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García-Guimarães M, Sanz-Ruiz R, Sabaté M, Velázquez-Martín M, Veiga G, Ojeda S, Avanzas P, Cortés C, Trillo-Nouche R, Pérez-Guerrero A, Gutiérrez-Barrios A, Becerra-Muñoz V, Lozano-Ruiz-Poveda F, Pérez de Prado A, Del Val D, Bastante T, Alfonso F. Spontaneous coronary artery dissection and ST-segment elevation myocardial infarction: Does clinical presentation matter? Int J Cardiol 2023; 373:1-6. [PMID: 36435331 DOI: 10.1016/j.ijcard.2022.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Some patients with spontaneous coronary artery dissection (SCAD) present as ST-segment-elevation myocardial infarction (STEMI). This study evaluates the characteristics, management and outcomes of SCAD patients presenting as STEMI compared to non-ST-segment elevation myocardial infarction (NSTEMI). METHODS We analysed data from consecutive patients included in the prospective Spanish Registry on SCAD. All coronary angiograms were centrally reviewed. All adverse events were adjudicated by an independent Clinical Events Committee. RESULTS Between June 2015 to December 2020, 389 patients were included. Forty-two percent presented with STEMI and 56% with NSTEMI. STEMI patients showed a worse distal flow (TIMI flow 0-1 38% vs 19%, p < 0.001) and more severe (% diameter stenosis 85 ± 18 vs 75 ± 21, p < 0.001) and longer (42 ± 23 mm vs 35 ± 24 mm, p = 0.006) lesions. Patients with STEMI were more frequently treated with percutaneous coronary intervention (PCI) (31% vs 16%, p < 0.001) and developed more frequently left ventricular systolic dysfunction (21% vs 8%, p < 0.001). No differences were found in combined major adverse events during admission (7% vs 5%, p = 0.463), but in-hospital reinfarctions (5% vs 1.4%, p = 0.039) and cardiogenic shock (2.6% vs 0%, p = 0.019) were more frequently seen in the STEMI group. At late follow-up (median 29 months) no differences were found in the incidence of major adverse cardiac and cerebrovascular events (13% vs 13%, p-value = 0.882) between groups. CONCLUSIONS Patients with SCAD and STEMI had a worse angiographic profile and were more frequently referred to PCI compared to NSTEMI patients. Despite these disparities, both short and long-term prognosis were similar in STEMI and NSTEMI SCAD patients.
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Affiliation(s)
- Marcos García-Guimarães
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Manel Sabaté
- Department of Cardiology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Maite Velázquez-Martín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Soledad Ojeda
- Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba. University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Pablo Avanzas
- Department of Cardiology, Hospital Universitario Central de Asturias, Health Research Institute of Asturias, ISPA, University of Oviedo, Oviedo, Spain
| | - Carlos Cortés
- Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ramiro Trillo-Nouche
- Department of Cardiology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Ainhoa Pérez-Guerrero
- Department of Cardiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Víctor Becerra-Muñoz
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Fernando Alfonso
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain.
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Negreira-Caamaño M, Abellán-Huerta J, Lozano-Ruiz-Poveda F, Sánchez-Pérez I, López-Lluva MT, Pérez-Díaz P, López JG, Jurado-Román A. Percutaneous Intervention in Diffuse Coronary Disease: Overlapping Versus Single Very Long Stent Technique. Results From the OVERLONG Registry. Angiology 2021; 72:979-985. [PMID: 33966474 DOI: 10.1177/00033197211014686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both stent length and stent overlap are associated with worse outcomes in the percutaneous treatment of diffuse coronary artery disease (dCAD). However, evidence comparing these issues is scarce. We aimed to compare the results between the use of single very long stent (VLS) and ≥2 overlapping stents (OS) in the treatment of dCAD. METHODS Seven hundred twenty-four consecutive lesions were included: 275 treated with a single VLS (≥40 mm) and 449 with ≥2 OS. Procedural characteristics were assessed, and survival analysis was performed to compare the incidence of major adverse cardiovascular events (MACE; composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization [TLR], or stent thrombosis) during a median follow-up of 31 months. RESULTS Procedures with VLS required less contrast volume (268 ± 122 vs 302 ± 113 cm3; P < .01), fluoroscopy time (16 ± 8 vs 21 ± 16 minutes; P < .01), and procedure duration (37 ± 18 vs 47 ± 27 minutes; P < .01) than the OS procedures. The VLS group showed lower incidence of MACE (4.4% vs 10.7%; P < .01), driven mainly by lower TLR rate (1.1% vs 4.7%; P < .01). The use of OS was an independent predictor of MACE. CONCLUSIONS In this study, the use of VLS for the treatment of dCAD was associated with better outcomes compared to OS.
