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Salinas P, García-Camarero T, Jimenez-Kockar M, Regueiro A, García-Blas S, Gomez-Menchero AE, Ojeda S, Vilchez-Tschischke JP, Amat-Santos I, Díez-Gil JL, Rondán J, Lozano Ruiz-Poveda F, de Miguel Castro A, Manzano MC, Pascual-Tejerina V, Cruz-González I, García Perez-Velasco J, Fernández-Diaz JA, Escaned J. Myocardial revascularization failure among patients requiring cardiac catheterization and secondary revascularization in contemporary clinical practice: Results of the REVASEC multicenter registry. Catheter Cardiovasc Interv 2023; 102:608-619. [PMID: 37582340 DOI: 10.1002/ccd.30804] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/30/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Myocardial revascularization failure (MRF) and Secondary revascularization (SR) are contemporary interventional cardiology challenges. AIM To investigate the characteristics, management, and prognosis of patients with myocardial revascularization failure (MRF) and need for secondary revascularization (SR) in contemporary practice. METHODS The REVASEC study is a prospective registry (NCT03349385), which recruited patients with prior revascularization referred for coronary angiography at 19 centers. The primary endpoint is a patient-oriented composite (POCE) at 1 year, including death, myocardial infarction, or repeat revascularization. RESULTS A total of 869 patients previously revascularized by percutaneous intervention (83%) or surgery (17%) were recruited. MRF was found in 83.7% (41.1% stent/graft failure, 32.1% progression of coronary disease, and 10.5% residual disease). SR was performed in 70.1%, preferably by percutaneous intervention (95%). The POCE rate at 1 year was 14% in the overall cohort, with 6.4% all-cause death. In the multivariate analysis, lower POCE rates were found in the groups without MRF (9.4%) and with disease progression (11%) compared with graft/stent failure (17%) and residual disease (18%), hazard ratio 0.67 (95% confidence interval: 0.45-0.99), p = 0.043. At 1 year, the SR group had less chronic persistent angina (19% vs. 34%, p < 0.001), but a higher rate of repeat revascularization (9% vs. 2.9%, p < 0.001). CONCLUSION MRF was found in 84% of patients with prior revascularization referred for coronary angiography. Stent/graft failure and residual coronary disease were associated with a worse prognosis. SR provided better symptom control at the expense of a higher rate of new revascularization.
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Affiliation(s)
- Pablo Salinas
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | - Sergio García-Blas
- Instituto de Investigación Sanitaria INCLIVA, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Soledad Ojeda
- Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Rodriguez-Leor O, Toledano B, López-Palop R, Rivero F, Brugaletta S, Linares JA, Benito T, Carrillo P, Puigfel M, Cediel G, Sadaba M, Vaquerizo B, Rondán J, Gómez I, Alfonso F, Sáez R, Planas A, Lozano F, Hernández F, Sabaté M, Ruíz-Arroyo JR, Torres F, de la Torre Hernández JM, Gutiérrez E, Cid-Álvarez AB, Díez JL, Fernández L, Moreu J, Ojeda S, Cerrato P, Ruiz-Quevedo V, Sanchis J, Gómez-Menchero A, Ocaranza R, Mohandes M, Hernández JM, Alfageme MM, Aguiar P, López Mínguez JR, Pérez de Prado A. Changes in the treatment strategy following intracoronary pressure wire in a contemporaneous real-life cohort of patients with intermediate coronary stenosis. Results from a nationwide registry. Cardiovasc Revasc Med 2023; 51:55-64. [PMID: 36822975 DOI: 10.1016/j.carrev.2023.01.027] [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: 07/21/2022] [Revised: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease. AIMS To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis. METHODS Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed. RESULTS 1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0 %). The extent of coronary artery disease changed in 771 patients (54.5 %). There was a change in treatment strategy in 779 patients (55.1 %) (18.0 % if medical treatment; 68.8 % if PCI; 58.9 % if surgery (p < 0.001 for PCI vs medical treatment; p = 0.041 for PCI vs CABG; p < 0.001 for medical treatment vs CABG)). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6 % vs 8.2 %, p = 0.034). CONCLUSIONS The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.
