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18 results on '"Pignatelli, P."'

1. Ischemic and bleeding risk by type 2 diabetes clusters in patients with acute coronary syndrome

Author

Cavallari, I., Maddaloni, E., Gragnano, F., Patti, G., Antonucci, E., Calabro, P., Cirillo, P., Gresele, P., Palareti, G., Pengo, V., Pignatelli, P., Marcucci, R., Moscarella, E., Cesaro, A., Grossi, G., Berteotti, M., De Rosa, G., Taglialatela, V., Digitale, L., Denas, G., Pastori, D., del Pinto, M., Fierro, T., Cavallari, Ilaria, Maddaloni, Ernesto, Gragnano, Felice, Patti, Giuseppe, Antonucci, Emilia, Calabrò, Paolo, Cirillo, Plinio, Gresele, Paolo, Palareti, Gualtiero, Pengo, Vittorio, Pignatelli, Pasquale, and Marcucci, Rossella

Subjects
Male, Registrie, Acute coronary syndrome, medicine.medical_specialty, medicine.medical_treatment, Hemorrhage, Type 2 diabetes, 030204 cardiovascular system & hematology, Diabete, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Major cardiovascular event, Diabetes mellitus, Internal medicine, Internal Medicine, Humans, Insulin, Medicine, Prospective Studies, Registries, 030212 general & internal medicine, Proportional Hazards Models, Aged, business.industry, Major cardiovascular events, Incidence, Bleeding, Type 2 Diabetes Mellitus, Middle Aged, medicine.disease, Clopidogrel, acute coronary syndromes, bleeding, diabetes, insulin, major cardiovascular events, Prospective Studie, Diabetes Mellitus, Type 2, Italy, Proportional Hazards Model, Emergency Medicine, Female, business, Ticagrelor, Mace, Human, medicine.drug
Abstract

The risk of ischemic events carried by different clusters of type 2 diabetes mellitus (DM) in the setting of secondary prevention is not definite and the association between DM and bleeding complications is controversial. We explored these issues in the START-ANTIPLATELET, a multicenter Italian registry including acute coronary syndrome (ACS) patients. Study outcome was 1-year incidence of the net composite endpoint including major adverse cardiovascular events (MACE) or any bleeding and its individual components across different DM strata (no DM, DM with or without insulin). Out of 951 patients, 20.0% had diabetes not on insulin and 2.5% had diabetes on insulin. The rate of the net composite endpoint was highest in patients receiving insulin (39.4 per 100 person-years vs 11.7 in diabetic patients not on insulin vs 14.0 in those without DM; p = 0.007). In DM, the higher risk of MACE was regardless of insulin use (p = 0.36). Conversely, the increase in bleeding complications was limited to patients on insulin (Hazard Ratio 2.31, 95% CI 0.93-5.71 vs no DM; p = 0.0105 across DM strata). On top of aspirin, the rates of the net composite endpoint were similar with ticagrelor/prasugrel or clopidogrel irrespective of DM status (p for interaction 0.63). In conclusion, in ACS patients, type 2 DM enhances the risk of MACE regardless of the DM cluster, whereas the propensity to bleeding related to DM seems confined to insulin-treated patients.

Published
2021

2. Corticosteroid use, myocardial injury and in-hospital cardiovascular events in patients with community-acquired pneumonia

Author

Cangemi, R., Carnevale, R., Cammisotto, V., Nocella, C., Bartimoccia, S., Taliani, G., Falcone, M., Calvieri, C., Pignatelli, P., Violi, F., Bertazzoni, G., Biliotti, E., Casciaro, M., Corica, B., De Angelis, M., Esvan, R., Ferraro, G., Sulekova, L. F., Franchi, C., Frist, B., Giordo, L., Lakin, S., Maccarone, A., Morelli, S., Catassi, G. N., Ozsoy, B., Palange, P., Capparuccia, M. R., Romiti, G. F., Rossi, E., Trape, S., Toriello, F., Vano, M., and Venditti, M.

Subjects
Male, medicine.medical_specialty, Community-acquired pneumonia, Troponin T, Adrenal Cortex Hormones, Internal medicine, Medicine, Humans, Pharmacology (medical), myocardial injury, Aged, Pharmacology, Aged, 80 and over, Heart Failure, biology, glucocorticoids, business.industry, Incidence (epidemiology), Hazard ratio, Pneumonia, Middle Aged, medicine.disease, Prognosis, Troponin, Confidence interval, Hospitals, Community-Acquired Infections, Heart failure, pneumonia, troponins, biology.protein, business, Mace, Biomarkers
Abstract

BACKGROUND AND PURPOSE Corticosteroids are often prescribed to community-acquired pneumonia (CAP) patients, but the relationship with major cardiovascular events (MACEs) is unclear. EXPERIMENTAL APPROACH 541 CAP patients were recruited (334 males, mean age 71.9 ± 16.2 years). High-sensitivity troponin T (hs-cTnT) was measured at admission, during the hospital stay and at discharge. MACE occurrence was registered during a long-term follow-up. KEY RESULTS Overall, 318 patients (59%) showed hs-cTnT elevation >99th percentile (>0.014 μg/L). Age, heart failure and the increasing quintiles of hs-cTnT (hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.82-2.58, P 0.014 μg/L at admission, 102 patients (31%) were on corticosteroids and showed lower hs-cTnT increase (P = .021), (NADPH) oxidase-2 (Nox2) activation (P = .005) and incidence of MACEs than untreated ones (HR 0.64, 95% CI 0.41-0.97, P = .038); no effect of corticosteroids on MACEs was observed in CAP patients with normal troponin. In vitro study showed that glucocorticoids have an antioxidant effect via downregulation of Nox2 activity. CONCLUSION AND IMPLICATIONS The study provides evidence that corticosteroid use is associated with lower increase of hs-cTnT and incidence of MACEs in CAP patients.

