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1. Risk factors for postoperative morbidity following appendectomy in the elderly: a nationwide prospective cohort study

Author

Poillucci, Gaetano, Podda, Mauro, Pisanu, Adolfo, Mortola, Lorenzo, Dalla Caneva, Patrizia, Massa, Giulia, Costa, Gianluca, Savastano, Riccardo, Cillara, Nicola, Collaborative Study Group endorsed by SICUT ACOI SICG SICE and Italian Chapter of WSES, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, Pp, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, Gm, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, P, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E., Poillucci G., Podda M., Pisanu A., Mortola L., Dalla Caneva P., Massa G., Costa G., Savastano R., Cillara N., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Balducci G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P.P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G.M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., De Luca M., De Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Fransvea P., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Lorenzon L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Poillucci, G, Podda, M, Pisanu, A, Mortola, L, Dalla Caneva, P, Massa, G, Costa, G, Savastano, R, Cillara, N, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
medicine.medical_specialty, Multivariate analysis, Sports medicine, Settore MED/18 - CHIRURGIA GENERALE, Critical Care and Intensive Care Medicine, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, NO, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Acute appendicitis, Appendectomy, Elderly, Frail patients, Postoperative complications, Internal medicine, medicine, Humans, Frail patient, Orthopedics and Sports Medicine, In patient, Prospective Studies, Prospective cohort study, Aged, Retrospective Studies, 030222 orthopedics, Creatinine, business.industry, Postoperative complication, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Appendicitis, chemistry, Emergency Medicine, Laparoscopy, Surgery, Acute appendiciti, Morbidity, Risk assessment, business
Abstract

Background: A limited number of studies investigating perioperative risk factors associated with emergency appendectomy in elderly patients have been published to date. Whether older age may be associated with poorer outcomes following appendectomy is still a matter of debate. The primary aim of this study was to determine the predictors of postoperative morbidity following appendectomy in patients aged ≥ 65years. Methods: Data regarding all elderly patients who underwent emergency appendectomy from January 2017 to June 2018 admitted 36 Italian surgical departments were prospectively collected and analyzed. Baseline demographics and perioperative variables were evaluated. Uni- and multivariate analyses adjusted for differences between groups were carried out to determine possible predictors of adverse outcomes after appendectomy. Results: Between January 2017 and June 2018, 135 patients aged ≥ 65years with a diagnosis of AA met the study inclusion criteria. Twenty-six patients (19.3%) were diagnosed with some type of postoperative complication. Decreasing the preoperative hemoglobin level showed a statistically significant association with postoperative complications (OR 0.77, CI 0.61–0.97, P = 0.03). Preoperative creatinine level (P = 0.02, OR 2.04, CI 1.12–3.72), and open appendectomy (P = 0.03, OR 2.67, CI 1.11–6.38) were significantly associated with postoperative morbidity. After adjustment, the only independent predictor of postoperative morbidity was preoperative creatinine level (P = 0.04, OR 2.01, CI 1.05–3.89). Conclusions: In elderly patients with AA, perioperative risk assessment in the emergency setting must be as accurate as possible to identify modifiable risk factors that can be addressed before surgery, such as preoperative hemoglobin and creatinine levels.

Published
2019
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2. The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study

Author

Costa, Gianluca, Fransvea, Pietro, Podda, Mauro, Pisanu, Adolfo, Carrano, Francesco Maria, Iossa, Angelo, Balducci, Genoveffa, Agresta, Ferdinando Collaborative Study Group: Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, Pp, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, Gm, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, Dalla Caneva, P, De Luca, M, De Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, Gm, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E., Costa G., Fransvea P., Podda M., Pisanu A., Carrano F.M., Iossa A., Balducci G., Agresta F., Alemanno G., Anania G., Antropoli M., Argenio G., Atzeni J., Avenia N., Azzinnaro A., Baldazzi G., Barbera G., Bellanova G., Bergamini C., Bersigotti L., Bianchi P.P., Bombardini C., Borzellino G., Bozzo S., Brachini G., Buonanno G.M., Canini T., Cardella S., Carrara G., Cassini D., Castriconi M., Ceccarelli G., Celi D., Ceresoli M., Chiarugi M., Cillara N., Cimino F., Cobuccio L., Cocorullo G., Colangelo E., Crucitti A., Dalla Caneva P., De Luca M., de Manzoni Garberini A., De Nisco C., De Prizio M., De Sol A., Dibella A., Falcioni T., Falco N., Farina C., Finotti E., Fontana T., Francioni G., Frezza B., Garulli G., Genna M., Giannessi S., Gioffre A., Giordano A., Gozzo D., Grimaldi S., Gulotta G., Iacopini V., Iarussi T., Laterza E., Leonardi A., Lepre L., Luridiana G., Malagnino A., Mar G., Marini P., Marzaioli R., Massa G., Mecarelli V., Mingoli A., Nigri G., Occhionorelli S., Paderno N., Palini G.M., Paradies D., Paroli M., Perrone F., Petruzzelli L., Pezzolla A., Piazza D., Piazza V., Piccoli M., Poillucci G., Porfidia R., Rossi G., Ruscelli P., Spagnoli A., Sulis R., Tartaglia D., Trana C., Travaglino A., Tomaiuolo P., Valeri A., Vasquez G., Zago M., Zanoni E., Costa, G, Fransvea, P, Podda, M, Pisanu, A, Carrano, F, Iossa, A, Balducci, G, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Crucitti, A, Dalla Caneva, P, De Luca, M, de Manzoni Garberini, A, De Nisco, C, De Prizio, M, De Sol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laterza, E, Leonardi, A, Lepre, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Male, Settore MED/18 - CHIRURGIA GENERALE, Endoscopy, Gastrointestinal, Cohort Studies, 0302 clinical medicine, Postoperative Complications, Elderly, Abdomen, 80 and over, Medicine, Prospective Studies, Prospective cohort study, Laparoscopy, Abdomen, Acute, Aged, 80 and over, medicine.diagnostic_test, Mortality rate, Age Factors, Prognosis, Multicenter study, Italy, Acute abdomen, 030220 oncology & carcinogenesis, Emergency surgery, 030211 gastroenterology & hepatology, Female, medicine.symptom, Cohort study, Risk, Gastrointestinal, medicine.medical_specialty, Acute, Malignancy, NO, 03 medical and health sciences, Humans, Aged, business.industry, acute abdomen, elderly, emergency surgery, laparoscopy, multicenter study, Endoscopy, medicine.disease, Surgery, Emergencies, Morbidity, business, Procedures and Techniques Utilization, Abdominal surgery
Abstract

