Luigi Di Serafino

Policlinico Federico II di Napoli · UOC Cardiologia

Background Myocardial ischemia with non–obstructive coronary arteries (INOCA) is a chronic coronary syndrome condition that is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced quality of life, myocardial infarction and heart failure. INOCA is usually under–diagnosed precisely. We report our exp...

Objectives: Patent hemostasis (PH) is essential for preventing radial artery occlusion (RAO) after trans-radial procedures; however, it remains unclear how it should be obtained. The aim of this multicenter randomized study was to evaluate whether the use of an adjustable device (AD), inflated with a pre-determined amount of air (AoA), was more ef...

Background There are limited data to assess pharmacodynamic (PD) profiles of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) and receiving cangrelor after pretreatment with ticagrelor. Methods The PharmacOdynaMic effects of cangrelor in PatiEnts wIth acute or chronIc coronary syndrome undergoing percutaneous coronar...

Heart failure (HF) has a global prevalence of 1–2%, and the incidence around the world is growing. The prevalence increases with age, from around 1% for those aged <55 years to >10% for those aged 70 years or over. Based on studies in hospitalized patients, about 50% of patients have heart failure with reduced ejection fraction (HFrEF), and 50% hav...

A significant proportion of patients presenting with signs and symptoms of myocardial ischemia have no “significant” epicardial disease; thereby, the assessment of coronary microcirculation gained an important role in improving diagnosis and guiding therapy. In fact, coronary microvascular dysfunction (CMD) could be found in a large proportion of t...

Aims Non-hyperemic pressure-derived Indexes (NHPI) provide diagnostic efficacy equivalent to fractional flow reserve (FFR) to guide percutaneous coronary interventions. In the Disengage (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, selective decannulation of the guiding ca...

Chest pain affects more than 100 million people globally, however up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease and ischemia with non-obstructive coronary artery disease (INOCA) is often a cause of the clinical picture. The symptoms reported by INOCA patients are very heterogeneous and often m...

#FullPhysiology is a comprehensive and systematic approach to evaluate patients with suspected coronary disease using PressureWire technology (Abbott Vascular, Santa Clara, CA, USA). This advancement in technology enables the investigation of each component of the coronary circulation, including epicardial, microvascular, and vasomotor function, wi...

Many studies have pointed out that inflammation plays a pivotal role in pathophysiology of acute coronary syndromes (ACS) because several inflammatory molecules impair the endothelial functions in the coronary circulation and promote atherothrombotic events. Recently, many clinical/experimental evidences indicate that elevated plasma levels of uric...

Background: Limited data are available on the risk of periprocedural myocardial infarction (MI) in patients undergoing complex versus noncomplex percutaneous coronary intervention (PCI). Methods: We assessed the risk of periprocedural MI according to the fourth Universal definition of myocardial infarction (UDMI) and several other criteria among...

Multivessel disease is observed in approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Data from randomized clinical trials has shown that complete revascularization in the STEMI setting improves clinical outcomes by reducing the risk of reinfarction and...

Background: Post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) values ≥0.90 are associated with a low incidence of adverse events. Objectives: The AQVA (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR) trial aims to test whether a QFR-base...

Background FFR represents the gold standard to functionally assess the ischemic potential of intermediate coronary artery stenoses particularly in patients presenting with multivessel disease. However, it is still underused in the current practice. Less invasive techniques have been identified for the evaluation of intermediate stenosis. The Quanti...

Aims Complex percutaneous coronary intervention (PCI) patients have greater risk of peri-procedural complications, with potential to be associated with poor short-term and late prognosis. Cangrelor is an intravenous P2Y12 receptor inhibitor characterized by rapid onset and offset effect of platelet inhibition which reduced the risk of thrombotic co...

Background In asymptomatic patients with haemodynamically significant internal carotid artery stenosis, if endarterectomy cannot be considered, a selective invasive angiography is indicated before deciding for percutaneous revascularization. Sometimes, the angiographic assessment of the stenosis might be discordant with the non-invasive assessment,...

Percutaneous coronary interventions (PCI) with stent deployment have an increasing role in the treatment of left main coronary artery (LMCA) stenosis. Accurate assessment of the LMCA by intravascular ultrasound (IVUS) has been shown to overcome the issues encountered with the two-dimensional coronary angiography. As a consequence, IVUS represents a...

