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Pier Filippo Fazzini - One of the best experts on this subject based on the ideXlab platform.

  • a randomized study of intravenous magnesium in acute myocardial infarction treated with Direct coronary Angioplasty
    American Heart Journal, 2000
    Co-Authors: Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Maurizio Trapani, David Antoniucci, Alberto Santini, Pier Filippo Fazzini
    Abstract:

    Abstract Background Notwithstanding the negative result of the International Study of Infarct Survival-4 (ISIS-4), the controversy about the role of magnesium in acute myocardial infarction is still open because, according to experimental data, magnesium could decrease myocardial damage and mortality only if infusion is started before reperfusion. This randomized placebo-controlled trial was designed to evaluate the effect of intravenous magnesium, delivered before, during, and after Direct coronary Angioplasty, in patients with acute myocardial infarction. Methods One-hundred fifty patients were randomized to intravenous magnesium sulfate or placebo. The primary end point was an infarct zone wall motion score index at 30 days, as a measure of infarct size. The secondary end points included creatine kinase peak, ventricular fibrillation/tachycardia within the first 24 hours, death and congestive heart failure within the 30-day follow-up, and 30-day left ventricular ejection fraction. Analysis was by intention to treat. Results There were no significant differences between the magnesium and placebo groups in the 30-day infarct zone wall motion score index (1.93 ± 0.61 vs 1.85 ± 0.51, P =.39), ventricular arrhythmias (24% vs 15%, P =.15), death (0 vs 1%, P =.32), heart failure (8% vs 7%, P =.75), and 30-day left ventricular ejection fraction (49% ± 11% vs 50% ± 9%, P = 0.55). There was a trend toward a higher creatine kinase peak in the magnesium group (3059 ± 2359 vs 2404 ± 1673, P =.052). Conclusions Intravenous magnesium delivered before, during, and after reperfusion did not decrease myocardial damage and did not improve the short-term clinical outcome in patients with acute myocardial infarction treated with Direct Angioplasty. (Am Heart J 2000;140:891-7.)

  • relation between st segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with Direct Angioplasty
    American Journal of Cardiology, 1998
    Co-Authors: Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Giampaolo Cerisano, Guia Moschi, Maurizio Trapani, David Antoniucci, Pier Filippo Fazzini
    Abstract:

    The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial infarction treated with successful Direct Angioplasty. Thirty-seven patients, successfully treated with Direct Angioplasty, underwent myocardial contrast echocardiography before and after Angioplasty. The sum of ST-segment elevation divided by the number of the leads involved (ST-segment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial grade 3 flow. After recanalization, myocardial reperfusion within the risk area was observed in 26 patients, whereas a no-reflow phenomenon occurred in 11. In patients with myocardial reperfusion, the ST-segment elevation index progressively declined, whereas in patients with no reflow, no significant change was observed. Reduction of > or = 50% in the ST-segment elevation index occurred in 20 of the 26 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of > or = 30% in the ST-segment elevation index occurred in 3 patients with reflow and in 7 with no reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment elevation index for predicting microvascular reflow were 77%, 91%, 95%, 62%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70%, 85%, and 81%, respectively. In conclusion, after successful Angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. Analysis of ST-segment changes predicts the degree of myocardial reperfusion.

  • systematic Direct Angioplasty and stent supported Direct Angioplasty therapy for cardiogenic shock complicating acute myocardial infarction in hospital and long term survival
    Journal of the American College of Cardiology, 1998
    Co-Authors: David Antoniucci, Giovanni M Santoro, Renato Valenti, Leonardo Bolognese, Guia Moschi, Maurizio Trapani, Pier Filippo Fazzini
    Abstract:

