L'Istat, grazie alle sinergie attivate con il Ministero dell'Interno per l'acquisizione tempestiva dei dati ANPR è in grado di contribuire alla diffusione di informazioni utili alla comprensione della situazione legata all'emergenza sanitaria da COVID-19.L'utilizzo a fini statistici, e il relativo trattamento, delle informazioni che l'Istituto nazionale di statistica acquisisce dall'Anagrafe Nazionale della Popolazione Residente (ANPR), come previsto dal DPCM n.194/2014, permette di diffondere i dati relativi alla mortalità generale di una parte dei comuni subentrati nell'ANPR, che a oggi ammontano a 5.866, circa tre quarti del totale dei comuni italiani.
The diffusion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) forced the Italian population to restrictive measures that modified patients' responses to non-SARS-CoV-2 medical conditions. We evaluated all patients with acute coronary syndromes admitted in 3 high-volume hospitals during the first month of SARS-CoV-2 Italian-outbreak and compared them with patients with ACS admitted during the same period 1 year before. Hospitalization for ACS R ESUM ELa propagation du coronavirus 2 du syndrome respiratoire aigu s evère (SRAS-CoV-2) a oblig e la population italienne à prendre des mesures contraignantes qui ont modifi e la r eaction des patients face aux affections m edicales non li ees au SRAS-CoV-2. Nous avons evalu e tous les patients atteints de syndromes coronariens aigus (SCA) admis dans 3 hôpitaux à fort volume d'activit e au cours du premier mois de l' epid emie italienne de SRAS-CoV-2 et les avons compar es aux After the first outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in late December 2019, in the Chinese city of Wuhan, Italy soon became the center of a fastgrowing epidemic in late February to March 2020: more severe in some areas of northern and central Italy. 1 After the first confirmed case reported on February 20, 2020, in Codogno, a small town near Milan, the rapid diffusion of the infection prompted the Italian government to proclaim a national lockdown on March 9, 2020, forcing the entire population to severe restrictive isolation measures. These measures, certainly helpful in reducing the diffusion of SARS-CoV-2 infection, significantly modified patients' responses to non-SARS-CoV-2 medical conditions, including acute coronary syndrome (ACS). 2 Because ACS is a life-threatening condition, with outcomes strictly dependent on prompt recognition and treatment, under-or misdiagnosis and late or missed treatment might be deleterious. In the current study, we report data from high-volume hospitals from 3 variably affected regionsdPiedmont, Marche, and Tuscanydto evaluate changes in rate of hospitalization for ACS during the first month of the SARS-CoV-2 Italian outbreak. MethodsThis is a multicentre, observational, retrospective study involving 3 high-volume centres distributed in northern and central Italy. Epidemiologic data of consecutive patients with ACS admitted in March 2019, and March 2020 were anonymously extracted and entered into a dedicated database. Data
BackgroundEuropean guidelines recommend the use of ticagrelor versus clopidogrel in patients with ST elevation myocardial infarction (STEMI). This recommendation is based on inconclusive results and subanalyses from clinical trials. Few data are available on the effects of ticagrelor in a real-world population.MethodsTo compare the effects of ticagrelor and clopidogrel in a real-world STEMI population, we conducted a pre-post case-control study examining all patients with STEMI included in the Cardio-STEMI Sanremo registry between February 2011 and June 2013. Cases and controls were defined according to P2Y12 inhibitors, correcting the bias due to lack of randomization by propensity score analysis. Ticagrelor was introduced in 2012 in both in-hospital and pre-hospital settings independently of this study.ResultsOf the 416 patients enrolled in the Cardio-STEMI registry, 401 with a definite diagnosis of STEMI were included in this study. One hundred forty-two patients received ticagrelor and 259 received clopidogrel. Regarding clinical presentation and procedural data, those in the ticagrelor group had lower CRUSADE scores (23 [14–36] vs 27 [18–38]; p = 0.015] but a higher proportion of radial access (33% vs 14%; p < 0.001), percutaneous coronary intervention (PCI; 92% vs 81 %; p = 0.002) and primary PCI ≤ 12 h (82% vs 66%; p = 0.001). The patients in the ticagrelor group had a higher procedural success rate (100% vs. 96%; p = 0.044). There was no difference in Bleeding Academic Research Consortium bleeding and in unadjusted incidence of hospital major adverse cardiovascular events (MACE; cardiac death, myocardial infarction, or stroke) but there was a significant reduction in unadjusted cardiac hospital death in the ticagrelor group (0.7% vs 5.4%; p = 0.024). After correcting for propensity score, hospital death (p = 0.22) and hospital MACE (p = 0.96) did not differ in both groups. The unadjusted survival at 1 year after STEMI was higher in the ticagrelor group (97.8% vs 87.8%; p = 0.024), and this result was confirmed by propensity score analysis (hazard ratio = 0.29 [0.08–0.99]; p = 0.048).ConclusionsIn this real-word propensity score analysis, ticagrelor did not affect the risk of MACE during the hospital phase, or the incidence of hospital bleeding in patients with STEMI. However, in this mono-centric experience, ticagrelor resulted in improved 1-year survival, even after correction by propensity score.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0524-3) contains supplementary material, which is available to authorized users.
Objective To report our initial experience of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)/acute coronary syndrome (ACS) patients undergoing standard of care invasive management. Background The rapid diffusion of the SARS‐CoV‐2 together with the need for isolation for infected patients might be responsible for a suboptimal treatment for SARS‐CoV‐2 ACS patients. Recently, the group of Sichuan published a protocol for COVID/ACS infected patients that see the thrombolysis as the gold standard of care. Methods We enrolled 31 consecutive patients affected by SARS‐COV‐2 admitted to our emergencies room for suspected ACS. Results All patients underwent urgent coronary angiography and percutaneous coronary intervention (PCI) when required except two patients with severe hypoxemia and unstable hemodynamic condition that were conservatively treated. Twenty‐one cases presented diffuse ST‐segment depression while in the remaining cases anterior and inferior ST‐elevation was present in four and six cases, respectively. PCI was performed in all cases expect two that were diagnosed as suspected myocarditis because of the absence of severe coronary disease and three with apical ballooning at ventriculography diagnostic for Tako‐Tsubo syndromes. Two patients conservatively treated died. The remaining patients undergoing PCI survived except one that required endotracheal intubation (ETI) and died at Day 6. ETI was required in five more patients while in the remaining cases CPAP was used for respiratory support. Conclusions Urgent PCI for ACS is often required in SARS‐CoV‐2 patients improving the prognosis in all but the most advanced patients. Complete patient history and examination, routine ECG monitoring, echocardiography, and careful evaluation of changes in cardiac enzymes should be part of the regular assessment procedures also in dedicated COVID positive units.
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