Piccaluga Dott.ssa Emanuela

Pubblicazioni su PubMed

• Achievement of target LDL-cholesterol level in patients with acute coronary syndrome undergoing percutaneous coronary intervention: The JET-LDL registry.
  Int J Cardiol

  2024 Feb;397():131659. doi: 10.1016/j.ijcard.2023.131659.
  
  Ferlini Marco, Munafò Andrea, Varbella Ferdinando, Delnevo Fabrizio, Solli Martina, Trabattoni Daniela, Piccaluga Emanuela, Cardile Antonino, Canova Paolo, Rossini Roberta, Celentani Dario, Ugo Fabrizio, Taglialatela Vittorio, Airoldi Falvio, Rognoni Andrea, Oliva Fabrizio, Porto Italo, Carugo Stefano, Castiglioni Battistina, Lettieri Corrado, Chinaglia Alessandra, Currao Alessia, Patti Giuseppe, Oltrona Visconti Luigi, Musumeci Giuseppe
  
  Abstract
  
  BACKGROUND:
  In patients with acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level 
  METHODS:
  The JET-LDL is a multicenter, observational, prospective registry created to investigate levels of LDL-C in consecutive patients with ACS undergoing PCI at 35 Italian hospitals, and to report their lipid lowering therapies (LLT). Follow-up was planned at 1 and 3 months. LDL-C reduction >50% from baseline or level 
  RESULTS:
  A total of 1095 patients were included: median age was 67 (58-75); 33.7% were already on LLT. Baseline LDL-C levels was 105 (76.5-137) mg/dL. At hospital discharge all patients were on LLT: 98.1% received statins (as mono or combination therapy), ezetimibe and PCSK9i were used in 60.1% and 8.5% of cases, respectively. Primary endpoint was achieved in 62% (95% CI 58-65) of cases. At 1-month LDL-C levels dropped to 53 (38-70) mg/dL (p 
  CONCLUSIONS:
  In this real-world registry of ACS patients undergoing PCI, recommend LDL-C levels were obtained in 62% of patients, but PCSK9i prescription was limited to 10% of cases. As LLT pattern appeared mainly improved at hospital discharge, an early and strong treatment should be considered.
  
  Copyright © 2023 Elsevier B.V. All rights reserved.
  
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• Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study.
  Clin Kidney J

  2023 Dec;16(12):2683-2692. doi: 10.1093/ckj/sfad221.
  
  Genovesi Simonetta, Porcu Luca, Rebora Paola, Slaviero Giorgio, Casu Gavino, Bertoli Silvio, Airoldi Flavio, Buskermolen Monique, Gallieni Maurizio, Pieruzzi Federico, Rovaris Giovanni, Montoli Alberto, Piccaluga Emanuela, Molon Giulio, Alberici Federico, Adamo Marianna, Gaspardone Achille, D'Angelo Giuseppe, Merella Pierluigi, Vezzoli Giuseppe, Trezzi Barbara, Mazzone Patrizio
  
  Abstract
  
  BACKGROUND:
  The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk.
  
  METHODS AND RESULTS:
  The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort,  = 106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort,  = 114) and the other without anticoagulation therapy (No-OAT cohort,  = 148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04-0.96;  = 0.045) and 0.16 (95%CI 0.04-0.66;  = 0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16-0.83;  = 0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23-1.12;  = 0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38-0.94;  = 0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34-0.78;  = 0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHADSVASc score (1.7 [95%CI 0.3-3.0] vs 6.7 events per 100 person/years,  
  CONCLUSION:
  In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.
  
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• Natural history and clinical burden of moderate aortic stenosis: a systematic review and explorative meta-analysis.
  J Cardiovasc Med (Hagerstown)

  2023 Sep;24(9):659-665. doi: 10.2459/JCM.0000000000001490.
  
  Morelli Martina, Galasso Michele, Esposito Giuseppe, Soriano Francesco Stefano, Nava Stefano, Da Pozzo Caterina, Bossi Irene, Piccaluga Emanuela, Bruschi Giuseppe, Maloberti Alessandro, Oliva Fabrizio, Oreglia Jacopo Andrea, Giannattasio Cristina, Montalto Claudio
  
  Abstract
  
  AIMS:
  The mortality risk of patients with moderate aortic stenosis is not well known, but recent studies suggested that it might negatively affect prognosis. We aimed to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of patients' baseline characteristics with prognosis.
  
  METHODS:
  Systematic research was conducted on PubMed. The inclusion criteria were inclusion of patients with moderate aortic stenosis; and report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. All patients with mild aortic stenosis or without aortic stenosis were considered controls. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.
  
  RESULTS:
  Fifteen studies and 11?596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than in controls in all timeframes analysed (all P ?0.0001). Left ventricular ejection fraction and sex did not significantly impact on the prognosis of patients with moderate aortic stenosis ( P ?=?0.4584 and P ?=?0.5792), while increasing age showed a significant interaction with mortality (estimate = 0.0067; 95% confidence interval: 0.0007-0.0127; P ?=?0.0323).
  
  CONCLUSION:
  Moderate aortic stenosis is associated with reduced survival. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of aortic valve replacement.
  
  Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
  
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• Radiation protection for healthcare professionals working in catheterisation laboratories during pregnancy: a statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the ESC Regulatory Affairs Committee and Women as One.
  EuroIntervention

  2023 May;19(1):53-62. doi: 10.4244/EIJ-D-22-00407.
  
  Manzo-Silberman Stéphane, Velázquez Maite, Burgess Sonya, Sahni Sheila, Best Patricia, Mehran Roxana, Piccaluga Emanuela, Vitali-Serdoz Laura, Sarma Amy, Barbash Israel Moshe, Mauri Josepa, Szyma?ski Piotr, Hinterbuchner Lynne, Stefanini Giulio, Gimelli Alessia, Maurovich-Horvat Pal, Boersma Lucas, Buchanan Gill Louise, Pontone Gianluca, Holmvang Lene, Karam Nicole, Neylon Antoinette, Morice Marie-Claude, Leclercq Christophe, Tarantini Giuseppe, Dudek Dariusz, Chieffo Alaide
  
  Abstract
  
  The European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the European Society of Cardiology (ESC) Regulatory Affairs Committee and Women as One support continuous review and improvement, not only in the practice of assuring patients a high quality of care but also in providing health professionals with support documents to help them in their career and enhance gender equity. Recent surveys have revealed that radiation exposure is commonly reported as the primary barrier for women pursuing a career in interventional cardiology or cardiac electrophysiology (EP). The fear of foetal exposure to radiation during pregnancy may lead to a prolonged interruption in their career. Accordingly, this joint statement aims to provide a clear statement on radiation risk and the existing data on the experience of radiation-exposed cardiologists who continue to work in catheterisation laboratories (cath labs) throughout their pregnancies. In order to reduce the barrier preventing women from accessing these careers, increased knowledge in the community is warranted. Finally, by going beyond simple observations and review of the literature, our document suggests proposals for improving workplace safety and for encouraging equity.
  
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• [Use of anticoagulants in patients with atrial fibrillation undergoing transcatheter aortic valve implantation].
  Rev Med Chil

  2022 May;150(5):618-624. doi: 10.4067/s0034-98872022000500618.
  
  Veas Nicolás, Winter José, Soriano Francesco, Valdebenito Martín, Piccaluga Emanuela, Nava Stefano, Muñoz Rodrigo, Cruz-González Ignacio, Puentes Angel, Lindefjeld Dante
  
  Abstract
  
  BACKGROUND:
  Transcatheter Aortic Valve Implantation (TAVI) is beneficial in patients with symptomatic severe Aortic Stenosis (AS). There is no consensus about the best anticoagulation strategy for patients with a recent TAVI and with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) are effective to prevent embolic events with a significant lower incidence of bleeding. There is scarce evidence about the use of these drugs in patients undergoing TAVI.
  
  AIM:
  To assess the management of anticoagulation at the moment of discharge of patients with AF and TAVI.
  
  MATERIAL AND METHODS:
  A four question survey was sent to cardiologists involved in TAVI programs in different international centers.
  
  RESULTS:
  The survey was answered by 72 interventional cardiologists. Even with the lack of randomized evidence, in most of the scenarios DOACs are prescribed at discharge in patients with indication for anticoagulation. Also, in patients with high bleeding risk, most cardiologists would perform a left atrial appendage closure. In patients with concomitant coronary artery disease, if a stent was recently implanted, prescription of the combination of a DOAC and one antiplatelet drug was the most common answer. In patients with a former coronary angioplasty, DOAC or Warfarin was the therapy of choice.
  
  CONCLUSIONS:
  In the absence of randomized data, interventional cardiologists prescribe DOACs at discharge to patients with AF and TAVI, without following current guidelines in most cases.
  
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• Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter.
  Nutr Metab Cardiovasc Dis

  2021 May;31(5):1501-1508. doi: 10.1016/j.numecd.2021.01.023.
  
  Maloberti Alessandro, Bossi Irene, Tassistro Elena, Rebora Paola, Racioppi Angelo, Nava Stefano, Soriano Francesco, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo, Vallerio Paola, Pirola Roberto, De Chiara Benedetta, Oliva Fabrizio, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND AIMS:
  Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation.
  
  METHODS AND RESULTS:
  231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function.
  