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

Published
2020

3. Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study

Author

Sartelli, aEmail Author, M., Baiocchi, bEmail Author, G. L., Saverio, Di, cEmail Author, S., Ferrara, dEmail Author, F., Labricciosa, eEmail Author, F. M., Ansaloni, fEmail Author, L., Coccolini, fEmail Author, F., Vijayan, gEmail Author, D., Abbas, hEmail Author, A., Abongwa, iEmail Author, H. K., Agboola, jEmail Author, J., Ahmed, kEmail Author, A., Akhmeteli, lEmail Author, L., Akkapulu, mEmail Author, N., Akkucuk, nEmail Author, S., Altintoprak, oEmail Author, F., Andreiev, gEmail Author, A. L., Anyfantakis, pEmail Author, D., Atanasov, qEmail Author, B., Bala, rEmail Author, M., Balalis, sEmail Author, D., Baraket, tEmail Author, O., Bellanova, uEmail Author, G., Beltran, vEmail Author, M., Melo, wEmail Author, R. B., Bini, xEmail Author, R., Bouliaris, yEmail Author, K., Brunelli, zEmail Author, D., Castillo, Mario, aaEmail Author, A., Catani, abEmail Author, M., Che, Jusoh, acEmail Author, A., Chichom-Mefire, adEmail Author, A., Cocorullo, aeEmail Author, G., Coimbra, afEmail Author, R., Colak, agEmail Author, E., Costa, ahEmail Author, S., Das, aiEmail Author, K., Delibegovic, ajEmail Author, S., Demetrashvili, akEmail Author, Z., Carlo, Di, alEmail Author, I., Kiseleva, amEmail Author, N., Zalabany, El, anEmail Author, T., Faro, aoEmail Author, M., Ferreira, apEmail Author, M., Fraga, aqEmail Author, G. P., Gachabayov, arEmail Author, M., Ghnnam, asEmail Author, W. M., Giménez, Maurel, atEmail Author, T., Gkiokas, auEmail Author, G., Gomes, avEmail Author, C. A., Griffiths, awEmail Author, E., Guner, axEmail Author, A., Gupta, ayEmail Author, S., Hecker, azEmail Author, A., Hirano, aqEmail Author, E. S., Hodonou, baEmail Author, A., Hutan, bbEmail Author, M., Ioannidis, Bc, O., Bdemail, Author, Isik, beEmail Author, A., Ivakhov, bfEmail Author, G., Jain, bgEmail Author, S., Jokubauskas, bhEmail Author, M., Karamarkovic, biEmail Author, A., Kauhanen, bjEmail Author, S., Kaushik, ayEmail Author, R., Kavalakat, bkEmail Author, A., Kenig, blEmail Author, J., Khokha, bmEmail Author, V., Khor, bnEmail Author, D., Kim, aaEmail Author, D., boEmail Author, J. I., Kong, bpEmail Author, V., Lasithiotakis, bqEmail Author, K., Leão, brEmail Author, P., Leon, bsEmail Author, M., Litvin, btEmail Author, A., Lohsiriwat, buEmail Author, V., López-Tomassetti, Fernandez, bvEmail Author, E., Lostoridis, bwEmail Author, E., Maciel, aaEmail Author, J., Major, bxEmail Author, P., Dimova, byEmail Author, A., Manatakis, bzEmail Author, D., Marinis, caEmail Author, A., Martinez-Perez, cbEmail Author, A., Marwah, ccEmail Author, S., Mcfarlane, Cd, M., Ceemail, Author, Mesina, cfEmail Author, C., Pȩdziwiatr, cgEmail Author, M., Michalopoulos, chEmail Author, N., Misiakos, ciEmail Author, E., Mohamedahmed, cjEmail Author, A., Moldovanu, ckEmail Author, R., Montori, fEmail Author, G., Mysore, Narayana, clEmail Author, R., Negoi, cmEmail Author, I., Nikolopoulos, cnEmail Author, I., Novelli, coEmail Author, G., Novikovs, amEmail Author, V., Olaoye, cpEmail Author, I., Omari, cqEmail Author, A., Ordoñez, crEmail Author, C. A., Ouadii, csEmail Author, M., Ozkan, ctEmail Author, Z., Pal, cuEmail Author, A., Palini, coEmail Author, G. M., Partecke, cvEmail Author, L. I., Pata, Francesco, cwEmail Author, F., cxEmail Author, M., Pereira, Júnior, cyEmail Author, G. A., Pintar, czEmail Author, T., Pisarska, daEmail Author, M., Ploneda-Valencia, dbEmail Author, C. F., Pouggouras, bwEmail Author, K., Prabhu, dcEmail Author, V., Ramakrishnapillai, ddEmail Author, P., Regimbeau, deEmail Author, J. -M., Reitz, dfEmail Author, M., Rios-Cruz, dgEmail Author, D., Saar, dhEmail Author, S., Sakakushev, diEmail Author, B., Seretis, djEmail Author, C., Sazhin, bfEmail Author, A., Shelat, dkEmail Author, V., Skrovina, dlEmail Author, M., Smirnov, dmEmail Author, D., Spyropoulos, dnEmail Author, C., Strzałka, doEmail Author, M., Talving, dhEmail Author, P., Teixeira, Gonsaga, dpEmail Author, R. A., Theobald, gEmail Author, G., Tomadze, dqEmail Author, G., Torba, drEmail Author, M., Tranà, aEmail Author, C., Ulrych, dsEmail Author, J., Uzunoğlu, nEmail Author, M. Y., Vasilescu, dtEmail Author, A., Occhionorelli, duEmail Author, S., Venara, dvEmail Author, A., Vereczkei, dwEmail Author, A., Vettoretto, dxEmail Author, N., Vlad, dtEmail Author, N., Walȩdziak, dyEmail Author, M., Yilmaz, dzEmail Author, T. U., Yuan, eaEmail Author, K. -C., Yunfeng, ebEmail Author, C., Zilinskas, bhEmail Author, J., Grelpois, deEmail Author, G., Catena, hEmail