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S Pirelli

Publications and source records attributed to S Pirelli.

At least 55 records · Page 3Linked to original sources
PubMed1987

Effectiveness of low-dose heparin in prevention of myocardial reinfarction.

728 patients aged 50-75 years who had had Q-wave myocardial infarction 6-18 months previously were enrolled in a randomised, multicentre trial of low-dose heparin in prevention of reinfarction. The control group (365 patients) received their study centres' usual therapy; the heparin group (363 patients) also received subcutaneous calcium heparin (12,500 IU daily). Mean (SD) follow-up was 708 (265) days in the heparin group and 687 (251) in the control group. The reinfarction rate was 63% lower in the heparin than in the control group (4/303, 1.32% v 13/365, 3.56%). The difference in cumulative reinfarction rate between the groups was significant by both drug-efficacy (chi 2 = 3.99, p less than 0.05) and intention-to-treat analysis (chi 2 = 3.84, p = 0.05). Heparin treatment reduced the cumulative general mortality rates by 48% on drug-efficacy analysis (chi 2 = 3.88, p less than 0.05) and by 34% on intention-to-treat analysis (chi 2 = 2.05, not significant). Cardiovascular mortality was also reduced (33%) but not significantly. However, fatal events attributable to thromboembolism (fatal reinfarction, stroke, pulmonary embolism) were significantly less frequent in the heparin than in the control group (1 v 7, p less than 0.05). 60 patients (16.5%) discontinued heparin treatment, but only 23 patients (6.3%) stopped because of side-effects. Low-dose heparin appears to be effective, safe, well tolerated, and free from haemorrhagic risk for the prevention of myocardial reinfarction.

Aged↗
PubMed1987

[Diagnostic reliability of clinical and instrumental data in identifying the presence of coronary disease in women with chest pain].

The present study was performed to assess the reliability of clinical symptom, rest and exercise electrocardiogram, exercise Thallium myocardial scintigraphy, as well as rest and exercise radionuclide angiocardiography, in order to detect significant coronary artery disease in 85 female patients with chest pain, who underwent coronary angiography. Of these, 54 underwent Thallium myocardial scintigraphy, 53 rest and exercise radionuclide angiocardiography. We have evaluated sensibility, specificity and positive and negative predictive value for each single variable or every possible combination. Within the population examined, Thallium myocardial scintigraphy reaches the highest sensibility (92%), specificity (92.5%), positive predictive (81%) and negative predictive value (97%). In comparison with all other clinical or instrumental parameters, taken either single or in combination. By subdividing the sample in two groups, of 20 and 65 patients respectively on the basis of the clinical symptom angina or thoracoalgy, with different predominance of coronaropathy (60 and 15%), Thallium myocardial scintigraphy is confirmed to be the most reliable diagnostic test (within the angina group sensibility 86%, specificity 100%, positive predictive value 100%, negative predictive value 83%, within the thoracoalgy group sensibility 100%, specificity 91%, positive predictive value 70%, negative predictive value 100%). However, within the thoracoalgy group, a negative maximal exercise test and a normal rest radionuclide angiocardiography detect patients with low probability of coronaropathy (negative predictive value respectively 100% and 93%). Within the angina group only Thallium myocardial scintigraphy significantly increases the predictive value of the angina symptom itself with respect to the presence of coronaropathy (positive predictive value of angina symptom alone 60%, of angina symptom plus Thallium myocardial scintigraphy 100%).

Adult↗
PubMed1986

Indications for surgical treatment in post-infarction angina.

In order to evaluate whether or not criteria for surgical revascularization in patients with early post-infarction angina (EPIA) should be different from those commonly used for patients with angina, the incidence and prognostic implications of EPIA were analysed in 188 AMI patients in Killip's class I or II on admission. Sixty-two patients (33%) complained of EPIA (Group I) and 126 patients were symptom-free (Group II). There were no differences between the two groups in in-hospital and late mortality and reinfarction. On the contrary, severity of angina was significantly associated with the occurrence of in-hospital and late cardiac death, reinfarction and revascularization procedures. EPIA patients underwent revascularization procedures significantly more frequently than group II patients, both during hospitalization (29% versus 1%; P less than 0.001) and follow up (10% versus 1%; P less than 0.01). Coronary artery involvement was significantly more severe in group I than in group II and in the operated patients compared with the non-operated ones. Our data suggest that the severity of angina should be the leading criterion for surgery, as it is able to identify most of the patients with severe coronary artery disease and poor prognosis.

Aged↗
PubMed1985

[Myocardial revascularization in patients with severe ventricular impairment. Short-term follow-up].