  CONCLUSIONS:
  In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
  
  Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
  
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• Gender Issues in Italian Catheterization Laboratories: The Gender-CATH Study.
  J Am Heart Assoc

  2021 Feb;10(5):e017537. doi: e017537.
  
  Bernelli Chiara, Cerrato Enrico, Ortega Rebecca, Piccaluga Emanuela, Ricottini Elisabetta, Chieffo Alaide, Masiero Giulia, Mattesini Alessio, La Manna Alessio, Musumeci Giuseppe, Tarantini Giuseppe, Mehran Roxana
  
  Abstract
  
  Background Women represent an increasing percentage of interventional cardiologists in Italy compared with other countries. However, gaps exist in understanding and adapting to the impact of these changing demographics. Methods and Results We performed a national survey to analyze demographics, gender-based professional difference, needs in terms of catheterization laboratory (Cath-Lab) abstention, and radiation safety issues in Italian Cath-Lab settings. A survey supported by the Italian Society of Interventional Cardiology (Società Italiana di Cardiologia Interventistica-Gruppo Italiano di Studi Emodinamici SICI-GISE) was mailed to all SICI-GISE members. Categorical data were compared using the ? test. 10 years of Cath-Lab experience. Notably, 26.4% were women. Workload was not gender-influenced (women performed "on-call" duty 69.8% versus men 68.3%; =0.97). Women were more frequently unmarried (22.1% women versus 8.7% men; =0.002) and childless (43.9% versus 56.1%;
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• Correction to: Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis.
  J Nephrol

  2021 Feb;34(1):75-76. doi: 10.1007/s40620-020-00800-6.
  
  Genovesi Simonetta, Porcu Luca, Slaviero Giorgio, Casu Gavino, Bertoli Silvio, Sagone Antonio, Buskermolen Monique, Pieruzzi Federico, Rovaris Giovanni, Montoli Alberto, Oreglia Jacopo, Piccaluga Emanuela, Molon Giulio, Gaggiotti Mario, Ettori Federica, Gaspardone Achille, Palumbo Roberto, Viazzi Francesca, Breschi Marco, Gallieni Maurizio, Contaldo Gina, D'Angelo Giuseppe, Merella Pierluigi, Galli Fabio, Rebora Paola, Valsecchi Mariagrazia, Mazzone Patrizio
  
  
  
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• Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis.
  J Nephrol

  2021 Feb;34(1):63-73. doi: 10.1007/s40620-020-00774-5.
  
  Genovesi Simonetta, Porcu Luca, Slaviero Giorgio, Casu Gavino, Bertoli Silvio, Sagone Antonio, Buskermolen Monique, Pieruzzi Federico, Rovaris Giovanni, Montoli Alberto, Oreglia Jacopo, Piccaluga Emanuela, Molon Giulio, Gaggiotti Mario, Ettori Federica, Gaspardone Achille, Palumbo Roberto, Viazzi Francesca, Breschi Marco, Gallieni Maurizio, Contaldo Gina, D'Angelo Giuseppe, Merella Pierluigi, Galli Fabio, Rebora Paola, Valsecchi Mariagrazia, Mazzone Patrizio
  
  Abstract
  
  BACKGROUND:
  In patients with end stage renal disease and atrial fibrillation (AF), undergoing chronic dialysis, direct oral agents are contraindicated and warfarin does not fully prevent embolic events while increasing the bleeding risk. The high hemorrhagic risk represents the main problem in this population. Aim of the study was to estimate the safety and efficacy for thromboembolic prevention of left atrial appendage (LAA) occlusion in a cohort of dialysis patients with AF and high hemorrhagic risk.
  
  METHODS:
  Ninety-two dialysis patients with AF who underwent LAA occlusion were recruited. For comparative purposes, two cohorts of dialysis patients with AF, one taking warfarin (oral anticoagulant therapy, OAT cohort, n?=?114) and the other not taking any OAT (no-therapy cohort, n?=?148) were included in the study. Primary endpoints were (1) incidence of peri-procedural complications, (2) incidence of 2-year thromboembolic and hemorrhagic events, (3) mortality at 2 years. In order to evaluate the effect of the LAA occlusion on the endpoints with respect to the OAT and No-therapy cohorts, a multivariable Cox regression model was applied adjusted for possible confounding factors.
  
  RESULTS:
  The device was successfully implanted in 100% of cases. Two major peri-procedural complications were reported. No thromboembolic events occurred at 2-year follow-up. The adjusted multivariable Cox regression model showed no difference in bleeding risk in the OAT compared to the LAA occlusion cohort in the first 3 months of follow-up [HR 1.65 (95% CI 0.43-6.33)], when most of patients were taking two antiplatelet drugs. In the following 21 months the bleeding incidence became higher in OAT patients [HR 6.48 (95% CI 1.32-31.72)]. Overall mortality was greater in both the OAT [HR 2.76 (95% CI 1.31-5.86)] and No-Therapy [HR 3.09 (95% CI 1.59-5.98)] cohorts compared to LAA occlusion patients.
  
  CONCLUSIONS:
  The study could open the way to a non-pharmacological option for thromboembolic protection in dialysis patients with AF and high bleeding risk.
  
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• Reproductive outcomes and Y chromosome instability in radiation-exposed male workers in cardiac catheterization laboratory.
  Environ Mol Mutagen

  2020 Mar;61(3):361-368. doi: 10.1002/em.22341.
  
  Andreassi Maria Grazia, Borghini Andrea, Vecoli Cecilia, Piccaluga Emanuela, Guagliumi Giulio, Del Greco Maurizio, Gaita Fiorenzo, Picano Eugenio
  
  Abstract
  
  Occupational radiation exposure may impact the reproductive outcome of male workers in the cardiac catheterization laboratory (cath Lab) who receive a dose of ~1-10 mSv/year. An increased copy number variation (CNV) in azoospermia factor region c (AZFc) of the Y chromosome is a marker of spermatogenic failure, previously associated with radiation exposure. This study sought to investigate the association between paternal exposure in the Cath Lab and adverse reproductive outcomes as well as to assess the induction of CNV in the AZFc region. In a case-control study, we enrolled 193 catheterization lab workers (Group I) and 164 age-matched unexposed controls (Group II). Reproductive outcomes were assessed through a structured questionnaire. Two sequence-tagged sites (SY1197 and SY579) in AZFc region were evaluated by qRT-PCR in 83 exposed and 47 unexposed subjects. Exposed workers had a higher prevalence of low birth weight in offspring (Group I = 13% vs. II = 5.3%, P = 0.02; OR = 2.7; 95% CI: 1.1-6.3; P = 0.02). The mean of CNV (microdeletion and microduplication) for SY1197 was significantly higher in the exposed workers (Group I = 1.53?±?0.85 vs. Group II = 1.02?±?0.41; P = 0.0005). Despite the study design limitations, our findings show that chronic occupational radiation exposure of male workers is correlated with higher prevalence of low birth weight in offspring and instability in the Y chromosome AZFc region. Environ. Mol. Mutagen. 61:361-368, 2020. © 2019 Wiley Periodicals, Inc.
  
  © 2019 Wiley Periodicals, Inc.
  
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• [SICI-GISE Position paper: Enhancing radiation safety in the catheterization laboratory].
  G Ital Cardiol (Rome)

  2019 Sep;20(9 Suppl 1):14S-28S. doi: 10.1714/3219.31965.
  
  Sciahbasi Alessandro, Piccaluga Emanuela, Andreassi Maria Grazia, Trianni Annalisa, Rosi Antonella, Sarandrea Alessandro, Longoni Matteo, Germinal Francesco, Santucci Stefano, Bernardi Guglielmo, Rigattieri Stefano, La Manna Alessio, Castiglioni Battistina, Limbruno Ugo, Mauro Ciro, Tarantino Fabio, Esposito Giovanni, Musumeci Giuseppe, Tarantini Giuseppe
  
  Abstract
  
  The radiation dose received by interventional cardiologists during their activity in the catheterization laboratory is a matter of concern in terms of possible deterministic and stochastic risk. At the same time, very often, the knowledge of the effect and consequences of radiation exposure in the interventional cardiology community is limited. This document endorsed by the Italian Society of Interventional Cardiology (SICI-GISE) provides recommendations for cardiologists' radiation protection. Radiation safety considerations dedicated to women and other staff personnel working in the catheterization laboratory are also discussed.
  
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• Radiation protection measures and sex distribution in European interventional catheterisation laboratories.
  EuroIntervention

  2020 May;16(1):80-82. doi: 10.4244/EIJ-D-18-01044.
  
  Manzo-Silberman Stéphane, Piccaluga Emanuela, Radu Maria D, James Stefan K, Schüpke Stefanie, Vaquerizo Beatriz, Kunadian Vijay, Capranzano Piera, Mehilli Julinda, Buchanan Gill Louise, Chieffo Alaide, Mauri Josepa
  
  
  
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• Increased mitochondrial DNA4977-bp deletion in catheterization laboratory workers with long-term low-dose exposure to ionizing radiation.
  Eur J Prev Cardiol

  2019 Jun;26(9):976-984. doi: 10.1177/2047487319831495.
  
  Borghini Andrea, Vecoli Cecilia, Piccaluga Emanuela, Guagliumi Giulio, Picano Eugenio, Andreassi Maria Grazia
  
  Abstract
  
  AIMS:
  Ionizing radiation may lead to mitochondrial DNA (mtDNA) mutations and changes in mtDNA content in cells, major driving mechanisms for carcinogenesis, vascular aging and neurodegeneration. The aim of this study was to investigate the possible induction of common mitochondrial deletion (mtDNA4977) and mtDNA copy number (mtDNA-CN) changes in peripheral blood of personnel working in high-volume cardiac catheterization laboratories (Cath Labs).
  
  METHODS:
  A group of 147 Cath Lab workers (median individual effective dose =?16.8?mSv, for the 41 with lifetime dosimetric record) and 74 unexposed individuals were evaluated. The occupational radiological risk score was computed for each subject on the basis of the length of employment, individual caseload and proximity to the radiation source. mtDNA4977 deletion and mtDNA-CN were assessed by using quantitative real-time polymerase chain reaction.
  
  RESULTS:
  Increased levels of mtDNA4977 deletion were observed in high-exposure Cath Lab workers compared with unexposed individuals ( p?0.0001). Conversely, mtDNA-CN was significantly greater in the low-exposure workers ( p?=?0.003). Occupational radiological risk score was positively correlated with mtDNA4977 deletion (Spearman's r?=?0.172, p?=?0.03) and inversely correlated with mtDNA-CN (Spearman's r?=?-0.202, p?=?0.01). In multiple regression model, occupational radiological risk score emerged as significant predictor of high levels of mtDNA4977 deletion (ß coefficient?=?0.236, p?=?0.04).
  