Author, F., Sartelli, M, Abu-Zidan, F, Labricciosa, F, Kluger, Y, Coccolini, F, Ansaloni, L, Leppaniemi, A, Kirkpatrick, A, Tolonen, M, Trana, C, Regimbeau, J, Hardcastle, T, Koshy, R, Abbas, A, Aday, U, Adesunkanmi, A, Ajibade, A, Akhmeteli, L, Akln, E, Akkapulu, N, Alotaibi, A, Altintoprak, F, Anyfantakis, D, Atanasov, B, Augustin, G, Azevedo, C, Bala, M, Balalis, D, Baraket, O, Baral, S, Barkai, O, Beltran, M, Bini, R, Bouliaris, K, Caballero, A, Calu, V, Catani, M, Ceresoli, M, Charalampakis, V, Jusoh, A, Chiarugi, M, Cillara, N, Cuesta, R, Cobuccio, L, Cocorullo, G, Colak, E, Conti, L, Cui, Y, De Simone, B, Delibegovic, S, Demetrashvili, Z, Demetriades, D, Dimova, A, Dogjani, A, Enani, M, Farina, F, Ferrara, F, Foghetti, D, Fontana, T, Fraga, G, Gachabayov, M, Gerard, G, Ghnnam, W, Maurel, T, Gkiokas, G, Gomes, C, Guner, A, Gupta, S, Hecker, A, Hirano, E, Hodonou, A, Hutan, M, Ilaschuk, I, Ioannidis, O, Isik, A, Ivakhov, G, Jain, S, Jokubauskas, M, Karamarkovic, A, Kaushik, R, Kenig, J, Khokha, V, Khokha, D, Kim, J, Kong, V, Korkolis, D, Kruger, V, Kshirsagar, A, Simoes, R, Lanaia, A, Lasithiotakis, K, Leao, P, Arellano, M, Listle, H, Litvin, A, Lizarazu Perez, A, Lopez-Tomassetti Fernandez, E, Lostoridis, E, Luppi, D, Machain V, G, Major, P, Manatakis, D, Reitz, M, Marinis, A, Marrelli, D, Martinez-Perez, A, Marwah, S, Mcfarlane, M, Mesic, M, Mesina, C, Michalopoulos, N, Misiakos, E, Moreira, F, Mouaqit, O, Muhtaroglu, A, Naidoo, N, Negoi, I, Nikitina, Z, Nikolopoulos, I, Nita, G, Occhionorelli, S, Olaoye, I, Ordonez, C, Ozkan, Z, Pal, A, Palini, G, Papageorgiou, K, Papagoras, D, Pata, F, Pedziwiatr, M, Pereira, J, Pereira Junior, G, Perrone, G, Pintar, T, Pisarska, M, Plehutsa, O, Podda, M, Poillucci, G, Quiodettis, M, Rahim, T, Rios-Cruz, D, Rodrigues, G, Rozov, D, Sakakushev, B, Sall, I, Sazhin, A, Semiao, M, Sharda, T, Shelat, V, Sinibaldi, G, Skicko, D, Skrovina, M, Stamatiou, D, Stella, M, Strzalka, M, Sydorchuk, R, Teixeira Gonsaga, R, Tochie, J, Tomadze, G, Ugoletti, L, Ulrych, J, Umarik, T, Uzunoglu, M, Vasilescu, A, Vaz, O, Vereczkei, A, Vlad, N, Waledziak, M, Yahya, A, Yalkin, O, Yilmaz, T, Unal, A, Yuan, K, Zachariah, S, Zilinskas, J, Zizzo, M, Pattonieri, V, Baiocchi, G, Catena, F, Universidade do Minho, Sartelli M., Abu-Zidan F.M., Labricciosa F.M., Kluger Y., Coccolini F., Ansaloni L., Leppaniemi A., Kirkpatrick A.W., Tolonen M., Trana C., Regimbeau J.-M., Hardcastle T., Koshy R.M., Abbas A., Aday U., Adesunkanmi A.R.K., Ajibade A., Akhmeteli L., Akln E., Akkapulu N., Alotaibi A., Altintoprak F., Anyfantakis D., Atanasov B., Augustin G., Azevedo C., Bala M., Balalis D., Baraket O., Baral S., Barkai O., Beltran M., Bini R., Bouliaris K., Caballero A.B., Calu V., Catani M., Ceresoli M., Charalampakis V., Jusoh A.C., Chiarugi M., Cillara N., Cuesta R.C., Cobuccio L., Cocorullo G., Colak E., Conti L., Cui Y., De Simone B., Delibegovic S., Demetrashvili Z., Demetriades D., Dimova A., Dogjani A., Enani M., Farina F., Ferrara F., Foghetti D., Fontana T., Fraga G.P., Gachabayov M., Gerard G., Ghnnam W., Maurel T.G., Gkiokas G., Gomes C.A., Guner A., Gupta S., Hecker A., Hirano E.S., Hodonou A., Hutan M., Ilaschuk I., Ioannidis O., Isik A., Ivakhov G., Jain S., Jokubauskas M., Karamarkovic A., Kaushik R., Kenig J., Khokha V., Khokha D., Kim J.I., Kong V., Korkolis D., Kruger V.F., Kshirsagar A., Simoes R.L., Lanaia A., Lasithiotakis K., Leao P., Arellano M.L., Listle H., Litvin A., Lizarazu Perez A., Lopez-Tomassetti Fernandez E., Lostoridis E., Luppi D., Machain V G.M., Major P., Manatakis D., Reitz M.M., Marinis A., Marrelli D., Martinez-Perez A., Marwah S., McFarlane M., Mesic M., Mesina C., Michalopoulos N., Misiakos E., Moreira F.G., Mouaqit O., Muhtaroglu A., Naidoo N., Negoi I., Nikitina Z., Nikolopoulos I., Nita G.-E., Occhionorelli S., Olaoye I., Ordonez C.A., Ozkan Z., Pal A., Palini G.M., Papageorgiou K., Papagoras D., Pata F., Pedziwiatr M., Pereira J., Pereira Junior G.A., Perrone G., Pintar T., Pisarska M., Plehutsa O., Podda M., Poillucci G., Quiodettis M., Rahim T., Rios-Cruz D., Rodrigues G., Rozov D., Sakakushev B., Sall I., Sazhin A., Semiao M., Sharda T., Shelat V., Sinibaldi G., Skicko D., Skrovina M., Stamatiou D., Stella M., Strzalka M., Sydorchuk R., Teixeira Gonsaga R.A., Tochie J.N., Tomadze G., Ugoletti L., Ulrych J., Umarik T., Uzunoglu M.Y., Vasilescu A., Vaz O., Vereczkei A., Vlad N., Waledziak M., Yahya A.I., Yalkin O., Yilmaz T.U., Unal A.E., Yuan K.-C., Zachariah S.K., Zilinskas J., Zizzo M., Pattonieri V., Baiocchi G.L., Catena F., HUS Abdominal Center, II kirurgian klinikka, University of Helsinki, İstinye Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, and Altintoprak, Fatih