Published
2021

3. Atrial fibrillation pattern, left atrial diameter and risk of cardiovascular events and mortality. A prospective multicenter cohort study

Author

Menichelli, D., Sciacqua, A., Cangemi, R., Andreozzi, P., Del Sole, F., Violi, F., Pignatelli, P., Pastori, D., Saliola, M., Casciaro, M. A., Vicario, T., and Astorri, G.

Subjects
medicine.medical_specialty, Left atrium, AF pattern, 030204 cardiovascular system & hematology, left atrium, cardiovascular events, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Left atrial, Internal medicine, Clinical endpoint, Humans, echocardiography, Medicine, atrial fibrillation, Heart Atria, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, business.industry, Proportional hazards model, Incidence, Atrial fibrillation, General Medicine, medicine.disease, medicine.anatomical_structure, Cardiology, business, Cardiovascular outcomes, Mace, Cohort study
Abstract

BACKGROUND There are conflicting evidence on the association between atrial fibrillation (AF) pattern, such as persistent/permanent (Pers/Perm) and paroxysmal (PAF) AF and risk of ischemic events. We investigated if left atrial diameter (LAd) may affect the risk of cardiovascular outcomes according to AF pattern. METHODS Prospective multicenter observational including 1,252 non-valvular AF patients (533 PAF and 719 Pers/Perm AF). Study endpoints were cardiovascular events (CVEs), major adverse cardiac events (MACE) and CV death. LA anteroposterior diameter (LAd) was obtained by transthoracic echocardiography. RESULTS Pers/Perm AF patients had a higher proportion of LAd above median than PAF (≥44 mm, 59.5% vs 37.5% respectively, P

Published
2020

4. Correction to: Major adverse cardiovascular events in non-valvular atrial fibrillation with chronic obstructive pulmonary disease: the ARAPACIS study