  CONCLUSION:
  mtDNA4977 deletion is significantly high in Cath Lab personnel. Beyond the well-recognized nuclear DNA, mtDNA damage might deserve attention as a pathogenetic molecular pathway and a potential therapeutic target of ionizing radiation damage.
  
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• Mycotic coronary aneurysms.
  J Cardiovasc Med (Hagerstown)

  2019 Jan;20(1):10-15. doi: 10.2459/JCM.0000000000000734.
  
  Buono Andrea, Maloberti Alessandro, Bossi Irene M, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo A, Moreo Antonella, Russo Claudio F, Oliva Fabrizio, Giannattasio Cristina
  
  Abstract
  
  : Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.
  
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• [Updated SICI-GISE position paper on institutional and operator requirements for transcatheter aortic valve implantation].
  G Ital Cardiol (Rome)

  2018 Sep;19(9):519-529. doi: 10.1714/2951.29672.
  
  Tarantini Giuseppe, Esposito Giovanni, Musumeci Giuseppe, Fraccaro Chiara, Franzone Anna, Castiglioni Battistina, La Manna Alessio, Limbruno Ugo, Marchese Alfredo, Mauro Ciro, Rigattieri Stefano, Tarantino Fabio, Gandolfo Caterina, Santoro Gennaro, Violini Roberto, Airoldi Flavio, Albiero Remo, Balbi Manrico, Baralis Giorgio, Bartorelli Antonio Luca, Bedogni Francesco, Benassi Alberto, Berni Andrea, Bonzani Giulio, Bortone Alessandro Santo, Braito Giuseppe, Briguori Carlo, Brscic Elvis, Calabrò Paolo, Calchera Ivan, Cappelli Bigazzi Maurizio, Caprioglio Francesco, Castriota Fausto, Cernetti Carlo, Cicala Cinzia, Cioffi Paolo, Colombo Antonio, Colombo Virgilio, Contegiacomo Gaetano, Cremonesi Alberto, D'Amico Maurizio, De Benedictis Mauro, De Leo Alessandro, Di Biasi Maurizio, Di Girolamo Domenico, Di Lorenzo Emilio, Di Mario Carlo, Dominici Marcello, Ettori Federica, Ferrario Maurizio, Fioranelli Massimo, Fischetti Dionigi, Gabrielli Gabriele, Giordano Arturo, Giudice Pietro, Greco Cesare, Indolfi Ciro, Leonzi Ornella, Lettieri Corrado, Loi Bruno, Maddestra Nicola, Marchionni Niccolò, Marrozzini Cinzia, Medda Massimo, Missiroli Bindo, My Luigi, Oreglia Jacopo Andrea, Palmieri Cataldo, Pantaleo Paolo, Paparoni Saro Roberto, Parodi Guido, Petronio Anna Sonia, Piatti Luigi, Piccaluga Emanuela, Pierli Carlo, Perkan Andrea, Pitì Antonino, Poli Arnaldo, Ramondo Angelo Bruno, Reale Maurizio Alessandro, Reimers Bernhard, Ribichini Flavio Luciano, Rosso Roberta, Saccà Salvatore, Sacra Cosimo, Santarelli Andrea, Sardella Gennaro, Satullo Gaetano, Scalise Filippo, Siviglia Massimo, Spedicato Leonardo, Stabile Amerigo, Tamburino Corrado, Tesorio Tullio Nicola Maria, Tolaro Salvatore, Tomai Fabrizio, Trani Carlo, Valenti Renato, Valsecchi Orazio, Valva Giuseppe, Varbella Ferdinando, Vigna Carlo, Vignali Luigi, Berti Sergio
  
  Abstract
  
  Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.
  
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• [Paclitaxel-coated balloons for in-stent restenosis treatment: long-term clinical results and predictors of recurrent target lesion revascularization].
  G Ital Cardiol (Rome)

  2018 Apr;19(4):232-238. doi: 10.1714/2898.29217.
  
  Bossi Irene, D'Anna Margherita, Vaccaro Valentina, Caria Maria Paola, Colombo Paola, De Marco Federico, Oreglia Jacopo, Piccalò Giacomo, Piccaluga Emanuela, Soriano Francesco, Oliva Fabrizio, Klugmann Silvio
  
  Abstract
  
  BACKGROUND:
  The aim of this study was to report clinical outcomes in patients treated with paclitaxel-coated balloons (PCB) for in-stent restenosis (ISR) in both bare metal (BMS) and drug-eluting stent (DES).
  
  METHODS:
  Between May 2009 and December 2015, we treated 155 ISR in 140 patients. At recruitment, 35% of patients had diabetes. Among the lesions, 125 were first occurrence (55 within BMS and 70 within DES) and 30 recurrent; 24 ISR were multi-metal layered. Mean reference diameter was 2.79 ± 0.52 mm and mean lesion length 13.2 ± 7.1 mm. PCB use included 32 Dior I, 97 InPact Falcon, 18 Panthera Lux, and 8 Restore DEB.
  
  RESULTS:
  At a median follow-up of 442 days, we observed 18 target lesion revascularizations (TLR), one myocardial infarction, 3 cardiac deaths, and 5 non-cardiac deaths. TLR occurrence differed according to type of ISR (4% within BMS, 14% within DES, 28% within recurrent ISR; p
  CONCLUSIONS:
  Our results confirm the safety and efficacy of PCB for ISR treatment both within BMS and DES. PCB type and recurrent ISR correlate with subsequent TLR.
  
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• Operator Pelvic Radiation Exposure During Percutaneous Coronary Procedures.
  J Invasive Cardiol

  2018 Feb;30(2):71-74. doi: JIC20171215-1.
  
  Sciahbasi Alessandro, Piccaluga Emanuela, Sarandrea Alessandro, Nucci Giacomo, Caretto Nicola, Rigattieri Stefano, Fedele Silvio, Romano Silvio, Penco Maria
  
  Abstract
  
  OBJECTIVES:
  To evaluate operator pelvic radiation exposure during percutaneous coronary procedures.
  
  BACKGROUND:
  During percutaneous coronary procedures, the operator's pelvic region is close to the x-ray source and is probably exposed to more radiation than the operator's thorax. However, no data are available on the pelvic radiation exposure of interventional cardiologists.
  
  METHODS:
  The RADIANT study (NCT01974453) is a prospective, single-center, observational study evaluating operator radiation exposure during percutaneous coronary procedures using electronic dosimeters placed at thorax level. In the last period of the study enrollment, a single operator was also equipped with an adjunctive electronic dedicated dosimeter to evaluate pelvic radiation exposure.
  
  RESULTS:
  From a total of 2028 procedures included in the RADIANT study, operator pelvic doses were available for 138 procedures (68 right radial, 55 left radial, and 15 transfemoral). Median fluoroscopy time was 226 sec (interquartile range [IQR], 117-407 sec) and the dose-area product (DAP) was 15.3 Gy?cm² (IQR, 9.3-27.8 Gy?cm²). Radiation dose at pelvic region was significantly higher (40.1 ?Sv; IQR, 22.7-76.3 ?Sv) compared to thorax dose (5.6 ?Sv; IQR, 1.5-12 ?Sv; P<.001 even after normalization by dap at pelvic vs thorax level p no significant differences were observed comparing dose in right radial left or femoral access>
  CONCLUSIONS:
  Operator radiation exposure to the pelvic region during percutaneous coronary procedures is significantly higher compared to thorax radiation dose independently of the vascular access site employed.
  
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• Low-Dose Exposure to Ionizing Radiation Deregulates the Brain-Specific MicroRNA-134 in Interventional Cardiologists.
  Circulation

  2017 Dec;136(25):2516-2518. doi: 10.1161/CIRCULATIONAHA.117.031251.
  
  Borghini Andrea, Vecoli Cecilia, Mercuri Antonella, Carpeggiani Clara, Piccaluga Emanuela, Guagliumi Giulio, Picano Eugenio, Andreassi Maria Grazia
  
  
  
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• Occupational Health Risks in Cardiac Catheterization Laboratory Workers.
  Circ Cardiovasc Interv

  2016 Apr;9(4):e003273. doi: 10.1161/CIRCINTERVENTIONS.115.003273.
  
  Andreassi Maria Grazia, Piccaluga Emanuela, Guagliumi Giulio, Del Greco Maurizio, Gaita Fiorenzo, Picano Eugenio
  
  Abstract
  
  BACKGROUND:
  Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure.
  
  METHODS AND RESULTS:
  We used a self-administered questionnaire to collect demographic information, work-related information, lifestyle-confounding factors, all current medications, and health status. A total number of 746 questionnaires were properly filled comprising 466 exposed staff (281 males; 44±9 years) and 280 unexposed subjects (179 males; 43±7years). Exposed personnel included 218 interventional cardiologists and electrophysiologists (168 males; 46±9 years); 191 nurses (76 males; 42±7 years), and 57 technicians (37 males; 40±12 years) working for a median of 10 years (quartiles: 5-24 years). Skin lesions (P=0.002), orthopedic illness (P16 years). In highly exposed physicians, adjusted odds ratio ranged from 1.7 for hypertension (95% confidence interval: 1-3; P=0.05), 2.9 for hypercholesterolemia (95% confidence interval: 1-5; P=0.004), 4.5 for cancer (95% confidence interval: 0.9-25; P=0.06), to 9 for cataract (95% confidence interval: 2-41; P=0.004).
  
  CONCLUSIONS:
  Health problems are more frequently observed in workers performing fluoroscopically guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory.
  
  © 2016 American Heart Association, Inc.
  