    Abstract Objectives. This prospective observational study was conducted to examine the apparent impact of a systematic Direct percutaneous transluminal coronary Angioplasty (PTCA) strategy on mortality in a series of 66 consecutive patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, and to analyze the predictors of outcome after successful Direct PTCA. Background. Previous studies have reported encouraging results with PTCA in patients with AMI complicated by cardiogenic shock, but a biased case selection for PTCA may have heavily influenced the observed outcomes. Methods. All patients admitted with AMI were considered eligible for Direct PTCA, including those with the most profound shock, and no upper age limit was used. The treatment protocol also included stenting of the infarct-related artery for a poor or suboptimal angiographic result after conventional PTCA. Results. Between January 1995 and March 1997, 364 consecutive patients underwent Direct PTCA, and in 66 patients AMI was complicated by cardiogenic shock. In patients with cardiogenic shock, Direct PTCA had a success rate of 94%; an optimal angiographic result was achieved in 85%; primary stenting of the infarct-related artery was accomplished in 47%; and the in-hospital mortality rate was 26%. Univariate analysis showed that patient age, chronic coronary occlusion and completeness of revascularization were significantly related to in-hospital mortality. The mean follow-up period was 16 ± 8 months. Survival rate at 6 months was 71%. Comparison of event-free survival in patients with a stented or nonstented infarct-related artery suggests an initial and long-term benefit of primary stenting. Conclusions. Systematic Direct PTCA, including stent-supported PTCA, can establish a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in the great majority of patients presenting with AMI and early cardiogenic shock. High performance criteria, including new devices such as coronary stents, should be considered in randomized trials where mechanical revascularization therapy is being tested.

  • rapid reduction of st segment elevation after successful Direct Angioplasty in acute myocardial infarction
    American Journal of Cardiology, 1997
    Co-Authors: Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Maurizio Trapani, David Antoniucci, Vieri Boddi, Pier Filippo Fazzini
    Abstract:

    The aim of this study was to evaluate whether assessment of ST-segment changes in the 12-lead electrocardiogram from admission to 30 minutes after successful Direct coronary Angioplasty can predict myocardial damage and functional outcome in patients with acute myocardial infarction (AMI). Of 158 consecutive patients, 117 (92 men, aged 61 ± 11 years) were prospectively classified into 2 groups: group 1, 2, which were more prevalent in group 1. Peak creatine kinase was significantly higher in group 1 (3,690 ± 2,809 vs 2,592 ± 1,960 U/L; p = 0.018). One-month echocardiograms were obtained in 102 patients (87%). Infarct zone wall motion score index decreased in both groups, but this reduction was higher in group 2 (p 0.22 decrease in infarct zone wall motion score index) was observed in 34% of group 1 and in 78% of group 2 patients (p <0.001). One-month left ventricular ejection fraction was higher in group 2 (p <0.001). At multivariate analysis, reduction of ST-segment elevation was the only independent predictor of functional recovery (p <0.001). In conclusion, ST-segment analysis provides rapid and inexpensive information allowing identification of patients who are likely to benefit the most from myocardial reperfusion as early as 30 minutes after the last balloon inflation.

  • Direct Angioplasty and stenting of the infarct related artery in acute myocardial infarction
    American Journal of Cardiology, 1996
    Co-Authors: David Antoniucci, Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Mario Leoncini, Pier Filippo Fazzini
    Abstract:

    Abstract The results of this study show that coronary stenting in the setting of acute myocardial infarction is feasible, and that acute and 1-month angiographic results after stenting seem superior to results after standard Angioplasty alone.

Bernhard Reimers - One of the best experts on this subject based on the ideXlab platform.

Raymond J Gibbons - One of the best experts on this subject based on the ideXlab platform.

  • the effect of blockade of the cd11 cd18 integrin receptor on infarct size in patients with acute myocardial infarction treated with Direct Angioplasty the results of the halt mi study
    Journal of the American College of Cardiology, 2002
    Co-Authors: David P Faxon, Raymond J Gibbons, Nicolas Chronos, Paul A Gurbel, Florence H Sheehan
    Abstract:

    Abstract Objectives The purpose of this study was to determine whether Hu23F2G (LeukoArrest), an antibody to the CD11/CD18 integrin receptors, would reduce infarct size in patients undergoing primary Angioplasty for an acute myocardial infarction. Background Reperfusion injury in acute myocardial infarction has been shown experimentally to be related to neutrophil accumulation. Inhibitors of the CD11/CD18 or CD18 integrin receptors have been shown to reduce infarct size in experimental models. Methods Patients within 6 h of onset of chest pain with ST-segment elevation were randomized to receive either 0.3 mg/kg or 1.0 mg/kg of Hu23F2G or placebo just before Angioplasty of occluded arteries (Thrombolysis in Myocardial Infarction TIMI flow grade 0 or 1). The primary end point was infarct size as measured by sestamibi single-photon emission computed tomography (SPECT) scan five to nine days later. Results Four-hundred and twenty patients were enrolled and received a placebo or the study drug. The groups did not differ in baseline or angiographic characteristics or Angioplasty results. Infarct size was 16%, 17.2% and 16.6%, for placebo, 0.3 mg/kg and 1.0 mg/kg, respectively, of the left ventricle (p = NS). No differences were evident in those patients with anterior myocardial infarction or those presenting within 2 h of onset of chest pain. Corrected TIMI frame count was also not different between groups. Clinical events at 30 days were very low, with a mortality of 0.8%, 1.4% and 3.3%, respectively. The drug was well tolerated, with a slight increase in minor infections in the high dose group. Conclusions The results of this multicenter, double-blind, placebo-controlled, randomized clinical trial demonstrated that an antibody to CD11/CD18 leukocyte integrin receptor did not reduce infarct size in patients who underwent primary Angioplasty.

