Biomedical subjects

Giuseppe Vecchi

Publications and source records attributed to Giuseppe Vecchi.

7 recordsLinked to original sources

PubMed2006

Clinical outcomes for sirolimus-eluting stents and polymer-coated paclitaxel-eluting stents in daily practice: results from a large multicenter registry.

OBJECTIVES: We compared the clinical outcome of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in a real-world scenario. BACKGROUND: In selected patients, SES has been associated with lower late luminal loss than PES. Whether this emerging biological difference could translate into different clinical efficacy in daily practice is presently unknown. METHODS: This analysis included 1,676 consecutive patients with de novo coronary lesions treated solely with drug-eluting stents (SES = 992; PES = 684). All patients were enrolled in a dynamic prospective registry comprising 13 hospitals. We assessed the cumulative incidence of major adverse cardiac events (MACE), defined as death, myocardial infarction (MI), and target vessel revascularization (TVR) during follow-up. RESULTS: Overall, 29% of the patients had diabetes, 23% had prior MI, and 9% had poor left ventricular function. ST-segment elevation MI was diagnosed at admission in 12%. Multivessel intervention was performed in 16%. At 1-year follow-up, SES was associated with a reduced incidence of MACE (9.2% SES vs. 14.1% PES; p = 0.007) and TVR (5.0% SES vs. 10.0% PES; p = 0.0008) compared to PES. A propensity analysis with many clinical and angiographic variables was carried out to adjust for baseline differences. In this analysis, SES was associated with a 44% risk reduction of MACE (hazard ratio 0.56, 95% confidence interval 0.39 to 0.78) and a 55% reduction of TVR (hazard ratio 0.45, 95% confidence interval 0.29 to 0.70). This result was consistent across most subgroups tested. Similar rates of death and MI were observed in the 2 treatment groups. CONCLUSIONS: In this large real-world population, SES improved 1-year clinical results as compared to PES.

Aged↗

PubMed2006

Effective intracoronary thrombectomy with the X-sizer catheter of the right coronary artery and left anterior descending artery in a patient with acute inferior and right ventricular infarction complicated by hypotension and diffuse intracoronary thrombosis.

Intracoronary thrombosis of non infarct-related arteries during an episode of acute myocardial infarction can be correlated with a general thrombogenic state and precipitated by prolonged hypotension. We report the case of a patient with acute inferior and right ventricular infarction with acute thrombotic obstruction of the proximal right coronary artery and associated sessile thrombus in the proximal left anterior descending artery, both successfully treated by thromboaspiration with the X-Sizer catheter (ev3, Inc., Plymouth, Minnesota, USA).

Adult↗

PubMed2005

Occurrence of non-Q wave myocardial infarction following percutaneous coronary intervention in the stent era: systematic monitoring of the three markers of myocardial necrosis.

OBJECTIVES: To compare the elevation of the three markers total creatine kinase (CK), CK-MB mass, and troponin I (TnI) and their relationship with clinical and procedural characteristics following percutaneous coronary intervention (PCI). METHODS: We prospectively evaluated 385 patients consecutively undergoing successful PCI. The three markers were systematically measured before and at 6, 12, and 24 hours after PCI. Any increase above the upper normal limit (UNL) of any marker has been considered abnormal when basal values were normal, while a further increase was needed when basal values were altered. Patients with ongoing acute myocardial infarction were excluded from the analysis. RESULTS: TnI was above UNL in 183 patients (51%); in 138 (38.5%) it was the only marker altered. CK-MB mass was elevated in 12.8% patients, more than 3x UNL in 5.5% and more than 5x UNL in 2.8%. In over one half of these patients, CK-MB values peaked at 12 hours following PCI. Total CK was above UNL in 23 patients only (6.4%) and more than twice UNL in 5 (1.4%). Only 1 patient out of the 5 with CK-MB mass more than 10x UNL had total CK higher than twice UNL. In our population, post-PCI elevation of myocardial necrosis markers correlate with the occurrence of minor procedural complications (observed overall in 7.8% cases; TnI and/or CK-MB > 1xUNL 96% vs 47.5%, P < 0.001) and the presence of higher complexity clinical and/or procedural features, such as multivessel disease, multivessel or multilesion PCI, multiple stenting and use of glycoprotein IIb/IIIa inhibitors. CONCLUSIONS: The elevation of at least one biochemical marker of myocardial necrosis is frequent following successful PCI with routine stent implantation. CK-MB mass is the most practical marker, having optimal kinetic and peaking with the first 12-18 hours post-PCI. Definitive data on the prognostic role and the applicability for the diagnosis of myocardial infarction of minor elevation of CK-MB mass or isolated increase of TnI are lacking.

