The immersive experience of virtual reality during chemotherapy in patients with early breast and ovarian cancers: The patient's dream study.

Background: A virtual reality experience (VRE) could represent a viable non-pharmacological intervention to reduce and better manage the main factors of psychophysical distress related to the diagnosis and treatment of cancer. Aim: The "Patient's Dream" study was a two-arm randomized controlled trial conducted at the Regina Elena National Cancer Institute - IRCCS (Rome, Italy) from April 2019 to January 2020 to evaluate VRE impact in patients affected by breast or ovarian cancer. Before starting the first cycle of chemotherapy (CT), patients were randomized to receive the VRE (VRE arm) as "distraction therapy" or to entertain themselves with conventional means (control arm). The primary aims were the assessment of psychological distress, anxiety and quality of life between the two study arms. Secondary endpoints were the perceived time during the first course of CT and the acute and late toxicity. Results: Fourty-four patients were enrolled, 22 patients were randomly assigned to the VRE arm and 22 to the control arm. Collected data underline the absence of prevalent disturbs of anxiety and depression in both groups. Nevertheless, even if the state anxiety values before and after CT decreased in both groups, this reduction was statistically significant over time only in the VRE arm. The duration of therapy perceived by patients undergoing distraction therapy was significantly shorter when compared to the control group. The use of VRE during the first CT cycle appeared to reduce asthenia outcomes. Conclusion: Obtained data suggest that the VRE positively influenced the levels of state anxiety among cancer patients and support the continuous research on VRE as a distraction intervention, with the aim to meet the clinical need for effective nonpharmacologic adjunctive therapies. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT05234996, identifier NCT05234996.

Anomalous spin-resolved point-contact transmission of holes due to cubic Rashba spin-orbit coupling.

Evidence is presented for the finite wave vector crossing of the two lowest one-dimensional spin-split subbands in quantum point contacts fabricated from two-dimensional hole gases with strong spin-orbit interaction. This phenomenon offers an elegant explanation for the anomalous sign of the spin polarization filtered by a point contact, as observed in magnetic focusing experiments. Anticrossing is introduced by a magnetic field parallel to the channel or an asymmetric potential transverse to it. Controlling the magnitude of the spin splitting affords a novel mechanism for inverting the sign of the spin polarization.

COMPARISON OF NATURALLY OCCURRING EIMERIA INFECTIONS IN ALPINE AND NERA DI VERZASCA GOAT BREEDS REARED IN A SUB-ALPINE ENVIRONMENT.

The present study aimed to describe the natural trend of Eimeria spp. oocysts shedding in different breeds of adult goats raised in a sub-Alpine ecosystem by quantitative copromicroscopic analysis. A 1-yr long longitudinal study was planned in a goat herd composed of non-native (Alpine) and autochthonous (Nera di Verzasca) breeds. FLOTAC double technique was implemented to analyze individual fecal samples collected monthly from 2 groups (non-native and native) of 10 goats each. A generalized linear mixed model, in which each goat was included as a random intercept effect, identified 4 predictors of logarithmically transformed oocysts per gram shedding: the number of days from parturition (F = 27.744; P < 0.001), the interaction between the goat breed and the number of days from parturition (F = 8.407; P = 0.004), the interaction between the number of days from parturition and the number of parturitions (F = 6.371; P = 0.012), and the interaction between the monthly rainfalls and temperatures (F = 4.536; P = 0.023). These results indicate that the physiological status (number of days from parturition) of adult goats and its interaction with other individual features (number of parturitions and breed) can affect Eimeria spp. oocysts shedding. Besides, a combination of climatic variables can pose a risk for Eimeria spp. infection in goats reared in the sub-Alpine environment.

High residual platelet reactivity after clopidogrel loading and long-term clinical outcome after drug-eluting stenting for unprotected left main coronary disease.