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Affiliation(s)
- Oriol Rodriguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
| | - Beatriz Toledano
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Fernando Rivero
- Servicio de Cardiología, Hospital de la Princesa, Madrid, Spain
| | - Salvatore Brugaletta
- Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Tomás Benito
- Servicio de Cardiología, Hospital de León, León, Spain
| | - Pilar Carrillo
- Servicio de Cardiología, Hospital de Sant Joan, Alacant, Spain
| | - Martí Puigfel
- Servicio de Cardiología, Hospital Josep Trueta de Girona, Girona, Spain
| | - German Cediel
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mario Sadaba
- Servicio de Cardiología, Hospital de Galdakao, Galdakao, Spain
| | | | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Spain
| | - Iván Gómez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Roberto Sáez
- Servicio de Cardiología, Hospital de Basurto, Basurto, Spain
| | - Ana Planas
- Servicio de Cardiología, Hospital de Castellón, Castellón de la Plana, Spain
| | - Fernando Lozano
- Servicio de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Felipe Hernández
- Servicio de Cardiología, Clínica Universitaria de Navarra, Madrid, Spain
| | - Manel Sabaté
- Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | | | | | - Enrique Gutiérrez
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago, Santiago de Compostela, Spain
| | - José Luís Díez
- Servicio de Cardiología, Hospital Universitari de la Fe, Valencia, Spain
| | - Luis Fernández
- Servicio de Cardiología, Hospital de Cruces, Barakaldo, Spain
| | - José Moreu
- Servicio de Cardiología, Hospital de Toledo, Toledo, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Pablo Cerrato
- Servicio de Cardiología, Hospital de Mérida, Mérida, Spain
| | | | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Mohsen Mohandes
- Servicio de Cardiología, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - Pablo Aguiar
- Servicio de Cardiología, Hospital San Pedro de Logroño, Logroño, Spain
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Vega B, de Prado AP, Rondán J, Cuellas-Ramón C, Miguel Vegas J, López Benito M, Benito-González T, Segovia E, Fernández-Vázquez e F, Lozano Í. Velocidad de desinflado del sistema de liberaci�n del <i>stent</i> en la angioplastia primaria: estudio aleatorizado. RECIC 2022. [DOI: 10.24875/recic.m21000230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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4
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Jurado-Román A, Miñana G, Salinas P, Regueiro A, Caballero-Borrego J, Martín-Moreiras J, Rivero F, Lacunza J, Rondán J, Amat-Santos IJ, Sanchís J, Gonzalo N, Sabaté M, Astorga JC, Mohandes M, Gómez-Menchero A, Fernández Díaz JA, Ojeda S, Paredes E, Vaquerizo B, Vinhas H, López M, Rodríguez S, Rúmiz E, Jiménez-Mazuecos J, Lee DH, Robles J, Gutiérrez A, Morales FJ, Consuegra L, Maristany J, Bosa Ojeda F, Goicolea J, Escaned J, Galeote G. Overlapping versus single long stents in long chronic total occlusions: insights of the Iberian CTO Registry. Minerva Cardiol Angiol 2022; 71:284-293. [PMID: 35420282 DOI: 10.23736/s2724-5683.22.06046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND It is unknown whether the availability of long drug-eluting stents modify the PCI strategy of long CTO. To describe the contemporary PCI strategy of long chronic total occlusions (CTO) using overlapping (OS) or single long stents (SS) and to analyze its results. METHODS 2842 consecutive CTO PCIs were included. T hose with an occlusion length ≥20 mm in which ≥ 1 DES was implanted were analyzed. We compared procedural characteristics and clinical outcomes of CTO treated with OS or SS. RESULTS 1088 CTO PCIs were analyzed (79.9% males; 64.7±10.6 years). Mean J-score was 2.8 ± 0.9. A SS was used in 38.5% of cases and OS in 61.5%. Total stent length was 64.1±29.9 mm; it was higher in the OS group (OS:79.9±25.5 mm vs SS:38.3±14.7 mm; p<0.0001). Mean number of stents in the OS group was 2.3±1. Very long stents (≥40 mm) were used in 27.4% of cases, more frequently in the OS group (OS:32.4% vs SS:19.3%; p<0.0001). After a mean follow-up of 19±15.9 months, the rate of adverse events (MACE) was 2% (cardiac death:1.6%, myocardial infarction:1.6%, target lesion revascularization:1.9% and stent thrombosis: 0.18%) with no significant differences between both groups. Overlapping was not an independent predictor of MACE. CONCLUSIONS In long CTO PCIs, OS is more frequently used than single stenting, especially in more complex procedures. Clinical outcomes at a mid-term follow-up are favorable. Using newer generation DES, overlapping was not an independent predictor of MACE, however a trend toward a higher event rate was observed in the OS group.
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Affiliation(s)
- Alfonso Jurado-Román
- La Paz University Hospital, Madrid, Spain - .,University General Hospital of Ciudad Real, Ciudad Real, Spain -
| | - Gema Miñana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), INCLIVA, Hospital Clínic Universitari, University of Valencia, Valencia, Spain
| | - Pablo Salinas
- Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | - Javier Lacunza
- University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Juan Rondán
- University Hospital of Cabueñes, Gijón, Spain
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Hospital Clínico Universitario, Valladolid, Spain
| | - Juan Sanchís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), INCLIVA, Hospital Clínic Universitari, University of Valencia, Valencia, Spain
| | - Nieves Gonzalo
- Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Hugo Vinhas
- University Hospital of Algarve, Algarve, Portugal
| | | | | | - Eva Rúmiz
- University General Hospital of Valencia, Valencia, Spain
| | | | - Dae-Hyun Lee
- University Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | - Javier Escaned
- Hospital Clinico Universitario San Carlos, Madrid, Spain
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5
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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Plaque modification in calcified chronic total occlusions: the PLACCTON study. Rev Esp Cardiol (Engl Ed) 2022; 75:213-222. [PMID: 34301507 DOI: 10.1016/j.rec.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. METHODS Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. RESULTS Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). CONCLUSIONS Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits.