Subjects
Male, Medicina Básica [Ciências Médicas], 030230 surgery, Logistic regression, 0302 clinical medicine, Injury Severity Score, Interquartile range, Risk Factors, Antibiotics, Abdomen, Diagnosis, Acute peritonitis, Early warning score, Emergency surgery, Source control, Adult, Aged, Chi-Square Distribution, Female, Hospital Mortality, Humans, Logistic Models, Middle Aged, Sepsis, Prognosis, Mortality rate, Acute peritoniti, lcsh:Medical emergencies. Critical care. Intensive care. First aid, aarly warning score, acute peritonitis, emergency surgery, source control, abdomen, adult, aged, chi-square distribution, female, hospital mortality, humans, injury severity score, logistic models, male, middle aged, risk factors, sepsis, prognosis, 3. Good health, Management, Ciências Médicas::Medicina Básica, Emergency Medicine, Research Article, Human, medicine.medical_specialty, Logistic Model, Sepsi, lcsh:Surgery, NO, 03 medical and health sciences, Internal medicine, medicine, Acute appendicitis, Science & Technology, business.industry, Risk Factor, Surgery, lcsh:RD1-811, lcsh:RC86-88.9, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, Observational study, business, Chi-squared distribution, Kidney disease
Abstract

Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Background Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28–66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4–10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0–1, 22.7% for those who had scores of 2–3, 46.8% for those who had scores of 4–5, and 86.7% for those who have scores of 7–8. Conclusions The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Published
2019

4. The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery

Author

Costa, Gianluca, Bersigotti, Laura, Massa, Giulia, Lepre, Luca, Fransvea, Pietro, Lucarini, Alessio, Mercantini, Paolo, Balducci, Genoveffa, Sganga, Gabriele, Crucitti, ERASO (Elderly Risk Assessment, Surgical Outcome) Collaborative Study Group:, F Agresta, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, P Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, M Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Costa, G, Crucitti, A, P Dalla Caneva, M De Luca, A de Manzoni Garberini, C De Nisco, M De Prizio, A De Sol, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Fransvea, P, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffrè, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lepre, L, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Massa, G, Mecarelli, V, Mercantini, P, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, M Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Tranà, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, Zanoni, E, Costa, G, Bersigotti, L, Massa, G, Lepre, L, Fransvea, P, Lucarini, A, Mercantini, P, Balducci, G, Sganga, G, Crucitti, A, Agresta, F, Alemanno, G, Anania, G, Antropoli, M, Argenio, G, Atzeni, J, Avenia, N, Azzinnaro, A, Baldazzi, G, Barbera, G, Bellanova, G, Bergamini, C, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buonanno, G, Canini, T, Cardella, S, Carrara, G, Cassini, D, Castriconi, M, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cimino, F, Cobuccio, L, Cocorullo, G, Colangelo, E, Dallacaneva, P, Deluca, M, deManzoni Garberini, A, Denisco, C, Deprizio, M, Desol, A, Dibella, A, Falcioni, T, Falco, N, Farina, C, Finotti, E, Fontana, T, Francioni, G, Frezza, B, Garbarino, G, Garulli, G, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Gulotta, G, Iacopini, V, Iarussi, T, Laracca, G, Laterza, E, Leonardi, A, Lorenzon, L, Luridiana, G, Malagnino, A, Mar, G, Marini, P, Marzaioli, R, Mecarelli, V, Mingoli, A, Nigri, G, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petrucciani, N, Petruzzelli, L, Pezzolla, A, Piazza, D, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Spagnoli, A, Sulis, R, Tartaglia, D, Trana, C, Travaglino, A, Tomaiuolo, P, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Aging, medicine.medical_specialty, Frail Elderly, Frailty Index, Emergency surgery, Frailty, Predictive tool, Procedure-specific morbidity, Procedure-specifc morbidity, Logistic regression, Risk Assessment, NO, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Internal validation, Aged, Frailty, Emergency surgery, Predictive tool, Procedure-specifc morbidity, Univariate analysis, Framingham Risk Score, Receiver operating characteristic, business.industry, Test (assessment), Italy, 030220 oncology & carcinogenesis, Emergency medicine, Original Article, Geriatrics and Gerontology, business
Abstract

Background Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. Study design 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called “EmSFI”. Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. Results 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654–0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682–0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. Conclusions The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.

Published
2020
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5. Frailty and emergency surgery in the elderly: protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

