients with a history of MI (OR=3.57, 95% confidence interval, [CI] 1.17-10.88, p=0.025) were at significantly higher risk of experiencing adverse events. Furthermore, in a combined outcome ROC curve analysis, the SSII showed good discrimination with an AUC of 0.73, p=0.001. A cutoff SSII >49 has been identified to have a sensitivity of 83% and specificity of 53% with approximately 45% of the patients experiencing an event during follow-up. CONCLUSION: Using SSII in CAD patients undergoing PMVR is feasible and of prognostic significance hence widening its clinical utility in valvular heart disease.

10 Article Predictors of disagreement between prospectively ECG-triggered dual-source coronary computed tomography angiography and conventional coronary angiography. 2016

Muzzarelli, Stefano / Suerder, Daniel / Murzilli, Romina / Donato, Lucia / Pedrazzini, Giovanni / Pasotti, Elena / Moccetti, Tiziano / Klersy, Catherine / Faletra, Francesco Fulvio. ·Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland. · Division of Internal Medicine and Public Health, Università degli Studi dell'Aquila, Italy. · Service of Biometry & Statistics, IRCCS Policlinico San Matteo, Pavia, Italy. · Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland. Electronic address: stefano.muzzarelli@cardiocentro.org. ·Eur J Radiol · Pubmed #27161064.

ABSTRACT: AIMS: To identify causes of misinterpretation in second generation, dual-source coronary computed tomography angiography (CCTA). METHODS: A retrospective re-interpretation was performed on 100 consecutive CCTA studies, previously performed with a 2×128 slice dual-source CT. Results were compared with coronary angiography (CA). CCTA and CA images were interpreted by 2 independent readers. At CCTA vessel diameter, image quality, plaque characteristics and localization (bifurcation vs. non) were described for all segments. Finally, aortic contrast-to-noise ratio (CNR) and the total Agatston calcium score were quantified. Agreement between CCTA and CA was assessed with the Kappa statistic after categorizing the stenosis severity at significant (≥50%) and critical (≥70%) cut-offs, and independent predictors of disagreement were determined by multivariable logistic regression, including patient characteristics such as body mass index (BMI), heart rate (HR), age and gender. RESULTS: Per-segment sensitivity and specificity at ≥50% and ≥70% stenosis was of 83-95%, and 73-97%, respectively. There was a substantial agreement between CCTA and CA (kappa-50%=0.78, SE=0.03; kappa-70%=0.72, SE=0.03). Worse motion-related quality score, smaller vessel diameter, calcification within the segment of interest and LAD location were independent predictors of disagreement at 50% stenosis. The same factors, excluded LAD location, in addition to bifurcation-location of the coronary lesion predicted misdiagnosis at 70% stenosis. HR per se and BMI did not predict disagreement. CONCLUSION: According to the literature a substantial agreement between CCTA and CA was found. However, discrepancies exist and are mainly related with motion-related degradation of image quality, specific vessel anatomy and plaque characteristics. Awareness of such potential limitations may help guiding interpretation of CCTA.

11 Article Can the optimal type of stent be predicted based on clinical risk factors? A subgroup analysis of the randomized BASKET-PROVE trial. 2016

Vassalli, Giuseppe / Klersy, Catherine / De Servi, Stefano / Galatius, Soeren / Erne, Paul / Eberli, Franz / Rickli, Hans / Hornig, Burkhard / Bertel, Osmund / Bonetti, Piero / Moccetti, Tiziano / Kaiser, Christoph / Pfisterer, Matthias / Pedrazzini, Giovanni / Anonymous5450859. ·Fondazione Cardiocentro Ticino, Lugano, Switzerland; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. · IRCCS Policlinico San Matteo, Servizio di Biometria e Statistica, Pavia, Italy. · Ospedale Civile di Legnano, Milan, Italy. · Gentofte University Hospital, Hellerup, Denmark. · State Hospital, Lucerne, Switzerland. · Triemli Hospital, Zurich, Switzerland. · State Hospital, St Gallen, Switzerland. · Clara Hospital, Basel, Switzerland. · Cardiovascular Center Zurich, Zurich, Switzerland. · State Hospital, Chur, Switzerland. · Fondazione Cardiocentro Ticino, Lugano, Switzerland. · University Hospital Basel, Basel, Switzerland. · Fondazione Cardiocentro Ticino, Lugano, Switzerland. Electronic address: giovanni.pedrazzini@cardiocentro.org. ·Am Heart J · Pubmed #26920590.

