PubMed Health⌕ Search

Biomedical subjects

M Trapani

Publications and source records attributed to M Trapani.

31 records · Page 2Linked to original sources
PubMed1998

Restenosis after coronary stenting in current clinical practice.

BACKGROUND: Randomized trials have demonstrated that planned coronary stenting may lower restenosis rate in patients with de novo short lesions. In a prospective study we sought to determine the frequency of restenosis, reocclusion, and adverse cardiovascular events after coronary stenting in a series of 258 consecutive nonselected patients, including those with complex lesions not fulfilling past and ongoing randomized trial criteria for stent implantation. METHODS: Criteria for stenting were as follows: (1) dissection associated with occlusion or threatened closure, (2) a residual percentage stenosis > 30% or nonocclusive dissection, (3) restenotic lesion or chronic total occlusion. RESULTS: In most cases (89%) the target lesion had two or more unfavorable morphologic characteristics, whereas only 11% of target lesions could be classified as type A or B1 lesions. Overall, the 6-month restenosis rate was 23%. By use of subgroup analysis restenosis rate was found to range widely, from 11% to 46%. With multivariate analysis, only four variables were found to be independently related to restenosis: age > 63 years (odds ratio [OR] = 2.651, p = 0.011), female sex (OR = 3.807, p = 0.002), lesion length > 12 mm (OR 3.185, p = 0.002), and type C lesion (OR 2.527, p = 0.014). CONCLUSIONS: Results from randomized trials on coronary stenting cannot be extrapolated to current clinical practice because most of the treated lesions do not fulfill the criteria adopted in these studies for stent implantation. The restenosis rate is nearly four times greater for long and complex lesions treated by multiple stent implantation as compared with simple lesions, and additional studies need to be performed to evaluate the efficacy of stenting on these lesions.

Adult↗
PubMed1998

Systematic direct angioplasty and stent-supported direct angioplasty therapy for cardiogenic shock complicating acute myocardial infarction: in-hospital and long-term survival.

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.

Adult↗
PubMed1998

A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial.

OBJECTIVES: This study sought to compare stenting of the primary infarct-related artery (IRA) with optimal primary percutaneous transluminal coronary angioplasty (PTCA) with respect to clinical and angiographic outcomes of patients with an acute myocardial infarction. BACKGROUND: Early and late restenosis or reocclusion of the IRA after successful primary PTCA significantly contributes to increased patient morbidity and mortality. Coronary stenting results in a lower rate of angiographic and clinical restenosis than standard PTCA in patients with angina and with previously untreated, noncomplex lesions. METHODS: After successful primary PTCA, 150 patients were randomly assigned to elective stenting or no further intervention. The primary end point of the trial was a composite end point, defined as death, reinfarction or repeat target vessel revascularization as a consequence of recurrent ischemia within 6 months of randomization. The secondary end point was angiographic evidence of restenosis or reocclusion at 6 months after randomization. RESULTS: Stenting of the IRA was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 9% in the stent group and 28% in the PTCA group (p=0.003); the incidence of restenosis or reocclusion was 17% in the stent group and 43% in the PTCA group (p=0.001). CONCLUSIONS: Primary stenting of the IRA, compared with optimal primary angioplasty, results in a lower rate of major adverse events related to recurrent ischemia and a lower rate of angiographically detected restenosis or reocclusion of the IRA.

Adult↗
PubMed1998

[Rapid resolution of ST-segment elevation predicts functional recovery in acute myocardial infarction treated with primary percutaneous transluminal coronary angioplasty].

