Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: Insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units Registry

Aims: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI

Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: Insights fromthe EYESHOT study

Aims Patients with acute coronary syndromes (ACSs) whoare managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. Methods and results We assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients withACS enrolled in the prospective, multicentre, nationwideEYESHOT(EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units) registry.Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P, 0.0001 and 50 vs. 33, P, 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively). Conclusion Almost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did

Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: Insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units Registry

Aims: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI

Glomerular filtration rate: A prognostic marker in atrial fibrillation-A subanalysis of the AntiThrombotic Agents Atrial Fibrillation.

OBJECTIVE An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA-AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF. METHODS AND RESULTS The ATA-AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post-hoc analysis included 1097 AF patients with eGFR data available and 1-year clinical follow-up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow-up. Patients were also divided in two groups according to the eGFR (<60 and ≥60 mL/min/1.73 m ). The Kaplan-Meyer curve for the mentioned endpoint showed a higher endpoint incidence in the group of patient with eGFR below 60 mL/min/1.73 m (P < 0.001). Using multivariate analysis (Cox regression), a trend toward a higher rate of occurrence of the primary endpoint was observed for eGFR below 60 mL/min/1.73 m without reaching the conventional level of statistical significance (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.99-1.99; P = 0.0572). When eGFR was included in the analysis as continuous variable a significant correlation was observed with the combined endpoint at the Cox regression (HR 0.99, 95% CI 0.98-0.99, P = 0.04). CONCLUSION The result of this post-hoc analysis indicates that an impaired eGFR is independently associated with worse prognosis among patients with AF

DETERMINANTS OF 6-MONTH MORTALITY IN SURVIVORS OF MYOCARDIAL-INFARCTION AFTER THROMBOLYSIS - RESULTS OF THE GISSI-2 DATA-BASE