ABSTRACT: BACKGROUND: The randomized BASKET-PROVE study showed no significant differences between sirolimus-eluting stents (SES), everolimus-eluting stents (EES), and bare-metal stents (BMS) with respect to the primary end point, rates of death from cardiac causes, or myocardial infarction (MI) at 2 years of follow-up, in patients requiring stenting of a large coronary artery. Clinical risk factors may affect clinical outcomes after percutaneous coronary interventions. We present a retrospective analysis of the BASKET-PROVE data addressing the question as to whether the optimal type of stent can be predicted based on a cumulative clinical risk score. METHODS: A total of 2,314 patients (mean age 66 years) who underwent coronary angioplasty and implantation of ≥1 stents that were ≥3.0 mm in diameter were randomly assigned to receive SES, EES, or BMS. A cumulative clinical risk score was derived using a Cox model that included age, gender, cardiovascular risk factors (hypercholesterolemia, hypertension, family history of cardiovascular disease, diabetes, smoking), presence of ≥2 comorbidities (stroke, peripheral artery disease, chronic kidney disease, chronic rheumatic disease), a history of MI or coronary revascularization, and clinical presentation (stable angina, unstable angina, ST-segment elevation MI). RESULTS: An aggregate drug-eluting stent (DES) group (n = 1,549) comprising 775 patients receiving SES and 774 patients receiving EES was compared to 765 patients receiving BMS. Rates of death from cardiac causes or nonfatal MI at 2 years of follow-up were significantly increased in patients who were in the high tertile of risk stratification for the clinical risk score compared to those who were in the aggregate low-mid tertiles. In patients with a high clinical risk score, rates of death from cardiac causes or nonfatal MI were lower in patients receiving DES (2.4 per 100 person-years, 95% CI 1.6-3.6) compared with BMS (5.5 per 100 person-years, 95% CI 3.7-8.2, hazard ratio 0.45, 95% CI 0.26-0.80, P = .007). However, they were not significantly different between receivers of DES and BMS in patients in the low-mid risk tertiles. CONCLUSIONS: This exploratory analysis suggests that, in patients who require stenting of a large coronary artery, use of a clinical risk score may identify those patients for whom DES use may confer a clinical advantage over BMS, beyond lower restenosis rates.

12 Article Long-term efficacy and safety of biodegradable-polymer biolimus-eluting stents: main results of the Basel Stent Kosten-Effektivitäts Trial-PROspective Validation Examination II (BASKET-PROVE II), a randomized, controlled noninferiority 2-year outcome trial. 2015

Kaiser, Christoph / Galatius, Soeren / Jeger, Raban / Gilgen, Nicole / Skov Jensen, Jan / Naber, Christoph / Alber, Hannes / Wanitschek, Maria / Eberli, Franz / Kurz, David J / Pedrazzini, Giovanni / Moccetti, Tiziano / Rickli, Hans / Weilenmann, Daniel / Vuillomenet, André / Steiner, Martin / Von Felten, Stefanie / Vogt, Deborah R / Wadt Hansen, Kim / Rickenbacher, Peter / Conen, David / Müller, Christian / Buser, Peter / Hoffmann, Andreas / Pfisterer, Matthias / Anonymous2050812. ·From the Department of Cardiology, University Hospital, Basel, Switzerland (C.K., R.J., N.G., P.B., A.H., M.P.) · Cardiology, Gentofte University Hospital, Copenhagen, Denmark (S.G., J.S.J., K.W.H.) · Cardiology, Elisabeth-Krankenhaus, Essen, Germany (C.N.) · Cardiology, University Hospital, Innsbruck, Austria (H.A., M.W.) · Cardiology, Triemlispital, Zürich, Switzerland (F.E., D.J.K.) · Cardiocentro, Lugano, Switzerland (G.P., T.M.) · Cardiology, State Hospital, St. Gallen, Switzerland (H.R., D.W.) · State Hospital, Aarau, Switzerland (A.V., M.S.) · Clinical Trial Unit, University Hospital Basel, Switzerland (S.V.F., D.R.V.) · Bruderholzspital, Bruderholz, Switzerland (P.R.) · and the Department of Internal Medicine, University Hospital Basel, Switzerland (D.C., C.M.). ·Circulation · Pubmed #25411159.