Author

Mingoli, A, Costa, Gianluca, Massa, Giulia, Agresta, F., Anania, G., Ansaloni, L., Antropoli, M., Argenio, G., Atzeni, J., Avenia, N., Azzinnaro, A., Balani, A., Baldazzi, G., Balducci, G., Barbera, G., Bellanova, G., Bergamini, C., Bersigotti, L., Bianchi, P. P., Bombardini, C., Borzellino, G., Bozzo, S., Brachini, G., Buccoliero, F., Buonanno, G. M., Buononato, M., Campanile, F. C., Canini, T., Cardella, S., Carrara, G., Cascini, F., Cassini, D., Castriconi, M., Catalini, G., Catena, F., Ceccarelli, G., Celi, D., Ceresoli, M., Chiarugi, M., Cillara, N., Cimino, F., Cobuccio, L., Coccolini, F., Cocorullo, G., Colangelo, E., Costa, G., Crafa, F., Crucitti, A., Dalla Caneva, P., De&nbsp, Luca, M., de&nbsp, Manzoni Garberini, A., De Nisco, C., Sol, A., Falcioni, T., Falco, N., Farina, C., Filippone, G., Finotti, E., Fiume, S., Fontana, T., Francioni, G., Fransvea, P., Frezza, B., Gemini, Simone, Genna, M., Giannessi, S., Gioffrè, A., Giordano, A., Gozzo, D., Grimaldi, S., Gulotta, G., Iarussi, T., Laterza, E., Lepre, L., Lorenzon, L., Lotti, R., Luridiana, G., Marini, P., Marzaioli, R., Massa, G., Mulas, S., Nagliati, C., Nigri, G., Niolu, P., Noviello, A., Occhionorelli, S., Paderno, N., Palini, G. M., Paradies, D., Paroli, M., Perrone, F., Petruzzelli, L., Pezzolla, A., Piazza, D., Piazza, V., Piccoli, M., Pisanu, A., Podda, M., Poillucci, Gaetano, Porfidia, R., Rossi, G., Ruscelli, P., Santella, S., Sartelli, M., Spagnoli, A., Sulis, R., Tarasconi, A., Tranà, C., Travaglino, A., Valeri, A., Vasquez, G., Zago, Michela, Zanoni, E., Costa, G, Massa, G, Anania, G, Atzeni, J, Cardella, S, Cimino, F, Cocorullo, G, Falco, N, Farina, M, Fontana, T, Gulotta, G, Piazza, D, Agresta, F, Ansaloni, L, Antropoli, M, Argenio, G, Avenia, N, Azzinnaro, A, Balani, A, Baldazzi, G, Balducci, G, Barbera, G, Bellanova, G, Bergamini, C, Bersigotti, L, Bianchi, P, Bombardini, C, Borzellino, G, Bozzo, S, Brachini, G, Buccoliero, F, Buonanno, G, Buononato, M, Campanile, F, Canini, T, Carrara, G, Cascini, F, Cassini, D, Castriconi, M, Catalini, G, Catena, F, Ceccarelli, G, Celi, D, Ceresoli, M, Chiarugi, M, Cillara, N, Cobuccio, L, Coccolini, F, Colangelo, E, Crafa, F, Crucitti, A, Dalla Caneva, P, Deluca, M, deManzoni Garberini, A, De Nisco, C, Desol, A, Falcioni, T, Farina, C, Filippone, G, Finotti, E, Fiume, S, Francioni, G, Fransvea, P, Frezza, B, Gemini, S, Genna, M, Giannessi, S, Gioffre, A, Giordano, A, Gozzo, D, Grimaldi, S, Iarussi, T, Laterza, E, Lepre, L, Lorenzon, L, Lotti, R, Luridiana, G, Marini, P, Marzaioli, R, Mingoli, A, Mulas, S, Nagliati, C, Nigri, G, Niolu, P, Noviello, A, Occhionorelli, S, Paderno, N, Palini, G, Paradies, D, Paroli, M, Perrone, F, Petruzzelli, L, Pezzolla, A, Piazza, V, Piccoli, M, Pisanu, A, Podda, M, Poillucci, G, Porfidia, R, Rossi, G, Ruscelli, P, Santella, S, Sartelli, M, Spagnoli, A, Sulis, R, Tarasconi, A, Trana, C, Travaglino, A, Valeri, A, Vasquez, G, Zago, M, and Zanoni, E

Subjects
Elderly patient, Emergency surgery, Frailty, Geriatric, Risk assessment, Scores, Aged, Aged, 80 and over, Clinical Protocols, Emergencies, Female, Humans, Italy, Logistic Models, Male, Multivariate Analysis, Outcome Assessment, Health Care, Postoperative Complications, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Frail Elderly, Outcome Assessment, 030230 surgery, law.invention, 0302 clinical medicine, Quality of life, law, 80 and over, Prospective cohort study, Multivariate Analysi, Emergencie, Mortality rate, Score, Intensive care unit, Outcome Assessment (Health Care), 030220 oncology & carcinogenesis, elderly patient, emergency surgery, frailty, geriatric, risk assessment, scores, Human, medicine.medical_specialty, Logistic Model, Prognosi, NO, 03 medical and health sciences, medicine, Clinical Protocol, business.industry, Perioperative, Surgery, Health Care, Prospective Studie, Settore MED/18 - Chirurgia Generale, Emergency medicine, Life expectancy, Observational study, Postoperative Complication, business
Abstract

Improvements in living conditions and progress in medical management have resulted in better quality of life and longer life expectancy. Therefore, the number of older people undergoing surgery is increasing. Frailty is often described as a syndrome in aged patients where there is augmented vulnerability due to progressive loss of functional reserves. Studies suggest that frailty predisposes elderly to worsening outcome after surgery. Since emergency surgery is associated with higher mortality rates, it is paramount to have an accurate stratification of surgical risk in such patients. The aim of our study is to characterize the clinicopathological findings, management, and short-term outcome of elderly patients undergoing emergency surgery. The secondary objectives are to evaluate the presence and influence of frailty and analyze the prognostic role of existing risk-scores. The final FRAILESEL protocol was approved by the Ethical Committee of “Sapienza” University of Rome, Italy. The FRAILESEL study is a nationwide, Italian, multicenter, observational study conducted through a resident-led model. Patients over 65years of age who require emergency surgical procedures will be included in this study. The primary outcome measures are 30-day postoperative mortality and morbidity rates. The Clavien-Dindo classification system is used to categorize complications. The secondary outcome measures include length of hospital stay, length of stay in intensive care unit, and predictive value for morbidity and mortality of several frailty and surgical risk-scores. The results of the FRAILESEL study will be disseminated through national and international conference presentations and peer-reviewed journals. The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov identifier: NCT02825082).