Author

Raparell, V, Pastori, D, Pignataro, S, Vestri, A, Pignatelli, P, Cangemi, R, Proietti, M, Davì, G, Hiatt, W, Lip, G, Corazza, G, Perticone, F, Violi, F, Basili, S, Alessandri, C, Serviddio, G, Palange, P, Greco, E, Bruno, G, Averna, M, Giammanco, A, Sposito, P, De Cristofaro, R, Carulli, L, Di Gennaro, L, Pellegrini, E, Cominacini, L, Mozzini, C, Pasini, A, Sprovieri, M, Spagnuolo, V, Cerqua, G, Cerasola, G, Mulé, G, Barbagallo, M, Lo Sciuto, S, Monteverde, A, Saitta, A, Lo Gullo, A, Malatino, L, Cilia, C, Terranova, V, Pisano, M, Pinto, A, Di Raimondo, D, Tuttolomondo, A, Conigliaro, R, Signorelli, S, De Palma, D, Galderisi, M, Cudemo, G, Galletti, F, Fazio, V, De Luca, N, Meccariello, A, Caputo, D, De Donato, M, Iannuzi, A, Bresciani, A, Giunta, R, Utili, R, Iorio, V, Adinolfi, L, Sellitto, C, Iuliano, N, Bellis, P, Tirelli, P, Sacerdoti, D, Vanni, D, Iuliano, L, Ciacciarelli, M, Pacelli, A, Palazzuoli, A, Cacciafesta, M, Gueli, N, Lo Iacono, C, Brusco, S, Verrusio, W, Nobili, L, Tarquinio, N, Pellegrini, F, Vincentelli, G, Ravallese, F, Santini, C, Letizia, C, Petramala, L, Zinnamosca, L, Minisola, S, Cilli, M, Colangelo, L, Falaschi, P, Martocchia, A, Pastore, F, Bertazzoni, G, E Halabieh E, Attall, Paradiso, M, Lizzi, E, Timmi, S, Battisti, P, Cerci, S, Ciavolella, M, Di Veroli, C, Malci, F, De Ciocchis, A, Abate, D, Castellino, P, Zanoli, L, Fidone, F, Mannarino, E, Pasqualini, L, Oliverio, G, Pende, A, Artom, N, Ricchio, R, Fimognari, F, Alletto, M, Messina, S, Sesti, G, Arturi, F, Succurro, E, Fiorentino, T, Pedace, E, Scarpino, P, Carullo, G, Maio, R, Sciacqua, A, Frugiuele, P, Battaglia, G, Atzori, S, Delitala, G, Angelucci, E, Sestili, S, Traisci, G, De Feudis, L, Di Michele, D, Fava, A, Balsano, C, De Ciantis, P, Desideri, G, Camerota, A, Mezzetti, M, Gresele, P, Vedovati, C, Fierro, T, Puccetti, L, Bertolotti, M, Mussi, C, Boddi, M, Savino, A, Contri, S, Degl'Innocenti, G, Saller, A, Fabris, F, Pesavento, R, Filippi, L, Vedovetto, V, Puato, M, Treleani, M, De Luca, E, De Zaiacomo, F, Giantin, V, Semplicini, A, Minuz, P, Romano, S, Fantin, F, Manica, A, Stockner, I, Pattis, P, Gutmann, B, Catena, C, Colussi, G, Sechi, L, Annoni, G, Bruni, A, Castagna, A, Spinelli, D, Miceli, E, Padula, D, Schinco, G, Spreafico, S, Secchi, B, Vanoli, M, Casella, G, Pulixi, E, Sansone, L, Serra, M, Longo, S, Antonaci, S, Belfiore, A, Frualdo, M, Palasciano, G, Ricci, L, Ventrella, F, Bianco, C, Santovito, D, Cipollone, F, Nicolai, S, Salvati, F, Rini, G, Scozzari, F, Muiesan, M, Salvetti, M, Bazza, A, Picardi, A, Vespasiani-Gentilucci, U, De Vincentis, A, Cosio, P, Terzolo, M, Madaffari, B, Parasporo, B, Fenoglio, L, Bracco, C, Melchio, R, Gentili, T, Salvi, A, Nitti, C, Gabrielli, A, Martino, G, Capucci, A, Brambatti, M, Sparagna, A, Tirotta, D, Andreozzi, P, Ettorre, E, Viscogliosi, G, Servello, A, Musumeci, M, Delfino, M, Giorgi, A, Glorioso, N, Melis, G, Marras, G, Matta, M, Sacco, A, Stellitano, E, Scordo, A, Russo, F, Caruso, A, Porreca, E, Tana, M, Ferri, C, Cheli, P, Portincasa, P, Muscianisi, G, Giordani, S, Stanghellini, V, Sabbà, C, Mancuso, G, Bartone, M, Calipari, D, Arcidiacono, G, Bellanuova, I, Ferraro, M, Marigliano, G, Cozzolino, D, Lampitella, A, Acri, V, Galasso, D, Mazzei, F, Buratti, A, Galasso, S, Porta, M, Brizzi, M, Fattorini, A, Sampietro, F, D'Angelo, A, Manfredini, R, Pala, M, Fabbian, F, Moroni, C, Valente, L, Lopreiato, F, Parente, F, Granata, M, Moia, M, Braham, S, Rossi, M, Pesce, M, Gentile, A, Catozzo, V, Baciarello, G, Cosimati, A, Ageno, W, Rancan, E, Guasti, L, Ciccaglioni, A, Negri, S, Polselli, M, Prisco, D, Marcucci, R, Ferro, D, Perri, L, Saliola, M, Del Ben, M, Angelico, F, Baratta, F, Migliacci, R, Porciello, G, Corrao, S, Raparelli, V, Napoleone, L, Talerico, G, Amoroso, D, Romiti, G, Ruscio, E, Toriello, F, Sperduti, N, Todisco, T, Di Tanna, G, Sacchetti, M, Puddu, P, Farcomeni, A, Anzaldi, M, Bazzini, C, Bianchi, P, Boari, B, Buonauro, A, Buttà, C, Buzzetti, E, Calabria, S, Capeci, W, Caradio, F, Carleo, P, Carrabba, M, Castorani, L, Cecchetto, L, Cicco, S, Cimini, C, Colombo, B, De Giorgi, A, De Vuono, S, De Corso, L, Denegri, A, D Giosia P, Durant Mangoni, E, Falsetti, L, Forgione, A, Giorgini, P, Grassi, D, Grembiale, A, Hijazi, D, Iamele, L, Lorusso, G, Marchese, A, Marra, A, Masala, M, Miceli, G, Montebianc Abenavoli, L, Murgia, G, Naccarato, P, Pattoneri, P, Perego, F, Pesce, P, Piano, S, Pinna, M, Pinto, D, Pretti, V, Pucci, G, Salinaro, F, Salzano, A, Santilli, F, Scarpini, F, Scicali, R, Sirico, D, Suppressa, P, Talia, M, Tassone, E, Torres, D, Vazzana, N, Vecchio, C, Vidili, G, Vitale, F, Zaccone, V, ARAPACI Stud Collaborators, Raparelli, Valeria, Pastori, Daniele, Pignataro, Serena Francesca, Vestri, Anna Rita, Pignatelli, Pasquale, Cangemi, Roberto, Proietti, Marco, Davì, Giovanni, Hiatt, William Robert, Lip, Gregory Yoke Hong, Corazza, Gino