New Diagnostic, Therapeutic and Organizational Strategies for Acute Coronary Syndromes Patients

141 Pages·2013·1.61 MB·English

by  Elena Corrada

Contributions to Statistics
Niccolò Grieco
Maurizio Marzegalli
Anna Maria Paganoni Editors
New Diagnostic,
Therapeutic and
Organizational
Strategies for Acute
Coronary Syndromes
Patients
Contributions to Statistics
For furthervolumes:
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ThiSisaFMBlankPage
Niccolo` Grieco (cid:129) Maurizio Marzegalli (cid:129)
Anna Maria Paganoni
Editors
New Diagnostic, Therapeutic
and Organizational Strategies
for Acute Coronary
Syndromes Patients
Editors
Niccolo` Grieco MaurizioMarzegalli
IntensiveCardiacCareUnit& DepartmentofCardiology
PrehospitalEmergencyCare AOSanCarloBorromeo
NiguardaHospital Milan
Milan Italy
Italy
AnnaMariaPaganoni
DepartmentofMathematics
PolitecnicodiMilano
Milan
Italy
ISSN1431-1968
ISBN978-88-470-5378-6 ISBN978-88-470-5379-3(eBook)
DOI10.1007/978-88-470-5379-3
SpringerMilanHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2013942465
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Preface
Thecontributionspublishedinthisvolumearetheresultofaselectionbasedonthe
presentations given at the Workshop on “Identification and development of new
diagnostic,therapeutic,andorganizationalstrategiesforpatientswithAcuteCoro-
narySyndromes”heldinMilanonFebruary15,2012.
The workshop was a conclusive event of a 3-year-long strategic program
supported by Italian Ministry of Health and Health Governance of Regione
Lombardia.1
Objective of the strategic program was the identification of new diagnostic,
therapeutic, and organizational strategies to be applied to patients with Acute
Coronary Syndromes (ACS), in order to improve the occurrence of clinical
outcomes.
Patients with ACS are at high risk of thrombosis (acute ischemic events),
arrhythmias (sudden death due to ventricular fibrillation), and a variety of
complications due to the complexity of therapeutic intervention (hemorrhagic
disorders,contrast-inducednephropathies,thrombosisofcoronarystents).
ThefirstpartofStrategicProgramwasstructuredintwofunctionalsubparts:the
first one was the statistical design of a region-wide registry automatically linked
withadministrativePublicHealthDatabase.TheRegistryisstillongoing;periodi-
cal statistical analysis was performed with innovative methods to deal with com-
plexlargedatabases.Atthesametimeasubprojectanalyzedthebestpatterntouse
existingadministrativedatabasestoclinicalandepidemiologicalpurposes.
The second part of Strategic Program was divided in three subprojects which
take advantage on new biomolecular and imaging strategies aimed at the identifi-
cationofpatientswithACSatthehighestriskof:
(cid:129) Thrombotic complications due to reduced renal function and prothrombotic
activationofbloodelements.
(cid:129) Ventricularfibrillationandsudden deathafteracute myocardialinfarction,due
totheprevalenceofgeneticpolymorphismsrelevantforthedisease.
v
vi Preface
(cid:129) Poorrevascularizationconsequenttoreducedventricularviabilityorfunctionas
identified with new imaging techniques, also in relation to newly identified
biomarkers.
Also this volume is structured in two different parts: first one focused on
cooperative project mainly on statistical analysis of large clinical and administra-
tive databases; second one focused on the development of innovative diagnostic
techniquesfortheprecociousidentificationofpatientsatmajorrisk.
We wish to thank all referees for their valuable contributions that made this
volume possible and Maurizio Bersani, Gabriella Borghi, Luciano Bresciani,
Massimo Casciello, Elena Corrada, Giancarlo Fontana, Carlo Lucchina, Maria
Novello Luciani, Antonio Mafrici, Silvio Marenzi, Antonio Marzocchi, Lorenzo
Menicanti, Luca Merlino, Luigi Oltrona Visconti, Peter J. Schwartz, Giovanni