In everyday clinical practice, a “significant” left main (LM) lesion is defined by a diameter stenosis ≥50% at the quantitative coronary angiography (QCA). However, angiography has several limitations for detecting significant coronary artery stenoses, particularly when LM stem is involved (Fisher et al., Catheter Cardiovasc Diagn 8(6):565–75, 1982...

Background Periprocedural myocardial infarction (MI) according to the Society for Cardiovascular Angiography and Interventions (SCAI) criteria has prognostic relevance among patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether the type of cardiac biomarker used for the diagnosis of periprocedural MI plays a r...

Background We sought to investigate the applicability and outcomes of a novel system to manage patients requiring transcatheter aortic valve implantation (TAVI) at a tertiary level hospital during the coronavirus disease-2019 (COVID-19) pandemic. Methods To analyse the impact of hospitalisation pathways during the pandemic on clinical outcomes of...

Background Several non-hyperemic pressure-derived Indexes (NHPI) have been introduced for the assessment of coronary stenosis, showing a good correlation with fractional flow reserve (FFR). Notably, either the assessment of NHPI during adenosine administration (NHPIADO) or the Hybrid Approach (NHPIHA), combining NHPI with FFR, have been showed to i...

Key Points • PCI driven by a positive FFR value might be associated with a significant reduction in mortality rate in patients presenting with chronic coronary syndromes as compared with angiography alone • FFR should not be considered only for deferring but also for correctly indicating revascularization with PCI • Future randomized studies sho...

Introduction: The pathophysiology of atherosclerosis and its acute complications, such as the Acute Coronary Syndromes (ACS), is continuously under investigation. Immunity and inflammation seem to play a pivotal role in promoting formation and grow of atherosclerotic plaques. At the same time, plaque rupture followed by both platelets' activation...

Background: Optimal duration of Dual Antiplatelet Therapy (DAPT) following percutaneous coronary intervention (PCI) of a bifurcation stenosis is still debated. We evaluated the impact of DAPT duration on clinical outcomes in all-comers patients undergoing bifurcation PCI included in the European Bifurcation Club (EBC) registry. Methods: We enrol...

Background Elderly status is steadily increasing among patients with acute coronary syndrome (ACS). Dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 receptor inhibitor is the cornerstone of treatment to prevent recurrent thrombotic complications in patients with ACS. However, DAPT in older patients is challenged by a concurrent heig...

Aims Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcathete...

Aims This study aims to evaluate the incidence and prognostic impact of transient left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable or self-expanding valves. Clinical, echocardiographic and electrocardiographic predictors of transient LBBB were also investigated. Methods a...

Aims COVID-19 pandemic deeply changed the management of patients with aortic stenosis. Many cardiac societies have drawn up guidelines for the optimal management of this population but applicability of such recommendations in the current clinical practice and their impact on clinical outcomes has not been adequately investigated. Methods and resul...

Background In asymptomatic patients at high surgical risk presenting with significant extracranial internal carotid artery stenoses, a selective invasive angiography is performed before carotid artery stenting (CAS). Sometimes, the angiographic findings of the stenosis could be discordant from those observed at the non-invasive imaging evaluation a...

Aim To analyze the prevalence and clinical implications of the eligibility criteria for prolonged dual antithrombotic therapy with ticagrelor 60 mg twice daily and/or rivaroxaban 2.5 mg twice daily in a contemporary real-world ACS registry. Methods Patients from the START-ANTIPLATELET registry (NCT02219984) were stratified according to the eligibi...

(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI...

Up to half of patients undergoing primary percutaneous coronary intervention of a culprit stenosis in the context of the ST-elevation MI may present with multivessel disease. The presence of non-culprit stenoses have been shown to affect the outcomes of these patients, and the results of the more recent randomised trials highlight the importance of...

Aims: Adherence to medical therapy following acute coronary syndrome (ACS) affects a patient's prognosis. In this cohort study, we sought to assess the factors that could affect a patient's adherence to therapy after ACS. Methods: We prospectively collected information from patients (N = 964) hospitalized at the coronary care unit of the Federic...

Background: Coronary microvascular dysfunction is a powerful prognostic factor in patients with coronary artery disease. We investigated the role of reactive digital hyperemia peripheral arterial tonometry (RH-PAT) as a non-invasive tool to identify patients with impaired coronary microvasculature. Methods: Patients undergoing elective coronary...