Roberto, Perticone, Francesco, Violi, Francesco, Basili, Stefania, Alessandri, C., Serviddio, G., Palange, P., Greco, E., Bruno, G., Averna, M., Giammanco, A., Sposito, P., De Cristofaro, R., Carulli, L., Di Gennaro, L., Pellegrini, E., Cominacini, L., Mozzini, C., Pasini, A.F., Sprovieri, M., Spagnuolo, V., Cerqua, G., Cerasola, G., Mulé, G., Barbagallo, M., Lo Sciuto, S., Monteverde, A., Saitta, A., Lo Gullo, A., Malatino, L., Cilia, C., Terranova, V., Pisano, M., Pinto, A., Di Raimondo, D., Tuttolomondo, A., Conigliaro, R., Signorelli, S., De Palma, D., Galderisi, M., Cudemo, G., Galletti, F., Fazio, V., De Luca, N., Meccariello, A., Caputo, D., De Donato, M.T., Iannuzi, A., Bresciani, A., Giunta, R., Utili, R., Iorio, V., Adinolfi, L.E., Sellitto, C., Iuliano, N., Bellis, P., Tirelli, P., Sacerdoti, D., Vanni, D., Iuliano, L., Ciacciarelli, M., Pacelli, A., Palazzuoli, A., Cacciafesta, M., Gueli, N., Lo Iacono, C., Brusco, S., Verrusio, W., Nobili, L., Tarquinio, N., Pellegrini, F., Vincentelli, G.M., Ravallese, F., Santini, C., Letizia, C., Petramala, L., Zinnamosca, L., Minisola, S., Cilli, M., Colangelo, L., Falaschi, P., Martocchia, A., Pastore, F., Bertazzoni, G., Attalla El Halabieh, E., Paradiso, M., Lizzi, E.M., Timmi, S., Battisti, P., Cerci, S., Ciavolella, M., Di Veroli, C., Malci, F., De Ciocchis, A., Abate, D., Castellino, P., Zanoli, L., Fidone, F., Mannarino, E., Pasqualini, L., Oliverio, G., Pende, A., Artom, N., Ricchio, R., Fimognari, F.L., Alletto, M., Messina, S., Sesti, G., Arturi, F., Succurro, E., Fiorentino, T.V., Pedace, E., Scarpino, P.E., Carullo, G., Maio, R., Sciacqua, A., Frugiuele, P., Battaglia, G., Atzori, S., Delitala, G., Angelucci, E., Sestili, S., Traisci, G., De Feudis, L., Di Michele, D., Fava, A., Balsano, C., De Ciantis, P., Desideri, G., Camerota, A., Mezzetti, M., Gresele, P., Vedovati, C., Fierro, T., Puccetti, L., Bertolotti, M., Mussi, C., Boddi, M., Savino, A., Contri, S., Degl’Innocenti, G., Saller, A., Fabris, F., Pesavento, R., Filippi, L., Vedovetto, V., Puato, M., Treleani, M., De Luca, E., De Zaiacomo, F., Giantin, V., Semplicini, A., Minuz, P., Romano, S., Fantin, F., Manica, A., Stockner, I., Pattis, P., Gutmann, B., Catena, C., Colussi, G., Sechi, L.A., Annoni, G., Bruni, A.A., Castagna, A., Spinelli, D., Miceli, E., Padula, D., Schinco, G., Spreafico, S., Secchi, B., Vanoli, M., Casella, G., Pulixi, E.A., Sansone, L., Serra, M.G., Longo, S., Antonaci, S., Belfiore, A., Frualdo, M., Palasciano, G., Ricci, L., Ventrella, F., Bianco, C., Santovito, D., Cipollone, F., Nicolai, S., Salvati, F., Rini, G.B., Scozzari, F., Muiesan, M.L., Salvetti, M., Bazza, A., Picardi, A., Vespasiani-Gentilucci, U., De Vincentis, A., Cosio, P., Terzolo, M., Madaffari, B., Parasporo, B., Fenoglio, L., Bracco, C., Melchio, R., Gentili, T., Salvi, A., Nitti, C., Gabrielli, A., Martino, G.P., Capucci, A., Brambatti, M., Sparagna, A., Tirotta, D., Andreozzi, P., Ettorre, E., Viscogliosi, G., Servello, A., Musumeci, M., Delfino, M., Giorgi, A., Glorioso, N., Melis, G., Marras, G., Matta, M., Sacco, A., Stellitano, E., Scordo, A., Russo, F., Caruso, A.A., Porreca, E., Tana, M., Ferri, C., Cheli, P., Portincasa, P., Muscianisi, G., Giordani, S., Stanghellini, V., Sabbà, C., Mancuso, G., Bartone, M., Calipari, D., Arcidiacono, G., Bellanuova, I., Ferraro, M., Marigliano, G., Cozzolino, D., Lampitella, A., Acri, V., Galasso, D., Mazzei, F., Buratti, A., Galasso, S., Porta, M., Brizzi, M.F., Fattorini, A., Sampietro, F., D’Angelo, A., Manfredini, R., Pala, M., Fabbian, F., Moroni, C., Valente, L., Lopreiato, F., Parente, F., Granata, M., Moia, M., Braham, S., Rossi, M., Pesce, M., Gentile, A., Catozzo, V., Baciarello, G., Cosimati, A., Ageno, W., Rancan, E., Guasti, L., Ciccaglioni, A., Negri, S., Polselli, M., Prisco, D., Marcucci, R., Ferro, D., Perri, L., Cangemi, R., Saliola, M., Del Ben, M., Angelico, F., Baratta, F., Migliacci, R., Porciello, G., Corrao, S., Proietti, M., Raparelli, V., Napoleone, L., Talerico, G., Amoroso, D., Romiti, G.F., Ruscio, E., Toriello, F., Sperduti, N., Todisco, T., Di Tanna, G., Sacchetti, M.L., Puddu, P.E., Farcomeni, A., Anzaldi, M., Bazzini, C., Bianchi, P.I., Boari, B., Buonauro, A., Buttà, C., Buzzetti, E., Calabria, S., Capeci, W., Caradio, F., Carleo, P., Carrabba, M.D., Castorani, L., Cecchetto, L., Cicco, S., Cimini, C., Colombo, B.M., De Giorgi, A., De Vuono, S., Del Corso, L., Denegri, A., Di Giosia, P., Durante Mangoni, E., Falsetti, L., Forgione, A., Giorgini, P., Grassi, D., Grembiale, A., Hijazi, D., Iamele, L., Lorusso, G., Marchese, A., Marra, A.M., Masala, M., Miceli, G., Montebianco Abenavoli, L., Murgia, G., Naccarato, P., Pattoneri, P., Perego, F., Pesce, P., Piano, S., Pinna, M., Pinto, D., Pretti, V., Pucci, G., Salinaro, F., Salzano, A., Santilli, F., Scarpini, F., Scicali, R., Sirico, D., Suppressa, P., Talia, M., Tassone, E.J., Torres, D., Vazzana, N., Vecchio, C.R., Vidili, G., Vitale, F., and Zaccone, V.