Published
2018

6. St. John’s Wort in Patients Non-responders to Clopidogrel Undergoing Percutaneous Coronary Intervention: a Single-Center Randomized Open-Label Trial (St. John’s Trial)

Author

Emanuele Barbato, Gabor G. Toth, Catalina Trana, William Wijns, Trana, C, Toth, G, Wijns, W, and Barbato, Emanuele

Subjects
Blood Platelets, Male, medicine.medical_specialty, Ticlopidine, Time Factors, Platelet Function Tests, medicine.medical_treatment, Drug Resistance, Pharmaceutical Science, Placebo, Single Center, Gastroenterology, law.invention, Percutaneous Coronary Intervention, P2Y12, Belgium, Randomized controlled trial, Predictive Value of Tests, law, Internal medicine, Genetics, medicine, Humans, Prospective Studies, Prospective cohort study, Genetics (clinical), Aged, Analysis of Variance, Chi-Square Distribution, Plants, Medicinal, Plant Extracts, business.industry, Percutaneous coronary intervention, Middle Aged, Clopidogrel, Treatment Outcome, Anesthesia, Conventional PCI, Molecular Medicine, Drug Therapy, Combination, Female, Cardiology and Cardiovascular Medicine, business, Hypericum, Platelet Aggregation Inhibitors, Phytotherapy, medicine.drug
Abstract

We assessed if St. John’s Wort (SJW) improves platelet response in patients (pts) resistant to clopidogrel after percutaneous coronary intervention (PCI). Stable angina pts non-responders to 600 mg clopidogrel (P2Y12 reaction units (PRU) >240) were randomized (2:1) to SJW (n = 15) or placebo (n = 8). SJW (300 mg × 3/day) was administrated for 2 weeks after PCI. Platelet reactivity was assessed by VerifyNowTM before (BL), 2 (T1), and 4 weeks (T2) after PCI. PRU significantly changed during protocol in SJW (BL (316 ± 60) vs. T1 (170 ± 87) vs. T2 (220 ± 96), p < 0.0001) and placebo group (BL (288 ± 36) vs. T1 (236 ± 31) vs. T2 (236 ± 62), p = 0.046). Yet, PRU changes from BL were higher at T1 in SJW than in placebo group (Δ%, −47 ± 24 vs. −16 ± 15, p = 0.0033), with no differences at T2 between the groups (Δ%, −30 ± 29 vs. −17 ± 24, p = 0.30). Residual platelet reactivity improved with SJW during the first month post-PCI.

Published
2013
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7. Long-Term Follow-Up After Fractional Flow Reserve–Guided Treatment Strategy in Patients With an Isolated Proximal Left Anterior Descending Coronary Artery Stenosis

Author

Michalis Hamilos, Marc Vanderheyden, Frank J. A. van Rooij, William Wijns, Fabio Mangiacapra, Jacqueline C.M. Witteman, Guy R. Heyndrickx, Emanuele Barbato, Olivier Muller, Jozef Bartunek, Argyrios Ntalianis, Catalina Trana, Eric Wyffels, Albert Hofman, Katia M.C. Verhamme, Bernard De Bruyne, Medical Informatics, Epidemiology, Cardiology, Muller, O, Mangiacapra, F, Ntalianis, A, Verhamme, Km, Trana, C, Hamilos, M, Bartunek, J, Vanderheyden, M, Wyffels, E, Heyndrickx, Gr, van Rooij, Fj, Witteman, Jc, Hofman, A, Wijns, W, Barbato, Emanuele, and De Bruyne, B.

Subjects
Male, Cardiac Catheterization, Time Factors, medicine.medical_treatment, Myocardial Infarction, Fractional flow reserve, Kaplan-Meier Estimate, Coronary Angiography, Severity of Illness Index, Belgium, Risk Factors, Registries, Angioplasty, Balloon, Coronary, Coronary Artery Bypass, fractional flow reserve, Netherlands, proximal left anterior descending coronary artery, Middle Aged, Fractional Flow Reserve, Myocardial, Survival Rate, myocardial ischemia, Treatment Outcome, Cardiology, Treatment strategy, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Long term follow up, Anterior Descending Coronary Artery, Revascularization, Risk Assessment, Disease-Free Survival, Predictive Value of Tests, Internal medicine, medicine, Humans, Aged, Proportional Hazards Models, Chi-Square Distribution, business.industry, Patient Selection, Coronary Stenosis, Hemodynamics, Cardiovascular Agents, medicine.disease, Surgery, Stenosis, Conventional PCI, business, Mace
Abstract

Objectives This study sought to evaluate the long-term clinical outcome of patients with an angio-graphically intermediate left anterior descending coronary artery (LAD) stenosis in whom the revascularization strategy was based on fractional flow reserve (FFR). Background When revascularization is based mainly on angiographic guidance, a number of hemodynamically nonsignificant stenoses will be revascularized. Methods In 730 patients with a 30% to 70% isolated stenosis in the proximal LAD and no significant valvular disease, FFR measurements were obtained to guide treatment strategy. When FFR was >= 0.80, the patients (n = 564) were treated medically (medical group); when FFR was < 0.80, the patients (n = 166) underwent a revascularization procedure (revascularization group; 13% coronary artery bypass graft surgery and 87% percutaneous coronary intervention). A 100% long-term clinical follow-up (median follow-up: 40 months) was obtained. The 5-year survival of the medical group was compared with that of a reference population. For each patient, 4 controls were selected from an age- and sex-matched control population. Results The 5-year survival estimate was 92.9% in the medical group versus 89.6% in the controls (p = 0.74). The mean diameter stenosis was significantly smaller in the medical than in the revascularization group (39 +/- 14% vs. 54 +/- 13%, p < 0.0001), but there was a large overlap between both groups. The 5-year event-free survival estimates (death, myocardial infarction, and target vessel revascularization) were 89.7% and 68.5%, respectively (p < 0.0001). Conclusions Medical treatment of patients with a hemodynamically nonsignificant stenosis (FFR >= 0.80) in the proximal LAD is associated with an excellent long-term clinical outcome with survival at 5 years similar to an age- and sex-matched control population. (J Am Coll Cardiol Intv 2011;4: 1175-82) (C) 2011 by the American College of Cardiology Foundation

Published
2011
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8. Association of biomarkers of lipid modification with functional and morphological indices of coronary stenosis severity in stable coronary artery disease

Author

Emanuele Barbato, Reto Auer, Michalis Hamilos, Karen Dierickx, Leen Delrue, Bernard De Bruyne, Olivier Muller, Jozef Bartunek, Fabio Mangiacapra, Argyrios Ntalianis, Emmanuel Valentin, Nicolas Rodondi, Catalina Trana, William Wijns, Muller, O, Ntalianis, A, Wijns, W, Delrue, L, Dierickx, K, Auer, R, Rodondi, N, Mangiacapra, F, Trana, C, Hamilos, M, Valentin, E, De Bruyne, B, Barbato, Emanuele, and Bartunek, J.