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• Trends of percutaneous coronary intervention in Italy in the last 10 years.
  J Cardiovasc Med (Hagerstown)

  2017 Mar;18(3):170-177. doi: 10.2459/JCM.0000000000000393.
  
  Danzi Gian Battista, Olivotti Luca, Valenti Renato, Bedogni Francesco, Ciarma Lorenzo, Cremonesi Alberto, Marchese Alfredo, Piccaluga Emanuela, Salvi Alessandro, Sardella Gennaro, Varbella Ferdinando, Berti Sergio,
  
  Abstract
  
  AIMS:
  To study the trends in the use of percutaneous coronary interventions (PCIs) in Italy between 2005 and 2014.
  
  METHODS:
  Publicly available data were obtained from the Italian Society of Invasive Cardiology (GISE), which organizes an annual audit of public and private cardiac catheterization laboratories.
  
  RESULTS:
  During the 10 years, more than 1.3 million PCIs were performed. The total number of PCIs per year increased by 23%, and reached 2342 procedures/million inhabitants in 2014: this was driven by a 91% increase in primary PCIs (PPCIs) for acute myocardial infarction, with the number of PPCIs/million inhabitants that nearly doubled from 291 to 536. Although the number of PCIs/million inhabitants was not homogeneously distributed over the country: even in 2014, it was higher in northern regions (2545) than in central (2229) or southern Italy and the islands (2138).
  
  CONCLUSION:
  The number of PCIs performed in Italy has steadily grown over the last decade. The trend was driven by a striking increase in the number of PPCIs for patients with acute myocardial infarction. The increase in the number of PCIs/million inhabitants was higher in northern Italy.
  
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• Uncommon late presentation of platypnea-orthodeoxia syndrome.
  J Geriatr Cardiol

  2015 Nov;12(6):687-9. doi: 10.11909/j.issn.1671-5411.2015.06.015.
  
  Toffetti Laura, Centola Marco, Massironi Laura, Pipia Cristina, Di Marco Fabiano, Colombo Alessandro, Piccaluga Emanuela
  
  
  
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• [SICI-GISE position paper on standards and guidelines for diagnostic and catheterization laboratories].
  G Ital Cardiol (Rome)

  2015 Oct;16(10):590-600. doi: 10.1714/2028.22050.
  
  Piccaluga Emanuela, Marchese Alfredo, Varbella Ferdinando, Sardella Gennaro, Danzi Gian Battista, Salvi Alessandro, Cremonesi Alberto, Merelli Antonella, Ciarma Lorenzo, Magro Beatrice, Bedogni Francesco,
  
  Abstract
  
  In the last few years, the activity of cath labs has undergone some notable changes, at present largely focusing on diagnosis and invasive therapy of a broad spectrum of cardiovascular diseases. Technological and pharmacological advances have allowed for procedures to be performed in patients who are increasingly complex, and cath labs have become the preferred venue for endovascular treatment of coronary artery disease, in particular acute coronary syndrome, as well as the treatment of structural heart disease and peripheral vascular disease. This position paper is an update of the 1996 and 2008 versions, given the present level of experience and the situation in Italy. It aims to provide the quality standards required to maintain adequate conditions of know-how and safety, as well as the structural and organizational requirements that are fundamental to obtain the best possible use of human and technological resources. Position papers should be a stimulus and guide for operators in the field as well as for those who govern health policies. This should allow for an improved and more rational allocation of cath labs in Italy, based on the real need for procedures and an optimal distribution and organization of the cardiovascular emergency networks while respecting the minimum standards of care.
  
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• [Position paper of the Italian Society of Invasive Cardiology (SICI-GISE) on indications for coronary angiography in patients with stable angina].
  G Ital Cardiol (Rome)

  2015 Oct;16(10):582-9. doi: 10.1714/2028.22048.
  
  Marchese Alfredo, Rossini Roberta, Basile Marco, Bedogni Francesco, Danzi Gian Battista, Musumeci Giuseppe, Paradies Valeria, Piccaluga Emanuela, Sardella Gennaro, Varbella Ferdinando, Giordano Arturo, Berti Sergio,
  
  Abstract
  
  Available data suggest a steep increase in stable coronary artery disease with age. Its prevalence reaches a peak of almost 12-14% in men aged 65-84 years with an annual mortality ranging from 1.2% to 2.4%. The diagnosis of stable angina is primarily based on history and therefore relies on clinical judgment. In addition, its diagnosis can be extremely challenging because of the frequent transition from unstable to stable angina. Current European guidelines on the management of stable coronary artery disease give increased importance to the pre-test probability, which strongly affects the diagnostic algorithms. Imaging techniques play a greater role in the diagnosis of stable angina than in the past. Conversely, despite recent advances in technology and in the physiological assessment of coronary stenosis, an ever decreasing relevance is conferred to coronary angiography. Another difficult and controversial issue relates to the prognostic benefit of myocardial revascularization. The aim of this position paper is to review the most relevant clinical aspects of the European guidelines on the management of stable coronary artery disease.
  
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• Neuropsychological Testing in Interventional Cardiology Staff after Long-Term Exposure to Ionizing Radiation.
  J Int Neuropsychol Soc

  2015 Oct;21(9):670-6. doi: 10.1017/S135561771500082X.
  
  Marazziti Donatella, Tomaiuolo Francesco, Dell'Osso Liliana, Demi Virginia, Campana Serena, Piccaluga Emanuela, Guagliumi Giulio, Conversano Ciro, Baroni Stefano, Andreassi Maria Grazia, Picano Eugenio
  
  Abstract
  
  This study aimed at comparing neuropsychological test scores in 83 cardiologists and nurses (exposed group, EG) working in the cardiac catheterization laboratory, and 83 control participants (non exposed group, nEG), to explore possible cognitive impairments. The neuropsychological assessment was carried out by means of a battery called "Esame Neuropsicologico Breve." EG participants showed significantly lower scores on the delayed recall, visual short-term memory, and semantic lexical access ability than the nEG ones. No dose response could be detected. EG participants showed lower memory and verbal fluency performances, as compared with nEG. These reduced skills suggest alterations of some left hemisphere structures that are more exposed to IR in interventional cardiology staff. On the basis of these findings, therefore, head protection would be a mandatory good practice to reduce effects of head exposure to ionizing radiation among invasive cardiology personnel (and among other exposed professionals).
  
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• Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection.
  Am J Cardiol

  2015 Jul;116(1):66-73. doi: 10.1016/j.amjcard.2015.03.039.
  
  Lettieri Corrado, Zavalloni Dennis, Rossini Roberta, Morici Nuccia, Ettori Federica, Leonzi Ornella, Latib Azeem, Ferlini Marco, Trabattoni Daniela, Colombo Paola, Galli Mario, Tarantini Giuseppe, Napodano Massimo, Piccaluga Emanuela, Passamonti Enrico, Sganzerla Paolo, Ielasi Alfonso, Coccato Micol, Martinoni Alessandro, Musumeci Giuseppe, Zanini Roberto, Castiglioni Battistina
  
  Abstract
  
  The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.
  
  Copyright © 2015 Elsevier Inc. All rights reserved.
  
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• Subclinical carotid atherosclerosis and early vascular aging from long-term low-dose ionizing radiation exposure: a genetic, telomere, and vascular ultrasound study in cardiac catheterization laboratory staff.
  JACC Cardiovasc Interv

  2015 Apr;8(4):616-27. doi: 10.1016/j.jcin.2014.12.233.
  
  Andreassi Maria Grazia, Piccaluga Emanuela, Gargani Luna, Sabatino Laura, Borghini Andrea, Faita Francesco, Bruno Rosa Maria, Padovani Renato, Guagliumi Giulio, Picano Eugenio
  
  Abstract
  
  OBJECTIVES:
  This study sought to assess the association between long-term radiation exposure in the catheterization laboratory (cath lab) and early signs of subclinical atherosclerosis.
  
  BACKGROUND:
  There is growing evidence of an excess risk of cardiovascular disease at low-dose levels of ionizing radiation exposure.
  
  METHODS:
  Left and right carotid intima-media thickness (CIMT) was measured in 223 cath lab personnel (141 male; age, 45 ± 8 years) and 222 unexposed subjects (113 male; age, 44±10 years). Leukocyte telomere length (LTL) was evaluated by quantitative reverse transcriptase polymerase chain reaction. The DNA repair gene XRCC3 Thr241Met polymorphism was also analyzed to explore the possible interaction with radiation exposure. The occupational radiological risk score (ORRS) was computed for each subject on the basis of the length of employment, individual caseload, and proximity to the radiation source. A complete lifetime effective dose (mSv) was recorded for 57 workers.
  
  RESULTS:
  Left, right, and averaged CIMTs were significantly increased in high-exposure workers compared with both control subjects and low-exposure workers (all p values
  CONCLUSIONS:
  Long-term radiation exposure in a cath lab may be associated with increased subclinical CIMT and telomere length shortening, suggesting evidence of accelerated vascular aging and early atherosclerosis.
  
  Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
  
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• [New Technologies in coronary interventional cardiology: results from the first inter-regional survey promoted by SICI-GISE in four regions of northern Italy ("the GISE TOLOVE" area: Tuscany, Lombardy, Veneto, Emilia-Romagna)].
  G Ital Cardiol (Rome)

  2015 Feb;16(2):100-7. doi: 10.1714/1798.19584.
  
  Mojoli Marco, Musumeci Giuseppe, Tarantini Giuseppe, Limbruno Ugo, Tarantino Fabio, Lettieri Corrado, Napodano Massimo, Fineschi Massimo, Menozzi Alberto, Pavei Andrea, Parodi Guido, Santarelli Andrea, Trabattoni Daniela, Marchese Alfredo, Piccaluga Emanuela, Danzi Gian Battista, Varbella Ferdinando, Bedogni Francesco, Sardella Gennaro, Berti Sergio
  
  Abstract
  
  BACKGROUND:
  The implementation of the latest medical innovations can vary widely within the same geographic area. This study aimed to describe the current status of recent innovations in the field of coronary interventional cardiology in 4 regions of Northern Italy.
  
