1
|
Flores-Umanzor E, Cepas-Guillen P, Álvarez-Contreras L, Caldentey G, Castrillo-Golvano L, Fernandez-Valledor A, Salazar-Rodriguez A, Arévalos V, Gabani R, Regueiro A, Brugaletta S, Roqué M, Freixa X, Martín-Yuste V, Sabaté M. Impact of chronic kidney disease in chronic total occlusion management and clinical outcomes. Cardiovasc Revasc Med 2021; 38:75-80. [PMID: 34334336 DOI: 10.1016/j.carrev.2021.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/17/2021] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Data on the impact of chronic kidney disease (CKD) on clinical outcomes in chronic total occlusion (CTO) patients is scarce, and the optimal treatment strategy for this population is not well established. This study aims to compare differences in CTO management and long-term clinical outcomes, including all-cause and cardiac mortalities, according to baseline glomerular filtration rate (GFR). METHODS All patients with at least one CTO diagnosed in our center between 2010 and 2014 were included. Demographic and clinical data were registered. All-cause and cardiac mortalities were assessed during a median follow-up of 4.03 years (IQR 2.6-4.8). Clinical outcomes were compared between patients with CKD (GFR < 60 mL/min/1.73 m2) and without CKD (GFR ≥ 60 mL/min/1.73 m2). RESULTS A total of 1248 patients (67.3 ± 10.9 years; 32% CKD) were identified. CKD patients were older and had a higher prevalence of hypertension, type 2 diabetes, peripheral arterial disease, and severe left ventricular dysfunction compared to patients with normal renal function (p < 0.05). Subjects with renal dysfunction were more often treated with MT alone, compared to patients without CKD (63% vs 45%; p < 0.001), who were more likely to undergo PCI or surgery. During follow-up, 386 patients [31%] died. CKD patients had a higher rate of all-cause and cardiac mortalities compared to patients without CKD (p < 0.001). The independent predictors for all-cause mortality were age, GFR < 60 mL/min/1.73 m2, Syntax Score I, and successful revascularization of the CTO (CABG or PCI-CTO). Among patients with CKD, advanced age, eGFR <30 mL/min/1.73 m2, and CTO successful revascularization were predictors of all-cause mortality. CONCLUSIONS Patients with CKD were more often treated with MT alone. At long-term follow-up, revascularization of the CTO is associated with lower all-cause and cardiac mortalities in this population.
Collapse
Affiliation(s)
- Eduardo Flores-Umanzor
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Pedro Cepas-Guillen
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Luis Álvarez-Contreras
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain; ABC Medical Center, Mexico City, Mexico
| | | | | | | | | | - Victor Arévalos
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Rami Gabani
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Salvatore Brugaletta
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Mercè Roqué
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Victoria Martín-Yuste
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain; Service de Cardiologie, Centre Hospitalier de Saintonge, Saintes, France
| | - Manel Sabaté
- Cardiology Department, Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain; CIBER CV CB16/11/00411, Spain.
| |
Collapse
|
2
|
Álvarez-Contreras L, Flores-Umanzor E, Cepas-Guillen P, Ferreira-González I, Freixa X, Regueiro A, Brugaletta S, Sabaté M, Martín-Yuste V. Clinical Impact of Medical Therapy Versus Revascularization in Patients With Chronic Coronary Total Occlusions. J Invasive Cardiol 2021; 33:E2-E8. [PMID: 33385980] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chronic total occlusions (CTOs) are prevalent angiographic findings in patients with suspected coronary artery disease. Conflicting results of randomized controlled trials and registries have not clarified the therapeutic approach for patients with CTO in clinical practice. Therefore, we sought to analyze variables influencing the decision-making process and their relationship with clinical outcomes according to the type of selected therapy. METHODS A total of 1248 consecutive patients with at least 1 CTO were identified between 2010 and 2014 at our institution. Clinical and angiographic variables were collected to allow the calculation of several predictive scores. Primary outcome was all-cause death at the longest follow-up available. Other endpoints of interest included cardiac mortality and myocardial infarction. Medical therapy (MT) alone was indicated in 719 patients (58%), whereas percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were used in 240 (19%) and 298 (24%), respectively. Age, acute myocardial infarction, previous CABG, and age, creatinine, ejection fraction (ACEF) score were independently associated with the decision for MT alone. Conversely, the presence of multivessel disease, left main coronary artery involvement, and high SYNTAX score favored the decision for CABG. At a median follow-up of 4.3 years, revascularization strategies were independently associated with all-cause mortality and cardiac mortality (hazard ratio [HR], 0.42; 95% confidence interval [CI] 0.27-0.65; P<.001 and HR, 0.32; 95% CI, 0.17-0.60; P<.001, respectively) for PCI and (HR, 0.39; 95% CI, 0.26-0.58 and HR, 0.51; 95% CI, 0.32-0.81; P<.01, respectively) for CABG. CONCLUSION Several clinical and angiographic parameters influence the decision-making process of patients with CTO. CTO revascularization with either PCI or CABG appeared to be associated with improved clinical outcomes at long-term follow-up as compared with MT alone.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Manel Sabaté
- Hospital Clínic; C/Villarroel, 170, Cardiology Department, 08036 Barcelona, Spain.
| | | |
Collapse
|
3
|
Ibarra-Torres A, Cabrera-Leal C, López-Medina G, Soto ME, Vallejo E, Rodríguez-Galván A, Álvarez-Contreras L. Aneurisma gigante de la arteria coronaria derecha, reporte de un caso y revisión de la literatura. ACM 2020; 89:248-253. [DOI: 10.24875/acm.m19000047] [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
|
4
|
Ibarra-Torres A, Cabrera-Leal C, López-Medina G, Soto ME, Vallejo E, Rodríguez-Galván A, Álvarez-Contreras L. Giant aneurysm of the right coronary artery, report of a case and review of the literature. Arch Cardiol Mex 2020; 90:102-105. [PMID: 31967588 DOI: 10.24875/acme.m19000055] [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] Open
Abstract
Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus toward its management in adult patients. The options are medical, surgical, or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with a history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.