Subjects
Male, medicine.medical_specialty, Cardiac Catheterization, medicine.medical_treatment, Pharmaceutical Science, Blood lipids, Fractional flow reserve, Coronary Artery Disease, Coronary Angiography, Group II Phospholipases A2, Severity of Illness Index, Coronary artery disease, Predictive Value of Tests, Internal medicine, Genetics, Odds Ratio, Medicine, Humans, Genetics (clinical), Cardiac catheterization, Aged, Peroxidase, Chi-Square Distribution, business.industry, Area under the curve, Coronary Stenosis, Middle Aged, medicine.disease, Lipid Metabolism, Prognosis, Coronary Vessels, Plaque, Atherosclerotic, Fractional Flow Reserve, Myocardial, Lipoproteins, LDL, Stenosis, Logistic Models, 1-Alkyl-2-acetylglycerophosphocholine Esterase, Multivariate Analysis, Cardiology, Linear Models, Molecular Medicine, Female, Lipid modification, Cardiology and Cardiovascular Medicine, business, Biomarkers, Lipoprotein
Abstract

Biomarkers of blood lipid modification and oxidative stress have been associated with increased cardiovascular morbidity. We sought to determine whether these biomarkers were related to functional indices of stenosis severity among patients with stable coronary artery disease. We studied 197 consecutive patients with stable coronary artery disease due to single vessel disease. Fractional flow reserve (FFR) ≤ 0.80 was assessed as index of a functionally significant lesion. Serum levels of secretory phospholipase A2 (sPLA2) activity, secretory phospholipase A2 type IIA (sPLA2-IIA), myeloperoxydase (MPO), lipoprotein-associated phospholipase A2 (Lp-PLA2), and oxidized low-density lipoprotein (OxLDL) were assessed using commercially available assays. Patients with FFR0.8 had higher sPLA2 activity, sPLA2 IIA, and OxLDL levels than patients with FFR ≤ 0.8 (21.25 [16.03-27.28] vs 25.85 [20.58-34.63] U/mL, p0.001, 2.0 [1.5-3.4] vs 2.6 [2.0-3.4] ng/mL, p0.01; and 53.0 [36.0-71.0] vs 64.5 [50-89.25], p0.001 respectively). Patients with FFR0.80 had similar Lp-PLA2 and MPO levels versus those with FFR ≤ 0.8. sPLA2 activity, sPLA2 IIA significantly increased area under the curve over baseline characteristics to predict FFR ≤ 0.8 (0.67 to 0.77 (95 % confidence interval [CI]: 0.69-0.85) p 0.01 and 0.67 to 0.77 (95 % CI: 0.69-0.84) p0.01, respectively). Serum sPLA2 activity as well as sPLA2-IIA level is related to functional characteristics of coronary stenoses in patients with stable coronary artery disease.

Published
2013

9. Pressure-diameter relationship in human coronary arteries

Author

Charles A. Taylor, Stylianos A. Pyxaras, Catalina Trana, Bernard De Bruyne, Olivier Muller, Emanuele Barbato, William Wijns, Fabio Mangiacapra, Muller, O, Pyxaras, Sa, Trana, C, Mangiacapra, F, Barbato, Emanuele, Wijns, W, Taylor, Ca, and De Bruyne, B.

Subjects
Male, Cardiac Catheterization, medicine.medical_specialty, Time Factors, Vasodilator Agents, medicine.medical_treatment, Isosorbide Dinitrate, Coronary Angiography, Prosthesis Design, Severity of Illness Index, Percutaneous Coronary Intervention, Angioplasty, Internal medicine, Humans, Medicine, Arterial Pressure, Aged, Cardiac catheterization, Chi-Square Distribution, business.industry, Coronary Stenosis, Balloon catheter, Stent, Percutaneous coronary intervention, Middle Aged, medicine.disease, Coronary Vessels, Coronary arteries, Stenosis, Treatment Outcome, medicine.anatomical_structure, Conventional PCI, Linear Models, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business
Abstract

Background— To quantify the changes in arterial dimensions after the acute changes in pressure associated with percutaneous coronary intervention (PCI). Methods and Results— Forty-eight patients with one angiographically moderate-to-severe stenosis were included in the study. The pressure proximal and distal to the stenosis and the arterial diameter proximal and distal to the stenosis were measured at baseline, after intracoronary nitrates, and after stent PCI. In addition, in 8 patients distal pressure and coronary diameter were assessed while graded, controlled stenoses were created in the stented segment by progressive inflation of a balloon catheter. The mean diameter of the proximal coronary segment was 2.75±0.08 mm, 2.92±0.08 mm (+7.4%), and 3.10±0.07 mm (+14.7%) at baseline, after nitrates and after PCI, respectively ( P P r 2 =0.57; P Conclusions— The diameter of coronary arteries markedly varies with their distending pressure. After re-establishment of a normal distending pressure by stenting of severe coronary stenoses, a proportional increase in vessel diameter is observed. This should be taken into account when choosing the stent diameter and is an argument to discourage direct stenting.

Published
2012

10. Effective radiation dose, time, and contrast medium to measure fractional flow reserve

Author

Marc Vanderheyden, Eric Wyffels, Frederic Van Durme, Argyrios Ntalianis, Luc Van Driessche, Fabio Mangiacapra, Jozef Bartunek, Emanuele Barbato, Liesbeth De Block, Bernard De Bruyne, Jo De Jans, Olivier Muller, Alex Heyse, Aaron Peace, Catalina Trana, Carina De Backer, Guy R. Heyndrickx, William Wijns, Ntalianis, A., Trana, C., Muller, O., Mangiacapra, F., Peace, A., De Backer, C., De Block, L., Wyffels, E., Bartunek, J., Vanderheyden, M., Heyse, A., Van Durme, F., Van Driessche, L., De Jans, J., Heyndrickx, G. R., Wijns, W., Barbato, Emanuele, and De Bruyne, B.

