Ospedale Maggiore

Pulmonary vein isolation (PVI) is an established treatment for symptomatic atrial fibrillation (AF). To date, cryoballoon (CB) ablation has been the most widely adopted single-shot approach, while pulsed field ablation (PFA) has emerged as a non-thermal alternative designed to preferentially ablate myocardial tissue and reduce collateral injury. PulseSelect™ is a CE-marked and FDA approved PFA system specifically developed for PVI. We compared acute and one-year outcomes of PulseSelect PFA versus fourth-generation cryoballoon (CB4) ablation in routine clinical practice. This multicenter analysis included 254 consecutive patients undergoing first-time PVI in 10 Italian medium-volume centers between January 2024 and February 2025: 121 treated with PulseSelect and 133 with CB4. Baseline clinical and echocardiographic characteristics were prospectively collected. Procedural workflow, anesthesia strategy, procedure duration, fluoroscopy time, and periprocedural complications were assessed. Follow-up consisted of scheduled visits with rhythm monitoring, and arrhythmia recurrence was evaluated using Kaplan–Meier analysis. A total of 254 consecutive patients (mean age 62 ± 9 years, 28.3

In patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI), clopidogrel is currently the preferred antiplatelet agent to be given in double antithrombotic therapy (DAT). To explore whether aspirin could be an alternative option, a post-hoc analysis of the Italian, multi-center, prospective PERSEO (PERcutaneouS coronary intErventions in patients treated with Oral anticoagulant therapy) registry was performed. Out of the 989 patients included in the analysis, 769 (78

BACKGROUND:Antibiotics can cause adverse drug reactions (ADRs) and hypersensitivity reactions (HSRs) through a variety of mechanisms. At our hospital, patients admitted with musculoskeletal tissue infection are followed by infectious disease consultants. The pharmacist only provides the therapy after verifying the correspondence (molecule, dosage and posology) of the motivated request (RMP) with the infectious disease consultancy. The aim was to identify adverse drug reactions, report them and providing training. METHODS:Following the pharmacist's analysis of the infectious disease consultations, ADRs relating to antibiotics were identified and they were entered into the Network of Pharmacovigilance data from Italy, also managing any integrations, and subsequently collected in an Excel file. A qualitative analysis of clinical status, suspected drugs, adverse drug reactions (ADRs) description and its degree of seriousness were collected. A training course was organised "Rischio infettivo: Strumenti, best practice e approfondimenti". RESULTS:The most involved drugs were daptomycin and piperacillin tazobactam; the most observed adverse reactions were dermatological manifestations, eosinophilia, increased transaminases. Most of the reports were not serious. They organized 13 training courses and formats 400 health workers. CONCLUSIONS:Our experience confirms an under-reporting and has highlighted that the contribution to reporting by hospital doctors and nurses is closely related to the valuable work of awareness and support of hospital pharmacists. They assist clinicians in detecting phenomena that may underline the onset of adverse reactions and, consequently, carry out a reporting activity that guarantees useful information for the management of antibiotic therapy. Disseminating and discussing the results of pharmacovigilance is an aspect that motivates the healthcare professional to report. Working to increase the identification of ADRs and the consequent reporting allows us to contribute to the appropriate prescription of antibiotics, avoiding the onset of resistance and also the exposure of the individual patient to serious and disabling side effects.

Abstract Background In patients with myocardial infarction (MI) and multivessel disease, diabetes mellitus is associated with more diffuse coronary atherosclerosis and worse clinical outcomes, often influencing revascularization decisions. The Functional Assessment in Elderly MI Patients with Multivessel Disease (FIRE) trial demonstrated the superiority of physiology-guided complete revascularization in older patients with MI. Whether this benefit is preserved in patients with diabetes remains uncertain. Methods In FIRE, 1445 patients aged ≥ 75 years with MI and multivessel disease were randomized to culprit-only or physiology-guided complete revascularization. In this prespecified analysis, outcomes were assessed according to diabetes status. The primary endpoint was a composite of death, MI, stroke, or revascularization at 3 years. The key secondary endpoint was cardiovascular death or MI. The safety endpoint included contrast-associated acute kidney injury, stroke, or Bleeding Academic Research Consortium type 3–5 bleeding. Results Among 1445 patients, 463 (32%) had diabetes. After adjustment for baseline characteristics, diabetes was independently associated with a higher risk of the primary endpoint (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.02–1.56) and heart failure (HR 1.35, 95% CI 1.01–1.83) at 3 years. Physiology-guided complete revascularization reduced the primary outcome in both patients with diabetes (HR 0.70, 95% CI 0.50–0.97) and without diabetes (HR 0.75, 95% CI 0.58–0.97), with no evidence of effect modification by diabetes status (p for interaction = 0.712). Similar consistency was observed for the key secondary and safety endpoints. Conclusions In older patients with MI and multivessel disease, physiology-guided complete revascularization reduces ischemic events irrespective of diabetes status, supporting its use in elderly diabetic patients. Trial registration ClinicalTrials.gov Identifier NCT03772743.