  METHODS:
  From April to May 2014, 4 regional delegations of the Italian Society of Invasive Cardiology (SICI-GISE) have promoted a multicenter survey. By means of a web-based methodology, a focused questionnaire was administered to head physicians of 97 cath-labs in 4 Italian regions within the "GISE TOLOVE" area (Lombardy, Veneto, Tuscany, Emilia-Romagna).
  
  RESULTS:
  Pharmacological and technological innovations in coronary interventional cardiology appear to be widely used in the area covered by this survey, with uniformity in application and availability of therapeutic devices and drugs within the 4 regions involved. The main limiting factors to the adoption of new technologies and drugs were economic factors or lack of scientific evidence for some specific devices or drugs.
  
  CONCLUSIONS:
  This survey showed widespread and consistent application of the main latest innovations in coronary interventional cardiology across 4 Italian regions of Northern Italy.
  
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• A multidisciplinary consensus document on follow-up strategies for patients treated with percutaneous coronary intervention.
  Catheter Cardiovasc Interv

  2015 Apr;85(5):E129-39. doi: 10.1002/ccd.25724.
  
  Rossini Roberta, Oltrona Visconti Luigi, Musumeci Giuseppe, Filippi Alessandro, Pedretti Roberto, Lettieri Corrado, Buffoli Francesca, Campana Marco, Capodanno Davide, Castiglioni Battistina, Cattaneo Maria Grazia, Colombo Paola, De Luca Leonardo, De Servi Stefano, Ferlini Marco, Limbruno Ugo, Nassiacos Daniele, Piccaluga Emanuela, Raisaro Arturo, Ravizza PierFranco, Senni Michele, Tabaglio Erminio, Tarantini Giuseppe, Trabattoni Daniela, Zadra Alessandro, Riccio Carmine, Bedogni Francesco, Febo Oreste, Brignoli Ovidio, Ceravolo Roberto, Sardella Gennaro, Bongo Sante, Faggiano Pompilio, Cricelli Claudio, Greco Cesare, Gulizia Michele Massimo, Berti Sergio, Bovenzi Francesco, , , ,
  
  Abstract
  
  The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. Of note, clinical evaluations and non-invasive exams are often performed to low risk patients. In the present consensus document, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Three strategies follow-up have been defined and types and timing of clinical and instrumental evaluations are reported. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners, who are in charge to manage post-PCI patients, equally contributed to the creation of the present document.
  
  © 2014 Wiley Periodicals, Inc.
  
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• Increased circulating cell-free DNA levels and mtDNA fragments in interventional cardiologists occupationally exposed to low levels of ionizing radiation.
  Environ Mol Mutagen

  2015 Apr;56(3):293-300. doi: 10.1002/em.21917.
  
  Borghini Andrea, Mercuri Antonella, Turchi Stefano, Chiesa Maria Rosa, Piccaluga Emanuela, Andreassi Maria Grazia
  
  Abstract
  
  Circulating cell-free DNA (ccf-DNA) and mtDNA (ccf-mtDNA) have often been used as indicators of cell death and tissue damage in acute and chronic disorders, but little is known about changes in ccf-DNA and ccf-mtDNA concentrations following radiation exposure. The aim of the study was to investigate the impact of chronic low-dose radiation exposure on serum ccf-DNA levels and ccf-mtDNA fragments (mtDNA-79 and mtDNA-230) of interventional cardiologists working in high-volume cardiac catheterization laboratory to assess their possible role as useful radiation biomarkers. We enrolled 50 interventional cardiologists (26 males; age?=?48.4?±?10 years) and 50 age- and gender-matched unexposed controls (27 males; age?=?47.6?±?8.3 years). Quant-iT? dsDNA High-Sensitivity assay was used to measure circulating ccf-DNA isolated from serum samples. Quantitative analysis of mtDNA fragments was performed by real-time PCR. No significant relationships were found between ccf-DNA and ccf-mtDNA, and age, gender, smoking, or other clinical parameters. Ccf-DNA levels (44.2?±?31.1 vs. 30.6?±?19.2 ng/ml, P?=?0.013), ccf-mtDNA-79 (2.6?±?2.1 vs. 1.1?±?0.8, P
  © 2014 Wiley Periodicals, Inc.
  
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• Risks Related To Fluoroscopy Radiation Associated With Electrophysiology Procedures.
  J Atr Fibrillation

  2014 ;7(2):1044. doi: 1044.
  
  Picano Eugenio, Piccaluga Emanuela, Padovani Renato, Antonio Traino Claudio, Grazia Andreassi Maria, Guagliumi Giulio
  
  Abstract
  
  The benefits of cardiac imaging are immense, and modern cardiac electrophysiology (EP) requires the extensive and versatile use of a variety of cardiac imaging and radiology-based techniques. In the cardiac electrophysiology lab, doses can range around a reference effective dose (ED) of 15 milliSievert corresponding to 750 chest x-rays for a cardiac radiofrequency ablation, ranging from less than 2 to > 60 mSv. The reference dose for a regular pacemaker or ICD implant is 4 mSv (range 1.4-17) and for a CRT implant is 22 mSv (range 2.2-95). Doses on the order of magnitude of 10-100 milliSievert (mSv) correspond to a low (albeit definite, not negligible) additional lifetime risk of fatal and non-fatal cancer from between 1 in 1000 (10 mSv) to 1 in 100 (100 mSv). The increasing use and complexity of cardiac electrophysiology techniques have not been matched by increasing awareness and knowledge by prescribers and practitioners. The protection of doctors is just as important as protection of patients. Most experienced (and most exposed) interventional cardiologists and electrophysiologists have an exposure per annum of around 5 mSv, two to three times higher than diagnostic radiologists, with a typical cumulative lifetime attributable risk on the order of magnitude of 1 cancer (fatal and non-fatal) per 100 exposed subjects. Operator dose per procedure correlates somewhat with the patient dose, but may be typically 1000 times lower depending upon the shielding employed (one unit of incidence scatter dose for the operator when 1000 units of incident dose are given to the patient). However, adequate radiation protection training and diligent protection can reduce this radiation exposure by 90%. The priority given to radioprotection in every cardiology department is an effective strategy for primary prevention of cancer, a strong indicator of the quality of the cardiology division, and the most effective shielding for enhancing the safety of patients, doctors, and staff.
  
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• [To know how to be protected: the risks of low-dose ionizing radiation exposure].
  G Ital Cardiol (Rome)

  2014 May;15(5):286-8. doi: 10.1714/1563.17023.
  
  Piccaluga Emanuela
  
  
  
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• Perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and non-cardiac surgery: a consensus document from Italian cardiological, surgical and anaesthesiological societies.
  EuroIntervention

  2014 May;10(1):38-46. doi: 10.4244/EIJV10I1A8.
  
  Rossini Roberta, Musumeci Giuseppe, Visconti Luigi Oltrona, Bramucci Ezio, Castiglioni Battistina, De Servi Stefano, Lettieri Corrado, Lettino Maddalena, Piccaluga Emanuela, Savonitto Stefano, Trabattoni Daniela, Capodanno Davide, Buffoli Francesca, Parolari Alessandro, Dionigi Gianlorenzo, Boni Luigi, Biglioli Federico, Valdatta Luigi, Droghetti Andrea, Bozzani Antonio, Setacci Carlo, Ravelli Paolo, Crescini Claudio, Staurenghi Giovanni, Scarone Pietro, Francetti Luca, D'Angelo Fabio, Gadda Franco, Comel Andrea, Salvi Luca, Lorini Luca, Antonelli Massimo, Bovenzi Francesco, Cremonesi Alberto, Angiolillo Dominick J, Guagliumi Giulio, , , , , , , , , , , , , , , , ,
  
  Abstract
  
  Optimal perioperative antiplatelet therapy in patients with coronary stents undergoing surgery still remains poorly defined and a matter of debate among cardiologists, surgeons and anaesthesiologists. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. Clinical practice guidelines provide little support with regard to managing antiplatelet therapy in the perioperative phase in the case of patients with non-deferrable surgical interventions and/or high haemorrhagic risk. Moreover, a standard definition of ischaemic and haemorrhagic risk has never been determined. Finally, recommendations shared by cardiologists, surgeons and anaesthesiologists are lacking. The present consensus document provides practical recommendations on the perioperative management of antiplatelet therapy in patients with coronary stents undergoing surgery. Cardiologists, surgeons and anaesthesiologists have contributed equally to its creation. On the basis of clinical and angiographic data, the individual thrombotic risk has been defined. All surgical interventions have been classified according to their inherent haemorrhagic risk. A consensus on the optimal antiplatelet regimen in the perioperative phase has been reached on the basis of the ischaemic and haemorrhagic risk. Aspirin should be continued perioperatively in the majority of surgical operations, whereas dual antiplatelet therapy should not be withdrawn for surgery in the case of low bleeding risk. In selected patients at high risk for both bleeding and ischaemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be taken into consideration.
  
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• [Upstream administration of oral antiplatelet agents in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention].
  G Ital Cardiol (Rome)

  2014 Feb;15(2):90-8. doi: 10.1714/1424.15778.
  
  Ferlini Marco, Mafrici Antonio, Marzegalli Maurizio, Piccaluga Emanuela, Sponzilli Carlo, Bramucci Ezio, Visconti Luigi Oltrona
  
  Abstract
  
  Current guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) recommend the administration of dual antiplatelet therapy with aspirin and an ADP receptor blocker "as early as possible" before angiography (upstream), though this suggestion is not based on the results of randomized clinical trials designed to investigate pre-hospital rather than in-hospital drug administration. The present review analyzed randomized clinical trials, registries and observational studies that assessed clopidogrel, prasugrel and ticagrelor administration in STEMI patients undergoing primary PCI to evaluate if their upstream use may be justified in clinical practice. A significant difference favoring early clopidogrel administration has been demonstrated in observational studies. No evidence is available for prasugrel and ticagrelor; however, the initial delay of their antiplatelet effect in STEMI patients could support an upstream strategy to obtain complete platelet inhibition in the first hours after PCI and prevent major adverse events (e.g., stent thrombosis) despite an increased risk of major bleeding, particularly in case of urgent bypass surgery. Data from specifically designed randomized clinical trials are warranted to establish whether early administration of prasugrel and ticagrelor may favor reperfusion and improve clinical outcome with an acceptable risk-benefit ratio.
  
