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Attilio Maseri - One of the best experts on this subject based on the ideXlab platform.
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Management of unstable angina at rest by verapamil A double-blind cross-over study in Coronary Care Unit
2016Co-Authors: Oberdan Parodi, Attilio Maseri, Ignazio SimonettiAbstract:SUMMARY A therapeutic trial with verapamil, a calcium-antagonist drug, was performed in 12 patients admitted to our Coronary Care Unit because offrequent daily attacks ofangina at rest attributed to Coronary vasospasm. After a 48-hour run-in period, oral verapamil 480 mg/day and placebo were administered alternately during 4 randomised 48-hour periods. Transient ischaemic attacks with ST segment elevation or depression, with or without pain, were documented by continuous electrocardiographic monitoring. The number of attacks during the run-in and 2 placebo periods were 128, 123, and 130, respectively, and 31 and 23 during the 2 treatment periods (P < 0.006 and P < 0.003). This drug therefore appears to be effective in the management of patients with frequent attacks of angina at rest. Although various forms ol medical and surgical treatment have been proposed for the management of unstable angina at rest, the results are incon-clusive (Cairns et al., 1976) and often conflicting (Conti et al., 1973; Bertolasi et al., 1974; Hultgren, 1976; Selzer et al., 1976; Clark et al., 1977). This may be because the patients are selected on purel
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increasing levels of interleukin il 1ra and il 6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in hospital Coronary events
Circulation, 1999Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Giuseppina Caligiuri, Francesca Ginnetti, Giamila Fantuzzi, Charles A Dinarello, Attilio MaseriAbstract:Background—A growing body of evidence suggests a role for inflammation in acute Coronary syndromes. The aim of this study was to assess the role of proinflammatory cytokines, their time course, and their association with prognosis in unstable angina. Methods and Results—We studied 43 patients aged 62±8 years admitted to our Coronary Care Unit for Braunwald class IIIB unstable angina. In each patient, serum levels of interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6) (which represent sensitive markers of biologically active IL-1β and tumor necrosis factor-α levels, respectively), and troponin T were measured at entry and 48 hours after admission. Troponin T–positive patients were excluded. Patients were divided a posteriori into 2 groups according to their in-hospital outcome: group 1 comprised 17 patients with an uneventful course, and group 2 comprised 26 patients with a complicated in-hospital course. In group 1, mean IL-1Ra decreased at 48 hours by 12%, and IL-6 diminished at 48 hours by ...
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elevated levels of c reactive protein at discharge in patients with unstable angina predict recurrent instability
Circulation, 1999Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Giuseppina Caligiuri, R Grillo, Antonino Buffon, Francesco Summaria, Francesca Ginnetti, Giovanni Fadda, Attilio MaseriAbstract:Background—In a group of patients admitted for unstable angina, we investigated whether C-reactive protein (CRP) plasma levels remain elevated at discharge and whether persistent elevation is associated with recurrence of instability. Methods and Results—We measured plasma levels of CRP, serum amyloid A protein (SAA), fibrinogen, total cholesterol, and Helicobacter pylori and Chlamydia pneumoniae antibody titers in 53 patients admitted to our Coronary Care Unit for Braunwald class IIIB unstable angina. Blood samples were taken on admission, at discharge, and after 3 months. Patients were followed for 1 year. At discharge, CRP was elevated (>3 mg/L) in 49% of patients; of these, 42% had elevated levels on admission and at 3 months. Only 15% of patients with discharge levels of CRP <3 mg/L but 69% of those with elevated CRP (P<0.001) were readmitted because of recurrence of instability or new myocardial infarction. New phases of instability occurred in 13% of patients in the lower tertile of CRP (≤2.5 mg/L)...
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plasma protein acute phase response in unstable angina is not induced by ischemic injury
Circulation, 1996Co-Authors: Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Luigi M. Biasucci, Giuseppina Caligiuri, Claudia Monaco, M B Pepys, Ruth J Gallimore, G A Lanza, Gaetano Quaranta, Attilio MaseriAbstract:Background Elevated levels of C-reactive protein (CRP) are associated with an unfavorable clinical outcome in patients with unstable angina. To determine whether ischemia-reperfusion injury causes this acute-phase response, we studied the temporal relation between plasma levels of CRP and ischemic episodes in 48 patients with unstable angina and 20 control patients with active variant angina, in which severe myocardial ischemia is caused by occlusive Coronary artery spasm. Methods and Results Blood samples were taken on admission and subsequently at 24, 48, 72, and 96 hours. All patients underwent Holter monitoring for the first 24 hours and remained in the Coronary Care Unit under ECG monitoring until completion of the study. On admission, CRP was significantly higher in unstable angina than in variant angina patients (P<.001). In unstable angina, 70 ischemic episodes (1.5±2 per patient) and in variant angina 192 ischemic episodes (9.6±10.7 per patient) were observed during Holter monitoring (P<.001), fo...