BACKGROUND: No data exist about the impact of high residual platelet reactivity (HRPR) after clopidogrel loading on long-term clinical outcome in patients undergoing drug-eluting stent (DES) implantation for unprotected left main disease (ULMD). METHODS AND RESULTS: Consecutive patients who underwent percutaneous coronary intervention for ULMD had prospective platelet reactivity assessment by light transmittance aggregometry after a loading dose of 600 mg of clopidogrel. The primary end point of the study was cardiac mortality, and the secondary end point was stent thrombosis. From January 2005 to September 2008, 215 consecutive patients were treated with DES for ULMD. The incidence of HRPR after clopidogrel loading was 18.6%. The median follow-up was 19.3 months. The overall estimated 1-, 2- and 3-year cardiac mortality rate was 3.9+/-1.3%, 7.5+/-2.2%, and 12.2+/-3.4%, respectively. The 3-year cardiac mortality rate was 8.0+/-3.1% in the low residual platelet reactivity (LRPR) group and 28.3+/-10.4% in the HRPR group (P=0.005). The 3-year stent thrombosis rate was 4.2+/-1.8% in the low residual platelet reactivity group and 16.0+/-7.3% in the HRPR group (P=0.021). By forward stepwise regression analysis, HRPR after clopidogrel loading was the only independent predictor of cardiac death (hazard ratio, 3.82; 95% confidence interval,1.38 to 10.54; P=0.010) and stent thrombosis (hazard ratio, 3.69; 95% confidence interval, 1.12 to 12.09; P=0.031). CONCLUSIONS: HRPR after 600-mg clopidogrel loading is a strong marker of increased risk of cardiac death and DES thrombosis in patients receiving DES stenting for ULMD. Routine assessment of in vitro residual platelet reactivity after clopidogrel loading in patients with ULMD potentially suitable for DES-supported percutaneous coronary intervention should be considered to guide patient care decisions.

Rheolytic thrombectomy in patients with massive and submassive acute pulmonary embolism.

OBJECTIVES: To appraise the impact of AngioJet rheolytic thrombectomy (RT) on angiographic and clinical endpoints in patients with acute pulmonary embolism (PE). BACKGROUND: The management of patients with acute PE and hemodynamic compromise, based mainly on anticoagulant and thrombolytic therapies, is challenging and still suboptimal in many patients. In such a setting, mechanical removal of thrombus from pulmonary circulation holds the promise of significant clinical benefits, albeit remains under debate. METHODS: We retrospectively report on 51 patients referred to our catheterization laboratory and treated with AngioJet RT. Patients were classified according to the degree of hemodynamic compromise (shock, hypotension, and right ventricular dysfunction) to explore thoroughly the degree of angiographic pulmonary involvement (angiographic massive PE was defined as the presence of a Miller index >or= 17) and the impact on angiographic (obstruction, perfusion, and Miller indexes) and clinical (all-cause death, recurrence of PE, bleeding, renal failure, and severe thrombocytopenia) endpoints of AngioJet RT. RESULTS: Angiographic massive PE was present in all patients with shock, whereas patients with right ventricular dysfunction and hypotension showed a similar substantial pulmonary vascular bed involvement. Technical success was obtained in 92.2% of patients, with a significant improvement in obstruction, perfusion and Miller indexes in each subgroup (all P < 0.0001). Four patients reported major bleedings and eight (15.7%) died in-hospital. Laboratory experience was significantly associated to a lower rate of major bleedings. All survivors were alive at long-term follow-up (35.5 +/- 21.7 months) except three who expired due to cancer and acute myocardial infarction. CONCLUSIONS: In experienced hands AngioJet RT can be operated safely and effectively in most patients with acute PE, either massive or submassive, and substantial involvement of pulmonary vascular bed.

Mechanisms of late stent malapposition after primary stenting in ST-elevation myocardial infarction: a subanalysis of the selection trial.