none647Background. Current knowledge of risk assessment in survivors of myocardial infarction is largely based on data gathered before the advent of thrombolysis. It must be determined whether and to what extent available information and proposed criteria of prognostication are applicable in the thrombolytic era. Methods and Results. We reassessed risk prediction in the 10 219 survivors of myocardial infarction with follow-up data available (ie, 98% of the total) who had been enrolled in the GISSI-2 trial, relying on a set of prespecified variables. The 3.5% 6-month all-cause mortality rate of these patients compared with the higher value of 4.6% found in the corresponding GISSI-1 cohort, originally allocated to streptokinase therapy, indicates a 24% reduction in postdischarge 6-month mortality. On multivariate analysis (Cox model), the following variables were predictors of 6-month all-cause mortality: ineligibility for exercise test for both cardiac (relative risk [RR], 3.30; 95% confidence interval [CI], 2.36-4.62) and noncardiac reasons (RR, 3.28; 95% CI, 2.23-4.72), early left ventricular failure (RR, 2.41; 95% Cl, 1.87-3.09), echocardiographic evidence of recovery phase left ventricular dysfunction (RR, 2.30; 95% CI, 1.78-2.98), advanced (more than 70 years) age (RR, 1.81; 95% Cl, 1.43 -2.30), electrical instability (ie, frequent and/or complex ventricular arrhythmias) (RR, 1.70; 95% Cl, 1.32-2.19), late left ventricular failure (RR, 1.54; 95% Cl, 1.17-2.03), previous myocardial infarction (RR, 1.47; 95% CI, 1.14-1.89), and a history of treated hypertension (RR, 1.32; 95% Cl, 1.05-1.65). Early post-myocardial infarction angina, a positive exercise test, female sex, history of angina, history of insulin-dependent diabetes, and anterior site of myocardial infarction were not risk predictors. On further multivariate analysis, performed on 8315 patients with the echocardiographic indicator of left ventricular dysfunction available, only previous myocardial infarction was not retained as an independent risk predictor. Conclusions. A decline in 6-month mortality of myocardial infarction survivors, seen within 6 hours of symptom onset, has been observed in recent years. Ineligibility for exercise test, early left ventricular failure, and recovery-phase left ventricular dysfunction are the most powerful (RR, >2) predictors of 6-month mortality among patients recovering from myocardial infarction after thrombolysis. Qualitative variables reflecting residual myocardial ischemia do not appear to be risk predictors. The lack of an independent adverse influence of early post-myocardial infarction angina on 6-month survival represents a major difference between this study and those of the prethrombolytic era.noneVOLPI A; DEVITA C; FRANZOSI MG; GERACI E; MAGGIONI AP; MAURI F; NEGRI E; SANTORO E; TAVAZZI L; TOGNONI G; FERUGLIO GA; LOTTO A; ROVELLI F; SOLINAS P; TAVAZZI L; TOGNONI G; BRUNO M; CAPPELLO T; COPPINI A; FINCATI F; MANTOVANI G; PANGRAZZI J; POGNA M; TURAZZA FM; ANSELMI M; BARBONAGLIA L; BIGI R; CAVALLI A; FRIGERIO M; GIORDANO A; GUALTIEROTTI C; TORTA D; CAROLA R; GIORDANO F; BARLOTTI R; LOPARCO G; VIGLINO GL; RUGGERI G; GIAMUNDO L; DANESI A; PACIARONI E; GAMBINI C; URBANO G; PURCARO A; FRANCESCONI M; FIGLIOLIA S; CANNONE M; ANTOLINI R; DEVOTI G; CRISTALLINI P; PORCIELLO PI; TEONI P; BURALI A; ZUCCONELLI V; DEMATTEIS C; IERVOGLINI A; SCATASTA M; AMABILI S; CARATTI CA; ZOLA G; FERRAGUTO P; SALICI G; CENTARO A; ROTIROTI D; GENOVESE M; GINEVRINO P; DAMATO N; ALTAMURA CM; COLONNA L; CASTELLANETA G; BOVENZI F; MESSINA D; GALANTINO A; CAMPOREALE N; CUCCHINI F; CAMPOSTELLA L; MALACRIDA R; GENONI M; PELLEGRINI P; BRIDDA A; RIGGI L; ACONE L; MOSCATIELLO G; BRUNO A; INVERNIZZI G; TESPILI M; GUAGLIUMI G; CASARI A; ALBANO T; TOMASSINI B; TORTA D; DIBIASE G; SCARAMUZZINO G; RUGGERO S; BRACCHETTI D; DECASTRO U; FULVI M; BRAITO E; ERLICHER A; OBERLECHNER W; GAGLIARDI RS; BIGHIGNOLI L; BONIZZATO G; RIZZI GM; SCAZZINA L; PERRINI A; STRANEO G; STRANEO U; SCIRE A; VERRIENTI A; GUADALUPI M; STORELLI A; ZUCCA L; DABUSTI M; ALBONICO B; DEPETRA V; TABACCHI GC; SCERVINO R; MEREU D; MAXIA P; BIANCO A; CRABU E; MANGIAMELI S; CENTAMORE G; MALFITANO D; AMICO C; VANCHERI F; SANTOPUOLI G; BALDINI F; PANTALEONI A; CONTESSOTTO F; TERLIZZI R; MERIGHI A; TURCHI E; TEGLIO V; PIGNATTI F; PEZZANA A; GOZZOLINO G; GIGLIO M; PETTINATI G; IEVA M; CIRICUGNO S; CORREALE E; ROMANO S; DIFUCCIA A; CASTELLANO B; NATALE A; CERNETTI C; CELEGON L; CANDELPERGHER G; ARIENZO F; RUSSO F; DEVIVO L; MAY L; ACHILLI G; BLASI A; SORRENTINO F; DATO A; GALLONE P; PALUMBO C; DELLAMONICA R; PAGANO L; ALBERTI A; ORSELLI L; DEPONTI C; PARMIGIANI ML; FERRARI M; ACITO P; BUSI F; DELLAVITTORIA G; BELLET C; BORTOLINI F; ROSSI A; CORONA C; BONDI S; NICCOLINI D; GAMBERI G; ARCURI G; MAIOLINO P; CARROZZA A; DELIO U; CAPRETTI G; MARINONI C; GUASCONI C; SONNINO S; PAGLIEI M; FERRARI G; LOMBARDI R; AGNELLI D; DERINALDIS G; CALCAGNILE A; SIGNORELLI S; BENDINELLI S; LUSETTI L; MOLLAIOLI M; COSMI F; PLASTINA F; VENNERI N; FERACO E; CATELLI P; POLUZZI C; DISTANTE S; BIANCHI C; COPPETTI S; ZAMPAGLIONE G; GATTO C; ZURLO R; USLENGHI E; MARGARIA F; MILANESE U; LOMANTO B; ZIACCHI V; RIVA D; BERTOCCHI P; TIRELLA G; DAULERIO M; SAURO G; BINI A; MAZZONI V; POGGI P; MARESTA A; JACOPI F; PATRONCINI A; PUPITA F; GAGGI S; FRAUSINI G; ANTONIOLI GE; MALACARNE C; CODECA L; CAPPATO R; ANDREOLI L; VARACCA S; BUIO E; FAZZINI PF; PUCCI P; SARRO F; VERGASSOLA R; BARCHIELLI M; DEMATTEIS D; CARRONE M; BRUNOZZI LT; MENICONI L; LIBERATI R; RADOGNA M; TALLONE M; CONTE R; IERI A; ZIPOLI A; SANSONI M; CANZIANI R; GUIDALI P; CRISTALLO E; MARIELLO F; MUZIO L; BENVENUTO MR; BALDINI MR; VECCHIO C; CHIARELLA F; FALCIDIENO M; CECCHI A; GIULIANO G; SEU V; PERUGINI P; TOSELLI