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elevated levels of interleukin 6 in unstable angina
Circulation, 1996Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Alessandra Vitelli, Antonio Giuseppe Rebuzzi, Sergio Altamura, Giuseppina Caligiuri, Gennaro Ciliberto, Claudia Monaco, Attilio MaseriAbstract:Background Elevated plasma levels of C-reactive protein have been found in the majority of patients with unstable angina. The evidence of elevated levels of acute-phase proteins in unstable angina is in line with a growing body of evidence that suggests that inflammation plays a role in this syndrome and is an indirect sign of increased production of interleukin-6, which is the major determinant of acute-phase–protein production by the liver. However, in unstable angina, there is no direct proof of the role played by interleukin-6. Methods and Results We measured levels of interleukin-6 in 38 patients with unstable angina at the time of their admission to the Coronary Care Unit and in 29 patients with stable angina. In the same groups of patients, we also measured C-reactive protein. Interleukin-6 (undetectable, ie, <3 pg/mL, in healthy volunteers) was detectable in 23 (61%) of 38 patients with unstable angina but in only 6 (21%) of 29 with stable angina (P<.01). Median interleukin-6 levels were 5.25 pg/m...
Joshua P Loh - One of the best experts on this subject based on the ideXlab platform.
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characteristics and outcomes of young patients with st segment elevation myocardial infarction undergoing primary percutaneous Coronary intervention retrospective analysis in a multiethnic asian population
Open heart, 2021Co-Authors: Benjamin Wl Tung, William Kristanto, Kalyar Win Saw, Siew Pang Chan, Winnie Sia, Koo Hui Chan, Mark Y Chan, William K F Kong, Ronald Lee, Joshua P LohAbstract:Objective ST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous Coronary intervention (PPCI) to help focus public health efforts in STEMI prevention. Methods Data from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young ( Results Of the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were Conclusion Young patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.
Luigi M. Biasucci - One of the best experts on this subject based on the ideXlab platform.
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increasing levels of interleukin il 1ra and il 6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in hospital Coronary events
Circulation, 1999Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Giuseppina Caligiuri, Francesca Ginnetti, Giamila Fantuzzi, Charles A Dinarello, Attilio MaseriAbstract:Background—A growing body of evidence suggests a role for inflammation in acute Coronary syndromes. The aim of this study was to assess the role of proinflammatory cytokines, their time course, and their association with prognosis in unstable angina. Methods and Results—We studied 43 patients aged 62±8 years admitted to our Coronary Care Unit for Braunwald class IIIB unstable angina. In each patient, serum levels of interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6) (which represent sensitive markers of biologically active IL-1β and tumor necrosis factor-α levels, respectively), and troponin T were measured at entry and 48 hours after admission. Troponin T–positive patients were excluded. Patients were divided a posteriori into 2 groups according to their in-hospital outcome: group 1 comprised 17 patients with an uneventful course, and group 2 comprised 26 patients with a complicated in-hospital course. In group 1, mean IL-1Ra decreased at 48 hours by 12%, and IL-6 diminished at 48 hours by ...
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elevated levels of c reactive protein at discharge in patients with unstable angina predict recurrent instability
Circulation, 1999Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Giuseppina Caligiuri, R Grillo, Antonino Buffon, Francesco Summaria, Francesca Ginnetti, Giovanni Fadda, Attilio MaseriAbstract:Background—In a group of patients admitted for unstable angina, we investigated whether C-reactive protein (CRP) plasma levels remain elevated at discharge and whether persistent elevation is associated with recurrence of instability. Methods and Results—We measured plasma levels of CRP, serum amyloid A protein (SAA), fibrinogen, total cholesterol, and Helicobacter pylori and Chlamydia pneumoniae antibody titers in 53 patients admitted to our Coronary Care Unit for Braunwald class IIIB unstable angina. Blood samples were taken on admission, at discharge, and after 3 months. Patients were followed for 1 year. At discharge, CRP was elevated (>3 mg/L) in 49% of patients; of these, 42% had elevated levels on admission and at 3 months. Only 15% of patients with discharge levels of CRP <3 mg/L but 69% of those with elevated CRP (P<0.001) were readmitted because of recurrence of instability or new myocardial infarction. New phases of instability occurred in 13% of patients in the lower tertile of CRP (≤2.5 mg/L)...
