Intensive Cardiac Care Unit - Centro Cardiologico Monzino

Critical Cardiology Area Intensive Cardiac Care Unit
Giancarlo MARENZI, MD
Director
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Activities 2011. The Intensive Cardiac
Care Unit (ICCU) is equipped with 13 beds provided
with ventilators (5 beds) and complete invasive
(hemodynamic and volumetric) and non-invasive
monitoring. The activity of the ICCU is mainly devoted to
the treatment of patients with acute coronary syndromes
(acute myocardial infarction, unstable angina) and their
complications, with major acute cardiovascular events
(cardiac arrest, acute pulmonary embolism, pericardial
effusion, aortic dissection, life-threatening arrhythmias,
conduction disturbances, acute heart failure, cardiogenic
shock etc.), and, generally, with high-risk conditions.
Patients with non-cardiovascular emergencies, such as
acute respiratory insufficiency and acute kidney injury
requiring respiratory and renal assistance, respectively,
are also admitted. In 2011 the ICCU accepted about 900
patients. The ICCU staff is trained to perform noninvasive (electrocardiogram, echocardiogram, vascular
echo-doppler) and invasive (cardiac catheterization,
pericardiocentesis, central venous and arterial
catheterization) procedures, and to support all activities
in catheterization laboratories and in emergency rooms
in case of cardiac arrest or need for cardiopulmonary
resuscitation or emergency interventions.
Both clinical and scientific activities of the Unit can be
summarized as follows:
1) prevention and treatment of renal complications
associated with cardiovascular diseases: acute
kidney injury is frequently observed in patients
admitted to this Unit because of acute cardiovascular
events and hemodynamic instability, and its
development is associated with relevant clinical and
prognostic implications, and with increased hospital
stay and costs of care. Acute kidney injury associated
with acute coronary syndromes, heart failure, and
contrast media toxicity is usually treated or prevented
with strategies based on the application of renal
replacement therapies (ultrafiltration, hemofiltration
acute coronary syndromes ad other cardiovascular
diseases are under investigation, in collaboration
with our research and clinical laboratories. In
particular, novel markers of myocardial necrosis and
hemodynamic instability (high-sensitivity troponins,
copeptin), myocardial reperfusion injury (cytochrome
c), reduced nitric oxide synthesis (dimethylarginines),
increased mortality risk (BNP, vitamin D deficiency,
acute hyperglycemia), and impaired platelet activity
are systematically evaluated in patients admitted
to our Unit, in order to improve patients’ risk
stratification and to elucidate potential mechanisms
underlying acute cardiac diseases.
and hemodiafiltration). In 2011 about 150 renal
replacement treatments were performed.
2)pericardial effusion treatment: pericardial effusion
and cardiac tamponade are common complications
of cardiac surgery, electrophysiological procedures,
percutaneous coronary interventions and cardiac
diseases. We routinely perform pericardiocentesis
under echocardiographic and radioscopic guidance
as an emergency life-saving procedure. Subsequent
intrapericardial treatments (antiblastic, sclerosing or
anti-inflammatory therapy) are administered. In 2011
we performed about 40 pericardiocentesis
3)evaluation of novel biomarkers: novel biomarkers of
Incidence of contrast-induced nephropathy (CIN) in STEMI patients with and without acute hyperglycemia, treated with primary angioplasty. eGFR = estimated glomerular filtration rate.
Acute hyperglycemia
No Acute hyperglycemia
P=0.01
50
P<0.001
45%
38%
40
P=0.13
CIN incidence, %
STAFF Senior Deputy Director: Gianfranco Lauri, MD
Deputy Directors: Emilio Assanelli, MD, Marco Grazi, MD,
Jeness Campodonico, MD
Senior Assistants: Ivana Marana, MD
Assistants: Monica De Metrio, MD, Marco Moltrasio, MD
Fellows: Angelo Cabiati, MD, Mara Rubino, MD
Residents: Valentina Milazzo, MD
Head Nurse: Ivana Favini
Nurses: Constantin Calugaru, Luisa Castellani Bencich,
Roberto Cerino, Massimiliano Croce, Marisa Dolera,
Tatiana Dragancea, Franca Falchi, Mercedes Maria Franco
Rocha, Francesca Gaggi, Alice Giolo, Andrea Gusmaroli,
Pierpaolo Iozzia, Larisa Ivanova, Pavla Kostalova, Petra
Kozlova, Federica Moneta, Davide Morandi, Mariangela
Alessandra Pace, Miguel Angel Pandia Palomino, Marco
Riboni, Sabino Sangermano, Domenico Santoro, Veronica
Barbara Sisti, Oriana Squilla, Elisabetta Volontè
Secretaries: Annamaria Bellavia, Salvina Comignolo
P<0.001
30
29%
27%
26%
P=0.01
20
16%
10
12%
16%
11%
7%
0
n=148 n=632
n=74 n=35
n=74 n=597
n=58 n=160
n=90 n=472
All patients
Diabetes
No diabetes
eGFR ≤ 60
eGFR > 60
mellitus
mellitus
ml/min/1.73m2
ml/min/1.73m2
CCM — Scientific Report 2011 — Ongoing research 2012
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The Unit is also involved in several multicenter
international trials evaluating new antithrombotic
therapies for the treatment of acute coronary syndromes
and for their secondary prevention. Finally, important
issues of investigative interest are represented by
the evaluation, diagnosis and treatment of pericardial
effusions, in collaboration with Istituto Europeo di
Oncologia, Milano (Cardiology Unit, Dr. Carlo Cipolla)
and San Raffaele Hospital, Milano (Hematoncology and
Bone Marrow Transplantation Unit, Dr. Fabio Ciceri).
Publications
Sisillo E, Marenzi G. N-Acetylcysteine for the prevention
of acute kidney injury after cardiac surgery. J Clin
Pharmacol 2011; 51(11):1603-10.
Marenzi G, De Metrio M, Bartorelli A. Author’s reply to
acute hyperglycemia: Is really a new risk marker for
contrast-induced nephropathy in patients with acute
myocardial infarction without diabetes and normal renal
function? Am Heart J 2011;162:e9.
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CCM — Scientific Report 2011 — Ongoing research 2012
Alexander JH, Lopes RD, James S, et al. for the
APPRAISE-2 Investigators (G. Marenzi). Apixaban with
antiplatelet therapy after acute coronary syndrome. New
Engl J Med 2011;365:699-708.
Oldgren J, Budaj A, Granger CB, Khder Y, Roberts
J, Siegbahn A, Jan G.P. Tijssen JGP, Van de Werf F,
Wallentin L, for the RE-DEEM investigators (G. Marenzi).
Dabigatran vs. placebo in patients with acute coronary
syndromes on dual antiplatelet therapy: a randomized,
double-blind, phase II trial. Eur Heart J 2011;32:2781-2789
Cristell N, Cianflone D, Durante A, Ammirati E, Vanuzzo
D, Banfi M, Calori G, Latib A, Crea F, Marenzi G, De
Metrio M, Moretti L, Li H, Uren NG, Hu D, Maseri A on
behalf of the FAMI Study Investigators. High-sensitivity
C-reactive protein is within normal levels at the very
onset of first ST-segment elevation acute myocardial
infarction in 41% of cases. A multiethnic case-control
study. J Am Coll Cardiol 2011;58:2654-2661
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