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Affiliation(s)
- José R Delgado-Arana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José R Rumoroso
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Gema Miñana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Mohsen Mohandes
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Pablo Salinas
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Alfonso Jurado-Román
- Departamento de Cardiología, Hospital La Paz, Madrid, Spain; Departamento de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - Javier Lacunza
- Departamento de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Fernando Rivero
- Departamento de Cardiología, Hospital de La Princesa, Madrid, Spain
| | | | - Juan Rondán
- Departamento de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | | | - Sandra Santos-Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Asier Subinas
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Víctor Arévalos
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alejandro Diego Nieto
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Sergio Rojas
- Departamento de Cardiología, Hospital Joan XXIII, Tarragona, Spain
| | - Soledad Ojeda
- Departamento de Cardiología, Hospital Reina Sofia, Instituto Maimónides de investigación biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Javier Goicolea
- Departamento de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Mario Sádaba
- Departamento de Cardiología, Hospital Galdakao, Bizkaia, Spain
| | - Itziar Gómez-Salvador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Manel Sabaté
- Departamento de Cardiología, Hospital Clínic, Instituto de Investigaciones Bioéticas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jean Carlos Núñez García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
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Delgado-Arana JR, Rumoroso JR, Regueiro A, Martín-Moreiras J, Miñana G, Mohandes M, Pan M, Salinas P, Caballero-Borrego J, Fernández-Díaz JA, Jurado-Román A, Lacunza J, Vaquerizo B, Rivero F, Abellán-Huerta J, Rondán J, Gómez Menchero A, Santos-Martínez S, Subinas A, Arévalos V, Diego Nieto A, Sanchis J, Rojas S, Ojeda S, Gonzalo N, López-Pérez M, Goicolea J, Sádaba M, Gómez-Salvador I, Sabaté M, Núñez García JC, Amat-Santos IJ. Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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7
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Rodríguez-Leor O, Torre-Hernández JMDL, García-Camarero T, López-Palop R, del Blanco BG, Carrillo X, Portero-Portaz JJ, Jiménez-Kockar M, Gómez-Lara J, Ojeda S, Alfonso F, Brugaletta S, del Viejo AP, Antonio Linares J, Fernández-Cisnal A, Vaquerizo B, Fernández-Salinas F, Díaz-Fernández JF, Rama-Merchán JC, Molina E, Muñoz-García É, Morales F, Trillo R, Tellería M, Rondán J, Avanzas P, Moreu J, Baz-Alonso JA, Hernández F, Escaned J, Sanchis J, Lozano F, Toledano B, Puigfel M, Sádaba y M, de Prado AP. Justificaci�n y dise�o del estudio Concordancia entre RFF e iFR en lesiones del tronco com�n. Estudio iLITRO-EPIC-07. RECIC 2022. [DOI: 10.24875/recic.m21000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Salinas P, Vilchez-Tschischke JP, Noriega F, Macaya F, Rosillo S, García-Camarero T, de la Torre-Hernández JM, de Tapia B, Jiménez-Kockar M, Regueiro A, Flores-Umanzor E, García-Blas S, González-D'Gregorio J, Gómez-Menchero AE, Díaz-Fernandez JF, Rondán J, Amat-Santos I, Ojeda S, Diez-Gil JL, de Miguel Castro A, Lozano Ruiz-Poveda F, Fernández-Diaz JA, Manzano MC, Cruz-González I, Pascual Tejerina V, García Pérez-Velasco J, Serra A, Poveda-Andrés JL, Macaya C, Escaned J. Design and rationale for a real-world prospective, multicenter registry of myocardial revascularization failure and secondary revascularization: The REVASEC study. Cardiovasc Revasc Med 2021; 40:50-56. [PMID: 34857473 DOI: 10.1016/j.carrev.2021.11.015] [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: 08/27/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/03/2022]
Abstract
AIM To investigate key aspects of the problem of myocardial revascularization failure (MRF) and repeat or secondary myocardial revascularization (SR) in contemporary practice. METHODS The registry of secondary revascularization (REVASEC) is an investigator-initiated, multicenter, prospective registry enhanced with data monitoring and independent event adjudication (ClinicalTrials.govNCT03349385). It includes patients with prior revascularization referred to coronary angiography for suspected MRF with broad inclusion criteria. The main objectives are to describe the characteristics of patients with prior revascularization referred for repeat angiography, to describe and the rate and mechanisms of MRF (stent or graft failure, coronary artery disease progression or residual coronary artery disease); to evaluate the management including medical treatment and SR of these patients; and to assess the prognosis according to the outlined causative mechanisms. The registry has one year follow up for the primary endpoint (Patient-oriented composite endpoint including all-cause death, any myocardial infarction or any new unplanned revascularization according to subsets of MRF), but extended follow-up will be carried out up to 5 years. CONCLUSION The REVASEC Registry will provide updated data on the characteristics, patterns of treatment, and 1-year outcomes of patients with MRF and SR in contemporary clinical practice.