BACKGROUND: One of the major predictors of late stent malapposition (LSM) is primary stenting in acute myocardial infarction. However, mechanisms of LSM are still under debate. METHODS: Patients with ST-elevation myocardial infarction (STEMI) and enrolled in the SELECTION trial (38 patients in the paclitaxel-eluting stent, PES, and 35 in the bare metal stent, BMS, cohort) were retrospectively analyzed to evaluate LSM, by means of intravascular ultrasound (IVUS) data recorded at the index and 7-month follow-up procedures. RESULTS: Stent malapposition was documented in 21 lesions in 21 patients (28.8%): in 8 of these 21 patients (38.1%) it was LSM. Although statistical significance was not reached, LSM was more frequent after PES than BMS implantation (15.8% vs. 5.7%). LSM was mainly located within the body of the stent (62.5% of the cases). At the LSM segment, a significant increase of vessel area (19.2 +/- 3.3 mm(2) vs. 21.9 +/- 5.3 mm(2), P = 0.04) and a reduction of plaque area (12.6 +/- 4.6 mm(2) vs. 9.1 +/- 3.9 mm(2), P = 0.04) were observed at IVUS between the index and follow-up procedure. CONCLUSIONS: After primary stenting for STEMI, LSM seems to be more frequent after PES rather than BMS implantation. In the STEMI setting, possible mechanisms leading to LSM include positive remodeling and plaque mass decrease.

Early and long-term clinical results of AngioJet rheolytic thrombectomy in patients with acute pulmonary embolism.

Anticoagulant and thrombolytic therapies are a mainstay in the management of acute pulmonary embolism (PE), especially when hemodynamic compromise is present. However, systemic drugs cannot achieve timely and effective treatment of acute PE in all patients. In such a setting, mechanical removal of thrombus from the pulmonary circulation holds the promise of significant clinical benefits, although it remains untested. We report early and long-term outcome of patients with massive or submassive acute PE treated with rheolytic thrombectomy by means of the 6Fr Xpeedior AngioJet device at our institution. Three main groups were defined pre hoc: subjects with severe (i.e., shock), moderate, or mild hemodynamic compromise. Technical and procedural successes, obstruction, perfusion and Miller indexes, and clinical events were appraised. In total 25 patients were treated with thrombectomy (8 in severe, 12 in moderate, and 5 in mild hemodynamic compromise). Technical and procedural successes were obtained in all patients, as confirmed by the significant improvement in obstruction, perfusion and Miller indexes overall, and in each subgroup (all p values <0.001). Improvement in obstruction, perfusion, and Miller indexes at the end of the procedure could also be confirmed in patients (n = 8) treated with local fibrinolysis and in the absence of concomitant thrombolysis (n = 17, p <0.05). Four patients died in hospital, all other patients but 1 were safely discharged after an appropriate hospital stay, and all were alive at long-term follow-up (median 61 months). In conclusion, this study supports at early and long-term follow-up the effectiveness and safety of rheolytic thrombectomy for PE.

Kounis syndrome: A concise review with focus on management.

Kounis syndrome is defined as the co-incidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergenic event and was first described by Kounis and Zavras in 1991 as an allergic angina syndrome. Multiple causes have been described and most of the data in the literature are derived from the description of clinical cases - mostly in adult patients - and the pathophysiology remains only partly explained. Three different variants of Kounis syndrome have been defined: type I (without coronary disease) is defined as chest pain during an acute allergic reaction in patients without risk factors or coronary lesions in which the allergic event induces coronary spasm that electrocardiographic changes secondary to ischemia; type II (with coronary disease) includes patients with pre-existing atheromatous disease, either previously quiescent or symptomatic, in whom acute hypersensitive reactions cause plaque erosion or rupture, culminating in acute myocardial infarction; more recently a type-III variant of Kounis syndrome has been defined in patients with preexisting coronary disease and drug eluting coronary stent thrombosis. The pathogenesis of the syndrome is discussed, and a therapeutic algorithm is proposed.