Sesana,CaterinaTridico,andCarloZocchetti.
Milan,Italy Niccolo` Grieco
January2013 MaurizioMarzegalli
AnnaMariaPaganoni
1“Development of new diagnostic, therapeutic and organizational strategies to be applied to
patientswithAcuteCoronarySyndromes”withfiveProjectparts(ProgrammaStrategicoRicerca
Finalizzata Ministero della Salute (Anno 2007) “Sviluppo di nuove strategie conoscitive,
diagnostiche, terapeutiche e organizzative in pazienti con sindromi coronariche acute” (ex art.
12D.Lgs.n.502/1992)):
(cid:129) ProjectpartofStrategicProgram1—RFPS-2007-2-634753
Institutionpresentingtheproject:RegioneLombardia—DirezioneGeneraleSanita`
“Exploitation,integrationandstudyofcurrentandfuturehealthdatabasesinLombardiafor
AcuteMyocardialInfarction”
ScientificCoordinator:MarzegalliMaurizio
(cid:129) ProjectpartofStrategicProgram2—RFPS-2007-2-634780
Institutionpresentingtheproject:CentroCardiologicoMonzino,IRCCS
“Identification of proteomic/proinflammatory and immune biomarkers in patients with Acute
CoronarySyndromesathighrisktodevelopclinicalevents:genomicandproteomicapproaches”
ScientificCoordinator:MarenziGianCarloSilvio
(cid:129) ProjectpartofStrategicProgram3—RFPS-2007-2-644418
Institutionpresentingtheproject:IstitutoAuxologicoItaliano
“Ventricularfibrillationduringmyocardialinfarction:geneticbasis”
ScientificCoordinator:SchwartzPeterJ.
(cid:129) ProjectpartofStrategicProgram4—RFPS-2007-2-634791
Institutionpresentingtheproject:RegioneEmilia-Romagna
“Detection, characterization and prevention of Major Adverse Cardiac Events after Drug
ElutingStentimplantationinpatientswithAcuteCoronarySyndrome”
ScientificCoordinator:MarzocchiAntonio
(cid:129) ProjectpartofStrategicProgram5—RFPS-2007-2-644709
Institutionpresentingtheproject:IRCCSPoliclinicoSanDonato
“Pathogenesis and therapy of acute myocardial infarction: new perspectives and innovative
therapeuticstrategies”
ScientificCoordinator:MenicantiLorenzo
Contents
PartI OrganizationalStrategiesinACS
GenderDifferencesinHospitalizationforAcuteMyocardial
InfarctioninLombardyDuringtheYears2000–2010. . . . .. . . . . .. . . 3
ElenaCorrada,CristinaMazzali,PietroBarbieri,GiuseppeFerrante,
MaurizioMarzegalli,MarcoMennuni,LucaMerlino,
PatriziaPresbitero,andPieraAngelicaMerlini
HeartDiseasesRegistriesBasedonHealthcareDatabases. . . . . . . . . . 25
CristinaMazzali,BarbaraSevergnini,MauroMaistrello,
PietroBarbieri,andMaurizioMarzegalli
DesigningandMiningaMulticenterObservationalClinicalRegistry
ConcerningPatientswithAcuteCoronarySyndromes. . . . . . . . . . . . . 47
FrancescaIeva
StatisticalMethodstoStudytheRepresentativeness
ofSTEMIArchive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
GiovanniCassariniandFrancescaIeva
UsingTextMiningtoValidateDiagnosesofAcuteMyocardial
Infarction..... .... .... ..... .... .... ..... .... .... ..... .... 69
StefanoBallerioandDarioCerizza
PartII NewDiagnosticandTherapeuticStrategiesinACS
PREDESTINATION:PRimaryvEntricularfibrillationandsuDden
dEathduringafirSTmyocardIaliNfArcTION:GeneticBasis. . . . . . . 85
GaetanoM.DeFerrari,ValentinaDeRegibus,VincenzoGionti,Daniela
Civardi,RobertoInsolia,MatteoPedrazzini,DavideGentilini,
AnnamariaDiBlasio,LiaCrotti,andPeterJ.Schwartz
MicroRNAsandTissueResponsetoAcuteIschemia. . . . . . . . . . . . . . 97
PasqualeFasanaroandFabioMartelli
vii
viii Contents
TheRoleofCardiacMagneticResonanceinSelectingPatients
withLeftVentricularDysfunctionUndergoingSurgicalVentricular
Reconstruction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
SerenellaCastelvecchioandLorenzoMenicanti
ChronicKidneyDiseaseinAcuteMyocardialInfarction:Clinical
RelevanceandNovelPotentialFieldsofInvestigation. . . . . . . . . . . . . 123
GiancarloMarenzi,MarinaCamera,CristinaBanfi,GualtieroColombo,
MartaBrambilla,MauraBrioschi,andElenaTremoli
Part I
Organizational Strategies in ACS