Subjects
Coronary angiography, Male, angiocardiography, Adenosine, Time Factors, Coronary Stenosi, Vasodilator Agents, Contrast Media, Predictive Value of Test, Fractional flow reserve, Coronary Angiography, Severity of Illness Index, Coronary artery disease, Belgium, Risk Factors, Vasodilator Agent, contrast medium, aged, adenosine, contrast medium, aged, article, cardiac imaging, controlled study, coronary artery disease, coronary artery obstruction, female, fractional flow reserve, human, hyperemia, major clinical study, male, priority journal, radiation dose, Aged, Coronary Stenosis, Female, Fractional Flow Reserve, Myocardial, Humans, Hyperemia, Middle Aged, Predictive Value of Tests, Radiation Dosage, Risk Assessment, coronary angiography, radiation, Fractional Flow Reserve, Myocardial, Predictive value of tests, Cardiology and Cardiovascular Medicine, Time Factor, Coronary stenosis, medicine, business.industry, Risk Factor, Radiation dose, radiation dose, Adenosine, medicine.disease, Contrast medium, Conventional PCI, business, Nuclear medicine
Abstract

Objectives This study sought to define the additional effective radiation dose, procedural time, and contrast medium needed to obtain fractional flow reserve (FFR) measurements after a diagnostic coronary angiogram. Background The FFR measurements performed at the end of a diagnostic angiogram allow the obtaining of functional information that complements the anatomic findings. Methods In 200 patients (mean age 66 ± 10 years) undergoing diagnostic coronary angiography, FFR was measured in at least 1 intermediate coronary artery stenosis. Hyperemia was achieved by intracoronary (n = 180) or intravenous (n = 20) adenosine. The radiation dose (mSv), procedural time (min), and contrast medium (ml) needed for diagnostic angiography and FFR were recorded. Results A total of 296 stenoses (1.5 ± 0.7 stenoses per patient) were assessed. The additional mean radiation dose, procedural time, and contrast medium needed to obtain FFR expressed as a percentage of the entire procedure were 30 ± 16% (median 4 mSv, range 2.4 to 6.7 mSv), 26 ± 13% (median 9 min, range 7 to 13 min), and 31 ± 16% (median 50 ml, range 30 to 90 ml), respectively. The radiation dose and contrast medium during FFR were similar after intravenous and intracoronary adenosine, though the procedural time was slightly longer with intravenous adenosine (median 11 min, range 10 to 17 min, p = 0.04) than with intracoronary adenosine (median 9 min, range 7 to 13 min). When FFR was measured in 3 or more lesions, radiation dose, procedural time, and contrast medium increased. Conclusions The additional radiation dose, procedural time, and contrast medium to obtain FFR measurement are low as compared to other cardiovascular imaging modalities. Therefore, the combination of diagnostic angiography and FFR measurements is warranted to provide simultaneously anatomic and functional information in patients with coronary artery disease. © 2010 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION.

Published
2010

11. Comparison of 600 versus 300-mg clopidogrel loading dose in patients with St-segment elevation myocardial infarction undergoing primary coronary angioplasty

Author

Olivier Muller, Emanuele Barbato, William Wijns, Argyrios Ntalianis, Fabio Mangiacapra, Marc Vanderheyden, Guy R. Heyndrickx, Catalina Trana, Jozef Bartunek, Bernard De Bruyne, Mangiacapra, F., Muller, O., Ntalianis, A., Trana, C., Heyndrickx, G. R., Bartunek, J., Vanderheyden, M., Wijns, W., De Bruyne, B., and Barbato, Emanuele

Subjects
Male, Registrie, angiocardiography, loading drug dose, medicine.medical_treatment, proportional hazards model, Coronary, Myocardial Infarction, coronary artery recanalization, Coronary Angiography, Prospective Studies, Registries, Myocardial infarction, Angioplasty, Balloon, Coronary, comparative study, adult, ST elevation, Hazard ratio, article, fibrinogen receptor antagonist, Middle Aged, Clopidogrel, Combined Modality Therapy, Survival Rate, aged, drug dose comparison, female, Treatment Outcome, priority journal, Cardiology, Cardiology and Cardiovascular Medicine, transluminal coronary angioplasty, medicine.drug, medicine.medical_specialty, Ticlopidine, Logistic Model, transluminal coronary angioplasty, Aged, Loading dose, fibrinogen receptor antagonist, adult, Angioplasty, Internal medicine, death, medicine, Humans, controlled study, cardiovascular diseases, human, Proportional Hazards Models, clopidogrel, ST segment elevation myocardial infarction, Chi-Square Distribution, business.industry, Platelet Aggregation Inhibitor, control group, percutaneous coronary intervention, Percutaneous coronary intervention, acetylsalicylic acid, medicine.disease, major clinical study, Prospective Studie, Logistic Models, Conventional PCI, No-Reflow Phenomenon, male, Aged, Balloon, Female, Platelet Aggregation Inhibitors, business
Abstract

The aim of the present study was to compare 600- and 300-mg clopidogrel loading doses in patients with ST-segment elevation myocardial infarctions who underwent primary percutaneous coronary intervention (PCI). Two hundred fifty-five consecutive patients presenting with ST-segment elevation myocardial infarctions who underwent primary PCI were enrolled. Patients were divided into 2 groups on the basis of the loading dose of clopidogrel received before the procedure (600 vs 300 mg). Procedural angiographic end points and 1-year major adverse cardiac events were compared between the 2 groups. Major adverse cardiac events were defined as death, nonfatal myocardial infarction, and target vessel revascularization. There were no significant differences in baseline clinical and angiographic features between the 2 groups: 157 (62%) in the clopidogrel 600 mg group and 98 (38%) in the 300 mg group. Patients receiving 600-mg loading dose of clopidogrel showed a significantly lower incidence of post-PCI myocardial blush grade 0 or 1 (odds ratio 0.64, 95% confidence interval 0.43 to 0.96, p = 0.03) and significantly less common no-reflow phenomenon (odds ratio 0.38, 95% confidence interval 0.15 to 0.98, p = 0.04) compared to those in the 300-mg group. Propensity-adjusted Cox analysis showed significantly higher survival free of major adverse cardiac events in patients receiving 600-mg loading dose of clopidogrel compared to those receiving the lower dose (hazard ratio 0.57, 95% confidence interval 0.33 to 0.98, p = 0.04). In conclusion, a 600-mg loading dose of clopidogrel is associated with improvements in procedural angiographic end points and 1-year clinical outcomes in patients with ST-segment elevation myocardial infarction who undergo primary PCI compared to a 300-mg dose. © 2010 Elsevier Inc. All rights reserved.

Published
2010

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