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plasma protein acute phase response in unstable angina is not induced by ischemic injury
Circulation, 1996Co-Authors: Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Luigi M. Biasucci, Giuseppina Caligiuri, Claudia Monaco, M B Pepys, Ruth J Gallimore, G A Lanza, Gaetano Quaranta, Attilio MaseriAbstract:Background Elevated levels of C-reactive protein (CRP) are associated with an unfavorable clinical outcome in patients with unstable angina. To determine whether ischemia-reperfusion injury causes this acute-phase response, we studied the temporal relation between plasma levels of CRP and ischemic episodes in 48 patients with unstable angina and 20 control patients with active variant angina, in which severe myocardial ischemia is caused by occlusive Coronary artery spasm. Methods and Results Blood samples were taken on admission and subsequently at 24, 48, 72, and 96 hours. All patients underwent Holter monitoring for the first 24 hours and remained in the Coronary Care Unit under ECG monitoring until completion of the study. On admission, CRP was significantly higher in unstable angina than in variant angina patients (P<.001). In unstable angina, 70 ischemic episodes (1.5±2 per patient) and in variant angina 192 ischemic episodes (9.6±10.7 per patient) were observed during Holter monitoring (P<.001), fo...
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elevated levels of interleukin 6 in unstable angina
Circulation, 1996Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Alessandra Vitelli, Antonio Giuseppe Rebuzzi, Sergio Altamura, Giuseppina Caligiuri, Gennaro Ciliberto, Claudia Monaco, Attilio MaseriAbstract:Background Elevated plasma levels of C-reactive protein have been found in the majority of patients with unstable angina. The evidence of elevated levels of acute-phase proteins in unstable angina is in line with a growing body of evidence that suggests that inflammation plays a role in this syndrome and is an indirect sign of increased production of interleukin-6, which is the major determinant of acute-phase–protein production by the liver. However, in unstable angina, there is no direct proof of the role played by interleukin-6. Methods and Results We measured levels of interleukin-6 in 38 patients with unstable angina at the time of their admission to the Coronary Care Unit and in 29 patients with stable angina. In the same groups of patients, we also measured C-reactive protein. Interleukin-6 (undetectable, ie, <3 pg/mL, in healthy volunteers) was detectable in 23 (61%) of 38 patients with unstable angina but in only 6 (21%) of 29 with stable angina (P<.01). Median interleukin-6 levels were 5.25 pg/m...
Takahiro Inoue - One of the best experts on this subject based on the ideXlab platform.
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association between early intensive Care or Coronary Care Unit admission and post discharge performance of activities of daily living in patients with acute decompensated heart failure
PLOS ONE, 2021Co-Authors: Masato Kanda, Kazuya Tateishi, Atsushi Nakagomi, Togo Iwahana, Sho Okada, Hiroyo Kuwabara, Yoshio Kobayashi, Takahiro InoueAbstract:The management of acute decompensated heart failure often requires intensive Care. However, the effects of early intensive Care Unit/Coronary Care Unit admission on activities of daily living (ADL) in acute decompensated heart failure patients have not been precisely evaluated. Thus, we retrospectively assessed the association between early intensive Care Unit admission and post-discharge ADL performance in these patients. Acute decompensated heart failure patients (New York Heart Association I-III) admitted on emergency between April 1, 2014, and December 31, 2018, were selected from the Diagnosis Procedure Combination database and divided into intensive Care Unit/Coronary Care Unit (ICU) and general ward (GW) groups according to the hospitalization type on admission day 1. The propensity score was calculated to create matched cohorts where admission style (intensive Care Unit/Coronary Care Unit admission) was independent of measured baseline confounding factors, including ADL at admission. The primary outcome was ADL performance level at discharge (post-ADL) defined according to the Barthel index. Secondary outcomes included length of stay and total hospitalization cost (expense). Overall, 12231 patients were eligible, and propensity score matching created 2985 pairs. After matching, post-ADL was significantly higher in the ICU group than in the GW group [mean (standard deviation), GW vs. ICU: 71.5 (35.3) vs. 78.2 (31.2) points, P<0.001; mean difference: 6.7 (95% confidence interval, 5.1-8.4) points]. After matching, length of stay was significantly shorter and expenses were significantly higher in the ICU group than in the GW group. Stratified analysis showed that the patients with low ADL at admission (Barthel index score <60) were the most benefited from early intensive Care Unit/Coronary Care Unit admission. Thus, early intensive Care Unit/Coronary Care Unit admission was associated with improved post-ADL in patients with emergency acute decompensated heart failure admission.
Giovanna Liuzzo - One of the best experts on this subject based on the ideXlab platform.