A; BASSO F; CORTI E; ROSSI P; DELFINO R; CAPONNETTO S; GNECCO G; GHIGLIOTTI G; PENNESI A; LOMBARDI G; RUGGIERI A; BERTOLO L; SLOMP L; LANZETTA T; MAZZARONE L; CRESTI A; BELLODI G; ZUARINI AM; VENERI L; PARCHI C; GIOVANELLI N; NEGRONI S; DETHOMATIS M; BARGHINI A; MARINO E; RICCI D; LEMME P; DIGIACOMO U; AQUARO G; RONZANI G; OTTELLO B; VONTI V; MORETTI S; PALERMO R; MARSILI P; SIDERI F; RAGAZZINI G; GRAMENZI S; BATTISTINI S; DIODATO T; VALERIO A; TUCCI C; DEPASQUALE B; GELFO PG; BERTULLA A; BOLLINI R; DEMARCHI E; BACCA F; DEGIORGI V; LOCATELLI V; SAVOIA MT; FERRACINI C; BARBARESI F; COTOGNI A; FRANCO G; ROMANO S; PASSONI F; DURBANO M; MORETTI G; PEROTTI S; CAPRETTI M; DELBENE P; CASCONE M; BALDINI U; ORLANDI M; ODDONE A; CAIZZI V; MASINI G; LAZZARI M; BALLERINI B; BOZZI L; MOCETTI T; BERTOLINI A; PASOTTI E; SANGUINETTI M; MANTOVANI R; TOGNOLI T; MAGGI A; TUSA M; CAMERONI E; GUERRA GP; REGGIANI A; REDAELLI S; GIUSTI S; TANTALO L; RIZZI A; DIGIOVANNI N; GUZZO V; GABRIELE M; COLOMBO G; ALBERZONI A; SALVIOLI G; GALFETTI F; DOVICO E; BELLUZZI F; GOLA E; CASELLATO F; LECCHI G; CONSOLO F; SACCA CB; CONSOLO A; PICCOLO E; GASPARINI G; DEVITA C; ALBERTI A; MASSA D; BELLI C; DOSSENA MG; CORSINI C; SANNA GP; AZZOLLINI M; TRUAZZA F; LOTTO A; NADOR F; DEMARTINI M; BOZZI G; SEREGNI R; PASTINE I; MORPURGO M; CASAZZA F; REGALIA F; MAGGIOLINI S; RIGO R; PANCALDI S; POZZETTI D; PASCOTTO P; FRANCESCHI L; DAINESE F; MELINI L; CAPPELLI C; BERNARDI C; PALMIERI M; BORGIONI L; ZILIO G; SANDRI R; ALITTO F; MASARO G; VALAGUSSA F; SCHIAVINA R; RAVESI D; DANIELLO L; PIANTADOSI FR; BARRA P; ROMEO D; MININNI N; SEVERINO S; MOSTACCI M; CASTELLARI M; BANDA D; ROLANDI R; VILLA WD; CARBONE V; ALLEGRI M; FASCIOLO L; PITTALIS M; MUREDDU V; SORO F; DELEDDA MG; MARRAS E; MARCHI SM; DELUCA C; MANETTA M; VOLTA SD; SPERANDEO V; DONZELLI M; VITRANO MG; GERACI E; PITROLO F; LAMONICA S; BELLANCA G; MESSINA G; MIRTO U; RAINERI A; TRAINA M; DIBENEDETTO A; RIBAUDO E; DIFRANCESCO M; RONCHITELLI R; CARONE M; DIGREGORIO D; DIPAOLO G; PASQUALE M; COREA L; COCCHIERI M; ALUNNI G; PAPI L; CHIRIATTI G; LUPETTI M; GAZZOLA U; ARRUZZOLI S; VILLANI GQ; MELLINI M; MADRUZZA L; PIAZZA R; MICHELI G; FRANCHINI C; BECHI S; MARTINES C; MARCHESE D; GABBIA G; BIGALLI A; CIUTI M; CABANI E; DELCITERNA F; ALFIERI A; CHITI M; LONGHINI J; CODELUPPI P; NEGRELLI M; ZANUTTINI D; NICOLOSI GL; MARTIN G; PETRELLA A; BARDAZZI L; BIANCO GA; CELLAMARE G; GIANNELLI F; LICITRA G; LICITRA R; LETTICA GV; TUMIOTTO G; BELLANTI G; BOSI S; CASALI G; MONDUCCI I; BARONE A; PARENTI F; HEYMAN J; COZZI E; BALDACCI G; BACCOS D; BRIGHI F; DESANCTIS A; BOCK R; PALMIERI M; ROSSI F; AMATI P; SEMPRINI P; NARDELLI A; BOTTERO G; VARTOLO C; MILAZZOTTO F; DICROCE G; DIMARIO F; ANGRISANI G; AZZOLINI P; NEJA CP; MANZOLI U; ROSSI E; TRANI C; MASINI V; SEBASTIANI F; TOPAI M; BORGIA MC; LUCIANI C; FERRI F; DEPAOLA D; CAPURSO S; TUGNOLI F; VETTA C; ALTIERI T; BORZI M; VISCOMI A; STRIANO U; SALITURI S; ZONZIN P; FIORENCIS R; BADIN A; RAVERA B; BALDI C; SILVESTRI F; ALLEMANO P; REYNAUD S; SANSON A; MILANI L; DESIMONE MV; RUSSO A; VILLELLA A; GRAZINI M; AMIDEI S; ANSELMI L; PICCANICOLINO R; MASCELLI G; TAGLIAMONTE A; MESSINA V; TEDESCHI C; BOSSI M; BISIOLI M; TACCHI G; PAGNI G; VIVALDI F; IBBA GV; SANNIA L; PEDRAZZINI F; BAGNI E; FABII S; ALVINO A; ANTONIELLI E; DORONZO B; MARTINENGO E; BECCHI G; SALMOIRAGHI A; DIGIOVANNA F; CARAMANNO G; CAPORICCI D; BRUN M; GIANI P; FERRARIO G; PECI P; RONCONI G; SKOUSE D; BIANCHI C; GIUSTINIANI S; CUCCHI GF; TAVASCI E; SILVERII A; MARCELLINI G; SPECA G; STANISCIA D; CIMINO A; SERAFINI N; DEBONIS P; CERRUTI P; BAZZUCCHI M; DALPRA F; SPEROTTO C; MOLE GD; BARBANO G; POMARI F; GASCHINO G; PARIGI A; GANDOLFO N; RONDONI F; BRUSCA A; DILEO M; GOLZIO PG; ABRATE M; SCLAVO MG; ROCCI R; POGGIO G; GIANI S; CUZZUCREA D; BRASCHI GB; SCIACCA R; SAMMARTANO A; FURLANELLO F; BRAITO G; CUZZATO V; TOTIS O; FAURETTO F; LEO F; GALATI A; PALMA P; CAMERINI F; MORGERA T; BARBIERI L; FERUGLIO GA; SLAVICK GA; FRESCO C; CUDA A; SARNICOLA P; ARZILLO P; BINAGHI G; MACCHI G; CALVERI G; DIMARCO G; LEVANTESI G; PANERAI C; CATURELLI G; FACCHIN L; SARTORE G; ZARDINI P; MARINO P; CARBONIERI E; NAVA S; MAZZINI C; NAVA R; SERRA N; SASSARA M; NICROSINI F; GANDOLFI P; BERGOGNONI G; BALLESTRA AM; VIOLO CVOLPI A; DEVITA C; FRANZOSI MG; GERACI E; MAGGIONI AP; MAURI F; NEGRI E; SANTORO E; TAVAZZI L; TOGNONI G; FERUGLIO GA; LOTTO A; ROVELLI F; SOLINAS P; TAVAZZI L; TOGNONI G; BRUNO M; CAPPELLO T; COPPINI A; FINCATI F; MANTOVANI G; PANGRAZZI J; POGNA M; TURAZZA FM; ANSELMI M; BARBONAGLIA L; BIGI R; CAVALLI A; FRIGERIO M; GIORDANO A; GUALTIEROTTI C; TORTA D; CAROLA R; GIORDANO F; BARLOTTI R; LOPARCO G; VIGLINO GL; RUGGERI G; GIAMUNDO L; DANESI A; PACIARONI E; GAMBINI C; URBANO G; PURCARO A; FRANCESCONI M; FIGLIOLIA S; CANNONE M; ANTOLINI R; DEVOTI G; CRISTALLINI P; PORCIELLO PI; TEONI P; BURALI A; ZUCCONELLI V; DEMATTEIS C; IERVOGLINI A; SCATASTA M; AMABILI S; CARATTI CA; ZOLA G; FERRAGUTO P; SALICI G; CENTARO A; ROTIROTI D; GENOVESE M; GINEVRINO P; DAMATO N; ALTAMURA CM; COLONNA L; CASTELLANETA G; BOVENZI F; MESSINA D; GALANTINO A; CAMPOREALE N; CUCCHINI F; CAMPOSTELLA L; MALACRIDA R; GENONI M; PELLEGRINI P; BRIDDA A; RIGGI L; ACONE L; MOSCATIELLO G; BRUNO A; INVERNIZZI G; TESPILI M; GUAGLIUMI G; CASARI A; ALBANO T; TOMASSINI B; TORTA D; DIBIASE G; SCARAMUZZINO G; RUGGERO S; BRACCHETTI D; DECASTRO U; FULVI M; BRAITO E; ERLICHER A; OBERLECHNER W; GAGLIARDI RS; BIGHIGNOLI L; BONIZZATO G; RIZZI GM; SCAZZINA L; PERRINI A; STRANEO G; STRANEO U; SCIRE A; VERRIENTI A; GUADALUPI M; STORELLI A; ZUCCA L; DABUSTI M; ALBONICO B; DEPETRA V; TABACCHI GC; SCERVINO R; MEREU D; MAXIA P; BIANCO A; CRABU E; MANGIAMELI S; CENTAMORE G; MALFITANO D; AMICO C; VANCHERI F; SANTOPUOLI G; BALDINI F; PANTALEONI