To assess the influence of aorto-coronary bypass grafting on surgical risk and short-term survival of patients with marked impairment of left ventricular (LV) function, we evaluated--among 435 patients who underwent coronary bypass surgery between January 1981 and December 1982--22 cases with: LV ejection fraction (EF) less than or equal to 0.35 (mean 0.27 +/- 0.06), LV end-diastolic pressure greater than or equal to 15 mmHg (mean 19.9 +/- 6.9 mmHg.), presence of three or more dysfunctional (hypokinetic or akinetic) segments on biplane LV angiography, three vessels disease in 90.1%. All patients but two had angina refractory to medical therapy. Operative mortality rate was 4.5%. Perioperative non fatal infarction rate was 9.1%. There were three late deaths. Mean duration of follow-up was 10.5 +/- 8.3 months with a survival of 81.8%. In the survivors we observed: dramatic improvement in respect to angina (94.5% are asymptomatic) and quality of life; exercise performance improvement (75% of patients have a functional impairment less than or equal to 30% at treadmill test); significant improvement in global and segmental LV function (mean echocardiographic EF 0.37 +/- 0.10, p less than 0.001). Because of relative low surgical risk and encouraging short-term results, aortocoronary bypass grafting can be performed even in patients with important LV disfunction, when associated with severe angina.

Adult↗
PubMed1985

[Assessment of coronary stenosis by myocardial scintigraphy with thallium-201 after dipyridamol infusion].

After a 4 minute i.v. dipyridamole infusion (0.14 mg/Kg/min) serial Thallium-201 scans were obtained in 45 patients, without myocardial necrosis, undergoing coronarography. Twelve patients had effort angina, 6 rest angina, 14 effort associated with rest angina, 13 had atypical chest pain. Thirty-two patients had a 50% or greater stenosis of 1 or more coronary artery (8 had three vessels disease, 7 two vessels, 17 one vessel); 13 patients had no significant coronary stenosis ("control group"). The test induced electrocardiographic signs of ischemia in 18 patients, all with significant coronary stenosis, 15 of them experienced angina too. Sensitivity of Thallium-201 for detecting coronary artery stenosis was 94% (30 of 32) and specificity was 85% (11 of 13). In the group of the 17 patients with one vessel disease we obtained a sensitivity and specificity of 100% (17 of 17). We conclude that Thallium-201 myocardial imaging after pharmacologic vasodilatation with dipyridamole is a highly sensitive and specific test for detecting coronary artery stenoses without necessary overt ischemia. In fact dipyridamole, as consequence of its important coronary vasodilatation, produces differences in myocardial perfusion with relative perfusion defects detectable with Thallium-201 imaging.

Adult↗
PubMed1984

Percutaneous transluminal coronary angioplasty. Critical assessment of preliminary results.

Since June 1981 until July 1983, 40 percutaneous transluminal coronary angioplasty procedures in 38 patients have been performed. Results in the whole series are as follows: stenosis crossed in 33 patients (83%); balloon inflation done in 31 (78%), not done in 2 due to clinical instability induced by crossing of the stenosis; successful dilatation obtained in 25 patients (63%); emergency bypass surgery in 6 patients (15%) with 2 perioperative myocardial infarctions; no deaths. The whole series can be subdivided in two groups by the following parameters: premedication by nitrates (A) or by verapamil (B); temporal concentration of the procedures: 1/month up to February 83 (A), 3.7/month thereafter (B). Results are different in the two groups: 21 attempts in 21 patients: stenosis crossed in 14 cases (67%), balloon inflated in 12 (57%), successful dilatation obtained in 8 patients (38%), emergency bypass in 5 patients (24%). 19 attempts in 17 patients (2 vessel angioplasty in 2 patients): stenosis crossed and balloon inflated in 19 (100%), successful dilatation in 17 cases (89%), uncomplicated emergency bypass in 1 patient (5%). On the basis of personal more recent results an optimistic attitude towards the percutaneous transluminal coronary angioplasty is justified.

Angioplasty, Balloon↗
PubMed1984

[The alkalinization test in the diagnosis of spontaneous angina].

The induction of alkalosis has been proposed as provocative test of coronary spasm in patients affected by vasospastic angina. We submitted to the test 43 patients, affected by angina with a previous documentation of spontaneous ischemia (19 patients with ST elevation and 24 patients with ST depression at the EKG registered during pain). Twelve patients had normal coronary arteries; in 14 patients a significant stenosis of a single vessel was present; in 15 patients 2 vessels were involved and in 2 a 3-vessel disease was demonstrated. The test induced ischemia in 17 patients (39.6%). The positivity of the test was strictly dependent on the period of time elapsed between the last documented crisis of angina and the provocative test: it induced ischemia in 75% of the patients who underwent the test in the acute phase: on the other hand it was constantly negative in patients who had not complained of anginal pain for more than 6 months. In the screening of patients with chest pain at rest, the test of alkalosis does not seem, therefore, useful as a diagnostic tool.