Background: We compared the prognostic value of the ADDED Index with visually estimated diameter (DS) of residual coronary stenosis (RS) in STEMI patients after successful PCI of the culprit lesion. Even though associated with a positive outcome, the functional assessment of non-culprit stenosis remains largely underused, especially in STEMI patie...

Background Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-lif...

Platelets aggregation leading to thrombosis plays a pivotal role in the pathophysiology of acute coronary syndrome (ACS) and of stent thrombosis. Antiplatelet therapy with aspirin plus an ADP-receptor inhibitor (ticagrerol, prasugrel or clopidogrel) is recommended to reduce the risk of other platelet-mediated events. Clopidogrel is recommended in p...

Aims: To assess, whether Culotte technique could be improved by an additional kissing dilation prior main branch (MB) stenting. Methods and results: Double-kissing (DK) Culotte was compared to Culotte and DK-Crush techniques in bench model (n=24). Results were evaluated for stent apposition, for luminal opening and for flow dynamics. Total proce...

The presence of myocardial ischemia significantly affects prognosis of patients with coronary artery disease. The fractional flow reserve (FFR) allows interventional cardiologists to evaluate whether an equivocal coronary artery stenosis is associated or not with myocardial ischemia, and therefore deserve to be properly treated. The present article...

Optimal medical therapy (OMT) at discharge is recommended after acute coronary syndrome (ACS). Few studies report the impact of OMT on long-term clinical outcome in a real-world scenario. We evaluated the impact of discharge OMT on top of dual-antiplatelet therapy (DAPT) on clinical outcome in the real-world ACS population of the Survey on anTicoag...

Background: Coronary microvascular dysfunction before percutaneous coronary intervention (PCI) predicts PCI-related myocardial injury in patients with stable coronary artery disease (CAD). Whether the dynamic changes of the microcirculation during PCI might be associated with the occurrence of procedure-related myocardial injury and infarction is...

Background Duration of Dual Antiplatelet Therapy (DAPT) following Acute Coronary Syndromes (ACS) or Stable Coronary Artery Disease (SCAD) treated with coronary stenting is still debated. Although current guidelines consider several “clinical” criteria to decide for short DAPT (<6 months), standard DAPT (12 months) and prolonged DAPT (>12 months), t...

The key role of platelets in pathophysiology of Acute Coronary Syndromes (ACS) has been well recognized. Platelet activation and aggregation, together with tissue factor-pathway activation, leads to acute thrombus formation in the coronary vessels at sites of plaque rupture. Thus, antiplatelet therapy with drugs able to interfere with platelet acti...

Background and aims: Increased platelet reactivity (PR) associated with variable degree of coronary microvascular impairment has been reported in patients on clopidogrel after elective percutaneous coronary intervention (PCI). Prasugrel provides more potent platelet inhibition than clopidogrel, though it is unknown whether it might also prevent PC...

Background Quantitative flow ratio ( QFR ) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–...

We investigated whether gender influences antiplatelet treatment in patients with acute coronary syndrome (ACS). The primary end point was major adverse cardiac and cerebrovascular events (MACCEs), a composite of death, myocardial infarction (MI), stroke, or target vessel revascularization. The coprimary end point was net adverse cardiac and cerebr...

We sought to assess in-stent variations in fractional flow reserve (FFR) in patients with previous percutaneous coronary intervention (PCI) and to associate any drop in FFR with findings by optical coherence tomography (OCT) imaging. Suboptimal post-PCI FFR values were previously associated with poor outcomes. It is not known to which extent in-ste...

Complex coronary artery bifurcation lesions occurred in hard clinical scenarios, such as acute coronary syndromes, may represent a challenge for interventional cardiologists, with not-defined general consensus on treatment. Even if provisional stenting is the most common option used to restore rapidly the coronary branches flow, improvements in ind...

Background: Collaterals in patients with coronary artery disease (CAD) limit myocardial infarction and improve survival. Macrophage migration inhibitory factor (MIF) might play a role in collateral development. We aimed this study to evaluate the association of Macrophage migration Inhibitory Factor (MIF) with the extent of collateralization in pa...

Dual-Axis Rotational Coronary Angiography (DARCA) has already been showed to reduce both contrast medium amount and radiation exposure as compared with conventional coronary angiography (CCA). However, a clinical benefit of such imaging modality has never been demonstrated. Aim of this study was to evaluate the efficacy of DARCA to prevent acute ki...