ABSTRACT: BACKGROUND: Biodegradable-polymer drug-eluting stents (BP-DES) were developed to be as effective as second-generation durable-polymer drug-eluting stents (DP-DES) and as safe >1 year as bare-metal stents (BMS). Thus, very late stent thrombosis (VLST) attributable to durable polymers should no longer appear. METHODS AND RESULTS: To address these early and late aspects, 2291 patients presenting with acute or stable coronary disease needing stents ≥3.0 mm in diameter between April 2010 and May 2012 were randomly assigned to biolimus-A9-eluting BP-DES, second-generation everolimus-eluting DP-DES, or thin-strut silicon-carbide-coated BMS in 8 European centers. All patients were treated with aspirin and risk-adjusted doses of prasugrel. The primary end point was combined cardiac death, myocardial infarction, and clinically indicated target-vessel revascularization within 2 years. The combined secondary safety end point was a composite of VLST, myocardial infarction, and cardiac death. The cumulative incidence of the primary end point was 7.6% with BP-DES, 6.8% with DP-DES, and 12.7% with BMS. By intention-to-treat BP-DES were noninferior (predefined margin, 3.80%) compared with DP-DES (absolute risk difference, 0.78%; -1.93% to 3.50%; P for noninferiority 0.042; per protocol P=0.09) and superior to BMS (absolute risk difference, -5.16; -8.32 to -2.01; P=0.0011). The 3 stent groups did not differ in the combined safety end point, with no decrease in events >1 year, particularly VLST with BP-DES. CONCLUSIONS: In large vessel stenting, BP-DES appeared barely noninferior compared with DP-DES and more effective than thin-strut BMS, but without evidence for better safety nor lower VLST rates >1 year. Findings challenge the concept that durable polymers are key in VLST formation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01166685.

13 Article Effect of high-intensity statin therapy on atherosclerosis in non-infarct-related coronary arteries (IBIS-4): a serial intravascular ultrasonography study. 2015

Räber, Lorenz / Taniwaki, Masanori / Zaugg, Serge / Kelbæk, Henning / Roffi, Marco / Holmvang, Lene / Noble, Stephane / Pedrazzini, Giovanni / Moschovitis, Aris / Lüscher, Thomas F / Matter, Christian M / Serruys, Patrick W / Jüni, Peter / Garcia-Garcia, Hector M / Windecker, Stephan / Anonymous2220805. ·Department of Cardiology, Bern University Hospital, 3010, Bern, Switzerland. · Clinical Trials Unit, Bern University, Bern, Switzerland. · Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen, Denmark. · Division of Cardiology, University Hospital, Geneva, Switzerland. · Cardiocentro, Lugano, Switzerland. · Cardiology Department, University Hospital Zurich, Zurich, Switzerland. · Cardialysis BV, Rotterdam, The Netherlands. · Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. ·Eur Heart J · Pubmed #25182248.