[Epidemiology of Tako-tsubo cardiomyopathy: the Tuscany Registry for Tako-tsubo Cardiomyopathy ]. / Epidemiologia della sindrome di tako-tsubo nel mondo reale: dati del Registro Toscano della Miocardiopatia da stress tipo Tako-tsubo.

BACKGROUND: Tako-tsubo (stress) cardiomyopathy (TTC) is a recently described acute cardiac syndrome that mimics ST-segment elevation myocardial infarction. The TTC Tuscany Registry is an observational prospective multicenter registry established to define the prevalence, epidemiology and prognosis of TTC in the Tuscany area. METHODS: From January 1 to December 31, 2009, 105 consecutive patients hospitalized in the 14 Cardiology Units of the Tuscany Region with a diagnosis of TTC, were enrolled in the registry. TTC diagnosis was made using the Mayo Clinic modified criteria. Clinical, instrumental, laboratory and 6-month follow-up data were collected. Results. TTC represented 1.2% of all myocardial infarctions in the Tuscany Region during 2009, and it was diagnosed in 0.6% of the angiographic exams performed during the same year. The data collected showed that TTC affects mainly the female gender (91%) in the post-menopausal period (70 ± 11 years), though 5% of patients were ≤50 years old. An antecedent stressful event was frequently detected (74%). The main clinical presentation was chest pain (86%), associated with ST-segment elevation (59%). Mean left ventricular ejection fraction on admission was 40 ± 9%, and was associated with apical (37%), midapical (49%) or midventricular (5%) wall motion abnormalities. Left ventricular ejection fraction recovered to 51 ± 9% in 7 ± 9 days. Heart failure was the most common complication in the acute phase (14%), and 4 patients presented with cardiogenic shock. No patient died during the index hospitalization. At 6-month follow-up, no patient had TTC recurrence, 9 patients were rehospitalized (7 for noncardiac disease) and 2 patients died of noncardiac causes. CONCLUSIONS: Our data, which represent the largest prospective series of patients with a diagnosis of TTC, show that the prevalence of TTC in Tuscany is similar that described in other national and international studies. Moreover, the data highlight that TTC may occur also in male patients and in patients aged <50 years. The mid-term prognosis is good, but the risk of acute complications related to heart failure cannot be neglected.

Application of 2011 American College of Cardiology Foundation/American Society of Echocardiography appropriateness use criteria in hospitalized patients referred for transthoracic echocardiography in a community setting.

BACKGROUND: A recent American College of Cardiology Foundation and American Society of Echocardiography document updated previous appropriate use criteria (AUC) for echocardiography. The aim of this study was to explore the application of the new AUC, and the resulting appropriateness rate, in hospitalized patients referred for transthoracic echocardiography (TTE) in a community setting. METHODS: A total of 931 consecutive inpatients referred for TTE were prospectively recruited in five community hospitals. Patients were categorized as having appropriate, uncertain, or inappropriate indications for TTE according to the AUC. An additional group of 259 inpatients, discharged without having been referred for TTE, was also considered. RESULTS: In the group referred for TTE, the large majority of indications (98.8%) were classifiable according to the AUC with good interobserver reproducibility. Indications were appropriate in 739 patients (80.3%), of uncertain appropriateness in 46 (5.0%), and inappropriate in 135 (14.7%). Compared with patients with appropriate or uncertain indications, those with inappropriate indications were younger and more often referred by noncardiologists. Most common causes of inappropriate indications were related to the lack of changes in clinical status or to the absence of cardiovascular symptoms and signs. Examinations with appropriate or uncertain indications had an impact on clinical decision making more often than those with inappropriate indications (86.7% vs 14.1%, P < .0001). In the group discharged without having been referred for TTE, TTE might have been appropriate in 16.2% of cases. CONCLUSIONS: Clinical application of the new AUC was highly feasible in a community setting. Although inpatient referral for TTE was appropriate in most patients, strategies aimed at implementing these criteria in clinical practice are desirable.