Collapse
Affiliation(s)
| | | | | | - María E Soto
- Cardiovascular Intensive Care, Centro Médico ABC, Mexico City, Mexico
| | - Enrique Vallejo
- Cardiovascular Imaging, Centro Médico ABC, Mexico City, Mexico
| | | | | |
Collapse
|
5
|
Arjona N, Rivas S, Álvarez-Contreras L, Guerra-Balcázar M, Ledesma-García J, Kjeang E, Arriaga LG. Glycerol electro-oxidation in alkaline media using Pt and Pd catalysts electrodeposited on three-dimensional porous carbon electrodes. NEW J CHEM 2017. [DOI: 10.1039/c6nj03739a] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Electrodeposition of Pd and Pt electrocatalysts on the entire structure of carbon paper and carbon nanofoam enhances the glycerol electro-oxidation.
Collapse
Affiliation(s)
- N. Arjona
- Centro de Investigación y Desarrollo Tecnológico en Electroquímica
- Unidad Tijuana
- Tijuana
- Mexico
| | - S. Rivas
- Facultad de Ingeniería
- División de Investigación y Posgrado
- Universidad Autónoma de Querétaro
- Querétaro
- Mexico
| | - L. Álvarez-Contreras
- Centro de Investigación en Materiales Avanzados S.C
- Complejo Industrial Chihuahua
- Chihuahua Chi
- Mexico
| | - M. Guerra-Balcázar
- Facultad de Ingeniería
- División de Investigación y Posgrado
- Universidad Autónoma de Querétaro
- Querétaro
- Mexico
| | - J. Ledesma-García
- Facultad de Ingeniería
- División de Investigación y Posgrado
- Universidad Autónoma de Querétaro
- Querétaro
- Mexico
| | - Erik Kjeang
- School of Mechatronic Systems Engineering
- Simon Fraser University
- Surrey
- Canada
| | - L. G. Arriaga
- Centro de Investigación y Desarrollo Tecnológico en Electroquímica
- Sanfandila
- Pedro Escobedo
- Qro
- Mexico
| |
Collapse
|
7
|
Maya-Cornejo J, Ortiz-Ortega E, Álvarez-Contreras L, Arjona N, Guerra-Balcázar M, Ledesma-García J, Arriaga LG. Copper-palladium core-shell as an anode in a multi-fuel membraneless nanofluidic fuel cell: toward a new era of small energy conversion devices. Chem Commun (Camb) 2015; 51:2536-9. [PMID: 25566986 DOI: 10.1039/c4cc08529a] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A membraneless nanofluidic fuel cell with flow-through electrodes that works with several fuels (individually or mixed): methanol, ethanol, glycerol and ethylene-glycol in alkaline media is presented. For this application, an efficient Cu@Pd electrocatalyst was synthesized and tested, resulting outstanding performance until now reported, opening the possibility of power nano-devices for multi-uses purposes, regardless of fuel re-charge employed.
Collapse
Affiliation(s)
- J Maya-Cornejo
- Centro de Investigación y Desarrollo Tecnológico en Electroquímica, 76703 Querétaro, México.
| | | | | | | | | | | | | |
Collapse
|
9
|
Arjona N, Dector A, Guerra-Bálcazar M, Álvarez-Contreras L, Sabaté N, Esquivel JP, Ledesma-García J, Arriaga LG. Effect of metal content on the electrocatalytic activity of AuxPdy mixtures and their use in a glucose membraneless microfluidic fuel cell. RSC Adv 2014. [DOI: 10.1039/c4ra03141e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Performance increase of a glucose membraneless microfluidic fuel cell using Au60Pd40 material electrodeposited on the anodic compartment.
Collapse
Affiliation(s)
- N. Arjona
- Centro de Investigación y DesarrolloTecnológico en Electroquímica
- 76703 Querétaro, Mexico
| | - A. Dector
- Centro de Investigación y DesarrolloTecnológico en Electroquímica
- 76703 Querétaro, Mexico
| | - M. Guerra-Bálcazar
- División de Investigación y Posgrado
- Facultad de Ingeniería
- Universidad Autónoma de Querétaro
- 76010 Querétaro, Mexico
| | | | - N. Sabaté
- Instituto de Microelectrónica de Barcelona
- IMB-CNM (CSIC)
- Campus UAB
- 08193 Bellaterra, Spain
| | - J. P. Esquivel
- Instituto de Microelectrónica de Barcelona
- IMB-CNM (CSIC)
- Campus UAB
- 08193 Bellaterra, Spain
| | - J. Ledesma-García
- Centro de Investigación en Materiales Avanzados
- 31109 Chihuahua, Mexico
| | - L. G. Arriaga
- Centro de Investigación y DesarrolloTecnológico en Electroquímica
- 76703 Querétaro, Mexico
| |
Collapse
|