ABSTRACT: AIM: The effect of long-term high-intensity statin therapy on coronary atherosclerosis among patients with acute ST-segment elevation myocardial infarction (STEMI) is unknown. The aim of this study was to quantify the impact of high-intensity statin therapy on plaque burden, composition, and phenotype in non-infarct-related arteries of STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: Between September 2009 and January 2011, 103 STEMI patients underwent intravascular ultrasonography (IVUS) and radiofrequency ultrasonography (RF-IVUS) of the two non-infarct-related epicardial coronary arteries (non-IRA) after successful primary PCI. Patients were treated with high-intensity rosuvastatin (40 mg/day) throughout 13 months and serial intracoronary imaging with the analysis of matched segments was available for 82 patients with 146 non-IRA. The primary IVUS end-point was the change in per cent atheroma volume (PAV). After 13 months, low-density lipoprotein cholesterol (LDL-C) had decreased from a median of 3.29 to 1.89 mmol/L (P < 0.001), and high-density lipoprotein cholesterol (HDL-C) levels had increased from 1.10 to 1.20 mmol/L (P < 0.001). PAV of the non-IRA decreased by -0.9% (95% CI: -1.56 to -0.25, P = 0.007). Patients with regression in at least one non-IRA were more common (74%) than those without (26%). Per cent necrotic core remained unchanged (-0.05%, 95% CI: -1.05 to 0.96%, P = 0.93) as did the number of RF-IVUS defined thin cap fibroatheromas (124 vs. 116, P = 0.15). CONCLUSION: High-intensity rosuvastatin therapy over 13 months is associated with regression of coronary atherosclerosis in non-infarct-related arteries without changes in RF-IVUS defined necrotic core or plaque phenotype among STEMI patients.

14 Article Acute multivessel revascularization improves 1-year outcome in ST-elevation myocardial infarction: a nationwide study cohort from the AMIS Plus registry. 2014

Jeger, Raban / Jaguszewski, Milosz / Nallamothu, Brahmajee N / Lüscher, Thomas F / Urban, Philip / Pedrazzini, Giovanni B / Erne, Paul / Radovanovic, Dragana / Anonymous5190782. ·Cardiology, University Hospital, Basel, Switzerland. · University Heart Center, University Hospital Zurich, Switzerland. · Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, USA. · Cardiovascular Department, Hôpital de La Tour, Geneva, Switzerland. · Cardiology, CardioCentro Ticino, Lugano, Switzerland. · Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland; AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Switzerland. Electronic address: paul.erne@erne-net.ch. · AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Switzerland. ·Int J Cardiol · Pubmed #24461983.

ABSTRACT: BACKGROUND: The optimal strategy for percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) in multi-vessel disease (MVD), i.e., multi-vessel PCI (MV-PCI) vs. PCI of the infarct-related artery only (IRA-PCI), still remains unknown. METHODS: Patients of the AMIS Plus registry admitted with an acute coronary syndrome were contacted after a median of 378 days (interquartile range 371-409). The primary end-point was all-cause death. The secondary end-point included all major adverse cardiovascular and cerebrovascular events (MACCE) including death, re-infarction, re-hospitalization for cardiac causes, any cardiac re-intervention, and stroke. RESULTS: Between 2005 and 2012, 8330 STEMI patients were identified, of whom 1909 (24%) had MVD. Of these, 442 (23%) received MV-PCI and 1467 (77%) IRA-PCI. While all-cause mortality was similar in both groups (2.7% both, p>0.99), MACCE was significantly lower after MV-PCI vs. IRA-PCI (15.6% vs. 20.0%, p=0.038), mainly driven by lower rates of cardiac re-hospitalization and cardiac re-intervention. Patients undergoing MV-PCI with drug-eluting stents had lower rates of all-cause mortality (2.1% vs. 7.4%, p=0.026) and MACCE (14.1% vs. 25.9%, p=0.042) compared with those receiving bare metal stents (BMS). In multivariate analysis, MV-PCI (odds ratio, OR 0.69, 95% CI 0.51-0.93, p=0.017) and comorbidities (Charlson index ≥ 2; OR 1.42, 95% CI 1.05-1.92, p=0.025) were independent predictors for 1-year MACCE. CONCLUSION: In an unselected nationwide real-world cohort, an approach using immediate complete revascularization may be beneficial in STEMI patients with MVD regarding MACCE, specifically when drug-eluting stents are used, but not regarding mortality. This has to be tested in a randomized controlled trial.

15 Article Multivessel versus culprit vessel percutaneous coronary intervention in ST-elevation myocardial infarction: is more worse? 2013

Jaguszewski, Milosz / Radovanovic, Dragana / Nallamothu, Brahmajee K / Lüscher, Thomas F / Urban, Philip / Eberli, Franz R / Bertel, Osmund / Pedrazzini, Giovanni B / Windecker, Stephan / Jeger, Raban / Erne, Paul / Anonymous2510780. ·Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. ·EuroIntervention · Pubmed #24384288.