Subjects
medicine.medical_specialty, Settore MED/09 - Medicina Interna, business.industry, Internal Medicine, Emergency Medicine, Emergency medicine, medicine, Non valvular atrial fibrillation, Pulmonary disease, business
Abstract

Correction to: Internal and Emergency Medicine (2018) 13:651–660 https://doi.org/10.1007/s11739-018-1835-9 In the original publication, one of the ARAPACIS collaborators Dr. “Leonardo Di Gennaro” name has been erroneously mentioned as “Leonardo De Gennaro”.

Published
2018

5. Mechanisms And Management Of Thrombo-Embolism In Atrial Fibrillation

Author

Francesco Violi, Pastori, D., and Pignatelli, P.

Subjects
Featured Review
Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population and in patients with a history of cardiovascular disease. AF is becoming an outbreak particularly for the western countries as it increases with advancing age; furthermore, AF has a negative social impact because it is associated with stroke and myocardial infarction. Thrombosis generated in the left atrial appendage with ensuing embolism in the cerebral circulation is considered the most important cause of ischemic stroke. In addition to thrombo-embolism, AF is characterized by a constellation of atherosclerotic risk factors, including hypertension, dyslipidaemia and diabetes, which may predispose to serious clinical complications of atherosclerosis such myocardial infarction. Even if interventional trials with oral anticoagulants such as warfarin reduced by about 60% the risk of stroke, AF patients still disclose an elevated residual cardiovascular risk, which may severely complicate the clinical course and management of AF. Recent trials with new oral anticoagulants (NOACs) are opening a new scenario for the treatment of AF, which could improve its management, as NOACs apparently would not require monitoring. However, important caveats are emerging in the real world of AF management, which are questioning the concept that NOACs do not need monitoring. Thus, issues related to compliance and large variability in blood concentration may negatively influence the cost/effectiveness benefit of NOACs. This review will focus on pathophysiology of thrombo-embolism and athero-thrombosis and the impact of old and new anticoagulants in the real world of AF management.

Published
2014

11. Resveratrol, at concentrations attainable with moderate wine consumption, stimulates human platelet nitric oxide production

Author

Gresele P, Pignatelli P, Guglielmini G, Carnevale R, Am, Mezzasoma, Ghiselli A, Momi S, and Francesco Violi

Subjects
Adult, Blood Platelets, Male, Nitrates, Microfilament Proteins, NADPH Oxidases, Wine, Middle Aged, Nitric Oxide, Phosphoproteins, p38 Mitogen-Activated Protein Kinases, Resveratrol, Stilbenes, Humans, Female, Phosphorylation, Cell Adhesion Molecules, Proto-Oncogene Proteins c-akt, Cells, Cultured, Nitrites
Abstract

The mechanisms through which moderate wine consumption reduces ischemic cardiovascular events are not yet fully unraveled. Grape extracts or a mixture of the polyphenols contained in wine were previously shown to increase nitric oxide (NO); however, little information is available on the effect of resveratrol, one of the main polyphenols of wine, on platelet NO production. We assessed the effects of resveratrol, at the concentrations attainable after moderate wine intake, on platelet NO production and the mechanism of this activity. Twenty healthy volunteers were studied before and after 15 d of controlled white or red wine intake (300 mL/d). After wine intake, plasma resveratrol and the release of NO by stimulated platelets increased significantly. Resveratrol, at the concentrations detected in plasma after wine intake, was incubated in vitro with washed platelets and several variables related to NO production and to signal transduction were measured. Resveratrol in vitro enhanced significantly the production of NO by stimulated platelets, the activity of platelet NO synthase (NOS), phosphorylation of protein kinase B, an activator of the endothelial NOS (eNOS), and phosphorylation of vasodilator-activated protein (VASP), an expression of the biologic activity of NO in platelets. Simultaneously, we observed decreased phosphorylation of P38 mitogen-activated protein kinase (p38MAPK), a proinflammatory pathway in human platelets, a reduction of the activity of NADPH oxidase, a major source of reactive oxygen species (ROS) and of the generation of O(2)(-) radicals, as detected by cytochrome C reduction. In conclusion, resveratrol, at concentrations attainable after moderate wine intake, activates platelet eNOS and in this way blunts the proinflammatory pathway linked to p38MAPK, thus inhibiting ROS production and ultimately platelet function. This activity may contribute to the beneficial effects of moderate wine intake on ischemic cardiovascular disease.