A; CONTESSOTTO F; TERLIZZI R; MERIGHI A; TURCHI E; TEGLIO V; PIGNATTI F; PEZZANA A; GOZZOLINO G; GIGLIO M; PETTINATI G; IEVA M; CIRICUGNO S; CORREALE E; ROMANO S; DIFUCCIA A; CASTELLANO B; NATALE A; CERNETTI C; CELEGON L; CANDELPERGHER G; ARIENZO F; RUSSO F; DEVIVO L; MAY L; ACHILLI G; BLASI A; SORRENTINO F; DATO A; GALLONE P; PALUMBO C; DELLAMONICA R; PAGANO L; ALBERTI A; ORSELLI L; DEPONTI C; PARMIGIANI ML; FERRARI M; ACITO P; BUSI F; DELLAVITTORIA G; BELLET C; BORTOLINI F; ROSSI A; CORONA C; BONDI S; NICCOLINI D; GAMBERI G; ARCURI G; MAIOLINO P; CARROZZA A; DELIO U; CAPRETTI G; MARINONI C; GUASCONI C; SONNINO S; PAGLIEI M; FERRARI G; LOMBARDI R; AGNELLI D; DERINALDIS G; CALCAGNILE A; SIGNORELLI S; BENDINELLI S; LUSETTI L; MOLLAIOLI M; COSMI F; PLASTINA F; VENNERI N; FERACO E; CATELLI P; POLUZZI C; DISTANTE S; BIANCHI C; COPPETTI S; ZAMPAGLIONE G; GATTO C; ZURLO R; USLENGHI E; MARGARIA F; MILANESE U; LOMANTO B; ZIACCHI V; RIVA D; BERTOCCHI P; TIRELLA G; DAULERIO M; SAURO G; BINI A; MAZZONI V; POGGI P; MARESTA A; JACOPI F; PATRONCINI A; PUPITA F; GAGGI S; FRAUSINI G; ANTONIOLI GE; MALACARNE C; CODECA L; CAPPATO R; ANDREOLI L; VARACCA S; BUIO E; FAZZINI PF; PUCCI P; SARRO F; VERGASSOLA R; BARCHIELLI M; DEMATTEIS D; CARRONE M; BRUNOZZI LT; MENICONI L; LIBERATI R; RADOGNA M; TALLONE M; CONTE R; IERI A; ZIPOLI A; SANSONI M; CANZIANI R; GUIDALI P; CRISTALLO E; MARIELLO F; MUZIO L; BENVENUTO MR; BALDINI MR; VECCHIO C; CHIARELLA F; FALCIDIENO M; CECCHI A; GIULIANO G; SEU V; PERUGINI P; TOSELLI A; BASSO F; CORTI E; ROSSI P; DELFINO R; CAPONNETTO S; GNECCO G; GHIGLIOTTI G; PENNESI A; LOMBARDI G; RUGGIERI A; BERTOLO L; SLOMP L; LANZETTA T; MAZZARONE L; CRESTI A; BELLODI G; ZUARINI AM; VENERI L; PARCHI C; GIOVANELLI N; NEGRONI S; DETHOMATIS M; BARGHINI A; MARINO E; RICCI D; LEMME P; DIGIACOMO U; AQUARO G; RONZANI G; OTTELLO B; VONTI V; MORETTI S; PALERMO R; MARSILI P; SIDERI F; RAGAZZINI G; GRAMENZI S; BATTISTINI S; DIODATO T; VALERIO A; TUCCI C; DEPASQUALE B; GELFO PG; BERTULLA A; BOLLINI R; DEMARCHI E; BACCA F; DEGIORGI V; LOCATELLI V; SAVOIA MT; FERRACINI C; BARBARESI F; COTOGNI A; FRANCO G; ROMANO S; PASSONI F; DURBANO M; MORETTI G; PEROTTI S; CAPRETTI M; DELBENE P; CASCONE M; BALDINI U; ORLANDI M; ODDONE A; CAIZZI V; MASINI G; LAZZARI M; BALLERINI B; BOZZI L; MOCETTI T; BERTOLINI A; PASOTTI E; SANGUINETTI M; MANTOVANI R; TOGNOLI T; MAGGI A; TUSA M; CAMERONI E; GUERRA GP; REGGIANI A; REDAELLI S; GIUSTI S; TANTALO L; RIZZI A; DIGIOVANNI N; GUZZO V; GABRIELE M; COLOMBO G; ALBERZONI A; SALVIOLI G; GALFETTI F; DOVICO E; BELLUZZI F; GOLA E; CASELLATO F; LECCHI G; CONSOLO F; SACCA CB; CONSOLO A; PICCOLO E; GASPARINI G; DEVITA C; ALBERTI A; MASSA D; BELLI C; DOSSENA MG; CORSINI C; SANNA GP; AZZOLLINI M; TRUAZZA F; LOTTO A; NADOR F; DEMARTINI M; BOZZI G; SEREGNI R; PASTINE I; MORPURGO M; CASAZZA F; REGALIA F; MAGGIOLINI S; RIGO R; PANCALDI S; POZZETTI D; PASCOTTO P; FRANCESCHI L; DAINESE F; MELINI L; CAPPELLI C; BERNARDI C; PALMIERI M; BORGIONI L; ZILIO G; SANDRI R; ALITTO F; MASARO G; VALAGUSSA F; SCHIAVINA R; RAVESI D; DANIELLO L; PIANTADOSI FR; BARRA P; ROMEO D; MININNI N; SEVERINO S; MOSTACCI M; CASTELLARI M; BANDA D; ROLANDI R; VILLA WD; CARBONE V; ALLEGRI M; FASCIOLO L; PITTALIS M; MUREDDU V; SORO F; DELEDDA MG; MARRAS E; MARCHI SM; DELUCA C; MANETTA M; VOLTA SD; SPERANDEO V; DONZELLI M; VITRANO MG; GERACI E; PITROLO F; LAMONICA S; BELLANCA G; MESSINA G; MIRTO U; RAINERI A; TRAINA M; DIBENEDETTO A; RIBAUDO E; DIFRANCESCO M; RONCHITELLI R; CARONE M; DIGREGORIO D; DIPAOLO G; PASQUALE M; COREA L; COCCHIERI M; ALUNNI G; PAPI L; CHIRIATTI G; LUPETTI M; GAZZOLA U; ARRUZZOLI S; VILLANI GQ; MELLINI M; MADRUZZA L; PIAZZA R; MICHELI G; FRANCHINI C; BECHI S; MARTINES C; MARCHESE D; GABBIA G; BIGALLI A; CIUTI M; CABANI E; DELCITERNA F; ALFIERI A; CHITI M; LONGHINI J; CODELUPPI P; NEGRELLI M; ZANUTTINI D; NICOLOSI GL; MARTIN G; PETRELLA A; BARDAZZI L; BIANCO GA; CELLAMARE G; GIANNELLI F; LICITRA G; LICITRA R; LETTICA GV; TUMIOTTO G; BELLANTI G; BOSI S; CASALI G; MONDUCCI I; BARONE A; PARENTI F; HEYMAN J; COZZI E; BALDACCI G; BACCOS D; BRIGHI F; DESANCTIS A; BOCK R; PALMIERI M; ROSSI F; AMATI P; SEMPRINI P; NARDELLI A; BOTTERO G; VARTOLO C; MILAZZOTTO F; DICROCE G; DIMARIO F; ANGRISANI G; AZZOLINI P; NEJA CP; MANZOLI U; ROSSI E; TRANI C; MASINI V; SEBASTIANI F; TOPAI M; BORGIA MC; LUCIANI C; FERRI F; DEPAOLA D; CAPURSO S; TUGNOLI F; VETTA C; ALTIERI T; BORZI M; VISCOMI A; STRIANO U; SALITURI S; ZONZIN P; FIORENCIS R; BADIN A; RAVERA B; BALDI C; SILVESTRI F; ALLEMANO P; REYNAUD S; SANSON A; MILANI L; DESIMONE MV; RUSSO A; VILLELLA A; GRAZINI M; AMIDEI S; ANSELMI L; PICCANICOLINO R; MASCELLI G; TAGLIAMONTE A; MESSINA V; TEDESCHI C; BOSSI M; BISIOLI M; TACCHI G; PAGNI G; VIVALDI F; IBBA GV; SANNIA L; PEDRAZZINI F; BAGNI E; FABII S; ALVINO A; ANTONIELLI E; DORONZO B; MARTINENGO E; BECCHI G; SALMOIRAGHI A; DIGIOVANNA F; CARAMANNO G; CAPORICCI D; BRUN M; GIANI P; FERRARIO G; PECI P; RONCONI G; SKOUSE D; BIANCHI C; GIUSTINIANI S; CUCCHI GF; TAVASCI E; SILVERII A; MARCELLINI G; SPECA G; STANISCIA D; CIMINO A; SERAFINI N; DEBONIS P; CERRUTI P; BAZZUCCHI M; DALPRA F; SPEROTTO C; MOLE GD; BARBANO G; POMARI F; GASCHINO G; PARIGI A; GANDOLFO N; RONDONI F; BRUSCA A; DILEO M; GOLZIO PG; ABRATE M; SCLAVO MG; ROCCI R; POGGIO G; GIANI S; CUZZUCREA D; BRASCHI GB; SCIACCA R; SAMMARTANO A; FURLANELLO F; BRAITO G; CUZZATO V; TOTIS O; FAURETTO F; LEO F; GALATI A; PALMA P; CAMERINI F; MORGERA T; BARBIERI L; FERUGLIO GA; SLAVICK GA; FRESCO C; CUDA A; SARNICOLA P; ARZILLO P; BINAGHI G; MACCHI G; CALVERI G; DIMARCO G; LEVANTESI G; PANERAI C; CATURELLI G; FACCHIN L; SARTORE G; ZARDINI P; MARINO P; CARBONIERI E; NAVA S; MAZZINI C; NAVA R; SERRA N; SASSARA M; NICROSINI F; GANDOLFI P; BERGOGNONI G; BALLESTRA AM; VIOLO