OBJECTIVES: This study was designed to prospectively assess the ability of the 12-lead electrocardiogram (ECG) and optimal ECG criteria to predict late functional recovery in patients with acute myocardial infarction (AMI) treated with primary coronary angioplasty (PTCA) BACKGROUND: A simple clinical method to predict clinical outcome in patients with reperfused AMI is highly desirable from a clinical point of view. METHODS: Seventy-five patients with AMI treated with successful PTCA (TIMI flow grade 3 and residual stenosis < 30%) underwent serial 12-lead ECG before PTCA and every hour for the first 6 hours and then at 9, 12, and 18 hours after PTCA. All patients underwent two-dimensional echocardiography before PTCA and 1 and 6 months later for the evaluation of regional wall motion. The ST segment level in the lead exhibiting the maximal ST elevation (ST increase max) and the sum of the ST segment elevation (sigma ST increases) were calculated on initial ECG and a cut-off values of > or = 50% reduction of ST increases max sigma ST increases elevation and sampling intervals were correlated with late functional recovery. A wall motion score index (WMSI: 1 = normal to 4 = dyskinesia) and 16-segment model were used. Reversible dysfunction was defined as a decrease of > or = 0.22 in WMSI. RESULTS: At univariate analysis a > or = 50% reduction of both ST increases max and sigma ST increases was related to late functional recovery. Multiple logistic regression analysis revealed that reduction of sigma ST increases was the most powerful predictor of late functional recovery (p = 0.008). A > or = 50% reduction of sigma ST increase within 4 hours of PTCA provided the optimal criterion for predicting late functional recovery. CONCLUSIONS: Rapid reduction of sigma ST increases elevation is an accurate predictor of left ventricular functional recovery in patients with AMI treated with primary PTCA. Optimal criteria include a reduction in sigma ST increases elevation > or = 50% within 4 hours of PTCA.

Adult↗
PubMed1997

Rapid reduction of ST-segment elevation after successful direct angioplasty in acute myocardial infarction.

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, <50% reduction in ST-segment elevation in a single selected lead (42 patients); group 2, > or =50% reduction in ST-segment elevation (75 patients). Baseline characteristics were similar except for anterior wall AMI and Killip class >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 <0.001). Functional recovery (>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.

Adult↗
PubMed1997

Bailout coronary stenting without anticoagulation or intravascular ultrasound guidance: acute and six-month angiographic results in a series of 120 consecutive patients.

The purpose of this study was to evaluate the feasibility, safety, and efficacy of bailout coronary stenting without anticoagulation or intravascular ultrasound guidance in patients with acute or unequivocal threatened closure after conventional angioplasty. One hundred twenty consecutive patients were prospectively enrolled according to the following criteria: 1) acute or threatened closure after balloon angioplasty; 2) reference vessel diameter > or = 2.5 mm. All patients after stent implantation were on antiplatelet treatment with aspirin and ticlopidine. Four types of stents were used: Palmaz-Schatz (J&J), Gianturco-Roubin (Cook), Freedom (Global Therapeutics), and Microstent (AVE). Procedural results: a total of 206 stents were implanted in 134 target lesions with a stent deployment success rate of 100%; 44 target lesions were treated with multiple stent implantation; the mean luminal diameter after stenting was 3.14 +/- 0.34 mm, and the mean final percent diameter stenosis was -2 +/- 10%; the mean balloon to vessel ratio was 1.11 +/- 0.15; the mean final pressure inflation was 13.9 +/- 2.4 atm; an optimal angiographic result was achieved in 128 lesions (96%). In-hospital results: in-hospital recurrent ischemia occurred in 4 patients (3%); recurrent ischemia resulted directly in death in 1 patient, in nonfatal Q-waves infarction in 2 patients, and in emergency coronary artery surgery in 1 patient. Six-month clinical follow-up results: event free survival rate was 77%; 1 patient had non fatal infarction; the incidence of repeat revascularization procedures was 19%; there were no cardiac deaths. Angiographic follow-up results (follow-up rate 93%): the restenosis or reocclusion rate was 28%. Bailout coronary stenting without chronic anticoagulation treatment or intravascular ultrasound guidance may be considered a highly feasible and safe treatment for acute or threatened closure after failed angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1996

Tetracycline fiber used alone or with scaling and root planing in periodontal maintenance patients: clinical results.