We describe the case of a patient presenting with ST-segment elevation myocardial infarction due to very late scaffold thrombosis. The patient was already admitted for an elective percutaneous recanalization of a chronically occluded left anterior descending artery (LAD). The procedure was performed according the sub-intimal tracking and re-entry (...

Background: Several clinical and laboratory variables have an impact on the prognosis of STEMI patients undergoing PPCI; however, little is known about the role of ongoing DAPT at the time of the event and the smoking status as prognostic factors affecting the outcome of these patients. Methods and results: Seven-hundred and thirteen consecutive...

Background: Coronary angiography has poor predictive value for functionally significant coronary artery stenosis. The Fractional Flow Reserve (FFR) currently represents the gold standard to define the ischemic potential of epicardial stenosis and, recently, the instantaneous wave-free ratio (iFR), has also been introduced as alternative to the FFR...

Background: Periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) might occur more frequently during challenging procedures such as PCI of chronic coronary total occlusion (CTO). The prognostic implication of PMI in CTO-PCI remains unclear. Methods: From January 2006 to September 2012, a total of 715 consecutive p...

We investigated the effect of β- and α-adrenergic blockers on fractional flow reserve (FFR) and index of microvascular resistance (IMR). In 43 patients (pts) with intermediate stenoses, we measured FFR and IMR before and after nonselective β-blocker propranolol (30 μg/kg, n = 20) and selective β1-blocker metoprolol (40 μg/kg, n = 23) IC; (b) In add...

Background: Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear. Objectives: The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such tha...

Background: Fractional flow reserve (FFR) measurement of intermediate coronary stenoses is recommended by guidelines when demonstration of ischemia by noninvasive testing is unavailable. The study aims to evaluate the penetration of this recommendation into current thinking about revascularization strategies for stable coronary artery disease. Me...

Age, Creatinine, and Ejection Fraction (ACEF) score predict clinical outcomes in pts undergoing elective PCI of non-occlusive coronary stenoses. We aimed at assessing the prognostic value of the ACEF score in patients undergoing successful PCI of CTO. ACEF score was calculated in 587 pts treated with PCI of CTO: successful in 433 (74%)(success grou...

A 51-year-old male patient presented to the emergency room with an anterior ST-elevation myocardial infarction. After a loading dose of both ticagrelor and aspirin, the patient underwent primary-PCI on the left anterior descending coronary artery with stent implantation. After successful revascularization, medical therapy included beta-blockers, st...

Aim: To assess ACEF (age, creatinine, and ejection fraction) and Clinical SYNTAX (CSS) score in the risk stratification of patients with heavily calcified stenosis undergoing rotational atherectomy with stent implantation (rota-stenting). Methods and results: ACEF and CSS were calculated in 221 consecutive patients with stable angina undergoing...

The present analysis addresses the potential clinical and physiologic significance of discordance in severity of coronary artery disease between the angiogram and fractional flow reserve (FFR) in a large and unselected patient population. Between September 1999 and December 2011, FFR and percent diameter stenosis (DS) as assessed by quantitative co...

Background: Coronary drug-eluting stents have significantly reduced the rate of in-stent restenosis, but the rate of in-stent thrombosis seems increased. In this study, we tested whether Quinacrine (Q) might reduce smooth muscle cells (SMC) proliferation while exerting minor effects on endothelial cells proliferation (EC) or thrombosis. Methods: Hu...

Monocyte–platelet aggregates (MPA) are increased in patients with acute coronary syndrome. We investigated whether MPA are associated with the presence of functionally significant coronary stenoses or with coronary arterial endothelial dysfunction. One hundred forty five patients undergoing elective coronary angiography were prospectively enrolled....

To improve the success rates of chronic total occlusion (CTO) intervention, a large range of CTO-dedicated guidewires (GWs), devices and techniques have been developed. However, such an abundant choice of materials confuses inexperienced operators. Therefore, the usefulness of a simple antegrade treatment algorithm with a limited set of GWs, for ea...

In the past, certain lesion characteristics of chronic total occlusions (CTOs) have been shown to have an influence on guidewire crossing and thus percutaneous coronary interventional outcome. However, a clear description of the individual impact of these characteristics on procedural outcome, procedural characteristics and treatment strategy is la...