  • intercenter variability in outcome for patients treated with Direct coronary Angioplasty during acute myocardial infarction
    American Heart Journal, 1998
    Co-Authors: Timothy F Christian, James H Okeefe, Peter B Berger, Michael Spain, Cindy L Grines, Marcus A Dewood, Raymond J Gibbons
    Abstract:

    Abstract Background Direct coronary Angioplasty is an effective therapy for acute myocardial infarction, but its success may be dependent on both ready availability and operator skill. The purpose of this study was to investigate the impact of the center performing Direct coronary Angioplasty for acute myocardial infarction while controlling for parameters known to affect outcome. Methods and Results The study group consisted of 99 patients with ST elevation who were treated with Direct Angioplasty in four high-volume centers. Patients were injected with technetium-99m sestamibi intravenously and then taken to the cardiac catheterization laboratory. Antegrade flow was graded before and after Direct coronary Angioplasty. Single photon emission computed tomography was performed 1 to 6 hours after injection to measure myocardium at risk and residual blood flow to the jeopardized zone using previously published quantitative methods. A repeat sestamibi injection and tomographic acquisition were performed at hospital discharge to measure actual infarct size. There were no significant differences by center for baseline clinical characteristics, mean myocardium at risk (29% to 37% left ventricle [LV]), time to reperfusion (3.1 to 4.1 hours), residual blood flow, infarct location, or antegrade flow. Despite these similarities, there were differences in outcome measures by center. Mean infarct size was as follows: center 1, 15%; center 2, 12%; center 3, 10%, center 4, 23% (all LV; p = 0.11). Mean left ventricular ejection fraction at discharge also demonstrated significant differences: center 1, 0.57; center 2, 0.47; center 3, 0.53; center 4, 0.47 ( p = 0.002). The prevalence of Thrombolysis in Myocardial Infarction grade 3 flow after Angioplasty significantly differed by center: center 1, 92%; center 2, 94%; center 3, 87%; center 4, 71%; ( p = 0.01). There was a low mortality rate for all four centers ranging from 0% to 6%. After adjustment for myocardium at risk, residual blood flow, and time to reperfusion, the primary outcome of the center where the Angioplasty was performed was an independent determinant of both infarct size and left ventricular ejection fraction. Conclusion The success of Direct coronary Angioplasty in reducing infarct size and preserving left ventricular function depends on the center performing the procedure. Direct measurement of the effectiveness of this reperfusion modality in community practice is required to assess the impact of this effect. (Am Heart J 1998;135:310-17.)

  • noninvasive prediction of residual blood flow within the risk area during acute myocardial infarction a multicenter validation study of patients undergoing Direct coronary Angioplasty
    American Heart Journal, 1997
    Co-Authors: Panithaya Chareonthaitawee, Timothy F Christian, Stuart T Higano, James H Okeefe, Peter B Berger, Michael K Oconnor, Michael Spain, Cindy L Grines, Raymond J Gibbons
    Abstract:

    Abstract Background In a previous study from a single center, radionuclide measures of collateral flow with technetium 99m sestamibi have been shown to be significantly associated with angiographic residual (antegrade and collateral) flow and independent predictors of final infarct size in acute myocardial infarction. This study examined whether the previously described radionuclide measures of blood flow to the infarct zone were reproducible with different laboratories and imaging systems. Methods and Results Residual flow to the infarct zone was assessed by both invasive and noninvasive methods in 77 patients with first-time myocardial infarction (32 anterior, 45 nonanterior). All patients underwent acute coronary angiography before any intervention within 8 hours of the onset of chest pain (4.0 ± 1.5 hours; range 1.2 to 7.9 hours). 99m Tc sestamibi was injected intravenously before reperfusion therapy, and tomographic imaging was performed 1 to 6 hours after injection. A central core laboratory processed the acquired images from three centers, each with a unique camera and computer system. Three previously published methods based on the severity of the acute perfusion defect were used to measure residual flow to the infarct zone (nadir, severity index, area). Antegrade (Thrombolysis in Myocardial Infarction flow) and collateral flow before Direct Angioplasty were blindly graded on a four-point scale (0 to 3) from the acute angiogram. The simple sum of the two grades was defined as the angiographic flow index, representing residual flow to the jeopardized zone. All three noninvasive measures of residual flow were highly associated with the angiographic flow index in a linear fashion: severity index ( p = 0.0006), area ( p = 0.003), and nadir (minimum/maximum counts; p = 0.004). This association was independent of the laboratory where the data were acquired. Conclusions Despite different laboratories and camera systems, radionuclide measures of residual flow were highly associated with the angiographic flow index before reperfusion therapy. These results suggest that these measures are applicable on a broader scale for the noninvasive determination of collateral and antegrade flow in acute myocardial infarction. (Am Heart J 1997;134:639-46.)