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• Olfactory non-cancer effects of exposure to ionizing radiation in staff working in the cardiac catheterization laboratory.
  Int J Cardiol

  2014 Feb;171(3):461-3. doi: 10.1016/j.ijcard.2013.12.223.
  
  Tonacci Alessandro, Baldus Giovanni, Corda Daniele, Piccaluga Emanuela, Andreassi Mariagrazia, Cremonesi Alberto, Guagliumi Giulio, Picano Eugenio
  
  
  
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• [ANMCO/SICI-GISE document on antiplatelet therapy in patients with acute coronary syndrome].
  G Ital Cardiol (Rome)

  2013 Dec;14(12):839-66. doi: 10.1714/1371.15242.
  
  De Luca Leonardo, Bolognese Leonardo, Valgimigli Marco, Ceravolo Roberto, Danzi Gian Battista, Piccaluga Emanuela, Rakar Serena, Cremonesi Alberto, Bovenzi Francesco Maria, ,
  
  Abstract
  
  Antiplatelet therapy is the cornerstone of the pharmacologic management of patients with acute coronary syndrome (ACS). Over the last years, several studies have evaluated old and new oral or intravenous antiplatelet agents in ACS patients. In particular, research was focused on assessing superiority of two novel platelet ADP P2Y12 receptor antagonists (i.e., prasugrel and ticagrelor) over clopidogrel. Several large randomized controlled trials have been undertaken in this setting and a wide variety of prespecified and post-hoc analyses are available that evaluated the potential benefits of novel antiplatelet therapies in different subsets of patients with ACS. The aim of this document is to review recent data on the use of current antiplatelet agents for in-hospital treatment of ACS patients. For each drug or class of drugs, strong evidence and/or areas of uncertainty that warrant further research are highlighted by examining 10 subgroups of patients with ACS.
  
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• [Coronary stenting and surgery: perioperative management of antiplatelet therapy in patients undergoing surgery after coronary stent implantation].
  G Ital Cardiol (Rome)

  2012 ;13(7-8):528-51. doi: 10.1714/1114.12251.
  
  Rossini Roberta, Bramucci Ezio, Castiglioni Battistina, De Servi Stefano, Lettieri Corrado, Lettino Maddalena, Musumeci Giuseppe, Visconti Luigi Oltrona, Piccaluga Emanuela, Savonitto Stefano, Trabattoni Daniela, Buffoli Francesca, Angiolillo Dominick J, Bovenzi Francesco, Cremonesi Alberto, Scherillo Marino, Guagliumi Giulio, ,
  
  Abstract
  
  The management of antiplatelet therapy in patients with coronary stents undergoing surgery is a growing clinical problem and often represents a matter of debate between cardiologists and surgeons. It has been estimated that about 4-8% of patients undergoing coronary stenting need to undergo surgery within the next year. Surgery represents one of the most common reasons for premature antiplatelet therapy discontinuation, which is associated with a significant increase in mortality and major adverse cardiac events, in particular stent thrombosis. In addition, surgery confers an additional risk of perioperative cardiac ischemic events, being high in these patients because of the pro-inflammatory and pro-thrombotic effects of surgery. Current international guidelines recommend to postpone non-urgent surgery for at least 6 weeks after bare metal stent implantation and for 6-12 months after drug-eluting stent implantation. However, these recommendations provide little support with regard to managing antiplatelet therapy in the perioperative phase in case of urgent operations and/or high hemorrhagic risk. Furthermore, ischemic and hemorrhagic risk is not defined in detail on the basis of clinical and procedural characteristics. Finally, guidelines shared with cardiologists and surgeons are lacking. The present consensus document provides practical recommendations on the management of antiplatelet therapy in the perioperative period in patients with coronary stents undergoing surgery. Cardiologists and surgeons contributed equally to its creation. An ischemic risk stratification has been provided on the basis of clinical and procedural data. All surgical interventions have been defined on the basis of the hemorrhagic risk. A consensus on the most appropriate antiplatelet regimen in the perioperative phase has been reached on the basis of the ischemic and hemorrhagic risk. Dual antiplatelet therapy should not be withdrawn for surgery at low bleeding risk, whereas aspirin should be continued perioperatively in the majority of surgical operations. In the event of interventions at high risk for both bleeding and ischemic events, when oral antiplatelet therapy withdrawal is required, perioperative treatment with short-acting intravenous glycoprotein IIb/IIIa inhibitors (tirofiban or eptifibatide) should be considered.
  
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• Impact of primary PCI volume on hospital mortality in STEMI patients: does time-to-presentation matter?
  J Thromb Thrombolysis

  2011 Aug;32(2):223-31. doi: 10.1007/s11239-011-0598-1.
  
  Navarese Eliano Pio, De Servi Stefano, Politi Alessandro, Martinoni Alessandro, Musumeci Giuseppe, Boschetti Enrico, Belli Guido, D'Urbano Maurizio, Piccaluga Emanuela, Lettieri Corrado, Klugmann Silvio
  
  Abstract
  
  The exact relationship between primary percutaneous coronary intervention (PCI) volume and mortality remains unclear. No data are available on how this relationship could be affected by time-to-presentation. The primary aim of this study was to evaluate the impact of hospital primary PCI volume on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients depending on time-to-presentation. The impact of primary PCI volume on in-hospital mortality was investigated in a prospective registry of the Lombardy region in Northern Italy, deriving data on mortality rates and number of primary PCIs from a cohort of 2,558 patients. We also explored this relationship at different times-to-presentation (?90 min, >90 min-180 min, >180 min) and risk profiles assessed with the TIMI Risk Index. A strong inverse relationship was found between primary PCI hospital volume and risk-adjusted mortality (r = -0.9; P 66 primary PCIs/year (OR = 0.21 [95% CI 0.10-0.47], P 90 min-180 min, the model was less significant (P = 0.02) with a higher threshold of procedures (>145 primary PCIs/year) required to provide benefits. The model was not predictive of survival for time-to-presentation >180 min (P = 0.30). The reduction of mortality of STEMI patients treated at high-volume primary PCI centers is time-dependent and affected by risk profile. The greatest benefit was observed in high-risk patients presenting within 90 min from symptoms onset.
  
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• Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty.
  Eur J Cardiovasc Prev Rehabil

  2011 Jun;18(3):526-32. doi: 10.1177/1741826710389395.
  
  Martinoni Alessandro, De Servi Stefano, Boschetti Enrico, Zanini Roberto, Palmerini Tullio, Politi Alessandro, Musumeci Giuseppe, Belli Guido, De Paolis Marcella, Ettori Federica, Piccaluga Emanuela, Sangiorgi Diego, Repetto Alessandra, D'Urbano Maurizio, Castiglioni Battistina, Fabbiocchi Franco, Onofri Marco, De Cesare Nicoletta, Sangiorgi Giuseppe, Lettieri Corrado, Poletti Fabrizio, Pirelli Salvatore, Klugmann Silvio,
  
  Abstract
  
  BACKGROUND:
  The purpose of this study is to present data on the effects of pre-hospital electrocardiogram (PH-ECG) on the outcome of ST elevation myocardial infarction (STEMI) patients treated with percutaneous coronary angioplasty (PCI) included in a registry undertaken in the Italian region of Lombardy. Pre-hospital 12-lead electrocardiogram is recommended by current guidelines in order to achieve faster times to reperfusion in patients with STEMI.
  
  METHODS:
  The registry includes 3901 STEMI patients who underwent primary PCI over an 18-month period.
  
  RESULTS:
  Mean age was 63?±?12 years. Admission through the emergency medical system (EMS) occurred in 1603 patients (40%): they were older, more frequently had previous MI, TIMI flow?=?0 at entry and were more frequently in Killip class >1 than patients who were not admitted through the EMS. Among the patients admitted through the EMS, PH-ECG was obtained in 475 patients (12%). These patients had less frequently an anterior MI, but more frequently had absence of TIMI flow at entry than patients whose ECG was not teletransmitted. Moreover, they had a significantly shorter first medical contact-to-balloon time and a trend toward a lower 30-day death rate (5.3% vs 7.9 %, p?=?0.06). However, only patients in Killip class 2-3 had a significantly lower mortality when the diagnostic ECG was transmitted, whereas no difference was found in Killip class 1 or Killip class 4 patients.
  
  CONCLUSIONS:
  In this registry, PH-ECG significantly decreased first medical contact-to-balloon time. Attempts to achieve faster reperfusion times should be undertaken, as this may result in improved outcome, particularly in patients with mild to moderate symptoms of heart failure.
  
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• Myocardial blood flow and infarct size after CD133+ cell injection in large myocardial infarction with good recanalization and poor reperfusion: results from a randomized controlled trial.
  J Cardiovasc Med (Hagerstown)

  2011 Apr;12(4):239-48. doi: 10.2459/JCM.0b013e328343d708.
  
  Colombo Alessandro, Castellani Massimo, Piccaluga Emanuela, Pusineri Enrico, Palatresi Simone, Longari Virgilio, Canzi Cristina, Sacchi Elisabetta, Rossi Edoardo, Rech Roberto, Gerundini Paolo, Viecca Maurizio, Deliliers Giorgio Lambertenghi, Rebulla Paolo, Soligo Davide, Giordano Rosaria
  
  Abstract
  
  OBJECTIVE:
  Large acute ST-elevation myocardial infarction (STEMI) sometimes leaves extensive ischemic damage despite timely and successful primary angioplasty. This clinical picture of good recanalization with incomplete reperfusion represents a good model to assess the reparative potential of locally administered cell therapy. Thus, we conducted a randomized controlled trial aimed at evaluating the effect of intracoronary administration of CD133 stem cells on myocardial blood flow and function in this setting.
  