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Affiliation(s)
- Pablo Salinas
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Jean Paul Vilchez-Tschischke
- Hospital Universitario y Politécnico La Fe, Valencia, Spain; Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
| | - Francisco Noriega
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Fernando Macaya
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Juan Rondán
- Hospital Universitario de Cabueñes, Gijón, Spain
| | | | - Soledad Ojeda
- Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimonides de Investigación Biomédica (IMIBIC), Universidad de Cordoba, Spain
| | | | | | | | | | | | | | | | | | - Antonio Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Carlos Macaya
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Javier Escaned
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Salinas P, Gonzalo N, Moreno VH, Fuentes M, Santos-Martinez S, Fernandez-Diaz JA, Amat-Santos IJ, Ojeda FB, Borrego JC, Cuesta J, Hernández JMDLT, Diego-Nieto A, Dubois D, Galeote G, Goicolea J, Gutiérrez A, Jiménez-Fernández M, Jiménez-Mazuecos J, Jurado A, Lacunza J, Lee DH, López M, Lozano F, Martin-Moreiras J, Martin-Yuste V, Millán R, Miñana G, Mohandes M, Morales-Ponce FJ, Núñez J, Ojeda S, Pan M, Rivero F, Robles J, Rodríguez-Leiras S, Rojas S, Rondán J, Rumiz E, Sabaté M, Sanchís J, Vaquerizo B, Escaned J. Choice of CTO scores to predict procedural success in clinical practice. A comparison of 4 different CTO PCI scores in a comprehensive national registry including expert and learning CTO operators. PLoS One 2021; 16:e0245898. [PMID: 33798205 PMCID: PMC8018648 DOI: 10.1371/journal.pone.0245898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures. METHODS Scores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared. RESULTS Mean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, p<0.001), similar to J-CTO and slightly inferior to CL score (- 0.011, p = 0.004). Regarding net reclassification improvement, CASTLE reclassified better than PROGRESS (overall continuous net reclassification improvement 0.379, p<0.001) in roughly 20% of cases. CONCLUSION Procedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.
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Affiliation(s)
- Pablo Salinas
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nieves Gonzalo
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Víctor H. Moreno
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Fuentes
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Sandra Santos-Martinez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Ignacio J. Amat-Santos
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Javier Cuesta
- Servicio de Cardiología, H. de la Princesa, Madrid, Spain
| | | | - Alejandro Diego-Nieto
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, IBSAL, CIBERCV, Salamanca, España
| | | | | | - Javier Goicolea
- Interventional Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | | | | | - Alfonso Jurado
- Servicio de Cardiología, H. la Paz, Madrid, Spain
- Servicio de Cardiología, H. Ciudad Real, Ciudad Real, Spain
| | - Javier Lacunza
- Servicio de Cardiología, H. de la Arrixaca, Murcia, Spain
| | - Dae-Hyun Lee
- Servicio de Cardiología, H. Valdecilla, Santander, Spain
| | - María López
- Servicio de Cardiología, H. León, León, Spain
| | | | - Javier Martin-Moreiras
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, IBSAL, CIBERCV, Salamanca, España
| | - Victoria Martin-Yuste
- CIBER CV, IDIBAPS, Instituto Cardiovascular, Servicio de Cardiología, H. Clinic Barcelona, Spain
| | - Raúl Millán
- Servicio de Cardiología, H. del Mar, Barcelona, Spain
| | - Gema Miñana
- Servicio de Cardiología, H. Clínico de Valencia. Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | | | - Julio Núñez
- Servicio de Cardiología, H. Clínico de Valencia. Universidad de Valencia, CIBERCV, Valencia, Spain
| | - Soledad Ojeda
- Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Manuel Pan
- Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | | | | | | | - Sergio Rojas
- Servicio de Cardiología, H. Joan XXIII, Tarragona, Spain
| | - Juan Rondán
- Servicio de Cardiología, H. Cabueñes, Gijón, Spain
| | - Eva Rumiz
- Servicio de Cardiología, H. General de Valencia, Valencia, Spain
| | - Manel Sabaté
- CIBER CV, IDIBAPS, Instituto Cardiovascular, Servicio de Cardiología, H. Clinic Barcelona, Spain
| | - Juan Sanchís
- Servicio de Cardiología, H. Clínico de Valencia. Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | - Javier Escaned
- Cardiology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Rodríguez-Leor O, Cid-Álvarez B, Pérez de Prado A, Rossello X, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Moreno R, Villa M, Ruíz-Salmerón R, Molano F, Sánchez C, Muñoz-García E, Íñigo L, Herrador J, Gómez-Menchero A, Gómez-Menchero A, Caballero J, Ojeda S, Cárdenas M, Gheorghe L, Oneto J, Morales F, Valencia F, Ruíz JR, Diarte JA, Avanzas P, Rondán J, Peral V, Pernasetti LV, Hernández J, Bosa F, Lorenzo PLM, Jiménez F, Hernández JMDLT, Jiménez-Mazuecos J, Lozano F, Moreu J, Novo E, Robles J, Moreiras JM, Fernández-Vázquez F, Amat-Santos IJ, Gómez-Hospital JA, García-Picart J, Blanco BGD, Regueiro A, Carrillo-Suárez X, Tizón H, Mohandes M, Casanova J, Agudelo-Montañez V, Muñoz JF, Franco J, Del Castillo R, Salinas P, Elizaga J, Sarnago F, Jiménez-Valero S, Rivero F, Oteo JF, Alegría-Barrero E, Sánchez-Recalde Á, Ruíz V, Pinar E, Pinar E, Planas A, Ledesma BL, Berenguer A, Fernández-Cisnal A, Aguar P, Pomar F, Jerez M, Torres F, García R, Frutos A, Nodar JMR, García K, Sáez R, Torres A, Tellería M, Sadaba M, Mínguez JRL, Merchán JCR, Portales J, Trillo R, Aldama G, Fernández S, Santás M, Pérez MPP. Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience. ACTA ACUST UNITED AC 2020; 73:994-1002. [PMID: 32917566 PMCID: PMC7834732 DOI: 10.1016/j.rec.2020.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022]
Abstract
Introduction and objectives The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. Methods Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. Results Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. Conclusions The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