14. Peripheral arterial disease has a strong impact on cardiovascular outcome in patients with acute coronary syndromes: from the START Antiplatelet registry

Author

Plinio Cirillo, Gentian Denas, L. Di Serafino, G. Palareti, Felice Gragnano, Emilia Antonucci, G. De Rosa, I. Cavallari, Giuseppe Guglielmini, M. Del Pinto, Paolo Calabrò, Vittorio Pengo, Danilo Menichelli, Giuseppe Patti, Guido Grossi, Giacomo Zoppellaro, Tiziana Fierro, Arturo Cesaro, C. Riccini, Daniele Pastori, Paolo Gresele, Pasquale Pignatelli, Rossella Marcucci, C. Piazzai, Gresele, P., Guglielmini, G., Del Pinto, M., Calabro, Paolo, Pignatelli, P., Patti, G., Pengo, V., Antonucci, E., Cirillo, P., Fierro, T., Palareti, G., Marcucci, R., Riccini, C., Cesaro, A., Gragnano, F., Menichelli, D., Pastori, D., Cavallari, I., Denas, G., Zoppellaro, G., Di Serafino, L., De Rosa, G., Grossi, G., Piazzai, C., Gresele, P, Guglielmini, G, Del Pinto, M, Calabrò, P, Pignatelli, P, Patti, G, Pengo, V, Antonucci, E, Cirillo, P, Fierro, T, Palareti, G, and Marcucci, R

Subjects
medicine.medical_specialty, Arterial disease, medicine.medical_treatment, 030204 cardiovascular system & hematology, peripheral artery disease, Revascularization, law.invention, Peripheral Arterial Disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Randomized controlled trial, PAD, Platelets, cardiovascular disease, Risk Factors, law, Internal medicine, medicine, acute coronary syndromes, Humans, In patient, Registries, 030212 general & internal medicine, Acute Coronary Syndrome, business.industry, Intermittent claudication, Peripheral, Treatment Outcome, Treatment decision making, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Medical therapy, Platelet Aggregation Inhibitors
Abstract

Background: Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-life setting. Methods: START-ANTIPLATELET is a multicenter registry enrolling ACS patient. Baseline clinical characteristics and treatment at discharge were recorded and follow-up was repeated at 6-months and 1-year. PAD was defined as intermittent claudication and/or previous revascularization. Results: Among 1442 patients enrolled, 103 (7.1%) had PAD. PAD patients were older (71.8 ± 10.6vs66.2 ± 12.6 yrs., p < 0.0001), more frequently hypertensive (90.3vs68.6%, p< 0.0001), hypercholesterolemic (66vs52%, p= 0.037), diabetic (51.5vs24%, p= 0.0001), obese (28.2vs19.3%, p= 0.029) and with previous TIA (7.8vs2.8%, p= 0.005) or stroke (11.7vs3.1%, p< 0.0001). Clinical presentation and acute treatment were similar in non-PAD and PAD patients, but the latter were discharged significantly less frequently on dual antiplatelet therapy (DAPT) (68.9vs85%, p= 0.005). After a median follow-up time of 11.1 months, major cardio/cerebrovascular event-free survival [MACCE, including cardiovascular death, MI, TIA and stroke, target-vessel revascularization (TVR) and major arterial ischemic events] was significantly shorter (9.0vs11.2 months, p= 0.02; HR 3.2, 2.4–8.4) in PAD patients and net adverse cardiovascular events (NACE = MACCE plus major hemorrhages) were significantly more frequent (19.1%vs10.5%, p = 0.049). Conclusions: PAD identifies a subgroup of ACS patients at significantly increased cardiovascular risk, but these patients tend to be undertreated. Patients admitted for ACS should be screened for PAD and optimal medical therapy at discharge should be implemented.

Published
2021

15. Optimal Medical Therapy on Top of Dual-Antiplatelet Therapy: 1-Year Clinical Outcome in Patients With Acute Coronary Syndrome: The START Antiplatelet Registry

Author

Emilia Antonucci, Paolo Calabrò, Luigi Di Serafino, Rossella Marcucci, Gualtiero Palareti, Pasquale Pignatelli, Plinio Cirillo, Vittorio Taglialatela, Paolo Gresele, Vittorio Pengo, Giuseppe Patti, Cirillo, P., Di Serafino, L., Taglialatela, V., Calabro, P., Antonucci, E., Gresele, P., Palareti, G., Patti, G., Pengo, V., Pignatelli, P., and Marcucci, R.