Left ventricular support device for cardiogenic shock during myocardial infarction due to stent thrombosis: a single centre experience.

BACKGROUND: Stent thrombosis (ST) is a new, rare, cause of STEMI. Few data are available about incidence and clinical impact of shock complicating acute myocardial infarction due to ST (st-STEMI). METHODS: From January 2004 to March 2007, 92 st-STEMI patients were observed: 14 (15.2%) of them presented with cardiogenic shock and were evaluated in the present analysis. In particular, clinical and angiographic characteristics of survivors and non-survivors to PCI were compared. RESULTS: St-STEMI was related to left main or multivessels stent thrombosis in 35.7% of cases; whereas in 93% of cases st-STEMI occurred in a territory with previous myocardial infarction. All patients underwent IABP implantation immediately before coronary angiography, whereas Impella LP 2.5 pump was used in 21% of cases when persistent cardiac low-output signs were recorded. PCI was successful in 80% of cases. In-hospital survival was 28.6%. Death occurred within the first 48 h in the majority of patients. At six-months all patients survived to the acute phase were alive. Survivors had significantly lower thrombus grade after wire passage (p=0.03) and, albeit not significant, they showed a higher rate of very late ST, longer times from symptoms onset to revascularization, and higher TIMI flow grade either before and after PCI. CONCLUSION: The incidence of cardiogenic shock in st-STEMI is high, particulary it seems to be two times higher than the rate reported during myocardial infarction. One third of cases is related to left main or multiple vessels ST. Shock in st-STEMI represents a dramatic event with very low in-hospital and early survival.

Heart rate as an independent prognostic risk factor in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: It has been shown that elevated heart rate identified patients with coronary artery disease and left ventricular dysfunction at increased risk of cardiovascular outcomes. OBJECTIVE: We sought to assess the prognostic impact of heart rate at presentation in patients with ST-elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: We collected 6-month follow-up data in 2477 consecutive patients with STEMI treated by primary PCI. Patients with atrio-ventricular block (n=64) and atrial fibrillation (n=34) were excluded from the analysis. The association of baseline heart rate with cardiovascular outcomes was analysed using Cox proportional hazard models for groups with a heart rate of 80 beats per min (bpm) or greater (n=799) versus those with a heart rate between 60 and 79 bpm (n=1192) and those with a heart rate less than 60 bpm (n=388). The variables related to mortality were: age (hazard ratio (HR) 1.072, 95% confidence interval (CI) 1.052-1.092, p<0.0001), cardiogenic shock (HR 4.622, 95% CI 2.892-7.387, p<0.0001), previous myocardial infarction (HR 1.724, 95% CI 1.036-2.869, p=0.036), peak creatine-kinase value (HR 1.227, 95% CI 1.142-1.318, p<0.0001), heart rate 80 bpm or greater (HR 2.170, 95% CI 1.414-3.332, p=0.0001), and optimal PCI result (HR 0.126, 95% CI 0.065-0.244, p=0.0001). For every increase of 5 bpm, there were increases in mortality (HR 1.321, 95% CI 1.232-1.415, p=0.0001), but not in reinfarction or in coronary revascularization rates. CONCLUSION: In patients with acute myocardial infarction undergoing primary PCI, elevated heart rate (80 bpm or greater) identifies those at increased risk of death. It is unknown whether heart rate reduction will result in improved outcome in this setting of patients.

Optical coherence tomography in unprotected left main coronary artery stenting.