  METHODS:
  Fifteen patients with large anterior STEMI, myocardial blush grade 0-1 and more than 50% ST-elevation recovery after optimal coronary recanalization (TIMI 3 flow) with stenting were randomly assigned to receive CD133 cells from either bone marrow (group A) or peripheral blood (group B), or to stay on drug therapy alone (group C). The cells were intracoronary injected within 10-14 days of STEMI. Infarct-related myocardial blood flow (MBF) was evaluated by NH positron emission tomography 2-5 days before cell administration and after 1 year.
  
  RESULTS:
  MBF increased in the infarct area from 0.419 (0.390-0.623) to 0.544 (0.371-0.729) ml/min per g in group A, decreased from 0.547 (0.505-0.683) to 0.295 (0.237-0.472) ml/min per g in group B and only slightly changed from 0.554 (0.413-0.662) to 0.491 (0.453-0.717) ml/min per g in group C (A vs. C: P = 0.023; B vs. C: P = 0.066). Left ventricular volume tended to increase more in groups B and C than in group A, ejection fraction and wall motion score index remained stable in the three groups.
  
  CONCLUSION:
  These findings support the hypothesis that intracoronary administration of bone marrow-derived, but not peripheral blood-derived CD133 cells 10-14 days after STEMI may improve long-term perfusion.
  
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• Defining high-risk patients with ST-segment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention: a comparison among different scoring systems and clinical definitions.
  Int J Cardiol

  2012 May;157(2):207-11. doi: 10.1016/j.ijcard.2010.12.007.
  
  Martinoni Alessandro, De Servi Stefano, Politi Alessandro, Palmerini Tullio, Musumeci Giuseppe, Ettori Federica, Zanini Roberto, Piccaluga Emanuela, Sangiorgi Diego, Repetto Alessandra, D'Urbano Maurizio, Castiglioni Battistina, Fabbiocchi Franco, Onofri Marco, Lauria Giulia, De Cesare Nicoletta, Sangiorgi Giuseppe, Lettieri Corrado, Belli Guido, Poletti Fabrizio, Pirelli Salvatore, Klugman Silvio
  
  Abstract
  
  BACKGROUND:
  Identification of high-risk patients with ST-segment elevation acute myocardial infarction (STEMI) is of the utmost importance for adequate patient stratification and evaluation of additive treatments. However, there is no consensus on the optimal definition of high-risk patients.
  
  METHODS:
  We therefore compared 5 scoring systems in the assessment of the risk of 30-day mortality in 3214 patients with STEMI treated with primary percutaneous coronary intervention (PCI).
  
  RESULTS:
  Clinical scores showed a large variability in risk stratifying patients. Identification of high-risk patients ranged from 15% (PAMI score ? 9) to 66% (McNamara definition). McNamara, Antoniucci and Brodie definitions had the best sensitivity (0.87-0.88 and 95% confidence intervals (CI) ranging from 0.82-0.93) while PAMI ? 9 had the best specificity (0.87 with 95% CI of 0.86-0.88), while its sensitivity was quite low (0.42). In a sample size simulation of a trial aimed at demonstrating a 33% difference in 30-day mortality between two hypothetical treatments, the number of STEMI patients needed to be screened varied from 4712 for the Brodie definition to 9038 for the PAMI ? 9 score.
  
  CONCLUSIONS:
  There is a large variability in risk stratification, sensitivity, specificity and predictive values among different scoring systems. These considerations should be taken into account when designing randomised trials.
  
  Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
  
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• The role of PET with 13N-ammonia and 18F-FDG in the assessment of myocardial perfusion and metabolism in patients with recent AMI and intracoronary stem cell injection.
  J Nucl Med

  2010 Dec;51(12):1908-16. doi: 10.2967/jnumed.110.078469.
  
  Castellani Massimo, Colombo Alessandro, Giordano Rosaria, Pusineri Enrico, Canzi Cristina, Longari Virgilio, Piccaluga Emanuela, Palatresi Simone, Dellavedova Luca, Soligo Davide, Rebulla Paolo, Gerundini Paolo
  
  Abstract
  
  UNLABELLED:
  Over the last decade, the effects of stem cell therapy on cardiac repair after acute myocardial infarction (AMI) have been investigated with different imaging techniques. We evaluated a new imaging approach using (13)N-ammonia and (18)F-FDG PET for a combined analysis of cardiac perfusion, metabolism, and function in patients treated with intracoronary injection of endothelial progenitors or with conventional therapy for AMI.
  
  METHODS:
  A total of 15 patients were randomly assigned to 3 groups based on different treatments (group A: bone marrow-derived stem cells; group B: peripheral blood-derived stem cells; group C: standard therapy alone). The number of scarred and viable segments, along with the infarct size and the extent of the viable area, were determined on a 9-segment (13)N-ammonia/(18)F-FDG PET polar map. Myocardial blood flow (MBF) was calculated for each segment on the ammonia polar map, whereas a global evaluation of left ventricular function was obtained by estimating left ventricular ejection fraction (LVEF) and end-diastolic volume, both derived from electrocardiography-gated (18)F-FDG images. Both intragroup and intergroup comparative analyses of the mean values of each parameter were performed at baseline and 3, 6, and 12 mo after AMI. During follow-up, major cardiac events were also registered.
  
  RESULTS:
  A significant decrease (P
  CONCLUSION:
  Our data suggest that a single nuclear imaging technique accurately analyzes changes in myocardial perfusion and metabolism occurring after stem cell transplantation.
  
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• LombardIMA: a regional registry for coronary angioplasty in ST-elevation myocardial infarction.
  J Cardiovasc Med (Hagerstown)

  2011 Jan;12(1):43-50. doi: 10.2459/JCM.0b013e328340334d.
  
  Politi Alessandro, Martinoni Alessandro, Klugmann Silvio, Zanini Roberto, Onofri Marco, Guagliumi Giulio, Fiorentini Cesare, Lettieri Corrado, Belli Guido, Piccaluga Emanuela, De Cesare Nicoletta, D'Urbano Maurizio, Ettori Federica, Repetto Alessandra, Musumeci Giuseppe, Castiglioni Battistina, Colombo Paola, Passamonti Enrico, Bramucci Ezio, Cattaneo Laura, Ferrari Giovanni, Repetto Sergio, Bartorelli Antonio, Pirelli Salvatore, De Servi Stefano,
  
  Abstract
  
  BACKGROUND:
  Percutaneous coronary intervention (PCI) has been shown to be the best reperfusion therapy for acute myocardial infarction with ST-elevation (STEMI), but data from registries show differences in patient populations and outcomes between randomized trials and real life.
  
  OBJECTIVES:
  We sought to provide information about the current status of this treatment with a registry collecting data in Lombardy, the most densely populated region in Italy, with widespread availability of cathlabs and a well-established network for the treatment of STEMI.
  
  METHODS AND RESULTS:
  Patient enrollment was performed by 32 hub centres recruiting 3901 STEMI patients who underwent PCI procedures within 12 h of the onset of symptoms, of whom 3317 patients underwent primary PCI, 376 'facilitated' PCI, and 208 rescue PCI in cathlabs located, in 77% of cases, in the same hospital of admission. In-hospital and 30-day total death were 4.4 and 6.6%, respectively. At multivariate analysis independent negative predictors of 30-day mortality were Killip class 3-4, number of involved ECG leads, chronic renal failure and age, whereas positive predictors were ST resolution more than 50% and postprocedural grade 3 thrombolysis in myocardial infarction flow.
  
  CONCLUSIONS:
  LombardIMA PCI registry enrolled STEMI patients representing a real-world population treated with PCI. Findings presented in this study may provide a benchmark for similar registries undertaken in other Italian regions and may be helpful to assess future possible developments of care for STEMI patients.
  
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• Prognostic implications of ST-segment elevation resolution in patients with ST-segment elevation acute myocardial infarction treated with primary or facilitated percutaneous coronary intervention.
  Am J Cardiol

  2010 Mar;105(5):605-10. doi: 10.1016/j.amjcard.2009.10.037.
  
  Palmerini Tullio, De Servi Stefano, Politi Alessandro, Martinoni Alessandro, Musumeci Giuseppe, Ettori Federica, Piccaluga Emanuela, Sangiorgi Diego, Lauria Giulia, Repetto Alessandra, Castiglioni Battistina, Fabbiocchi Franco, Onofri Marco, De Cesare Nicoletta, D'Urbano Maurizio, Poletti Fabrizio, Sangiorgi Giuseppe, Zanini Roberto, Lettieri Corrado, Belli Guido, Pirelli Salvatore, Klugmann Silvio,
  
  Abstract
  
  Scant data are available on the relation between ST-segment elevation (STE) resolution and 30-day mortality in patients with STE acute myocardial infarction treated with percutaneous coronary intervention in contemporary, real world, clinical practice. Furthermore, whether the prognostic value of STE resolution is influenced by the patient clinical risk profile or postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow has never been investigated. Lombardima was an observational registry implemented in Lombardy, a Northern Italian region. The clinical characteristics, electorcardiographic parameters, and procedural data were prospectively entered into a Web-based database. In the present study, we enrolled 3,403 patients. STE resolution occurred in 2,452 patients (group 1) and did not in 951 patients (group 2). The mortality rate was 2.4% in group 1 and 11.3% in group 2 (p
  Copyright 2010 Elsevier Inc. All rights reserved.
  