Subjects
Acute coronary syndrome, medicine.medical_specialty, cute coronary syndromes, 030204 cardiovascular system & hematology, Outcome (game theory), acute coronary syndrome, 03 medical and health sciences, 0302 clinical medicine, male, Internal medicine, middle aged, 80 and over, medicine, In patient, 030212 general & internal medicine, humans, platelet aggregation inhibitors, Aged, 80 and over, business.industry, percutaneous coronary intervention, drug-eluting stents, registries, medicine.disease, stroke, aged, female, myocardial infarction, optimal medical therapy, dual-antiplatelet therapy, aged, 80 and over, coronary artery disease, treatment outcome, Cardiology and Cardiovascular Medicine, business, Medical therapy
Abstract

Optimal medical therapy (OMT) at discharge is recommended after acute coronary syndrome (ACS). Few studies report the impact of OMT on long-term clinical outcome in a real-world scenario. We evaluated the impact of discharge OMT on top of dual-antiplatelet therapy (DAPT) on clinical outcome in the real-world ACS population of the Survey on anTicoagulated pAtients RegisTer ANTIPLATELET registry. The primary end point was major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction, stroke, or target vessel revascularization. The co-primary end point was net adverse cardiac and cerebrovascular event (NACE), based on MACCE plus major bleeding. Consecutive patients with ACS with 1-year follow-up were enrolled. They were evaluated at discharge for the use of a β-blocker, angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers and statins. Optimal medical therapy was defined as the use of ≥2 of 3 medications. At multivariate analysis, both MACCE and NACE were significantly higher in non-OMT patients than in OMT patients (MACCE 18 [19] vs 59 [9], hazard ratio [HR] = 0.44 [0.26-0.75], P = .002, NACE 19 [20] vs 67 [10], HR = 0.47 [0.28-0.79], P = .004). In this real-world scenario, OMT at discharge on top of DAPT seems associated with a better clinical outcome compared with patients discharged on non-OMT.

Published
2019

16. Italian intersociety consensus on DOAC use in internal medicine

Author

Cecilia Becattini, Mauro Silingardi, Armando D'Angelo, Francesca Santilli, Francesco Violi, Giovanni Davì, Anna Falanga, Simi, Francesco Dentali, Luca Masotti, Roberto M. Santi, Domenico Prisco, Raimondo De Cristofaro, Gualberto Gussoni, Pasquale Pignatelli, Antonella Tufano, Walter Ageno, Gualtiero Palareti, Giovanni Di Minno, Fadoi, Prisco, Domenico, Ageno, Walter, Becattini, Cecilia, D'Angelo, Armando, Davì, Giovanni, De Cristofaro, Raimondo, Dentali, Francesco, DI MINNO, Giovanni, Falanga, Anna, Gussoni, Gualberto, Masotti, Luca, Palareti, Gualtiero, Pignatelli, Pasquale, Santi, Roberto M, Santilli, Francesca, Silingardi, Mauro, Tufano, Antonella, Violi, Francesco, Prisco, D, Ageno, W, Becattini, C, D'Angelo, A, Davì, G, De Cristofaro, R, Dentali, F, Di Minno, G, Falanga, A, Gussoni, G, Masotti, L, Palareti, G, Pignatelli, P, Santi, R, Santilli, F, Silingardi, M, Tufano, A, and Violi, F

Subjects
pulmonary embolism, liver diseases, Administration, Oral, factor xa inhibitors, direct oral anticoagulant, antithrombins, atrial fibrillation, drug interactions, elderly, internist, novel oral anticoagulant, venous thromboembolism, venous thrombosis, administration, oral, anticoagulants, clinical competence, consensus, dabigatran, drug-related side effects and adverse reactions, food-drug interactions, humans, internal medicine, italy, perioperative period, pyrazoles, pyridines, pyridones, rivaroxaban, stroke, thiazoles, time factors, 030204 cardiovascular system & hematology, oral, chemistry.chemical_compound, 0302 clinical medicine, Edoxaban, 030212 general & internal medicine, Stroke, Atrial fibrillation, Direct oral anticoagulant, Drug interactions, Elderly, Internist, Novel oral anticoagulant, Pulmonary embolism, Venous thromboembolism, Venous thrombosis, Emergency Medicine, Apixaban, medicine.drug, medicine.medical_specialty, Drug interaction, administration, Dabigatran, 03 medical and health sciences, Internal medicine, Internal Medicine, medicine, Adverse effect, Intensive care medicine, Rivaroxaban, business.industry, Settore MED/09 - MEDICINA INTERNA, Venous thrombosi, medicine.disease, chemistry, Direct thrombin inhibitor, business
Abstract

The direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic characteristics to ensure their correct use, laboratory monitoring and the appropriate management of adverse events. This document represents a consensus paper on the use of DOACs by representatives of three Italian scientific societies: the Italian Society of Internal Medicine (SIMI), the Federation of the Associations of Hospital Managers (FADOI), and the Society for the Study of Haemostasis and Thrombosis (SISET). This document formulates expert opinion guidance for pragmatic managing, monitoring and reversing the anticoagulant effect of DOACs in both chronic and emergency settings. This practical guidance may help the internist to create adequate protocols for patients hospitalized ion internal medicine wards, where patients are often elderly subjects affected by poly-morbidities and renal insufficiency, and, thus, require particular attention to drug–drug interactions and peri-procedural protocols.