AIMS: Delayed or incomplete stent endothelisation and stent malapposition may predispose to DES thrombosis that can be a catastrophic event in the left main coronary artery (LMCA). OCT can accurately identify stent struts and arterial tissue, but is limited by the need of vessel blood clearance and penetration; also no data exist on its use in LMCA. We sought to verify whether optical coherence tomography (OCT) can accurately assess arterial wall response after drug eluting stent (DES) implantation in the LMCA. METHODS AND RESULTS: OCT images were obtained in 15 patients (mean age 70.7 + or - 8.0 years) six months after LMCA DES implantation. Acquisitions were performed without proximal balloon occlusion during isoosmolar contrast injection through a 6 Fr guiding catheter without side holes at a speed of 2-3 mL/sec. Offline image analyses were performed to evaluate assessable stent area (all slices), strut coverage, apposition, and abnormal tissue responses for every three slices (= every 0.45 mm). All OCT images were obtained without periprocedural complications. Overall, 69 + or - 20% of the stent inner area was analysable; this corresponded to 2.7 + or - 0.8 analysable quadrants per slice. Out of 1,281 struts, 1,136 (88.7%) were well apposed and fully covered, 101 (7.8%) were uncovered; and 45 (3.5%) were malapposed although nine of the malapposed struts (20%) were covered by some tissue. In five patients OCT detected abnormal intraluminal tissue, and in two cases this finding was related to uncovered struts. CONCLUSIONS: OCT assessment of vascular response after LMCA DES implantation is safe and feasible. Further development of OCT imaging technology will be necessary for complete evaluation of LMCA stents.

[Percutaneous rheolytic thrombectomy with AngioJet for pulmonary embolism: methods and results in the experience of a high-volume center]. / Trombectomia reolitica percutanea con AngioJet nell'embolia polmonare: metodologia e risultati nell'esperienza di un centro ad alto volume.

BACKGROUND: Pulmonary embolism is a common disease with significant mortality. Anticoagulant and thrombolytic therapies are a mainstay in the management of acute pulmonary embolism, especially with hemodynamic compromise. However, systemic drugs cannot achieve timely and effective treatment of acute pulmonary embolism in all patients. Recently, rheolytic thrombectomy has been proven to be effective in the treatment of massive thrombosis in vein grafts. The purpose of this study was to describe the rheolytic thrombectomy procedure and to evaluate the efficacy of thrombus removal using the AngioJet catheter in patients with acute massive and submassive pulmonary embolism. METHODS: Thirty consecutive patients (16 men, 14 women, mean age 67.9 +/- 13.5 years) with massive or submassive pulmonary embolism were treated with rheolytic thrombectomy. The Miller index and the systolic pulmonary pressure were evaluated pre- and post-rheolytic thrombectomy. In-hospital results were analyzed according to the learning curve of operators. RESULTS: Technical success was achieved in 93.3% of patients. Eleven patients received adjunctive loco-regional thrombolytic agent (alteplase) or abciximab. A significant improvement in the obstruction, perfusion and Miller indexes and in the systolic pulmonary pressure was observed after rheolytic thrombectomy (p <0.0001) in all patients. The achievement of a larger experience by the operators was associated with a less procedural complication rate (i.e. post-procedural increase in creatinine, cardiac arrest during the procedure, post-procedural hemoptysis, and in-hospital mortality). Total in-hospital mortality occurred in 5 patients (16.7%), 60% of them presented with cardiogenic shock. All patients were alive at the 12-month follow-up, except one who died after 3 months for myocardial infarction. CONCLUSIONS: Percutaneous rheolytic thrombectomy using the AngioJet catheter may be a valid treatment option for patients with massive or submassive pulmonary embolism with rapid and significant hemodynamic improvement and encouraging results at early and long-term follow-up. Greater laboratory and operator experience yield better clinical results.

ST-segment elevation myocardial infarction due to early and late stent thrombosis a new group of high-risk patients.