This study evaluated the 6-month clinical response to sustained-release tetracycline fibers used alone or with scaling and root planing in 25 adult periodontal maintenance patients. All subjects had at least one pocket > or = 4.0 mm that bled on probing and required therapy. Thirty-six teeth were treated with tetracycline fibers for 7 to 12 days; twelve of the 36 teeth also received scaling and root planing. The selection of teeth for scaling and root planing was based on the condition of the teeth. Therapeutic results were evaluated by changes in probing depth and frequency of bleeding on probing. Use of tetracycline fibers and fibers with scaling produced 1.8- and 1.7-mm reductions in probing depth, respectively, 1 month after treatment; reductions declined to 1.3 and 0.8 mm at 3 months, but rebounded to 1.5 and 1.3 mm at 6 months. The percentage of teeth exhibiting bleeding on probing decreased from 100% at baseline to 68% and 50% in the fiber and fiber plus scaling groups, respectively, at 6 months. None of the differences was statistically significant. Tetracycline fibers clearly decreased clinical signs of periodontal inflammation. Addition of scaling and root planing at the time of fiber placement further decreased, although not significantly, the degree of inflammation.

Adult↗
PubMed1995

Efficacy of femoral intra-arterial administration of teicoplanin in gram-positive diabetic foot infections.

In this study the efficacy and safety femoral intra-arterial administration of teicoplanin in the treatment of diabetic foot infections caused by gram-positive bacteria were evaluated. Twenty-five hospitalized diabetic patients with foot ulcers or with foot ulcers and metatarsophalangeal osteomyelitis were included in the study. In the ulcers Staphylococcus aureus was present alone in 16 patients and was associated with Pseudomonas aeruginosa in 2 patients, with Candida albicans in 2, and with coagulase-negative Staphylococcus in 1 patient. In 4 patients other gram-positive bacteria were isolated. All isolated strains were resistant to various antibiotics tested. Teicoplanin, 200 mg, was administered once a day by femoral intra-arterial injection for an average period of 14.72 +/- 7.16 days (range ten to thirty-six days). Six patients were treated with an additional antibiotic intramuscularly or intravenously because of a mixed infection. At the end of the therapy microbiological assessment confirmed that gram-positive infection was eliminated in all patients. Clinical outcome demonstrated that healing occurred in 18 patients (72%) and improvement in 7 patients (28%). No adverse drug reactions were observed during the treatment. The results demonstrate that femoral intra-arterial administration of teicoplanin was highly effective in skin- and bone-infected lesions in the diabetic foot. This method may represent a further advantage in management of this severe diabetic complication.

Adult↗
PubMed1990

[A longitudinal clinical study of the efficacy of tetracyclines combined with root planing in patients with periodontal disease].

A retrospective longitudinal study was performed to assess the effectiveness of tetracycline therapy associated with root planing compared with root planing alone in patients affected by medium to severe periodontal disease. From an analysis of results it appeared that the combined therapy was generally more successful, even though statistical significance was only achieved in cases of healing angular bone lesions. In conclusion, larger studies should be carried out to contribute to broaden the spectrum of indications for the use of antibiotic therapy in periodontal disease in adults.

Adult↗
PubMed1985

[Flowmetric, thermometric and rheologic studies in obliterating arterial diseases of the lower extremities treated with buflomedil].

Ten subjects with peripheral arterial occlusive disease were treated with buflomedil, analysing the effect of every single intravenous administration of the drug, and the effect of the administration repeated for a period of 5 days. This controlled study was aimed at evaluating the state of the peripheral blood flow, not just relating to the flowmetric parameters, but also to those more directly connected to the metabolic and functional conditions of the microcirculation. During every single administration, blood flow, skin and muscular temperatures were recorded. As concerned the drug's chronic effect, endurance limit, skin and muscular temperatures, whole blood viscosity, plasma viscosity and red cell filterability were recorded before beginning the treatment and after 15 days. The results of this study show that during a single buflomedil infusion no modifications have been observed in blood flow and muscular temperature, whereas skin temperature showed a slight increase. On the contrary, after a 15 days treatment, muscular temperature and endurance limit significantly increased, without flowmetric changes. A significant decrease in values of blood viscosity at high shear-rate was recorded too. The overall results seem to indicate that after treatment with buflomedil there is an improvement of the metabolic muscular conditions, probably due to a stimulant effect of the drug on microcirculatory blood flow.

Aged↗