Published
2017

17. Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: implications for risk and therapy

Author

Violi, Francesco, Daví, Giovanni, Hiatt, William, Lip, Gregory Y. H., Corazza, Gino R., Perticone, Francesco, Proietti, Marco, Pignatelli, Pasquale, Vestri, Anna R., Basili, Stefania, Pende, Aldo, Violi, F., Daví, G., Hiatt, W., Lip, G., Corazza, G., Perticone, F., Proietti, M., Pignatelli, P., Vestri, A., Basili, S., and Mule', G..

Subjects
Adult, Male, Registrie, Risk, Middle Aged, Peripheral Arterial Disease, atrial fibrillation, cardiovascular disease, peripheral vascular disease, Aged, Atrial Fibrillation, Female, Humans, Internal Medicine, Italy, Prevalence, Registries, Societies, Medical, Ankle Brachial Index, Cardiology and Cardiovascular Medicine, Medical, Societies, Human

18. Antiplatelet treatment in acute coronary syndrome patients: Real-world data from the START-Antiplatelet Italian Registry

Author

Gualtiero Palareti, Carlo Di Mario, Anna Maria Gori, Paolo Gresele, Pasquale Pignatelli, Serafina Valente, Rossella Marcucci, Plinio Cirillo, Vittorio Pengo, Giuseppe Patti, Emilia Antonucci, Guido Grossi, Paolo Calabrò, Marcucci, Rossella, Patti, Giuseppe, Calabrò, Paolo, Gori, Anna Maria, Grossi, Guido, Cirillo, Plinio, Pengo, Vittorio, Gresele, Paolo, Pignatelli, Pasquale, Antonucci, Emilia, di Mario, Carlo, Valente, Serafina, Palareti, Gualtiero, Marcucci, R., Patti, G., Calabro, P., Gori, A. M., Grossi, G., Cirillo, P., Pengo, V., Gresele, P., Pignatelli, P., Antonucci, E., di Mario, C., Valente, S., and Palareti, G.

Subjects
Male, Registrie, Ticagrelor, Prasugrel, medicine.medical_treatment, Myocardial Infarction, Social Sciences, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Antiplatelet Therapy, Pathology and Laboratory Medicine, Vascular Medicine, Habits, Endocrinology, 0302 clinical medicine, Cardiovascular Disease, Atrial Fibrillation, Chronic Kidney Disease, Medicine and Health Sciences, Smoking Habits, Psychology, Prospective Studies, Registries, 030212 general & internal medicine, Aspirin, Multidisciplinary, DAPT, P2Y12 inhibitors, Pharmaceutics, Platelet Activation, Antiplatelet therapy, Acute Coranary Syndrome, Drugs, Middle Aged, Clopidogrel, Stroke, Treatment Outcome, Italy, Nephrology, Cardiovascular Diseases, platelets, Cerebrovascular Disorder, Thrombosi, Medicine, Female, Arrhythmia, TIMI, Research Article, medicine.drug, Human, Risk, Acute coronary syndrome, medicine.medical_specialty, thrombosis, coagulation, Endocrine Disorders, Science, Cardiology, Hemorrhage, Follow-Up Studie, 03 medical and health sciences, Signs and Symptoms, Percutaneous Coronary Intervention, Drug Therapy, Diagnostic Medicine, Internal medicine, Diabetes Mellitus, medicine, Humans, Platelet activation, cardiovascular diseases, Acute Coronary Syndrome, Aged, Pharmacology, Behavior, business.industry, Platelet Aggregation Inhibitor, Statins, Biology and Life Sciences, Percutaneous coronary intervention, Thrombosis, medicine.disease, Cerebrovascular Disorders, Prospective Studie, Metabolic Disorders, business, Prasugrel Hydrochloride, Platelet Aggregation Inhibitors, Follow-Up Studies
Abstract

BackgroundDespite great advances with the introduction of ticagrelor and prasugrel in the treatment of acute coronary syndromes (ACS), the risk of thrombosis and bleeding remains significant and affects the choice of clinicians in the treatment of the single patient. Large registries are effective tools to explore patterns of drug administration and adherence to guideline recommendations in real-world clinical practice.MethodsSTART- antiplatelet is a prospective, observational registry carried out by seven Italian cardiology institutions on patients admitted for ACS aimed to document the real world treatment of ACS patients, adding also data on 12-month follow-up. We present data on the first 1050 patients who have completed 1-year follow-up on a total of 1537 patients. Primary end-points were: 1) MACCE (Major Adverse Cardiovascular and Cerebrovascular Events) including all-cause and cardiovascular mortality, non fatal MI, urgent revascularization, TIA and ischemic stroke; 2) Major and minor bleeding according to TIMI, GUSTO and ISTH classifications.ResultsThe dual antiplatelet treatment most prescribed was aspirin plus ticagrelor (47.9%) and aspirin plus clopidogrel (32.1%). At a mean follow-up was 335±131 days, both ticagrelor and prasugrel are associated with a statistically significant reduced total and cardiovascular mortality. Both prasugrel and ticagrelor do not show a significant increased incidence of major and minor bleedings with respect to clopidogrel. Patients with monotherapy had significantly higher incidence of both ischemic stroke and major bleedings.DiscussionThe analysis of the register has documented that both ticagrelor and prasugrel are associated with a statistically significant reduced total and cardiovascular mortality but both do not show a significant increased incidence of major and minor bleedings with respect to clopidogrel.

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