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PubMed2005

Cost of single-vessel and multivessel coronary drug-eluting stenting: comparison to the DRG funding level.

BACKGROUND: Large-scale utilization of drug-eluting stents (DES) presents significant economic limitations, related to the current high cost of the device and the absence of adequate reimbursement from the health care system. The aim of the study was to evaluate the cost of single-vessel and multivessel drug-eluting stenting and to compare it with the DRG funding level. METHODS: Between November 2003 and May 2004, we studied 100 consecutive patients who underwent a percutaneous coronary intervention (PCI) with DES, 50 single-vessel and 50 multivessel procedures, in order to evaluate the real procedure costs of DES. The cost fields calculated in the analysis included: costs for the materials and drugs used in each procedure, costs related to medical personnel and staff, costs for equipment depreciations, and costs for total hospitalization based on the length of stay in the coronary care unit and/or in the cardiology ward. RESULTS: With regard to the 50 patients with single-vessel disease, 63 lesions were treated with 58 DES. With regard to the 50 patients with multivessel disease, the average number of treated vessels was 2.3 and of lesions 2.8. An average of 2.7 DES per patient was implanted; glycoprotein Ilb/IIIa inhibitors were used in 70% of cases. The multivessel procedure necessitated an average of 1.62 guide catheters, 1.86 guides, 1.36 balloons, and 475 +/- 124 ml of contrast medium; the average endoscopy time was 16 +/- 8 min while the total procedural time was 106 +/- 37 min. The procedural success rate was 100% for both groups. The post-PCI hospital stay was 2.1 +/- 1.7 days for patients with single-vessel disease and 2.8 +/- 2.6 days for patients with multivessel disease; the total was 4.7 +/- 2.8 and 6 +/- 3.2 days respectively. The mean total cost of hospital stay for PCI and DES was 6390 +/- 2274 Euro for single-vessel PCI and 9828 +/- 3026 Euro for multivessel PCI, split as follows: materials 2915 +/- 963 Euro and 5294 +/- 1177 Euro, procedural costs 404 +/- 55 and 446 +/- 99 Euro, costs of hospital stay 3070 +/- 2024 Euro and 4089 +/- 2517 Euro respectively for single-vessel and multivessel PCI. CONCLUSIONS: The mean total cost of a single-vessel PCI with DES falls within the DRG 112 reimbursement level for coronary angioplasty of 7006 Euro, while that of multivessel PCI with multiple DES is about 40% above the same reimbursement level. Interestingly, the multivessel PCI cost with multiple DES does fall within the reimbursement amount related to DRG 107 for bypass surgery procedures (14,322 Euro).

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PubMed2004

Diffuse cystic lung diseases: correlation between radiologic and functional status.