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Affiliation(s)
- Oriol Rodríguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Islas Baleares, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Ana Serrador
- Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Javier Martín-Moreiras
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - José Ramón Rumoroso
- Servicio de Cardiología, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital de Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Borja Ibáñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Ignacio Cruz-González
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital de Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jesús Oneto
- Hospital Universitario de Jerez de la Frontera
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Juan Franco
- Hospital Universitario Fundación Jiménez Díaz
| | | | - Pablo Salinas
- Hospital Clínico San Carlos y Hospital Príncipe de Asturias
| | | | | | | | | | | | | | | | | | | | - Eduardo Pinar
- Luciano Consuegra-Sánchez, Hospital Universitario Santa Lucía de Cartagena
| | - Ana Planas
- Hospital General Universitario de Castellón
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ramiro Trillo
- Hospital Clínico Universitario Santiago de Compostela
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Lozano I, Rondán J, Vegas JM, Segovia E. Definition of Myocardial Infarction Type 4a: Can We Define Its Diagnosis and Systematize Clinical Practice? Rev Esp Cardiol (Engl Ed) 2019; 72:695-696. [PMID: 30971379 DOI: 10.1016/j.rec.2019.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Eduardo Segovia
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Amat-Santos IJ, Martin-Yuste V, Fernández-Díaz JA, Martin-Moreiras J, Caballero-Borrego J, Salinas P, Ojeda S, Rivero F, Núñez Villota J, Mohandes M, Dubois D, Bosa Ojeda F, Rumiz E, de la Torre Hernández JM, Jiménez-Mazuecos J, Lacunza J, Tejedor P, Gómez I, Goncalves-Ramirez LR, Rojas P, Sabaté M, Goicolea J, Diego Nieto A, Jiménez-Fernández M, Escaned J, Gonzalo N, Pardo L, Cuesta J, Miñana G, Sanchis J, Rojas S, Millán R, Vaquerizo B, Rodríguez S, Lee DH, Morales FJ, Gutiérrez A, López M, Maristany J, Rondán J, Galeote G, Kabbanni Z, Rodríguez S, Teruel L, Sadaba M, Jurado A, Mainar V, Sánchez-Rubio J, Vinhas H, Fernandes R. Procedural, Functional and Prognostic Outcomes Following Recanalization of Coronary Chronic Total Occlusions. Results of the Iberian Registry. ACTA ACUST UNITED AC 2019; 72:373-382. [DOI: 10.1016/j.rec.2018.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/13/2018] [Indexed: 10/28/2022]
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13
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Lozano Í, Rondán J, Vegas JM, Segovia E. Tratamiento antitrombótico tras implante percutáneo de válvula aórtica: grandes lagunas para una cuestión de extrema importancia. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lozano Í, Rondán J, Vegas JM, Segovia E. Initiatives to Achieve Excellence in the Care of Acute Coronary Syndrome. Rev Esp Cardiol (Engl Ed) 2017; 70:1026-1027. [PMID: 28774631 DOI: 10.1016/j.rec.2017.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Íñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Eduardo Segovia
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Lozano Í, Rondán J, Vegas JM, Segovia E. Demanda futura de procedimientos intervencionistas en cardiopatía estructural. ¿Es sensato realizar TAVI solo en centros con cirugía cardiaca? Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lozano Í, Rondán J, Vegas JM, Segovia E. Future Demand for Interventional Procedures in Structural Heart Disease. Is It Wise to Perform TAVI Only in Centers With On-site Cardiac Surgery? ACTA ACUST UNITED AC 2017; 70:307. [PMID: 28254254 DOI: 10.1016/j.rec.2017.01.014] [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] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Íñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Eduardo Segovia
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Lozano I, Vegas JM, Rondán J, Segovia E. Consensus Document on Polypill and Secondary Prevention. Does It Include Patients With Stents? Rev Esp Cardiol (Engl Ed) 2016; 69:995. [PMID: 27544237 DOI: 10.1016/j.rec.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Eduardo Segovia
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Lozano I, Rondán J, Vegas JM, Segovia E. Sustainability of the Health System: Beyond Cost-effectiveness Analyses. Rev Esp Cardiol (Engl Ed) 2016; 69:880-881. [PMID: 27387051 DOI: 10.1016/j.rec.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Eduardo Segovia
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Lozano I, Rondán J, Vegas JM, Segovia E. Trombectomía en angioplastia primaria: ¿aclaran los últimos grandes estudios las dudas sobre su utilidad? Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lozano I, Rondán J, Vegas JM, Segovia E. Thrombectomy in Primary Angioplasty: Do the Latest Large Studies Address the Doubts About Its Usefulness? ACTA ACUST UNITED AC 2015; 69:230-1. [PMID: 26652133 DOI: 10.1016/j.rec.2015.09.010] [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] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Eduardo Segovia
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
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Lozano I, Suárez-Cuervo A, Rondán J, Avanzas P, Vegas JM, Morís C. Redes de atención al infarto con elevación del ST: ¿cuál es el área idónea de referencia para angioplastia primaria? Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lozano I, Suárez-Cuervo A, Rondán J, Avanzas P, Vegas JM, Morís C. Care Network for ST-elevation Myocardial Infarction: What Is the Ideal Catchment Area for Primary Angioplasty? ACTA ACUST UNITED AC 2015; 68:444-5. [PMID: 25814182 DOI: 10.1016/j.rec.2014.12.015] [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] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain.
