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Biomedical subjects

C Fresco

Publications and source records attributed to C Fresco.

24 records · Page 2Linked to original sources
PubMed1990

The GISSI-2 trial: premises, results, epidemiological (and other) implications. Gruppo Italiano per lo Studio delia Sopravvivenza nell'Infarto Miocardico.

Population trials on myocardial infarction have produced significant advances in therapeutic results. The first clearly stated aim of the GISSI-2 protocol was the assessment of the overall benefit to a population attributable to the application of a package of pharmacological treatments (thrombolysis, intravenous beta blockade, and oral aspirin) shown effective in reducing mortality in large-scale randomized clinical trials. At variance with the classical concept of trials, a clinical epidemiological interest came first: The comparison between drugs was considered a main target of the investigation only within that broader framework, and was explicitly formulated as the direct confrontation between two concepts or two generations of thrombolysis. A selective, highly efficient, and specific new thrombolytic agent, tissue plasminogen activator (tPA), is compared with streptokinase with the expectation that the more selective approach could enhance the benefits of specificity, drastically limiting the systemic risks aspects (hemorrhagic complications). The main results of GISSI-2 are summarized. GISSI-2 may be considered a reliable window on the epidemiology of AMI in a whole country. There are implications for the transfer of these clinical findings into public health applications and for the choice of future research priorities.

Adrenergic beta-Antagonists↗
PubMed1990

GISSI trials in acute myocardial infarction. Rationale, design, and results.

The first Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto (GISSI) study showed striking evidence of the effectiveness and safety of intravenous thrombolytic treatment in acute myocardial infarction (MI). Since publication in The Lancet, the original report has become a reference work for every paper which deals with thrombolysis. In addition to GISSI's scientific value, these studies applied formal research to routine clinical practice outside of referral centers. Nearly all Italian CCUs took part in the GISSI projects, so that the results provide a profile of the patient who seeks care for acute MI in Italy. This wide data base allowed GISSI investigators to look into some relevant clinical events, eg, primary ventricular fibrillation, stroke, and in-hospital reinfarction. The GISSI-2 trial followed the GISSI-1 philosophy. The package of treatments recommended after extensive discussion with all the investigators (beta-blocker, aspirin, nitrates) was widely adopted. Now, only five years after the start of the GISSI-1, the overall mortality of Italian patients with acute MI has decreased from 13.0 percent to about 9 percent, and the number of patients with acute MI arriving in hospital within 1 h of the onset of symptoms has increased 50 percent. It is the wish of the GISSI investigators that this approach to treating acute MI will be regarded and acknowledged as their major contribution to the problem.

Clinical Trials as Topic↗
PubMed1990

[Epidemiology of the avoidable delay in patients with acute myocardial infarct admitted to the coronary care unit].

Despite the availability of safe and effective drugs for the treatment of acute myocardial infarction, nowadays, only a minority of patients arrive at the hospital early enough to receive the benefit of these treatments. The reason for this is still uncertain. Our intention was to review the literature on this topic, check if there were some issues that could be identified as delay-promoters, and see if any Italian data were available, in order to make a comparison with international data. We found a substantial agreement among the Authors that median total delay (i.e. the time between the onset of symptoms and the arrival at the hospital) is between three and five hours, and it seems that this has remained fairly stable over the years. The decision delay (i.e. the time between the onset of symptoms and the first medical contact) is almost unanimously indicated as the major single component in the total delay. This represents around 40% of the pre-hospital phase. Transportation time appears to play only a slight role, if indeed any, in the total delay. Nonetheless, mobile coronary units have consistently shown that they can reduce thrombolysis time (e.g. the time between the onset of symptoms and the start of thrombolytic infusion) by almost 60 minutes, and this time-gain is comparable with the reduction in total delay obtained in Sweden with a media campaign. Strongly contrasting results were obtained from the analysis of the delay-determining factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Care Units↗
PubMed1990

[Malignant ventricular arrhythmias in the subacute and late phases of myocardial infarction. Clinical arrhythmological characteristics and prognostic value].

The purposes of this study are as follows: 1) to describe the clinical and arrhythmological characteristics of 30 patients (23 male, 7 female, mean age: 61 years) who suffered from episodes of ventricular tachycardia and/or ventricular fibrillation between the 7th and the 90th day following acute myocardial infarction; 2) to evaluate the effectiveness of treatment with amiodarone also taking into account the results of electrophysiologic study; 3) to correlate our results with data from previous studies. The site of the acute myocardial infarction was anterior in 16 patients, inferior in 12, and anterior and inferior in 2. Twenty patients had early post-acute myocardial infarction complications (67%) such as cardiac failure (16), bundle branch blocks (9) and ventricular fibrillation in the first 48 hours (6). The mean ejection fraction was 33 +/- 8% and a left ventricular aneurysmatic evolution was observed in 13 patients (43%). The first episodes of spontaneous ventricular arrhythmias occurred after a mean interval of 32 +/- 24 days following acute myocardial infarction. These occurred in the form of ventricular fibrillation in 19 patients (63%) and of ventricular tachycardia in the other 11 (37%). The patients experienced 5.6 +/- 5 episodes of ventricular fibrillation or ventricular tachycardia. Of the 30 patients, 28 received amiodarone, 1 procainamide and 1 propafenone. Five of the 28 patients treated with amiodarone were also given either procainamide or propafenone due to the early recurrence of ventricular tachycardia or fibrillation. One patient underwent early left ventricular aneurysmatic resection due to refractory ventricular fibrillation. Two groups of patients were distinguished on the basis of the electrophysiologic study results obtained during anti-arrhythmic treatment: group A consisted of 17 cases in which a sustained ventricular tachycardia was inducible (57%), group B consisted of 13 cases in which a sustained ventricular tachycardia was not inducible (43%). During a mean follow-up period of 31.6 +/- 26 months the total mortality rate was 23% in group A and 46% in group B (p = ns), the incidence of sudden death was 17% in group A and 23% in group B (p = ns), the incidence of non fatal ventricular tachycardia or ventricular fibrillation recurrences was 24% in group A and 0% in group B (0.05 less than p less than 0.1). One group A patient successfully underwent a heart transplant. The negative predictive value of ventricular stimulation in relation to sudden death and to non-fatal arrhythmic recurrences was 77% and 100%; the positive predictive value was 17 and 28%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

[Diagnostic value of Q wave changes during the exercise test. Review of the literature and personal experience].

UNLABELLED: To test if a low Q wave voltage and its faulty increase after exercise is an additional sign of myocardial ischemia, 64 pts with no previous myocardial infarction, bundle branch block or left ventricular hypertrophy were studied by a treadmill test and coronary angiography. Nineteen had single vessel disease (SVD), 21 double vessel disease (DVD), 4 triple vessel disease (TVD) and 20 normal coronary arteries. Sensitivity (SENS), specificity (SPEC) and predictive value (P) of Q wave changes have resulted as follows: 84%, 55%, 80.4%, respectively, compared to 79.5%, 75%, 87.5% of ST modifications associated or not with angina. The SENS of Q wave changes was 72% in SVD and 92% in multivessel disease (p less than 0.05). In 68% of our pts ST and Q wave changes gave concordant results and their combination increased SENS, SPEC, PV to 90.1%, 80%, 90.3%. IN CONCLUSION: Q wave analysis can provide further evidence of myocardial ischemia and can increase SENS, SPEC of stress test. In our experience Q wave is a more sensitive finding than ST depression in multivessel disease.

Coronary Disease↗