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Coronary Artery Disease: HELP
Articles by Giovanni Battista Pedrazzini
Based on 15 articles published since 2008

Between 2008 and 2019, G. B. Pedrazzini wrote the following 15 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 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.

4 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.

5 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.

6 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.

7 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 / Anonymous6030859. ·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.

8 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 / Anonymous1670812. ·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.

9 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 / Anonymous2120805. ·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.

10 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.

11 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 / Anonymous2470780. ·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.

12 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.

13 Article Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. 2009

Sjauw, Krischan D / Konorza, Thomas / Erbel, Raimund / Danna, Paolo L / Viecca, Maurizio / Minden, Hans-Heinrich / Butter, Christian / Engstrøm, Thomas / Hassager, Christian / Machado, Francisco P / Pedrazzini, Giovanni / Wagner, Daniel R / Schamberger, Rainer / Kerber, Sebastian / Mathey, Detlef G / Schofer, Joachim / Engström, Annemarie E / Henriques, Jose P S. ·Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands. ·J Am Coll Cardiol · Pubmed #20082934.

ABSTRACT: OBJECTIVES: This retrospective multicenter registry evaluated the safety and feasibility of left ventricular (LV) support with the Impella 2.5 (Abiomed Europe GmbH, Aachen, Germany) during high-risk percutaneous coronary intervention (PCI). BACKGROUND: Patients with complex or high-risk coronary lesions, such as last remaining vessel or left main lesions, are increasingly being treated with PCI. Because periprocedural hemodynamic compromise and complications might occur rapidly, many of these high-risk procedures are being performed with mechanical cardiac assistance, particularly in patients with poor LV function. The Impella 2.5, a percutaneous implantable LV assist device, might be a superior alternative to the traditionally used intra-aortic balloon pump. METHODS: The Europella registry included 144 consecutive patients who underwent a high-risk PCI. Safety and feasibility end points included incidence of 30-day adverse events and successful device function. RESULTS: Patients were older (62% >70 years of age), 54% had an LV ejection fraction < or = 30%, and the prevalence of comorbid conditions was high. Mean European System for Cardiac Operative Risk Evaluation score was 8.2 (SD 3.4), and 43% of the patients were refused for coronary artery bypass grafting. A PCI was considered high-risk due to left main disease, last remaining vessel disease, multivessel coronary artery disease, and low LV function in 53%, 17%, 81%, and 35% of the cases, respectively. Mortality at 30 days was 5.5%. Rates of myocardial infarction, stroke, bleeding requiring transfusion/surgery, and vascular complications at 30 days were 0%, 0.7%, 6.2%, and 4.0%, respectively. CONCLUSIONS: This large multicenter registry supports the safety, feasibility, and potential usefulness of hemodynamic support with Impella 2.5 in high-risk PCI.

14 Article Relation between coronary atherosclerotic plaques and traditional risk factors in people with no history of cardiovascular disease undergoing multi-detector computed coronary angiography. 2009

Faletra, F F / Klersy, C / D'Angeli, I / Penco, M / Procaccini, V / Pasotti, E / Marcolongo, A / Pedrazzini, G B / De Castro, S / Scappaticci, M / Moccetti, T / Auricchio, A. ·Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland. francesco.faletra@cardiocentro.org ·Heart · Pubmed #19406736.

ABSTRACT: AIMS: To prospectively investigate the prevalence of coronary artery plaques (CAP) as detected by computed tomography-based angiography in a large number of consecutive individuals with no history of coronary artery disease (CAD) or acute coronary syndrome; to evaluate whether traditional risk factors are related to prevalence of CAP and to the expected 10-year risk of first major or fatal cardiovascular event (CVE). DESIGN: Prospective, single-centre, cross-sectional study. SETTING: The division of Cardiology at Fondazione Cardiocentro Ticino Lugano, Switzerland. METHODS: We prospectively included 920 consecutive individuals with no history of CAD who underwent computed tomography coronary angiography (CTCA). Risk estimation of fatal and non-fatal CVE was assessed using Global Assessment Risk (GAR) and Systematic Coronary Risk Evaluation (SCORE), respectively. Logistic regression was used to assess the association of risk factors with the prevalence of CAP. RESULTS: CAP was found in 459 (49.9%) individuals. Older age, higher body mass index, male gender, diabetes, hypertension and dyslipidaemia all increased the likelihood of the CAP burden at univariable analysis (p<0.001). At the multivariable analysis older age, male gender, hypertension and diabetes independently increased the likelihood of CAP burden (p<0.001). An increase in likelihood of CAP was observed in the presence of one, two and three or more risk factors and with an increasing value of GAR and SCORE. Notably, about 18% of subjects with CAP did not report any traditional risk factors and among individuals without CAPs, 12% had three or more risk factors. CONCLUSIONS: A direct relation between the prevalence of CAP, number of risk factors and the related 10-year risk of CVE was found. 18% of subjects without risk factors had CAP. In these individuals CTCA may help in further optimising the risk reduction strategies on an individual basis.

15 Article Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosis. 2008

Pedrazzini, Giovanni Battista / Masson, Serge / Latini, Roberto / Klersy, Catherine / Rossi, Maria Grazia / Pasotti, Elena / Faletra, Francesco Fulvio / Siclari, Francesco / Minervini, Fabrizio / Moccetti, Tiziano / Auricchio, Angelo. ·Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland. ·Am J Cardiol · Pubmed #18774001.

ABSTRACT: The accuracy of the logistic EuroSCORE (logES), a widely used risk prediction algorithm for cardiac surgery including aortic valve surgery, usually overestimates observed perioperative mortality. Elevated brain natriuretic peptide (BNP) in symptomatic patients with aortic stenosis (AS) is associated with a poor short-term outcome after aortic valve replacement. We aimed to compare BNP with the logES for predicting short- and long-term outcome in symptomatic patients with severe AS undergoing aortic valve replacement. We prospectively studied 144 consecutive patients referred for aortic valve replacement (42% women, 73 +/- 9 years, mean aortic gradient 51 +/- 18 mm Hg, and left ventricular ejection fraction 61 +/- 11%) undergoing either isolated aortic valve replacement (58%) or combined to bypass grafting. Both plasma BNP and logES was estimated before surgery. The median BNP plasma level and logES were 157 pg/ml (interquartile range [IQR] 61 to 440) and 6.6% (IQR 4.2 to 12.2), respectively. The perioperative mortality was 6% and the overall mortality by the end of the study was 13%. Patients with logES >10.1% (upper tertile) had a higher risk of dying over time (hazard ratio [HR] 2.86, p = 0.037), as had patients with BNP >312 pg/ml (HR 9.01, p <0.001). Discrimination (based on C statistic) and model performance (based on Akaike information criterion) were better for BNP than for logES. At the bivariable analysis, only BNP was an independent predictor of death (HR 8.2, p = 0.002). Preoperative BNP was even more accurate than logES in predicting outcome. In conclusion, in symptomatic patients with severe AS, high preoperative BNP plasma level and high logES confirm their predicting value for short- and long-term outcome.