| | | | - Juan Rondán
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Pablo Avanzas
- Servicio de Cardiología, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - José M Vegas
- Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - César Morís
- Servicio de Cardiología, Hospital Central de Asturias, Oviedo, Asturias, Spain
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Lopez-Palop R, Carrillo P, Torres F, Lozano I, Frutos A, Avanzas P, Cordero A, Rondán J. Resultados del empleo de la reserva fraccional de flujo en la valoración de lesiones no causales en el síndrome coronario agudo. Rev Esp Cardiol 2012; 65:164-70. [DOI: 10.1016/j.recesp.2011.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 09/18/2011] [Indexed: 01/19/2023]
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Martín M, Romero Tarín E, Luyando LH, Rondán J, Morales C. Myocardial bridging: light in the tunnel. Int J Cardiovasc Imaging 2009; 25:555-7. [DOI: 10.1007/s10554-009-9470-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
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Lozano I, Martín D, Torres F, Avanzas P, Rondán J, García-Ruiz JM, Hernández E, Bayón J, Vegas JM, Espolita A. Knowledge of coronary stents, thrombosis and dual antiplatelet therapy among Spanish dentists. Rev Esp Cardiol 2009; 62:153-7. [PMID: 19232188 DOI: 10.1016/s1885-5857(09)71533-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES The coexistence of heart and dental disease is common and antiplatelet therapy with aspirin and clopidogrel following a percutaneous intervention can interfere with dental practice. Our aim was to study dentists' knowledge of percutaneous coronary interventions and their approach to affected patients. METHODS A questionnaire was used to evaluate the knowledge of 100 randomly selected dentists in Spain about coronary stents, antiplatelet therapy, and guidelines prepared by American medical societies, including the American Dental Association, and to determine how frequently they consulted a cardiologist. RESULTS Data were collected from 100 dentists. Of these, 17 had no knowledge of coronary stents, but only one did not interrupt dual therapy: 12 consulted a cardiologist and the remaining four discontinued therapy themselves. Of the 83 who knew about stents, only 28 (34%) understood the difference between bare metal and drug-eluting stents. The drug clopidogrel's name was known by 21%, while 60% recognized one of the drug's commercial names and 45% recognized the other. Of the 83 aware of stents, 48 (58%) knew of the possibility of stent thrombosis, but only three knew about possible mortality. Cardiologists were consulted before dental procedures in 83% of cases. Only 36% knew about the existence of the guidelines. CONCLUSIONS Although Spanish dentists' knowledge of coronary interventions was limited, in the majority of cases a cardiologist was consulted before a patient taking dual antiplatelet therapy was treated. Only a small percentage of those questioned knew of the existence of American medical society guidelines.
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Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Lozano Í, Martín D, Torres F, Avanzas P, Rondán J, García-Ruiz JM, Hernández E, Bayón J, Vegas JM, Espolita A. Grado de conocimiento de stents coronarios, trombosis y doble antiagregación entre los odontólogos en España. Rev Esp Cardiol (Engl Ed) 2009. [DOI: 10.1016/s0300-8932(09)70157-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lozano I, Avanzas P, Lee DH, Lasa G, Rondán J, Moris C. Drug-eluting stent implantation in bifurcated lesions with balloon-crushing technique and 6 fr guiding catheter: immediate and mid-term results. J Invasive Cardiol 2007; 19:27-31. [PMID: 17297182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED Bifurcated lesions are associated with higher complexity and restenosis. Sometimes implantation of two stents is necessary, requiring larger guiding catheters. We describe the implantation of two drug-eluting stents (DES) utilizing the balloon-crushing technique and 6 Fr catheters. METHODS This was a prospective and observational study of a cohort of 15 consecutive patients with 1 bifurcated lesion treated with 2 DES through a 6 Fr catheter and the balloon-crushing technique between April and November 2005. The baseline characteristics of the patients, lesions and procedures were registered. Clinical follow up was obtained by telephone contact. RESULTS Patient age ranged from 71.6+/- 9.4 years; 6 patients (40%) had diabetes; ejection fraction was 56 +/- 12%; radial access was used in 4 patients (26.6%). In 9 patients (60%) the target lesion was the left main artery; in 3 patients (20%) the target lesion was the LAD/diagonal and in the remaining 3 patients (20%), the target lesion was the circumflex/obtuse marginal. The median follow-up period was 316 days. There were 2 sudden deaths: 1 patient whose target lesion was the left main artery died 10 days following the procedure, and the other patient whose lesion was in the in LAD/diagonal died at day-187, 10 days following stent thrombosis. Both of them presented with severe ventricular dysfunction prior to the intervention. One patient required new percutaneous intervention due to in-segment restenosis in the left main artery. The composite major adverse cardiac events at follow up was 5 (33.3%, 2 deaths, 2 non-Q-wave myocardial infarctions and 1 revascularization). CONCLUSIONS This technique permits the treatment of bifurcated lesions with 2 stents using 6 Fr guiding catheters, which could be very useful in radial access procedures. However, though the angiographic results were very satisfactory, the events observed in the follow-up period require a word of caution about its mid-term safety.