OBJECTIVES: The aim of this retrospective study was to compare clinical and angiographic outcomes between patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) and de novo coronary thrombosis. BACKGROUND: There are limited data for procedural and mid-term outcomes of patients with ST presenting with STEMI. METHODS: From January 2004 to March 2007, 115 definite ST patients were observed: 92 (80%) of them presented as STEMI and were compared with a consecutive group of 98 patients with de novo STEMI. All patients underwent primary percutaneous coronary intervention. Primary end points were successful angiographic reperfusion and distal embolization. Major adverse cardiovascular and cerebrovascular events (MACCE), evaluated at 6-month follow-up, were defined as death, nonfatal myocardial reinfarction, target vessel revascularization, and cerebrovascular accident. RESULTS: Successful reperfusion rate was lower in patients with ST (p < 0.0001), whereas distal embolization rate was higher (p = 0.01) in comparison with patients with de novo STEMI. Stent thrombosis proved to be an independent predictor of unsuccessful reperfusion at propensity-adjusted binary logistic regression (odds ratio 6.8, p = 0.004). In-hospital MACCE rate was higher in patients with ST (p = 0.003), whereas no differences were observed at 6-month follow-up among hospital survivors between the 2 groups (p = 0.7). CONCLUSIONS: Stent thrombosis identifies a subgroup of patients with STEMI with poor angiographic and early clinical outcomes, suggesting that the management of these patients should be improved.

Comparison of primary angioplasty in rural and metropolitan areas within an integrated network.

AIMS: To compare reperfusion times and in-hospital outcome of patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a teaching hospital (TH) with or without inter-hospital transfer and in community hospitals. METHODS AND RESULTS: We performed a retrospective analysis of 536 patients with STEMI treated between January 2005 and December 2006 with primary PCI. Three groups were identified. A: 207 patients presented to the TH. B: 121 patients transferred to TH from metropolitan area hospitals (MAH). C: 208 patients presented in two rural area hospitals (RAH) with primary PCI capability. Baseline characteristics were similar. Door-to-balloon (DtB) times were significantly (p<0.001) higher in group B (median 120, range 90-180 min) both compared to group A (median 60, range 45-90 min) and C (median 73, range 55-99 min). In group B 79,5% of patients present a DtB > 90 min. In-hospital mortality was 4.9%, 3.3% and 4.3% respectively in group A, B and C without significant differences. CONCLUSIONS: The expansion of primary PCI to RAH achieves reperfusion delays similar to that of patients admitted to TH. Transferred patients present very higher DtB when compared to patients treated on-site. In-hospital outcome are similar but further studies are warranted.

Outlook of drug-eluting stent implantation for unprotected left main disease: insights on long-term clinical predictors.

BACKGROUND: Percutaneous coronary intervention (PCI) has been increasingly employed to treat unprotected left main coronary artery (LMCA) stenosis, with variable success. This strategy has been applied to patients undergoing drug-eluting stent (DES) implantation for unprotected LMCA stenosis. METHODS: From April 2003 to June 2006, 114 consecutive patients with de novo unprotected LMCA stenosis underwent PCI with DES, and were followed over a mean period of 17.1 +/- 9.1 months. The primary endpoint of the study was the occurrence of major adverse cardiovascular events (MACE) (cardiac death, myocardial infarction [MI] or target lesion revascularization [TLR]). RESULTS: LMCA stenting was successfully performed in all patients. In-hospital mortality was 3.5%, with no in-hospital non-fatal MI or emergency coronary artery bypass grafts. During the follow-up period, the all-cause mortality rate was 7.9%, with 3.5% cardiac-related deaths. TLR was performed in 7.9% of patients, and the MACE rate was 14.9%. All non-surviving patients were at high surgical risk (EuroSCORE > 6) and had a significantly higher EuroSCORE than surviving patients that patients with a EuroSCORE < or = 11 had significantly improved survival rates over those with a EuroSCORE > 11 (p < 0.0001). Moreover, most of the patients who died of cardiac causes were diabetic (71.4% vs. 26.6%; p < 0.05). Acute coronary syndromes, as clinical presentation, and non-ostial LMCA disease were also significantly more common within non-surviving patients (100% vs. 67%; p < 0.05, and 92.3% vs. 66.3%; p = 0.05, respectively). CONCLUSIONS: Stenting of unprotected LMCA appears to be associated with a favorable mid-term outlook, especially in selected patients.