Objective In the past, certain lesion characteristics of chronic total occlusions (CTOs) have been shown to have an infl uence on guidewire crossing and thus percutaneous coronary interventional outcome. However, a clear description of the individual impact of these characteristics on procedural outcome, procedural characteristics and treatment str...

Fractional Flow Reserve (FFR) is well established for patients (pts) undergoing percutaneous coronary intervention, yet little is known for candidates to coronary artery bypass graft surgery (CABG). From 2006 to 2010, we retrospectively included in this registry 627 consecutive pts treated by CABG having at least one angiographically intermediate s...

Purpose: The Age, Creatinine, and Ejection Fraction (ACEF) score can reliably predict clinical outcomes in patients undergoing elective coronary artery bypass surgery. However, its utility in patients undergoing percutaneous coronary intervention of a chronic total occlusion is not known. Methods: ACEF score was calculated in 308 consecutive patien...

Purpose: The presence of an epicardial narrowing of ≥50% diameter stenosis is traditionally considered a cornerstone of the definition of obstructive coronary artery disease (CAD). The present analysis was conducted to evaluate the value of angiographic measurements in assessing the functional severity of CAD in a large and non-selected patient pop...

Purpose: Chronically total occluded coronary artery (CTO) is often associated with collateral circulation that is only partially supplying to the lack of antegrade blood flow. Therefore, variable degree of residual myocardial ischemia might still be present. The macrophage migration inhibitory factor (MIF), secreted by endothelial cells, has been s...

Purpose: Revascularization is indicated with documented ischemia or fractional flow reserve (FFR) ≤0.80 in case of angiographic intermediate stenoses. While FFR is well established for patients (pts) undergoing percutaneous coronary intervention, little is known for candidates to coronary artery bypass graft surgery (CABG). We aimed at investigatin...

Fractional flow reserve (FFR)-guided percutaneous revascularization (percutaneous coronary intervention [PCI]) of intermediate stenosis in native coronary artery is safe and associated with better clinical outcomes as compared with an angiography-guided PCI. It is unknown whether this applies to coronary artery bypass grafts (CABGs). We included 22...

Aims: Endothelium dysfunction has been reported in patients (pts) undergoing transradial catheterisation. Alterations of the hand microcirculation possibly associated with systemic inflammation have never previously been reported. We aimed at investigating possible alteration of hand endothelial microcirculation secondary to transradial heart cath...

Background Previous studies failed to assess the individual prognostic role of thrombus aspiration (TA) or abciximab in primary percutaneous coronary intervention (pPCI), due their prevalent combined use.Methods and ResultsA total of 644 consecutive ST-segment elevation myocardial infarction patients treated with pPCI were included in this retrospe...

Objectives: This study investigated the influence of intracoronary enalaprilat on coronary microvascular function and peri-procedural outcome measures in patients with stable angina undergoing percutaneous coronary intervention (PCI). Background: Intracoronary angiotensin-converting enzyme inhibitors have been shown to relieve myocardial ischemi...

Background: Percutaneous coronary intervention (PCI) modulates platelet reactivity (PR). Objectives: To assess: (i) the impact of coronary interventions on periprocedural variations (Δ) of PR; (ii) whether ΔPR correlates with periprocedural myocardial infarction (PMI); and (iii) the mechanisms of these variations in vitro. Methods and results:...

Novel Regulators and Inhibitors of Aortic Valve Calcification –ESC-Congress 2012 ,Munich ,Germany

Background: Lower extremity peripheral arterial disease (LE-PAD) reduces walking capacity and is associated with an increased cardiovascular risk. Endovascular revascularization of LE-PAD improves walking performance and quality of life. In the present study, we determined whether successful lower limbs revascularization also impacts cardiovascula...

Urotensin II (UTII) and its seven trans-membrane receptor (UTR) are up-regulated in the heart under pathological conditions. Previous in vitro studies have shown that UTII trans-activates the epidermal growth factor receptor (EGFR), however, the role of such novel signalling pathway stimulated by UTII is currently unknown. In this study, we hypothe...

In routine clinical practice, a sizeable proportion of patients with suspected coronary artery disease (CAD) undergo coronary angiography without prior non-invasive functional evaluation. In this situation, the decision wheter to perform revascularization is taken solely on the basis of angiographic parameters, which are often limited in assessing...