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Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Avanzas P, Martín M, Lozano I, Rondán J, Llaneza JM, Morís C. Resultados inmediatos y a largo plazo del cierre percutáneo del acceso femoral en el tratamiento endovascular de la enfermedad de aorta torácica. Rev Esp Cardiol (Engl Ed) 2006. [DOI: 10.1157/13091889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Avanzas P, Martín M, Lozano I, Rondán J, Llaneza JM, Morís C. [Immediate and long-term results of percutaneous suture of femoral access-site after endovascular treatment of thoracic aortic disease]. Rev Esp Cardiol 2006; 59:838-41. [PMID: 16938234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The use of stent grafts for treating diseases of the aorta has been assisted by the development of new percutaneous techniques for closing the access site. The purpose of this study is to describe our clinical experience and results obtained using percutaneous closure devices for femoral artery closure after the placement of stent grafts.
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Affiliation(s)
- Pablo Avanzas
- Area del Corazón, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, España
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Martin M, Lozano I, Morís C, Rondán J, Avanzas P, Suárez E, Simarro C, Díaz-Molina B. An incidental finding during cardiac catheterization. Int J Cardiol 2006; 106:137-8. [PMID: 16321682 DOI: 10.1016/j.ijcard.2004.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2004] [Accepted: 12/31/2004] [Indexed: 11/26/2022]
Abstract
Coronary artery obstruction during cardiac catheterization is rare. It is a serious complication and has been reported to occur in 0.15 to 0.5% of cases. Thromboembolism, air embolism and coronary dissection have been described as the most common causes of intraprocedural coronary occlusion. Aortic valve masses can also cause coronary obstruction. We report the case of a young woman with a complication and an incidental finding during angiographic procedure. A surgical treatment was needed.
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Affiliation(s)
- Maria Martin
- Hospital Universitario Central de Asturias, Department of Cardiology, Oviedo, Spain.
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Rondán J, Lozano I, Morís C, Martín M, Avanzas P, Suárez E. Cateterismo cardíaco por vía radial derecha con catéter Judkins izquierdo. Estudio prospectivo. Rev Esp Cardiol 2005. [DOI: 10.1157/13077239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rondán J, Lozano I, Morís C, Martín M, Avanzas P, Suárez E. [Cardiac catheterization via the right radial artery with a Judkins left catheter. A prospective study]. Rev Esp Cardiol 2005; 58:868-71. [PMID: 16022819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Radial artery access improves the patient's well-being, permits earlier ambulation and diminishes vascular complications after cardiac catheterization. Using the same catheter to study the left and right coronary arteries may facilitate the technique. In a cohort of 100 patients we prospectively analyzed the possibility of studying both coronary arteries with a Judkins left 3.5 catheter. The variables studied were percentage of successful access, complications, and procedural time from insertion of the guiding catheter to the end of ventriculography. It was possible to catheterize both coronary arteries with the same catheter in 94 cases (94%) with a procedural time of 16.7 (6.8) min. In 6 patients a JR4 catheter was required, in one of them due to severe spasm of the right coronary artery ostium and due to impossibility to catheterize the ostium in the other 5. There were no cases of severe radial artery spasm.
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Affiliation(s)
- Juan Rondán
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Lozano I, López-Palop R, Pinar E, Saura D, Fuertes J, Rondán J, Suárez E, Valdés M, Morís C. [Direct stenting in saphenous vein grafts. Immediate and long-term results]. Rev Esp Cardiol 2005; 58:270-7. [PMID: 15766449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous interventions on saphenous vein grafts are associated with a worse outcome than in native vessels, mainly because of the risk of embolization. Direct stenting may diminish aggression to the vessel. This study reports the results of direct stenting in saphenous vein grafts. PATIENTS AND METHOD We compared 2 cohorts of consecutive patients treated with direct stenting (DS) and stenting with predilatation (PD) in saphenous vein grafts between September 1998 and March 2003. In-hospital and long-term results and predictors of mortality were analyzed. RESULTS The DS group contained 71 patients with 83 lesions, and the PD group contained 46 patients with 54 lesions. There were no differences in age, risk factors, age of the graft, ejection fraction, stent length, need for postdilatation or number of stents per lesion, although the DS group contained more women (DS=38%, PD=17%, P=.02), and stent diameter was larger (DS=3.59 [0.59] mm, PD=3.21 [0.59] mm, P=.001) in the DS group. Creatine phosphokinase elevation was > or =2-fold in 10% (DS=7%, PD=16%, P=.1). One patient died in the hospital. Median follow-up time was 36.1 months. Survival was 94+/- 2% at 12 months, 87+/-3% at 24 months, 82+/-17% at 36 months, 67+/-8% at 48 months and 58+/-7% at 60 months. Revascularization rate was 14% for the target lesion and 20.5% for the target vessel, with no differences between groups in mortality or revascularization success rate. Predictors of mortality were ejection fraction and smoking habit. CONCLUSIONS Survival after stenting in saphenous vein grafts is similar with direct and conventional techniques, although there was a tendency toward a lower incidence of myocardial infarction with the former. Although the in-hospital results were favorable, long-term survival was less favorable with both techniques.