BACKGROUND: High-resolution CT (HRCT) scanning plays an important role in the diagnosis of diffuse cystic lung diseases (DCLDs). However, its role in the clinical evaluation of patients affected by DCLD has not yet been well-clarified. At present, pulmonary function tests are the only methods available for the evaluation of lung impairment due to these diseases, but their sensitivity and reliability are still limited. PURPOSE: The aim of this study was to correlate the quantitative score of cystic-aerial lesions obtained by a HRCT density mask (DM) software with pulmonary function data in DCLDs. METHODS: Spirometry, lung volumes, diffusion capacity, arterial blood gas (ABG) analysis, 6-min walking test (6-MWT), and HRCT with DM quantitative evaluation were performed in a cohort of 25 patients (lymphangioleiomyomatosis [LAM], 13 patients; Langerhans cells histiocytosis [LCH], 12 patients). Linear regression was used for the statistical analysis. The sum and mean of the air-trapping percentages at three different levels of DM study (ie, aortic arch, left lower lobe bronchus origin, and 2 cm from the diaphragmatic muscle), and various functional parameters and exercise performance values were matched for the analysis. RESULTS: An obstructive pattern was present in 13 patients (52%; LCH group, 8 patients; LAM group, 5 patients). A predominant restrictive pattern was detected only in three patients (12%; LCH group, two patients; LAM group, one patient). Nine patients (36%) walked < 350 m, and 14 of 23 patients (61%) had a significant decrease in arterial oxygen saturation during exercise (> 4 U). The results of DM quantitative study (sum and mean) significantly correlated with FVC (r = - 0.56; p < 0.001), FEV(1)/vital capacity (r = - 0.94; p < 0.002), midexpiratory phase of forced expiratory flow (r = - 0.84; p < 0.05), FEV(1) (r = - 0.82; p < 0.05), and diffusing capacity of the lung for carbon monoxide (r = - 0.82; p < 0.05), bronchial airway resistance (r = 0.79; p < 0.05), and distance walked on the 6-MWT (r = - 0.53; p < 0.05). No significant correlation was found with the results of ABG analysis. CONCLUSIONS: In DCLDs, HRCT scans with quantitative assessment performed by a DM software showed a very good correlation with functional parameters. Therefore, DM could be considered, in combination with a complete functional assessment, in the initial evaluation of patients affected by DCLDs. However, further studies are needed to assess its usefulness in the follow-up of these patients.

Adult↗

PubMed2002

[Ad-hoc coronary angioplasty: organizational model, clinical results and costs].

BACKGROUND: Our center routinely employs the strategy of ad hoc percutaneous coronary intervention (PCI) after diagnostic catheterization in previously informed and prepared patients with anatomical and clinical indications for some years. The aim of this study was to evaluate clinical results and resource consumption of the ad hoc PCI strategy in our center. METHODS: We evaluated the results and resource consumption of 783 PCIs performed between January 1, 1999 and June 30, 2001, divided into 642 (82%) ad hoc and 141 (18%) deferred PCIs. We analyzed the patients' in-hospital clinical and procedural characteristics, the 1 and 6-month outcomes and resource consumption (costs of materials, quantity of contrast medium, fluoroscopic time and duration of procedures) in the two groups. RESULTS: Patients in the ad hoc group had more frequently previous PCI, hypertension, diabetes, acute coronary syndrome, single vessel disease, single lesion and single vessel PCI, stent use and direct stenting, use of glycoprotein IIb/IIIa inhibitors and hemostatic devices; those in the deferred PCI group had more frequently previous myocardial infarction, stable angina, elective programmed hospital admission for PCI and multilesion single vessel PCI. The clinical results were good: clinical success in 97% of cases, in-hospital major adverse clinical events occurred in 2%, non-Q wave myocardial infarction in 3.4% (creatine-kinase-MB > 3 times higher than the upper normal limit in serial routine controls), major vascular complications in 0.4%, 1-month and 6-month major adverse clinical events in 4 and 9% respectively, without any difference between the two groups. Ad hoc PCI resulted in less contrast medium use, a shorter procedure duration, lower costs and shorter fluoroscopy times with respect to deferred PCI plus diagnostic catheterization, although not statistically significant. CONCLUSIONS: In our experience, ad hoc PCI was safe and effective. Costs were lower and less resources were required. Patients were satisfactorily assisted and the logistics and organization of the procedure were optimal.

Aged↗

PubMed2002

Spontaneous coronary dissection of all three coronary arteries: a case description with medium-term angiographic follow-up.

Spontaneous coronary artery dissection is a rare cause of ischemic heart disease, often related with a poor prognosis. We report the case of a 38-year-old woman without cardiovascular risk factors, admitted to our coronary care unit for unstable angina with ECG findings of inferior ischemia. The day after, an acute anterior myocardial infarction occurred and was treated with intravenous thrombolysis. Again, there were ECG signs of transient inferior ischemia. Coronary angiography showed widespread spontaneous coronary dissection involving the terminal left main stem, both the left anterior descending and circumflex artery, and the right coronary artery even peripherally, rendering any type of revascularization procedure inappropriate. The patient was placed on beta-blockers, acetylsalicylic acid and nitrates and her symptoms resolved; the 17-month angiographic follow-up showed almost complete healing of spontaneous coronary artery dissection. The peculiarities of the case are discussed and a review of the literature is provided.

Adult↗