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• Primary percutaneous coronary intervention: different outcome for different subgroups?
  J Cardiovasc Med (Hagerstown)

  2009 Oct;10 Suppl 1():S27-34. doi: 10.2459/01.JCM.0000362041.25767.bc.
  
  Savonitto Stefano, Briguori Carlo, Ribichini Flavio, Tomai Fabrizio, Piccaluga Emanuela
  
  Abstract
  
  Over the past 20 years, the widespread use of pharmacological and mechanical reperfusion therapies, as well as a faster delivery of care, has considerably improved survival in acute coronary syndromes. Primary percutaneous coronary intervention (PCI), in particular, has improved the long-term prognosis of patients with ST-segment elevation myocardial infarction. There are, however, particular subgroups of individuals (elderly patients, women and patients with chronic kidney disease) that require special management during PCI because of their higher risk profile and the presence of numerous other concomitant pathologies. To date, a general consensus on the management of these patients in different phases of their clinical course is still lacking, but it is largely acknowledged that patients with the highest risk profile are often denied a reperfusion treatment.
  
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• Acetylcysteine and non-ionic isosmolar contrast-induced nephropathy--a randomized controlled study.
  Nephrol Dial Transplant

  2009 Oct;24(10):3103-7. doi: 10.1093/ndt/gfp306.
  
  Ferrario Francesca, Barone Maria Teresa, Landoni Giovanni, Genderini Augusto, Heidemperger Marco, Trezzi Matteo, Piccaluga Emanuela, Danna Paolo, Scorza Daniele
  
  Abstract
  
  INTRODUCTION:
  Intravenous administration of saline and non-ionic isosmolar contrast media significantly reduces the incidence of contrast-induced nephropathy, one of the most common causes of acute renal failure. Results with oral N-acetylcysteine are conflicting. The aim of our study was to evaluate the prophylactic role of N-acetylcysteine in patients with stable chronic renal failure undergoing coronary and/or peripheral angiography and/or angioplasty.
  
  METHODS:
  We randomized 200 elective, consecutive patients (mean age 74.9 +/- 7.3 years; 65% male, 25% diabetics) with basal creatinine clearance 0.5 mg/dl or >25% within 3 days after the procedure. Serum creatinine was measured at baseline, 24, 48 and 72 h after the procedure.
  
  RESULTS:
  Contrast-induced nephropathy was 8/99 (8.1%) in the N-acetylcysteine group versus 6/101 (5.9%) in the placebo group, P = 0.6. No difference was noted in high-risk subgroups such as diabetics (4/25 versus 2/25 P = 0.4) and those with serum creatinine clearance
  CONCLUSION:
  In our experience, N-acetylcysteine did not prevent contrast-induced nephropathy in patients receiving isosmolar (iodixanol) contrast media and adequate hydration.
  
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• Emergency percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by out-of-hospital cardiac arrest: early and medium-term outcome.
  Am Heart J

  2009 Mar;157(3):569-575.e1. doi: 10.1016/j.ahj.2008.10.018.
  
  Lettieri Corrado, Savonitto Stefano, De Servi Stefano, Guagliumi Giulio, Belli Guido, Repetto Alessandra, Piccaluga Emanuela, Politi Alessandro, Ettori Federica, Castiglioni Battistina, Fabbiocchi Franco, De Cesare Nicoletta, Sangiorgi Giuseppe, Musumeci Giuseppe, Onofri Marco, D'Urbano Maurizio, Pirelli Salvatore, Zanini Roberto, Klugmann Silvio,
  
  Abstract
  
  BACKGROUND:
  The role of emergency reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) resuscitated after an out-of-hospital cardiac arrest (OHCA) has not been clearly established yet. The aim of this study was to evaluate the in-hospital and postdischarge outcomes of STEMI patients surviving OHCA and undergoing emergency angioplasty (percutaneous coronary intervention [PCI]) within an established regional network.
  
  METHODS:
  We prospectively collected data on 2,617 consecutive patients with STEMI treated with emergency PCI in 2005; in-hospital and 6-month outcomes of 99 patients who had experienced OHCA were compared with those of 2,518 patients without OHCA. The OHCA patients also underwent a cerebral performance evaluation after 12 months.
  
  RESULTS:
  OHCA patients were at higher clinical risk at presentation (cardiogenic shock 26% vs 5%, P
  CONCLUSIONS:
  Resuscitated OHCA patients undergoing emergency PCI for STEMI have worse clinical presentation and higher in-hospital mortality compared to those without OHCA. However, subsequent cardiac events are similar, and neurologic recovery is more favorable than reported in most previous series.
  
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• [Percutaneous coronary interventions in elderly patients: clinical indications and adjunctive medical treatment. The Italian Drug Evaluation in Angioplasty (IDEA) study].
  G Ital Cardiol (Rome)

  2006 Feb;7(2):136-44.
  
  Bossi Irene, Piccaluga Emanuela, Scatturin Melania, Corvaja Nicola, Pasquetto Giampaolo, Steffanon Luigi, Oberhollenzer Rainer, Colombo Paola, Bolognese Leonardo, Savonitto Stefano
  
  Abstract
  
  BACKGROUND:
  Specific guidelines for interventional cardiology in elderly patients are not available, and it appears that aged patients are treated more conservatively. Nevertheless data on the real clinical practice are lacking. The aim of the study was to describe different therapeutic strategies in elderly patients enrolled in the Italian Drug Evaluation in Angioplasty (IDEA) study.
  
  METHODS:
  The IDEA study is a registry of consecutive percutaneous coronary interventions (PCI) performed from September 15 to 29, 2003, at 79 Italian cath-labs.
  
  RESULTS:
  Out of 1517 consecutive PCI patients, 491 (32%) were aged > or = 70 years. Compared to younger patients, those > or = 70 years old showed more frequently (p or = 70 years, acute coronary syndrome was the more frequent clinical indication for PCI (54 vs 49% in patients or = 70 years (2.9 vs 0.9%, p = 0.004), particularly in patients treated for acute coronary syndromes (5.5 vs 1.4%, p = 0.002). In these patients, more bleeding complications (7.1 vs 3.9%, p
  CONCLUSIONS:
  Compared to younger patients, elderly patients enrolled in the IDEA study had a higher risk profile and higher in-hospital morbidity and mortality. Except for a lower use of glycoprotein IIb/IIIa receptor antagonists for acute myocardial infarction, no discriminations were observed in elderly patients in terms of clinical indications, antiplatelet therapy and drug-eluting stent use.
  
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• A case of life-saving pharmacologic and mechanical coronary dethrombosis.
  Ital Heart J

  2004 Nov;5(11):864-8.
  
  Colombo Alessandro, Danna Paolo, Piccaluga Emanuela, Viecca Maurizio
  
  Abstract
  
  The present report refers to a case of life-threatening acute myocardial infarction due to thrombotic occlusion of the left main stem, in which an aggressive dethrombotic intervention (pharmacologic and mechanical) was totally successful, thanks to a well developed right coronary system and the use of intra-aortic balloon pump.
  
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• Absence of clinical signs of cardiac denervation after percutaneous myocardial laser revascularization.
  Int J Cardiol

  2003 Oct;91(2-3):129-35.
  
  Guzzetti Stefano, Colombo Alessandro, Piccaluga Emanuela, Tagliabue Luca, Magatelli Renata, Cantoni Giulia, Viecca Maurizio
  
  Abstract
  
  BACKGROUND:
  Percutaneous myocardial revascularization with laser (PMR) is a catheter-based technique that has generated much interest in the treatment of patients with severe coronary artery disease. Several mechanisms have been proposed to explain the reported clinical benefits of this technique. Cardiac autonomic denervation is among these.
  
  METHODS:
  We studied 32 consecutive patients with chronic severe angina not suitable for other revascularization approaches. Canadian Class Society (CCS) class clinical assessment, Naughton exercise stress test, and scintigraphic myocardial perfusion were evaluated before and 1 and 6 months after PMR. Ewing's autonomic tests, heart rate variability (HRV), and plasmatic catecholamines were assessed before revascularization in non-diabetic and diabetic patients and repeated 1 month after PMR in 13 non-diabetics. A psychological test was carried out before PMR to evaluate the attitude towards this new procedure.
  
  RESULTS:
  All the markers of autonomic cardiac control were unmodified after the procedure. Moreover, scintigraphic perfusion measured in the lasered areas was similar before and after the procedure. On the other hand, the clinical conditions significantly improved (CCS class from 3+/-0.8 to 1.9+/-0.9 at 1 month, P
  CONCLUSIONS:
  PMR improves symptoms in patients with end-stage coronary artery disease in the absence of any detectable clinical sign of heart denervation.
  
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• Effects of heart rate on phasic Y-graft blood flow and flow reserve in patients with complete arterial myocardial revascularizaton: an intravascular Doppler catheter study.
  Eur J Cardiothorac Surg

  2003 Jul;24(1):81-5; discussion 85.
  
  Lemma Massimo, Mangini Andrea, Gelpi Guido, Innorta Andrea, Danna Paolo, Lavarra Francesco, Piccaluga Emanuela, Antona Carlo
  
  Abstract
  
  OBJECTIVE:
  It is not well established whether the blood flow of arterial composite Y-grafts can efficiently respond to the flow demand of the coronary system early postoperatively. The aim of this study was to evaluate if soon after the operation, arterial composite Y-grafts can increase blood flow in response to an increase in myocardial oxygen consumption (MVO2).
  
  METHODS:
  Twenty-seven patients who received complete arterial myocardial revascularization using the left internal thoracic artery (LITA) and the radial artery (RA) as composite Y-graft gave their consent to a pre-discharge coronary angiography and intravascular flow velocity measurements using a Doppler guide wire. Flow measurements were performed in the LITA main stem, the distal LITA and the RA, both at rest and during atrial pacing at the 85% of the patient age-predicted maximum. The heart rate-systolic blood pressure product was considered as an indirect index of MVO2. Hyperemic flow was determined after injection of adenosine. The flow reserve (FR) was defined as the ratio of blood flow during maximal hyperemia (Qmax) to baseline flow (Qbasal).
  
  RESULTS:
  Atrial pacing increased MVO2 significantly (P
  CONCLUSIONS:
  Soon after the operation, arterial composite Y-grafts can significantly increase blood flow in response to conditions of increased MVO2, keeping normal the myocardial O2 supply-to-demand ratio.
  
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