MEDICAL SCIENCE. GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction

A multicentre, randomised, open trial with a 2 x 2 factorial design was conducted to compare the benefits and risks of two thrombolytic agents, streptokinase (SK, 1\ub75 MU infused intravenously over 30-60 min) and alteplase (tPA, 100 mg infused intravenously over 3 h) in patients with acute myocardial infarction admitted to coronary care units within 6 h from onset of symptoms. The patients were also randomised to receive heparin (12 500 U subcutaneously twice daily until discharge from hospital, starting 12 h after beginning the tPA or SK infusion) or usual therapy. All patients without specific contraindications were given atenolol (5-10 mg iv) and aspirin (300-325 mg a day). The end-point of the study was the combined estimate of death plus severe left ventricular damage. 12 490 patients were randomised to four treatment groups (SK alone, SK plus heparin, tPA alone, tPA plus heparin). No specific differences between the two thrombolytic agents were detected as regards the combined end-point (tPA 23\ub71%; SK 22\ub75%; relative risk 1\ub704, 95% Cl 0\ub795-1\ub713), nor after the addition of heparin to the aspirin treatment (hep 22\ub77%, no hep 22\ub79%; RR 0\ub799, 95% Cl 0\ub791-1\ub708). The outcome of patients allocated to the four treatment groups was similar with respect to baseline risk factors such as age, Killip class, hours from onset of symptoms, and site and type of infarct. The rates of major in-hospital cardiac complications (reinfarction, post-infarction angina) were also similar. The incidence of major bleeds was significantly higher in SK and heparin treated patients (respectively, tPA 0\ub75%, SK 1\ub70%, RR 0\ub757, 95% Cl 0\ub738-0\ub785; hep 1\ub70%, no hep 0\ub76%, RR 1\ub764, 95% Cl 1\ub709-2\ub745), whereas the overall incidence of stroke was similar in all groups. SK and tPA appear equally effective and safe for use in routine conditions of care, in all infarct patients who have no contraindications, with or without post-thrombolytic heparin treatment. The 8\ub78% hospital mortality of the study population (compared with approximately 13% in the control cohort of the GISSI-1 trial) indicates the beneficial impact of the proven acute treatments for AMI. \ua9 1990

Prognostic impact of diabetes and prediabetes on survival outcomes in patients with chronic heart failure: a post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial

Background-The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial.Methods and Results-We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n= 2852), pre-DM (n= 2013), and non-DM (n= 2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively).Conclusions-Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure

Prognostic impact of diabetes and prediabetes on survival outcomes in patients with chronic heart failure: A post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial

826BACKGROUND: The independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre-DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre-DM on survival outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. METHODS AND RESULTS: We assessed the risk of all-cause death and the composite of all-cause death or cardiovascular hospitalization over a median follow-up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI-HF trial, who were stratified by presence of DM (n=2852), pre-DM (n=2013), and non-DM (n=2070) at baseline. Compared with non-DM patients, those with DM had remarkably higher incidence rates of all-cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non-DM patients and those with pre-DM. Cox regression analysis showed that DM, but not pre-DM, was associated with an increased risk of all-cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28-1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all-cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02-1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01-1.29, respectively). CONCLUSIONS: Presence of DM was independently associated with poor long-term survival outcomes in patients with chronic heart failure.openopenDauriz, Marco; Targher, Giovanni; Temporelli, Pier Luigi; Lucci, Donata; Gonzini, Lucio; Nicolosi, Gian Luigi; Marchioli, Roberto; Tognoni, Gianni; Latini, Roberto; Cosmi, Franco; Tavazzi, Luigi; Maggioni, Aldo Pietro*; Moccetti, T.; Rossi, M.G.; Pasotti, E.; Vaghi, F.; Roncarolo, P.; Zunino, M.T.; Matta, F.; Actis Perinetto, E.; Gaita, F.; Azzaro, G.; Zanetta, M.; Paino, A.M.; Parravicini, U.; Vegis, D.; Conte, R.; Ferraro, P.; De Bernardi, A.; Morelloni, S.; Fagnani, M.; Greco Lucchina, P.; Montagna, L.; Bellone, E.; Sappè, D.; Ferraro, F.; Delucchi, M.; Reynaud, S.G.; Dore, M.; La Brocca, A.; Massobrio, N.; Bo, L.; Trinchero, R.; Imazio, M.; Brocchi, G.; Nejrotti, A.; Rissone, L.; Gabasio, S.; Zocchi, C.; Randazzo, S.; Crenna, A.; Giannuzzi, P.; Bonanomi, E.; Mezzani, A.; De Marchi, M.; Begliuomini, G.; Gianonatti, C.A.; Gavazzi, A.; Grosu, A.; Dei Cas, L.; Nodari, S.; Garyfallidis, P.; Bertoletti, A.; Bonifazi, C.; Arisi, S.; Mascaro, F.; Fraccarollo, M.; Dell'Orto, S.; Sfolcini, M.; Bortolini, F.; Raccagni, D.; Turelli, A.; Santarone, M.; Miglierina, E.; Sormani, L.; Jemoli, R.; Tettamanti, F.; Pirelli, S.; Bianchi, C.; Verde, S.; Mariani, M.; Ziacchi, V.; Ferrazza, A.; Russo, A.; Bortolotti, M.; Pasini, G.F.; Volpi, A.; Jones, K.N.; Cuzzucrea, D.; Gullace, G.; Carbone, C.; Granata, A.; De Servi, S.; Del Rosso, G.; Inserra, C.; Renaldini, E.; Zappa, C.; Moretti, M.; Zanini, R.; Ferrari, M.; Moroni, E.; Cei, A.; Lissi, C.; Dovico, E.; Fiorentini, C.; Palermo, P.; Brusoni, B.; Negrini, M.; Heyman, J.; Danzi, G.B.; Finzi, A.; Frigerio, M.; Turazza, F.; Beretta, L.; Sachero, A.; Casazza, F.; Squadroni, L.; Lombardi, F.; Marano, L.; Margonato, A.; Fragasso, G.; Febo, O.C.; Aiolfi, E.; Olmetti, F.; Grieco, A.; Antonazzo, V.; Specchia, G.; Mortara, A.; Robustelli, F.; Songini, M.G.; Schweiger, C.; Frisinghelli, A.; Palvarini, M.; Campana, C.; Scelsi, L.; Ajmone Marsan, N.; Cobelli, F.; Gualco, A.; Opasich, C.; De Feo, S.; Mazzucco, R.; Iannone, M.A.; Diaco, T.; Zaniboni, D.; Milanesi, G.; Nassiacos, D.; Meloni, S.; Giani, P.; Nicoli, T.; Malinverni, C.; Gusmini, A.; Pozzoni, L.; Bisiani, G.; Margaroli, P.; Schizzarotto, A.; Daverio, A.; Occhi, G.; Partesana, N.; Bandini, P.; Rosella, M.G.; Giustiniani, S.; Cucchi, G.; Pedretti, R.; Raimondo, R.; Vaninetti, R.; Fedele, A.; Ghezzi, I.; Rezzonico, E.; Salerno Uriarte, J.A.; Morandi, F.; Salvucci, F.; Valenti, C.; Graziano, G.; Romanò, M.; Cimminiello, C.; Mangone, I.; Lombardo, M.; Quorso, P.; Marinoni, G.; Breghi, M.; Erckert, M.; Dienstl, A.; Mirante Marini, G.; Stefenelli, C.; Cioffi, G.; Buczkowska, E.; Bonanome, A.; Bazzanini, F.; Parissenti, L.; Serafini, C.; Catania, G.; Tarantini, L.; Rigatelli, G.; Boni, S.; Pasini, A.; Masini, E.; Zampiero, A.A.; Zanchetta, M.; Franceschetto, L.; Delise, P.; Marcon, C.; Sacchetta, A.; Borgese, L.; Artusi, L.; Casolino, P.; Corbara, F.; Banzato, A.; Barbiero, M.; Aldegheri, M.P.; Bazzucco, R.; Crivellenti, G.; Raviele, A.; Zanella, C.; Pascotto, P.; Sarto, P.; Milan, S.; Barbieri, E.; Girardi, P.; Dalla Villa, W.; Dalle Mule, J.; Di Sipio, M.L.; Cazzin, R.; Milan, D.; Zonzin, P.; Carraro, M.; Rossi, R.; Carbonieri, E.; Rossi, I.; Stritoni, P.; Meneghetti, P.; Risica, G.; Tenderini, P.L.; Vassanelli, C.; Zanolla, L.; Perini, G.; Brighetti, G.; Chiozza, R.; Giuliano, G.; Baldin, M.G.; Gortan, R.; Cesanelli, R.; Nicolosi, G.L.; Piazza, R.; Mos, L.; Vriz, O.; Pavan, D.; Pascottini, G.; Alberti, E.; Werren, M.; Solinas, L.; Sinagra, G.; Longaro, F.; Fioretti, P.; Albanese, M.C.; Miani, D.; Gianrossi, R.; Pende, A.; Rubartelli, P.; Magaia, O.; Domenicucci, S.; Caruso, D.; Faraguti, A.S.; Magliani, L.; Miccoli, F.; Guglielmino, G.; Bertoli, D.; Cantarelli, A.; Orlandi, S.; Vallebona, A.; Pozzati, A.; Brega, G.; Pancaldi, L.G.; Vandelli, R.; Urbinati, S.; Poci, M.G.; Zoli, M.; Costa, G.M.; Guiducci, U.; Zobbi, G.; Tartagni, F.; Tisselli, A.; Gentili, A.; Pieri, P.; Cagnetta, E.; Bendinelli, S.; Barbieri, A.; Conti, R.; Ferrari, R.; Merlini, F.; Fucili, A.; Moruzzi, P.; Buia, E.; Galvani, M.; Ferrini, D.; Baggioni, G.; Yiannacopulu, P.; Canè, G.; Bonfiglioli, A.; Zandomeneghi, R.; Brugioni, L.; Giannini, A.; Di Ruvo, R.; Giuliani, M.; Rusconi, L.; Del Corso, P.; Piovaccari, G.; Bologna, F.; Venturi, P.; Melandri, F.; Bagni, E.; Bolognese, L.; Perticucci, R.; Zuppiroli, A.; Nannini, M.; Consoli, N.; Petrone, P.; Pipitò, C.; Colombi, L.; Bernardi, D.; Mariani, P.R.; Testa, R.; Mazzinghi, F.; Cosmi, F.; Cosmi, D.; Zipoli, A.; Cecchi, A.; Castelli, G.; Ciaccheri, M.; Mori, F.; Pieri, F.; Valoti, P.; Chiarantini, D.; Santoro, G.M.; Minneci, C.; Marchi, F.; Milli, M.; Zambaldi, G.; Zipoli, A.; Brandinelli Geri, A.A.; Cipriani, M.; Alessandri, M.; Severi, S.; Stefanelli, S.; Comella, A.; Poddighe, R.; Digiorgio, A.; Carluccio, M.; Berti, S.; Rizza, A.; Bonatti, V.; Molendi, V.; Brancato, A.; D'Aprile, N.; Giappichini, G.; Del Vecchio, S.; Mantini, G.; De Tommasi, F.; Meucci, G.; Cordoni, M.; Bechi, S.; Barsotti, L.; Baldini, P.; Romei, M.; Scopelliti, G.; Lauri, G.; Pestelli, F.; Furiozzi, F.; Cocchieri, M.; Severini, D.; Patriarchi, F.; Chiocchi, P.; Buccolieri, M.; Martinelli, S.; Wee, A.; Angelici, F.; Bernardinangeli, M.; Proietti, G.; Biscottini, B.; Panciarola, R.; Marinacci, L.; Perna, G.P.; Gabrielli, D.; Moraca, A.; Moretti, L.; Partemi, L.; Gregori, G.; Amici, R.; Patteri, G.; Capone, P.; Savini, E.; Morgagni, G.L.; Paccaloni, L.; Pezzuoli, F.; Carincola, S.; Papi, S.; De Crescentini, S.; Gerardi, P.; Midi, P.; Gallenzi, E.; Pajes, G.; Mancone, C.; Di Spirito, V.; Di Gennaro, M.; Calcagno, S.; Toscano, S.; Antonicoli, S.; Carta, F.; Giorgi, G.; Comito, F.; Daniele, E.; Ciarla, O.; Gelfo, P.G.; Acquaviva, A.; Testa, D.; Testa, G.; Pagliaro, F.A.; Russo, F.; Vetta, F.; Marchese, I.; Di Sciascio, G.; D'Ambrosio, A.; Leggio, F.; Del Sindaco, D.; Lacchè, A.; Avallone, A.; Risa, M.P.; Azzolini, P.; Baldo, E.; Giovannini, E.; Pulignano, G.; Tondo, C.; Picchio, E.; Biffani, E.; Tanzi, P.; Pozzar, F.; Farnetti, F.; Azzarito, M.; Santini, M.; Varveri, A.; Ferraiuolo, G.; Valtorta, C.; Gaspardone, A.; Barbato, G.; Ceci, V.; Aspromonte, N.; Bellocci, F.; Colizzi, C.; Fedele, F.; Perez, F.I.; Galati, A.; Rossetti, A.; Mainella, A.; Ciuffetta, D.; Matteucci, C.; Busi, G.; De