  • time to reperfusion with Direct coronary Angioplasty and thrombolytic therapy in acute myocardial infarction
    American Journal of Cardiology, 1994
    Co-Authors: Peter B Berger, Bernard J Gersh, David R Holmes, Malcolm R Bell, Mona R Hopfenspirger, Raymond J Gibbons
    Abstract:

    Abstract An analysis was performed of the Mayo Clinic randomized trial of Direct percutaneous transluminal coronary Angioplasty and tissue-type plasminogen activator (t-PA) to determine the time required to achieve reperfusion with Direct coronary Angioplasty. Because patients in the Mayo trial assigned to t-PA did not undergo protocol coronary angiography, reperfusion rates from the Thrombolysis in Myocardial Infarction (TIMI) I trial in which patients underwent coronary angiography 30, 60 and 90 minutes after thrombolytic therapy were used for comparison. TIMI perfusion grade 2 or 3 flow in the infarct artery was considered to represent reperfusion after thrombolysis. In the 56 patients assigned to t-PA, the mean time from randomization to initiation of the t-PA infusion was 20 minutes. Twenty minutes were therefore added to the previously reported 30-, 60- and 90-minute reperfusion rates to express these in terms of time from randomization (50, 80 and 110 minutes). In the 48 patients who had Direct Angioplasty, the mean time from randomization to arrival in the cardiac catheterization laboratory was 45 minutes; it took a mean of 6 additional minutes for patients to be prepared and draped and arterial access obtained, and a mean of 27 additional minutes to complete angiography and achieve reperfusion. At 50, 80 and 110 minutes after randomization, the reperfusion rates for Direct coronary Angioplasty were 12, 54 and 83%, similar to previously reported TIMI reperfusion rates with t-PA (24, 57 and 71%, respectively, p = NS) but significantly greater at 80 and 110 minutes than was reported for streptokinase (8, 23 and 31%, respectively, p = 0.001). If only normalization of coronary blood flow (TIMI perfusion grade 3 flow) was considered to represent reperfusion, reperfusion rates for Direct coronary Angioplasty would be significantly greater than for either t-PA or streptokinase. Thus, Direct coronary Angioplasty is rapid, and reperfusion rates compare favorably with those reported for thrombolytic therapy.

  • residual flow to the infarct zone as a determinant of infarct size after Direct Angioplasty
    Circulation, 1993
    Co-Authors: Ian P Clements, Timothy F Christian, Stuart T Higano, Raymond J Gibbons, Bernard J Gersh
    Abstract:

    BACKGROUND In acute myocardial infarction, residual flow to the infarct zone either through antegrade flow in the infarct-related coronary artery or collateral flow from the non-infarct-related arteries is often present before reperfusion therapy. The purpose of this study was to assess the influence of antegrade flow in the infarct-related artery and/or collateral flow to the infarct zone before successful Direct Angioplasty on infarct size and myocardial salvage in patients with acute evolving myocardial infarction. METHODS AND RESULTS Sixty patients with acute evolving myocardial infarction underwent Direct successful Angioplasty without prior thrombolytic therapy. The myocardium at risk of infarction, the final infarct size, and myocardial salvage were measured by tomographic perfusion imaging with 99mTc sestamibi. Antegrade flow in the infarct-related artery before intervention was graded according to the Thrombolysis in Myocardial Infarction (TIMI) study group classification. Collateral flow to the infarct zone before Angioplasty was also graded (0 through 3, 0 being no collateral flow). The presence of even minimal antegrade flow before Angioplasty (TIMI grade 1) in the infarct-related artery compared with absent flow was associated with a significant reduction in final infarct size (9 +/- 17% versus 23 +/- 19% of left ventricle, P = .02) and a significant increase in myocardial salvage (23 +/- 16% versus 14 +/- 13% of left ventricle, P = .05) after Angioplasty. When antegrade flow in the infarct-related artery was absent before Angioplasty, the presence of collateral flow before Angioplasty resulted in a significantly smaller final infarct size (P = .01) and more myocardial salvage (P = .05) after Angioplasty. Both antegrade infarct-related artery flow and collateral flow to the infarct zone had significant independent ability to predict infarct size after Angioplasty. When collateral grade and TIMI grade were added to provide an estimate of residual flow, a model including residual flow, myocardium at risk, and the interaction of residual flow and infarct site explained 83% of the variability in infarct size after Angioplasty. CONCLUSIONS The presence of antegrade flow in the infarct-related artery and/or collateral flow to the infarct zone before Direct Angioplasty in acute evolving infarction results in a smaller infarct size after Direct successful Angioplasty.