ABSTRACT: AIMS: We examined what type of STEMI patients are more likely to undergo multivessel PCI (MPCI) in a "real-world" setting and whether MPCI leads to worse or better outcomes compared with single-vessel PCI (SPCI) after stratifying patients by risk. METHODS AND RESULTS: Among STEMI patients enrolled in the Swiss AMIS Plus registry between 2005 and 2012 (n=12,000), 4,941 were identified with multivessel disease. We then stratified patients based on MPCI use and their risk. High-risk patients were identified a priori as those with: 1) left main (LM) involvement (lesions, n=263); 2) out-of-hospital cardiac arrest; or 3) Killip class III/IV. Logistic regression models examined for predictors of MPCI use and the association between MPCI and in-hospital mortality. Three thousand eight hundred and thirty-three (77.6%) patients underwent SPCI and 1,108 (22.4%) underwent MPCI. Rates of MPCI were greater among high-risk patients for each of the three categories: 8.6% vs. 5.9% for out-of-hospital cardiac arrest (p<0.01); 12.3% vs. 6.2% for Killip III/IV (p<0.001); and 14.5% vs. 2.7% for LM involvement (p<0.001). Overall, in-hospital mortality after MPCI was higher when compared with SPCI (7.3% vs. 4.4%; p<0.001). However, this result was not present when patients were stratified by risk: in-hospital mortality for MPCI vs. SPCI was 2.0% vs. 2.0% (p=1.00) in low-risk patients and 22.2% vs. 21.7% (p=1.00) in high-risk patients. CONCLUSIONS: High-risk patients are more likely to undergo MPCI. Furthermore, MPCI does not appear to be associated with higher mortality after stratifying patients based on their risk.

16 Article Heterogeneity of human monocytes: an optimized four-color flow cytometry protocol for analysis of monocyte subsets. 2011

Tallone, Tiziano / Turconi, Giovanna / Soldati, Gianni / Pedrazzini, Giovanni / Moccetti, Tiziano / Vassalli, Giuseppe. ·Swiss Stem Cells Foundation and Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland. tiziano.tallone@cardiocentro.org ·J Cardiovasc Transl Res · Pubmed #21308491.

ABSTRACT: Monocytes are central mediators in the development of atherosclerotic plaques. They circulate in blood and eventually migrate into tissue including the vessel wall where they give rise to macrophages and dendritic cells. The existence of monocyte subsets with distinct roles in homeostasis and inflammation suggests specialization of function. These subsets are identified based on expression of the CD14 and CD16 markers. Routinely applicable protocols remain elusive, however. Here, we present an optimized four-color flow cytometry protocol for analysis of human blood monocyte subsets using a specific PE-Cy5-conjugated monoclonal antibody (mAb) to HLA-DR, a PE-Cy7-conjugated mAb to CD14, a FITC-conjugated mAb to CD16, and PE-conjugated mAbs to additional markers relevant to monocyte function. Classical CD14(+)CD16(-) monocytes (here termed "Mo1" subset) expressed high CCR2, CD36, CD64, and CD62L, but low CX(3)CR1, whereas "nonclassical" CD14(lo)CD16(+) monocytes (Mo3) essentially showed the inverse expression pattern. CD14(+)CD16(+) monocytes (Mo2) expressed high HLA-DR, CD36, and CD64. In patients with stable coronary artery disease (n = 13), classical monocytes were decreased, whereas "nonclassical" monocytes were increased 90% compared with healthy subjects with angiographically normal coronary arteries (n = 14). Classical monocytes from CAD patients expressed higher CX(3)CR1 and CCR2 than controls. Thus, stable CAD is associated with expansion of the nonclassical monocyte subset and increased expression of inflammatory markers on monocytes. Flow cytometric analysis of monocyte subsets and marker expression may provide valuable information on vascular inflammation. This may translate into the identification of monocyte subsets as selective therapeutic targets, thus avoiding adverse events associated with indiscriminate monocyte inhibition.