Angelis, A.; Farina, G.; Granatelli, A.; Leone, F.; Frasca, F.; Pajes, G.; Di Giovambattista, R.; Castellani, G.; Massaro, G.; Mastrogiuseppe, G.; Vacri, A.; De Sanctis, F.; Cioli, M.; Di Luzio, S.; Napoletano, C.; Piccioni, L.L.; De Simone, G.; Ottaviano, A.; Mazza, V.; Spedaliere, C.; Staniscia, D.; Calgione, E.; De Marco, G.; Chiacchio, T.; Di Napoli, T.; Romanzi, S.; Salvatore, G.; Golino, P.; Palermo, A.; Mascia, F.; Vetrano, A.; Vinciguerra, A.; Caliendo, L.; Longobardi, R.; De Caro, G.; Di Nola, R.; Piemonte, F.; Prinzi, D.; De Rosa, P.; De Rosa, V.; Riello, F.; Capuano, V.; Vecchio, G.; Landi, M.; Amato, S.; Garofalo, M.; Caruso, D.; D'Avino, M.; Sensale, P.; Maiolica, O.; Santoro, R.; Caso, P.; Miceli, D.; Maurea, N.; Bianchi, U.; Crispo, C.; Chiariello, M.; Perrone Filardi, P.; Russo, L.; Capuano, N.; Ungaro, G.; Vergara, G.; Scafuro, F.; D'Angelo, G.; Campaniello, C.; Bottiglieri, P.; Volpe, A.; Battista, R.; De Risi, L.; Cardillo, G.; Sibilio, G.; Marino, A.P.; Silvestri, F.; Predotti, P.; Iervoglini, A.; Stefanelli, S.; De Matteis, C.; Sarnicola, P.; Matarazzo, M.M.; Baldi, S.; Iuliano, V.; Astarita, C.; Cuccaro, P.; Liguori, A.; Liguori, G.; Gregorio, G.; Petraglia, L.; Antonelli, G.; Amodio, G.; De Luca, I.; Traversa, D.; Franchini, G.; Lenti, M.L.; Cavallari, D.; D'Agostino, C.; Scalera, G.; Altamura, C.M.; Russo, M.; Mascolo, A.R.; Pettinati, G.; Ciricugno, S.A.; Scrutinio, D.; Passantino, A.; Mastrangelo, D.; Di Masi, A.; De Carne, R.; Cannone, M.; Dibiase, F.; Pensato, M.; Loliva, F.; Trapani, F.; Panettieri, I.; Leone, L.; Di Biase, M.; Carrone, M.; Gallone, V.; Cocco, F.; Costantini, M.; Tritto, C.; Cavalieri, F.; Stella, L.; Magliari, F.; Callerame, M.; De Giorgi, A.; Pellegrino, L.; Correra, M.; Portulano, V.; Nisi, G.L.; Grassi, G.; Cristallo, E.; De Laura, D.; Salerno, C.; Fanelli, R.; Villella, M.; Pede, S.; Renna, A.; De Lorenzi, E.; Urso, L.; Lenti, V.; Peluso, A.; Baldi, N.; Polimeni, G.; Galati, A.; Palma, P.; Lauletta, R.; Tagliamonte, E.; Cirillo, T.; Silvestri, B.; Centonze, G.; D'Alessandro, B.; Truncellito, L.; Mecca, D.; Petruzzi, M.A.; Coviello, R.O.M.; Lopizzo, A.; Chiaffitelli, M.; Barbuzzi, S.; Gubelli, S.; Germinario, G.; Cosentino, N.; Mingrone, A.; Vico, R.; Borrello, G.; Mazza, M.L.; Cimino, R.; Galasso, D.; Cassadonte, F.; Talarico, U.; Perticone, F.; Cassano, S.; Catapano, F.; Calemme, S.; Feraco, E.; Cloro, C.; Misuraca, G.; Caporale, R.; Vigna, L.; Spagnuolo, V.; De Rosa, F.; Spadafora, G.; Zampaglione, G.; Russo, R.; Schipani, F.A.; Ferragina, A.F.; Stranieri, D.; Musca, G.; Carpino, C.; Bencardino, P.; Raimondo, F.; Musacchio, D.; Pulitanò, G.; Ruggeri, A.; Provenzano, A.; Salituri, S.; Musolino, M.; Calandruccio, S.; Marrari, A.; Tripodi, E.; Scali, R.; Anastasio, L.; Arone, A.; Aragona, P.; Donnangelo, L.; Comito, M.G.A.; Bilotta, F.; Vaccaro, I.; Rametta, R.; Ventura, V.; Bonvegna, A.; Alì, A.; Cinnirella, C.; Raineri, M.; Pompeo, F.; Cascio Ingurgio, N.; Carini, V.; Coco, R.; Giunta, G.; Leonardi, G.; Randazzo, V.; Di Blasi, V.; Tamburino, C.; Russo, G.; Mangiameli, S.; Cardillo, R.; Castelli, D.; Inserra, V.; Arena, A.; Gulizia, M.M.; Raciti, S.; Rapisarda, G.; Romano, R.; Prestifilippo, P.; Braschi, G.B.; Ledda, G.; Terrazzino, R.; De Caro, M.; Scilabra, G.; Graffagnino, B.; Grassi, R.; Di Tano, G.; Scimone, G.F.; Vasquez, L.; Coppolino, C.; Casale, A.; Castelli, M.; D'Urso, G.; D'Antonio, E.; Lo Presti, L.; Badalamenti, E.; Conti, P.; Sanfilippo, N.; Cirrincione, V.; Cinà, M.T.; Cusimano, G.; Taormina, A.; Giuliano, P.; Bajardi, A.; Mandalà, V.; Canonico, A.; Geraci, G.; Sabella, F.P.; Enia, F.; Floresta, A.M.; Lo Cascio, I.; Gumina, D.; Cavallaro, A.; Piccione, G.; Ferrante, R.; Blandino, M.; Iudicello, M.S.; Mossuti, E.; Romano, G.; Lombardo, L.; Monastra, P.; Di Vincenzo, D.; Porcu, M.; Orrù, P.; Muscas, F.; Giardina, G.; Corda, M.; Locci, G.; Podda, A.; Ledda, M.; Siddi, P.; Lai, C.; Pili, G.; Mercuro, G.; Mureddu, G.; Ganau, A.; Meloni, G.; Poddighe, G.; Sanna, G.; Barlera, Simona; Franzosi, Maria Grazia; Porcu, Maurizio; Yusuf, Salim; Camerini, Fulvio; Cohn, Jay N.; Decarli, Adriano; Pitt, Bertram; Sleight, Peter; Poole-Wilson, Philip A.; Geraci, Enrico; Scherillo, Marino; Fabbri, Gianna; Bartolomei, Barbara; Bertoli, Daniele; Cobelli, Franco; Fresco, Claudio; Ledda, Antonietta; Levantesi, Giacomo; Opasich, Cristina; Rusconi, Franco; Sinagra, Gianfranco; Turazza, Fabio; Volpi, Alberto; Ceseri, Martina; Alongi, Gianluca; Atzori, Antonio; Bambi, Filippo; Bastarolo, Desiree; Bianchini, Francesca; Cangioli, Iacopo; Canu, Vittoriana; Caporusso, Concetta; Cenni, Gabriele; Cintelli, Laura; Cocchio, Michele; Confente, Alessia; Fenicia, Eva; Friso, Giorgio; Gianfriddo, Marco; Grilli, Gianluca; Lazzaro, Beatrice; Lonardo, Giuseppe; Luise, Alessia; Nota, Rachele; Orlando, Mariaelena; Petrolo, Rosaria; Pierattini, Chiara; Pierota, Valeria; Provenzani, Alessandro; Quartuccio, Velia; Ragno, Anna; Serio, Chiara; Spolaor, Alvise; Tafi, Arianna; Tellaroli, Elisa; Ghio, Stefano; Ghizzardi, Elisa; Masson, Serge; Crociati, Lella; La Rovere, Maria Teresa; Corrà, Ugo; Di Giulio, Paola; Finzi, Andrea; Gorini, Marco; Milani, Valentina; Orsini, Giampietro; Bianchini, Elisa; Cabiddu, Silvia; Cangioli, Ilaria; Cipressa, Laura; Cipressa, Maria Lucia; Di Bitetto, Giuseppina; Ferri, Barbara; Galbiati, Luisa; Lorimer, Andrea; Pera, Carla; Priami, Paola; Vasamì, AntonellaDauriz, Marco; Targher, Giovanni; Temporelli, Pier Luigi; Lucci, Donata; Gonzini, Lucio; Nicolosi, Gian Luigi; Marchioli, Roberto; Tognoni, Gianni; Latini, Roberto; Cosmi, Franco; Tavazzi, Luigi; Maggioni, Aldo Pietro; Moccetti, T.; Rossi, M. G.; Pasotti, E.; Vaghi, F.; Roncarolo, P.; Zunino, M. T.; Matta, F.; Actis Perinetto, E.; Gaita, F.; Azzaro, G.; Zanetta, M.; Paino, A. M.; Parravicini, U.; Vegis, D.; Conte, R.; Ferraro, P.; De Bernardi, A.; Morelloni, S.; Fagnani, M.; Greco Lucchina, P.; Montagna, L.; Bellone, E.; Sappè, D.; Ferraro, F.; Delucchi, M.; Reynaud, S. G.; Dore, M.; La Brocca, A.; Massobrio, N.; Bo, L.; Trinchero, R.; Imazio, M.; Brocchi, G.; Nejrotti, A.; Rissone, L.; Gabasio, S.; Zocchi, C.; Randazzo, S.; Crenna, A.; Giannuzzi, P.; Bonanomi, E.; Mezzani, A.; De Marchi, M.; Begliuomini, G.; Gianonatti, C. A.; Gavazzi, A.; Grosu, A.; Dei Cas, L.; Nodari, S.; Garyfallidis, P.; Bertoletti, A.; Bonifazi, C.; Arisi, S.; Mascaro, F.; Fraccarollo, M.; Dell'Orto, S.; Sfolcini, M.; Bortolini, F.; Raccagni, D.; Turelli, A.; Santarone, M.; Miglierina, E.; Sormani, L.; Jemoli, R.; Tettamanti, F.; Pirelli, S.; Bianchi, C.; Verde, S.; Mariani, M.; Ziacchi, V.; Ferrazza, A.; Russo, A.; Bortolotti, M.; Pasini, G. F.; Volpi, A.; Jones, K. N.; Cuzzucrea, D.; Gullace, G.; Carbone, C.; Granata, A.; De Servi, S.; Del Rosso, G.; Inserra, C.; Renaldini, E.; Zappa, C.; Moretti, M.; Zanini, R.; Ferrari, M.; Moroni, E.; Cei, A.; Lissi, C.; Dovico, E.; Fiorentini, C.; Palermo, P.; Brusoni, B.; Negrini, M.; Heyman, J.; Danzi, G. B.; Finzi, A.; Frigerio, M.; Turazza, F.; Beretta, L.; Sachero, A.; Casazza, F.; Squadroni, L.; Lombardi, F.; Marano, L.; Margonato, A.; Fragasso, G.; Febo, O. C.; Aiolfi, E.; Olmetti, F.; Grieco, A.; Antonazzo, V.; Specchia, G.; Mortara, A.; Robustelli, F.; Songini, M. G.; Schweiger, C.; Frisinghelli, A.; Palvarini, M.; Campana, C.; Scelsi, L.; Ajmone