Giovanni M Santoro - One of the best experts on this subject based on the ideXlab platform.

  • a randomized study of intravenous magnesium in acute myocardial infarction treated with Direct coronary Angioplasty
    American Heart Journal, 2000
    Co-Authors: Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Maurizio Trapani, David Antoniucci, Alberto Santini, Pier Filippo Fazzini
    Abstract:

    Abstract Background Notwithstanding the negative result of the International Study of Infarct Survival-4 (ISIS-4), the controversy about the role of magnesium in acute myocardial infarction is still open because, according to experimental data, magnesium could decrease myocardial damage and mortality only if infusion is started before reperfusion. This randomized placebo-controlled trial was designed to evaluate the effect of intravenous magnesium, delivered before, during, and after Direct coronary Angioplasty, in patients with acute myocardial infarction. Methods One-hundred fifty patients were randomized to intravenous magnesium sulfate or placebo. The primary end point was an infarct zone wall motion score index at 30 days, as a measure of infarct size. The secondary end points included creatine kinase peak, ventricular fibrillation/tachycardia within the first 24 hours, death and congestive heart failure within the 30-day follow-up, and 30-day left ventricular ejection fraction. Analysis was by intention to treat. Results There were no significant differences between the magnesium and placebo groups in the 30-day infarct zone wall motion score index (1.93 ± 0.61 vs 1.85 ± 0.51, P =.39), ventricular arrhythmias (24% vs 15%, P =.15), death (0 vs 1%, P =.32), heart failure (8% vs 7%, P =.75), and 30-day left ventricular ejection fraction (49% ± 11% vs 50% ± 9%, P = 0.55). There was a trend toward a higher creatine kinase peak in the magnesium group (3059 ± 2359 vs 2404 ± 1673, P =.052). Conclusions Intravenous magnesium delivered before, during, and after reperfusion did not decrease myocardial damage and did not improve the short-term clinical outcome in patients with acute myocardial infarction treated with Direct Angioplasty. (Am Heart J 2000;140:891-7.)

  • relation between st segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with Direct Angioplasty
    American Journal of Cardiology, 1998
    Co-Authors: Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Giampaolo Cerisano, Guia Moschi, Maurizio Trapani, David Antoniucci, Pier Filippo Fazzini
    Abstract:

    The aim of this study was to evaluate the relation between myocardial perfusion and ST-segment changes in patients with acute myocardial infarction treated with successful Direct Angioplasty. Thirty-seven patients, successfully treated with Direct Angioplasty, underwent myocardial contrast echocardiography before and after Angioplasty. The sum of ST-segment elevation divided by the number of the leads involved (ST-segment elevation index) was calculated at 1, 5, 10, 20, and 30 minutes after restoration of a Thrombolysis In Myocardial Infarction trial grade 3 flow. After recanalization, myocardial reperfusion within the risk area was observed in 26 patients, whereas a no-reflow phenomenon occurred in 11. In patients with myocardial reperfusion, the ST-segment elevation index progressively declined, whereas in patients with no reflow, no significant change was observed. Reduction of > or = 50% in the ST-segment elevation index occurred in 20 of the 26 patients with reflow and in 1 of the 11 with no reflow (p = 0.0002). An additional increase of > or = 30% in the ST-segment elevation index occurred in 3 patients with reflow and in 7 with no reflow (p = 0.003). Sensitivity, specificity, positive and negative predictive values, and accuracy of the reduction in the ST-segment elevation index for predicting microvascular reflow were 77%, 91%, 95%, 62%, and 81%, respectively. The corresponding values of the increase in ST-segment elevation index for predicting no reflow were 64%, 88%, 70%, 85%, and 81%, respectively. In conclusion, after successful Angioplasty, different patterns of myocardial perfusion are associated with different ST-segment changes. Analysis of ST-segment changes predicts the degree of myocardial reperfusion.