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Affiliation(s)
| | - José Abellán-Huerta
- Interventional Cardiology Unit, Cardiology Department, University General Hospital of Ciudad Real, Spain
| | | | - Ignacio Sánchez-Pérez
- Interventional Cardiology Unit, Cardiology Department, University General Hospital of Ciudad Real, Spain
| | | | - Pedro Pérez-Díaz
- Cardiology Department, University General Hospital of Ciudad Real, Spain
| | | | - Alfonso Jurado-Román
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
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Sanchez-Perez I, Abellan-Huerta J, Jurado-Roman A, Lopez-Lluva MT, Pinilla-Echeverri N, Perez-Diaz P, Piqueras-Flores J, Lozano-Ruiz-Poveda F. Long-Term Follow-Up of Percutaneous Coronary Intervention With Paclitaxel-Eluting Balloon Catheter. Angiology 2020; 72:364-370. [PMID: 33334115 DOI: 10.1177/0003319720979246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drug-eluting balloons currently constitute a therapeutic tool used in percutaneous coronary interventions (PCI). Long-term results remain unknown. We evaluated the prognosis of PCI using a second generation paclitaxel-eluting balloon (PEB) in real-world patients. We included all PCI with PEB in de novo or in-stent restenosis coronary lesions performed in our unit from March 2009 to March 2019. We assessed the composite of major adverse cardiovascular events (MACE) rate after a median follow-up of 42 months. Consecutive patients (n = 320) with 386 lesions were included; 46.9% presented with stable angina and 53.1% acute coronary syndromes; 52.6% of the lesions were in-stent restenosis and 47.3% de novo lesions with a mean diameter of 2.4 ± 0.5 mm. A bare metal stent was implanted in 6.7% and a drug-eluting stent in 8.5% of patients. The MACE rate was 8%: 10 (2.6%) cardiovascular deaths, 13 (3.4%) myocardial infarctions, and 16 (4.1%) target lesion revascularization. The all-cause death rate was 5.2%. No cases of thrombosis were recorded. In conclusion, PEB was a safe and effective tool to treat in-stent restenosis and de novo coronary lesions, especially small vessel disease, during long-term follow-up.
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Affiliation(s)
- Ignacio Sanchez-Perez
- Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
| | - Jose Abellan-Huerta
- Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
| | - Alfonso Jurado-Roman
- Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
| | - Maria T Lopez-Lluva
- Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
| | - Natalia Pinilla-Echeverri
- 62703McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Pedro Perez-Diaz
- Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
| | - Jesus Piqueras-Flores
- Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
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Abellán-Huerta J, Jurado-Román A, Lozano-Ruiz-Poveda F, López-Lluva MT, Negreira-Caamaño M, Pérez-Díaz P, Requena-Ibañez JA, Sánchez-Pérez I. Clinical Prognosis Associated With the Use of Overlapping Stents With Homogenous Versus Heterogeneous Pharmacological Characteristics for the Treatment of Diffuse Coronary Artery Disease. Cardiovasc Revasc Med 2020; 21:1355-1359. [PMID: 32354584 DOI: 10.1016/j.carrev.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical impact of percutaneous coronary intervention (PCI) and implantation of overlapping stents (OS) using platforms with the same versus different pharmacological characteristics is unknown. Our objective was to compare the outcomes of PCI with OS according to their pharmacological characteristics. METHODS In this observational single-center registry, we included all PCI performed from April 2014 to December 2018 in which overlapping drug-eluting stents were implanted. Two groups were created according to whether the stents release the same drug [homogeneous: (HO)] or different [heterogeneous: (HE)]. The primary endpoint was the need for target lesion revascularization (TLR). Clinical assessment was performed after the procedure, bianually and at the end of follow-up (June 2019). RESULTS 381 lesions with OS (HO: 209; HE: 172) were included (75.1% male, 66.7 ± 11.6 years). Clinical presentation was stable coronary artery disease in 49.9%. Syntax score was 23.7 ± 13.3. The number of OS implanted was 2.2 ± 0.5 and the total stent length was 59.5 ± 20.1 mm (HE: 61.5 ± 21.6 vs. HO: 57.8 ± 18.8 mm; p < 0.01). After a median follow-up of 21 months, the HE group showed a lower TLR rate than the HO group (HE:2.3% vs HO:7.2%; p = 0.03). The rates of cardiac death (p = 0.44), myocardial infarction (p = 0.36) and stent thrombosis (p = 0.85) were similar between groups. In the multivariate analysis, the OS with homogeneous-drug devices was an independent predictor of a higher rate of TLR. CONCLUSIONS PCI using OS with homogeneous pharmacological characteristics was associated with a higher rate of TLR in comparison with the implantation of OS with heterogeneous pharmacological characteristics.
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Affiliation(s)
- José Abellán-Huerta
- Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain.
| | - Alfonso Jurado-Román
- Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain
| | | | - María T López-Lluva
- Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain
| | | | - Pedro Pérez-Díaz
- Clinical Cardiology Department, University General Hospital of Ciudad Real, Spain
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López-Lluva MT, Jurado-Román A, Sánchez-Pérez I, Jiménez-Díaz J, Marina-Breysse M, Pinilla-Echeverri N, Piqueras-Flores J, Hernández-Jiménez V, Lozano-Ruiz-Poveda F. Transcatheter aortic valve implantation: the importance of an experienced multidisciplinary team. EUROINTERVENTION 2016; 12:926. [PMID: 27639746 DOI: 10.4244/eijv12i7a151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- María Thiscal López-Lluva
- Interventional Cardiology Unit, Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
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