Marsan, N.; Cobelli, F.; Gualco, A.; Opasich, C.; De Feo, S.; Mazzucco, R.; Iannone, M. A.; Diaco, T.; Zaniboni, D.; Milanesi, G.; Nassiacos, D.; Meloni, S.; Giani, P.; Nicoli, T.; Malinverni, C.; Gusmini, A.; Pozzoni, L.; Bisiani, G.; Margaroli, P.; Schizzarotto, A.; Daverio, A.; Occhi, G.; Partesana, N.; Bandini, P.; Rosella, M. G.; Giustiniani, S.; Cucchi, G.; Pedretti, R.; Raimondo, R.; Vaninetti, R.; Fedele, A.; Ghezzi, I.; Rezzonico, E.; Salerno Uriarte, J. A.; Morandi, F.; Salvucci, F.; Valenti, C.; Graziano, G.; Romanò, M.; Cimminiello, C.; Mangone, I.; Lombardo, M.; Quorso, P.; Marinoni, G.; Breghi, M.; Erckert, M.; Dienstl, A.; Mirante Marini, G.; Stefenelli, C.; Cioffi, G.; Buczkowska, E.; Bonanome, A.; Bazzanini, F.; Parissenti, L.; Serafini, C.; Catania, G.; Tarantini, L.; Rigatelli, G.; Boni, S.; Pasini, A.; Masini, E.; Zampiero, A. A.; Zanchetta, M.; Franceschetto, L.; Delise, P.; Marcon, C.; Sacchetta, A.; Borgese, L.; Artusi, L.; Casolino, P.; Corbara, F.; Banzato, A.; Barbiero, M.; Aldegheri, M. P.; Bazzucco, R.; Crivellenti, G.; Raviele, A.; Zanella, C.; Pascotto, P.; Sarto, P.; Milan, S.; Barbieri, E.; Girardi, P.; Dalla Villa, W.; Dalle Mule, J.; Di Sipio, M. L.; Cazzin, R.; Milan, D.; Zonzin, P.; Carraro, M.; Rossi, R.; Carbonieri, E.; Rossi, I.; Stritoni, P.; Meneghetti, P.; Risica, G.; Tenderini, P. L.; Vassanelli, C.; Zanolla, L.; Perini, G.; Brighetti, G.; Chiozza, R.; Giuliano, G.; Baldin, M. G.; Gortan, R.; Cesanelli, R.; Nicolosi, G. L.; Piazza, R.; Mos, L.; Vriz, O.; Pavan, D.; Pascottini, G.; Alberti, E.; Werren, M.; Solinas, L.; Sinagra, G.; Longaro, F.; Fioretti, P.; Albanese, M. C.; Miani, D.; Gianrossi, R.; Pende, A.; Rubartelli, P.; Magaia, O.; Domenicucci, S.; Caruso, D.; Faraguti, A. S.; Magliani, L.; Miccoli, F.; Guglielmino, G.; Bertoli, D.; Cantarelli, A.; Orlandi, S.; Vallebona, A.; Pozzati, A.; Brega, G.; Pancaldi, L. G.; Vandelli, R.; Urbinati, S.; Poci, M. G.; Zoli, M.; Costa, G. M.; Guiducci, U.; Zobbi, G.; Tartagni, F.; Tisselli, A.; Gentili, A.; Pieri, P.; Cagnetta, E.; Bendinelli, S.; Barbieri, A.; Conti, R.; Ferrari, R.; Merlini, F.; Fucili, A.; Moruzzi, P.; Buia, E.; Galvani, M.; Ferrini, D.; Baggioni, G.; Yiannacopulu, P.; Canè, G.; Bonfiglioli, A.; Zandomeneghi, R.; Brugioni, L.; Giannini, A.; Di Ruvo, R.; Giuliani, M.; Rusconi, L.; Del Corso, P.; Piovaccari, G.; Bologna, F.; Venturi, P.; Melandri, F.; Bagni, E.; Bolognese, L.; Perticucci, R.; Zuppiroli, A.; Nannini, M.; Consoli, N.; Petrone, P.; Pipitò, C.; Colombi, L.; Bernardi, D.; Mariani, P. R.; Testa, R.; Mazzinghi, F.; Cosmi, F.; Cosmi, D.; Zipoli, A.; Cecchi, A.; Castelli, G.; Ciaccheri, M.; Mori, F.; Pieri, F.; Valoti, P.; Chiarantini, D.; Santoro, G. M.; Minneci, C.; Marchi, F.; Milli, M.; Zambaldi, G.; Zipoli, A.; Brandinelli Geri, A. A.; Cipriani, M.; Alessandri, M.; Severi, S.; Stefanelli, S.; Comella, A.; Poddighe, R.; Digiorgio, A.; Carluccio, M.; Berti, S.; Rizza, A.; Bonatti, V.; Molendi, V.; Brancato, A.; D'Aprile, N.; Giappichini, G.; Del Vecchio, S.; Mantini, G.; De Tommasi, F.; Meucci, G.; Cordoni, M.; Bechi, S.; Barsotti, L.; Baldini, P.; Romei, M.; Scopelliti, G.; Lauri, G.; Pestelli, F.; Furiozzi, F.; Cocchieri, M.; Severini, D.; Patriarchi, F.; Chiocchi, P.; Buccolieri, M.; Martinelli, S.; Wee, A.; Angelici, F.; Bernardinangeli, M.; Proietti, G.; Biscottini, B.; Panciarola, R.; Marinacci, L.; Perna, G. P.; Gabrielli, D.; Moraca, A.; Moretti, L.; Partemi, L.; Gregori, G.; Amici, R.; Patteri, G.; Capone, P.; Savini, E.; Morgagni, G. L.; Paccaloni, L.; Pezzuoli, F.; Carincola, S.; Papi, S.; De Crescentini, S.; Gerardi, P.; Midi, P.; Gallenzi, E.; Pajes, G.; Mancone, C.; Di Spirito, V.; Di Gennaro, M.; Calcagno, S.; Toscano, S.; Antonicoli, S.; Carta, F.; Giorgi, G.; Comito, F.; Daniele, E.; Ciarla, O.; Gelfo, P. G.; Acquaviva, A.; Testa, D.; Testa, G.; Pagliaro, F. A.; Russo, F.; Vetta, F.; Marchese, I.; Di Sciascio, G.; D'Ambrosio, A.; Leggio, F.; Del Sindaco, D.; Lacchè, A.; Avallone, A.; Risa, M. P.; Azzolini, P.; Baldo, E.; Giovannini, E.; Pulignano, G.; Tondo, C.; Picchio, E.; Biffani, E.; Tanzi, P.; Pozzar, F.; Farnetti, F.; Azzarito, M.; Santini, M.; Varveri, A.; Ferraiuolo, G.; Valtorta, C.; Gaspardone, A.; Barbato, G.; Ceci, V.; Aspromonte, N.; Bellocci, F.; Colizzi, C.; Fedele, F.; Perez, F. I.; Galati, A.; Rossetti, A.; Mainella, A.; Ciuffetta, D.; Matteucci, C.; Busi, G.; De Angelis, A.; Farina, G.; Granatelli, A.; Leone, F.; Frasca, F.; Pajes, G.; Di Giovambattista, R.; Castellani, G.; Massaro, G.; Mastrogiuseppe, G.; Vacri, A.; De Sanctis, F.; Cioli, M.; Di Luzio, S.; Napoletano, C.; Piccioni, L. L.; De Simone, G.; Ottaviano, A.; Mazza, V.; Spedaliere, C.; Staniscia, D.; Calgione, E.; De Marco, G.; Chiacchio, T.; Di Napoli, T.; Romanzi, S.; Salvatore, G.; Golino, P.; Palermo, A.; Mascia, F.; Vetrano, A.; Vinciguerra, A.; Caliendo, L.; Longobardi, R.; De Caro, G.; Di Nola, R.; Piemonte, F.; Prinzi, D.; De Rosa, P.; De Rosa, V.; Riello, F.; Capuano, V.; Vecchio, G.; Landi, M.; Amato, S.; Garofalo, M.; Caruso, D.; D'Avino, M.; Sensale, P.; Maiolica, O.; Santoro, R.; Caso, P.; Miceli, D.; Maurea, N.; Bianchi, U.; Crispo, C.; Chiariello, M.; Perrone Filardi, P.; Russo, L.; Capuano, N.; Ungaro, G.; Vergara, G.; Scafuro, F.; D'Angelo, G.; Campaniello, C.; Bottiglieri, P.; Volpe, A.; Battista, R.; De Risi, L.; Cardillo, G.; Sibilio, G.; Marino, A. P.; Silvestri, F.; Predotti, P.; Iervoglini, A.; Stefanelli, S.; De Matteis, C.; Sarnicola, P.; Matarazzo, M. M.; Baldi, S.; Iuliano, V.; Astarita, C.; Cuccaro, P.; Liguori, A.; Liguori, G.; Gregorio, G.; Petraglia, L.; Antonelli, G.; Amodio, G.; De Luca, I.; Traversa, D.; Franchini, G.; Lenti, M. L.; Cavallari, D.; D'Agostino, C.; Scalera, G.; Altamura, C. M.; Russo, M.; Mascolo, A. R.; Pettinati, G.; Ciricugno, S. A.; Scrutinio, D.; Passantino, A.; Mastrangelo, D.; Di Masi, A.; De Carne, R.; Cannone, M.; Dibiase, F.; Pensato, M.; Loliva, F.; Trapani, F.; Panettieri, I.; Leone, L.; Di Biase, M.; Carrone, M.; Gallone, V.; Cocco, F.; Costantini, M.; Tritto, C.; Cavalieri, F.; Stella, L.; Magliari, F.; Callerame, M.; De Giorgi, A.; Pellegrino, L.; Correra, M.; Portulano, V.; Nisi, G. L.; Grassi, G.; Cristallo, E.; De Laura, D.; Salerno, C.; Fanelli, R.; Villella, M.; Pede, S.; Renna, A.; De Lorenzi, E.; Urso, L.; Lenti, V.; Peluso, A.; Baldi, N.; Polimeni, G.; Galati, A.; Palma, P.; Lauletta, R.; Tagliamonte, E.; Cirillo, T.; Silvestri, B.; Centonze, G.; D

Regular Wine Consumption in Chronic Heart Failure: Impact on Outcomes, Quality of Life, and Circulating Biomarkers

Background-Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial. Methods and Results-A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P&lt;0.0001), less frequent symptoms of depression (Geriatric Depression Scale, adjusted P=0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P&lt;0.0001, and pentraxin-3, P=0.01) after adjusting for possible confounders. Conclusions-We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0033633