  • systematic Direct Angioplasty and stent supported Direct Angioplasty therapy for cardiogenic shock complicating acute myocardial infarction in hospital and long term survival
    Journal of the American College of Cardiology, 1998
    Co-Authors: David Antoniucci, Giovanni M Santoro, Renato Valenti, Leonardo Bolognese, Guia Moschi, Maurizio Trapani, Pier Filippo Fazzini
    Abstract:

    Abstract Objectives. This prospective observational study was conducted to examine the apparent impact of a systematic Direct percutaneous transluminal coronary Angioplasty (PTCA) strategy on mortality in a series of 66 consecutive patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, and to analyze the predictors of outcome after successful Direct PTCA. Background. Previous studies have reported encouraging results with PTCA in patients with AMI complicated by cardiogenic shock, but a biased case selection for PTCA may have heavily influenced the observed outcomes. Methods. All patients admitted with AMI were considered eligible for Direct PTCA, including those with the most profound shock, and no upper age limit was used. The treatment protocol also included stenting of the infarct-related artery for a poor or suboptimal angiographic result after conventional PTCA. Results. Between January 1995 and March 1997, 364 consecutive patients underwent Direct PTCA, and in 66 patients AMI was complicated by cardiogenic shock. In patients with cardiogenic shock, Direct PTCA had a success rate of 94%; an optimal angiographic result was achieved in 85%; primary stenting of the infarct-related artery was accomplished in 47%; and the in-hospital mortality rate was 26%. Univariate analysis showed that patient age, chronic coronary occlusion and completeness of revascularization were significantly related to in-hospital mortality. The mean follow-up period was 16 ± 8 months. Survival rate at 6 months was 71%. Comparison of event-free survival in patients with a stented or nonstented infarct-related artery suggests an initial and long-term benefit of primary stenting. Conclusions. Systematic Direct PTCA, including stent-supported PTCA, can establish a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in the great majority of patients presenting with AMI and early cardiogenic shock. High performance criteria, including new devices such as coronary stents, should be considered in randomized trials where mechanical revascularization therapy is being tested.

  • rapid reduction of st segment elevation after successful Direct Angioplasty in acute myocardial infarction
    American Journal of Cardiology, 1997
    Co-Authors: Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Maurizio Trapani, David Antoniucci, Vieri Boddi, Pier Filippo Fazzini
    Abstract:

    The aim of this study was to evaluate whether assessment of ST-segment changes in the 12-lead electrocardiogram from admission to 30 minutes after successful Direct coronary Angioplasty can predict myocardial damage and functional outcome in patients with acute myocardial infarction (AMI). Of 158 consecutive patients, 117 (92 men, aged 61 ± 11 years) were prospectively classified into 2 groups: group 1, 2, which were more prevalent in group 1. Peak creatine kinase was significantly higher in group 1 (3,690 ± 2,809 vs 2,592 ± 1,960 U/L; p = 0.018). One-month echocardiograms were obtained in 102 patients (87%). Infarct zone wall motion score index decreased in both groups, but this reduction was higher in group 2 (p 0.22 decrease in infarct zone wall motion score index) was observed in 34% of group 1 and in 78% of group 2 patients (p <0.001). One-month left ventricular ejection fraction was higher in group 2 (p <0.001). At multivariate analysis, reduction of ST-segment elevation was the only independent predictor of functional recovery (p <0.001). In conclusion, ST-segment analysis provides rapid and inexpensive information allowing identification of patients who are likely to benefit the most from myocardial reperfusion as early as 30 minutes after the last balloon inflation.

  • Direct Angioplasty and stenting of the infarct related artery in acute myocardial infarction
    American Journal of Cardiology, 1996
    Co-Authors: David Antoniucci, Giovanni M Santoro, Renato Valenti, Piergiovanni Buonamici, Leonardo Bolognese, Mario Leoncini, Pier Filippo Fazzini
    Abstract:

    Abstract The results of this study show that coronary stenting in the setting of acute myocardial infarction is feasible, and that acute and 1-month angiographic results after stenting seem superior to results after standard Angioplasty alone.

Massimo Napodano - One of the best experts on this subject based on the ideXlab platform.