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increasing levels of interleukin il 1ra and il 6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in hospital Coronary events
Circulation, 1999Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Giuseppina Caligiuri, Francesca Ginnetti, Giamila Fantuzzi, Charles A Dinarello, Attilio MaseriAbstract:Background—A growing body of evidence suggests a role for inflammation in acute Coronary syndromes. The aim of this study was to assess the role of proinflammatory cytokines, their time course, and their association with prognosis in unstable angina. Methods and Results—We studied 43 patients aged 62±8 years admitted to our Coronary Care Unit for Braunwald class IIIB unstable angina. In each patient, serum levels of interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6) (which represent sensitive markers of biologically active IL-1β and tumor necrosis factor-α levels, respectively), and troponin T were measured at entry and 48 hours after admission. Troponin T–positive patients were excluded. Patients were divided a posteriori into 2 groups according to their in-hospital outcome: group 1 comprised 17 patients with an uneventful course, and group 2 comprised 26 patients with a complicated in-hospital course. In group 1, mean IL-1Ra decreased at 48 hours by 12%, and IL-6 diminished at 48 hours by ...
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elevated levels of c reactive protein at discharge in patients with unstable angina predict recurrent instability
Circulation, 1999Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Giuseppina Caligiuri, R Grillo, Antonino Buffon, Francesco Summaria, Francesca Ginnetti, Giovanni Fadda, Attilio MaseriAbstract:Background—In a group of patients admitted for unstable angina, we investigated whether C-reactive protein (CRP) plasma levels remain elevated at discharge and whether persistent elevation is associated with recurrence of instability. Methods and Results—We measured plasma levels of CRP, serum amyloid A protein (SAA), fibrinogen, total cholesterol, and Helicobacter pylori and Chlamydia pneumoniae antibody titers in 53 patients admitted to our Coronary Care Unit for Braunwald class IIIB unstable angina. Blood samples were taken on admission, at discharge, and after 3 months. Patients were followed for 1 year. At discharge, CRP was elevated (>3 mg/L) in 49% of patients; of these, 42% had elevated levels on admission and at 3 months. Only 15% of patients with discharge levels of CRP <3 mg/L but 69% of those with elevated CRP (P<0.001) were readmitted because of recurrence of instability or new myocardial infarction. New phases of instability occurred in 13% of patients in the lower tertile of CRP (≤2.5 mg/L)...
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plasma protein acute phase response in unstable angina is not induced by ischemic injury
Circulation, 1996Co-Authors: Giovanna Liuzzo, Antonio Giuseppe Rebuzzi, Luigi M. Biasucci, Giuseppina Caligiuri, Claudia Monaco, M B Pepys, Ruth J Gallimore, G A Lanza, Gaetano Quaranta, Attilio MaseriAbstract:Background Elevated levels of C-reactive protein (CRP) are associated with an unfavorable clinical outcome in patients with unstable angina. To determine whether ischemia-reperfusion injury causes this acute-phase response, we studied the temporal relation between plasma levels of CRP and ischemic episodes in 48 patients with unstable angina and 20 control patients with active variant angina, in which severe myocardial ischemia is caused by occlusive Coronary artery spasm. Methods and Results Blood samples were taken on admission and subsequently at 24, 48, 72, and 96 hours. All patients underwent Holter monitoring for the first 24 hours and remained in the Coronary Care Unit under ECG monitoring until completion of the study. On admission, CRP was significantly higher in unstable angina than in variant angina patients (P<.001). In unstable angina, 70 ischemic episodes (1.5±2 per patient) and in variant angina 192 ischemic episodes (9.6±10.7 per patient) were observed during Holter monitoring (P<.001), fo...
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elevated levels of interleukin 6 in unstable angina
Circulation, 1996Co-Authors: Luigi M. Biasucci, Giovanna Liuzzo, Alessandra Vitelli, Antonio Giuseppe Rebuzzi, Sergio Altamura, Giuseppina Caligiuri, Gennaro Ciliberto, Claudia Monaco, Attilio MaseriAbstract:Background Elevated plasma levels of C-reactive protein have been found in the majority of patients with unstable angina. The evidence of elevated levels of acute-phase proteins in unstable angina is in line with a growing body of evidence that suggests that inflammation plays a role in this syndrome and is an indirect sign of increased production of interleukin-6, which is the major determinant of acute-phase–protein production by the liver. However, in unstable angina, there is no direct proof of the role played by interleukin-6. Methods and Results We measured levels of interleukin-6 in 38 patients with unstable angina at the time of their admission to the Coronary Care Unit and in 29 patients with stable angina. In the same groups of patients, we also measured C-reactive protein. Interleukin-6 (undetectable, ie, <3 pg/mL, in healthy volunteers) was detectable in 23 (61%) of 38 patients with unstable angina but in only 6 (21%) of 29 with stable angina (P<.01). Median interleukin-6 levels were 5.25 pg/m...