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Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
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Lozano Í, López-Palop R, Pinar E, Saura D, Fuertes J, Rondán J, Suárez E, Valdés M, Morís C. Implante de stent directo en puentes de safena. Resultados inmediatos y a largo plazo. Rev Esp Cardiol 2005. [DOI: 10.1157/13072474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lozano Í, Herrera C, Morís C, Gómez-Hospital JA, Rondán J, Iráculis E, Martín M, Cequier Á, Suáreza E, Esplugas E. Stent liberador de fármacos en lesiones de tronco coronario izquierdo en pacientes no candidatos a revascularización quirúrgica. Rev Esp Cardiol 2005. [DOI: 10.1157/13071888] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lozano I, Herrera C, Morís C, Gómez-Hospital JA, Rondán J, Iráculis E, Martín M, Cequier A, Suárez E, Esplugas E. [Drug-eluting stents in patients with left main coronary lesions who are not candidates for surgical revascularization]. Rev Esp Cardiol 2005; 58:145-52. [PMID: 15743560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION AND OBJECTIVES Surgical revascularization is the treatment of choice in patients with left main coronary artery stenosis. Conventional stents are not a valid alternative because of the rate of restenosis and sudden cardiac death. Drug-eluting stents, which reduce the rate of restenosis, may represent an alternative to cardiac surgery. The objective of this study was to describe the results with drug-eluting stents in patients with left main coronary artery stenosis who were poor candidates for surgical revascularization. PATIENTS AND METHOD We prospectively followed a consecutive series of patients who were poor candidates for surgical revascularization and were treated with implantation of a drug-eluting stent in the left main coronary artery between May 2002 and April 2004. In-hospital and long-term results were analyzed. Follow-up included angiographic and intravascular ultrasound (IVUS) studies. RESULTS Forty-two patients (25 men, 59.5%) with a mean age of 70.1 (10.5) years were studied. Fourteen (33%) had diabetes, and 7 (16.7%) had a protected left main coronary artery. The reasons for ruling out surgery were poor distal vessels in 19 (45.2%), previous surgery in 9 (21.4%), age in 6 (14.3%), primary angioplasty in 5 (11.4%), and other reasons in 3 (7.2%). Four patients (9.5%) died before discharge, three of them after primary angioplasty. No in-hospital revascularization procedures were needed. Median follow-up time was 288 days; mean follow-up time was 315 (241) days. Another four patients died after discharge (9.5%) on days 5, 24, 34 and 115. Angioplasty was repeated in one patient, and another was referred for heart transplantation. CONCLUSIONS Drug-eluting stents represent a valid alternative in patients with left main coronary artery stenosis who are poor candidates for surgical revascularization. Randomized studies with a longer follow-up should be performed to evaluate their benefits in patients eligible for surgery.
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Affiliation(s)
- Iñigo Lozano
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
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Barriales V, Tamargo JA, Aguado MG, Martín M, Rondán J, Posada IS. Electrical storm as initial presentation of arrhytmogenic right ventricular cardiomyopathy in an elderly woman. Int J Cardiol 2004; 94:331-3. [PMID: 15094006 DOI: 10.1016/j.ijcard.2003.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2002] [Accepted: 04/02/2003] [Indexed: 11/18/2022]
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is an unusual cause of electrical storm in the elderly. We report the case of a 76-year-old woman with no previous known disease who developed recurrent ventricular tachycardia and fibrillation. Postmortem examination revealed histological features of arrhythmogenic right ventricular dysplasia.
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Barriales V, Tamargo JA, Aguado MG, Martín M, Rondán J, Segovia E, Morís C. Floating thrombi on the Eustachian valve as a complication of venous thromboembolic disease. Int J Cardiol 2004; 93:289-91. [PMID: 14975561 DOI: 10.1016/s0167-5273(03)00153-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2002] [Accepted: 12/24/2002] [Indexed: 11/21/2022]
Abstract
Floating right heart thrombi can occur in 4-18% of patients with pulmonary embolism. Usually, the diagnosis is done by echocardiography and carries an important prognostic significance as thrombi can embolize at any moment and severe pulmonary embolism is the most frequent way of floating right heart thrombi presentation (mortality rate >40%). We present a case report of floating right thrombi in a patient with proven deep venous thrombosis complicated with nonmassive pulmonary embolism that was successfully treated with thrombolysis.
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