Angina Pectoris↗
PubMed1981

Effects of nifedipine, acebutolol, and their association on exercise tolerance in patients with effort angina.

The action of nifedipine (N), acebutolol (A), and their association (A+N) was studied in 16 patients suffering from effort angina with documented coronary artery disease. The therapeutic action was valued by bicycle effort stress test after oral administration of medications in comparison with placebo (P), following a double-blind random sequence of treatments. Working capacity significantly increased after A (507 +/- 450 mkp, p less than 0.05), after N (1,140 +/- 767 mkp, p less than 0.001), and after A+N (1,198 +/- 644 mkp, p less than 0.01). The increments of work after P administration were not significant. Moreover, fatigue instead of angina appeared as a stopping criterion in 8 patients after A+N, and in only 1 patient after P, A, and N.

Acebutolol↗
PubMed1981

[Clinical and angiographic study of 51 patients with myocardial infarction aged up to 35 years (author's transl)].

The clinical and angiographic data of 51 patients 35 years-old or below with myocardial infarction were studied. The average age of the patients was 30.2 years. Cigarette smoking and familiar history for coronary artery disease (present respectively in 74.5 and 39.1 per cent of the patients) were the most frequent risk factors for coronary disease. The patients were divided into two groups without (group A) and with (group B) post-infarctional complications (angina, dangerous ventricular arrhythmias, left ventricular failure, re-infarction). The coronary arteries were normal in 46.1 per cent of the patients of group A, and in 11.1 per cent of the patients of group B (p less than 0,05). 33.3 per cent of the patients of group A were affected by 1 vessel disease and so were 40.7 per cent of the patients of group B (p = ns). 48.1 per cent of the patients of group B were affected by 2 or 3 vessels disease and so were 25 per cent of patients group A (p = ns). Left ventricular angiography revealed severe impairment of contractility in 70,3 per cent of the patients of group B and in 45.8 per cent in group A. A history of angina before myocardial infarction was connected with the presence of coronary artery disease in 87 per cent of patients.

Adult↗
PubMed1981

[Exercise test in 100 healthy children between 5 and 12 years of age (author's transl)].

100 healthy children, between 5 and 12 years of age underwent maximal exercise test on a bicycle ergometer in sitting position. Particularly interesting seem to be the observations on maximal heart rate during exercise, maximum work load, energy cost in terms of heart rate, EGG during exercise. As concerning the maximal heart rate, it was observed a levelling of around 195 beats min. for all the subjects. A low increase of systolic blood pressure was observed during strenuous exercise. The maximum tolerated work load increases accordingly with the increase of body surface area and age; taking into account the maximum value of heart rate during exercise (195 for all subjects), it arises a different energetic cost in terms of beats per min. in favour of 12 years subjects compared to youngers. None rhythm or conduction disturbances was observed during exercise, neither variations of the ventricular repolarization appeared during exercise.

Age Factors↗
PubMed1979

[Single vessel coronary disease. I. Differences in clinical and prognostic aspects and in surgical results in isolated lesions of the anterior descending branch and of other coronary branches].

This study includes 290 patients having a 75% or greater stenosis of a sinlge coronary vessel, divided into two groups: 205 cases with isolated lesions of the left anterior descending coronary artery (LAD) and 85 with a stenosis of the circumflex (CF) or of the right (RCA) coronary artery. The following data have been compared in the two groups: -- characters of angina; -- results of stress testing; -- extent of left ventricular contraction impairment; -- natural history of unoperated patients; -- surgical risk; -- long term survival of operated patients; -- effect of medical or surgical treatment on symptoms. Results were as follows: -- LAD patients had slightly more severe symptoms and lower exercise tolerance than CF and RCA patients; -- no significant differences were noted as regards left ventricular contraction; -- five year survival rates were only slightly different both regarding unoperated patients (80 +/- 5% survival in LAD disease group; 86 +/- 5% in CF and RCA disease) and operated cases (83 +/- 5% in LAD lesions, 86 +/- 7% in CF and RCA disease); -- surgical risk was relatively low in both groups; -- progress of symptoms after bypass surgery was very favourable. Based on these results, indications for surgery in single coronary vessel disease are discussed.

Adult↗