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Sanchis J, Bueno H, García-Blas S, Alegre O, Martí D, Martínez-Sellés M, Domínguez-Pérez L, Díez-Villanueva P, Barrabés JA, Marín F, Villa A, Sanmartín M, Llibre C, Sionís A, Carol A, Fernández-Cisnal A, Calvo E, Morales MJ, Elízaga J, Gómez I, Alfonso F, García del Blanco B, Formiga F, Núñez E, Núñez J, Ariza-Solé A. Invasive Treatment Strategy in Adults With Frailty and Non-ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240809. [PMID: 38446482 PMCID: PMC10918507 DOI: 10.1001/jamanetworkopen.2024.0809] [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: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 03/07/2024] Open
Abstract
Importance The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non-ST-segment elevation myocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year. Objective To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up. Design, Setting, and Participants The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged ≥70 years) with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle. Interventions Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. Main outcomes and measures The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions. Results Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95% CI, 2.72-3.60) years in the invasive and 3.06 (95% CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, -188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (-28 [95% CI, -63 to 7] days), which improved after the first year (192 [95% CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95% CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points. Conclusions and Relevance In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behavior. Trial registration ClinicalTrials.gov Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Sergio García-Blas
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Oriol Alegre
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - David Martí
- Central Defense Hospital, Alcalá University, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Laura Domínguez-Pérez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Pablo Díez-Villanueva
- University Hospital La Princesa, Autonomous University of Madrid, Instituto de Investigación Sanitaria Princesa, CIBERCV, Madrid, Spain
| | | | - Francisco Marín
- University Hospital Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria–Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Adolfo Villa
- Southeast University Hospital, Arganda del Rey, Madrid, Spain
| | | | - Cinta Llibre
- University Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | - Antoni Carol
- Moisés Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Agustín Fernández-Cisnal
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Elena Calvo
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jaime Elízaga
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Iván Gómez
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
- Complutense University, Madrid, Spain
| | - Fernando Alfonso
- University Hospital La Princesa, Autonomous University of Madrid, Instituto de Investigación Sanitaria Princesa, CIBERCV, Madrid, Spain
| | | | - Francesc Formiga
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eduardo Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Julio Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, Instituto de Investigación Sanitaria Clínico Valencia, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Valencia, Spain
| | - Albert Ariza-Solé
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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Sanchis J, Bueno H, Miñana G, Guerrero C, Martí D, Martínez-Sellés M, Domínguez-Pérez L, Díez-Villanueva P, Barrabés JA, Marín F, Villa A, Sanmartín M, Llibre C, Sionís A, Carol A, García-Blas S, Calvo E, Morales Gallardo MJ, Elízaga J, Gómez-Blázquez I, Alfonso F, García del Blanco B, Núñez J, Formiga F, Ariza-Solé A. Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non-ST-Segment Elevation Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:407-415. [PMID: 36877502 PMCID: PMC9989957 DOI: 10.1001/jamainternmed.2023.0047] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 10/28/2022] [Accepted: 01/09/2023] [Indexed: 03/07/2023]
Abstract
Importance To our knowledge, no randomized clinical trial has compared the invasive and conservative strategies in frail, older patients with non-ST-segment elevation acute myocardial infarction (NSTEMI). Objective To compare outcomes of invasive and conservative strategies in frail, older patients with NSTEMI at 1 year. Design, Setting, and Participants This multicenter randomized clinical trial was conducted at 13 Spanish hospitals between July 7, 2017, and January 9, 2021, and included 167 older adult (≥70 years) patients with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Data analysis was performed from April 2022 to June 2022. Interventions Patients were randomized to routine invasive (coronary angiography and revascularization if feasible; n = 84) or conservative (medical treatment with coronary angiography for recurrent ischemia; n = 83) strategy. Main Outcomes and Measures The primary end point was the number of days alive and out of the hospital (DAOH) from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization. Results The study was prematurely stopped due to the COVID-19 pandemic when 95% of the calculated sample size had been enrolled. Among the 167 patients included, the mean (SD) age was 86 (5) years, and mean (SD) Clinical Frailty Scale score was 5 (1). While not statistically different, DAOH were about 1 month (28 days; 95% CI, -7 to 62) greater for patients managed conservatively (312 days; 95% CI, 289 to 335) vs patients managed invasively (284 days; 95% CI, 255 to 311; P = .12). A sensitivity analysis stratified by sex did not show differences. In addition, we found no differences in all-cause mortality (hazard ratio, 1.45; 95% CI, 0.74-2.85; P = .28). There was a 28-day shorter survival in the invasive vs conservatively managed group (95% CI, -63 to 7 days; restricted mean survival time analysis). Noncardiac reasons accounted for 56% of the readmissions. There were no differences in the number of readmissions or days spent in the hospital after discharge between groups. Neither were there differences in the coprimary end point of ischemic cardiac events (subdistribution hazard ratio, 0.92; 95% CI, 0.54-1.57; P = .78). Conclusions and Relevance In this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year. Based on these findings, a policy of medical management and watchful observation is recommended for older patients with frailty and NSTEMI. Trial Registration ClinicalTrials.gov Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Gema Miñana
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Carme Guerrero
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - David Martí
- Central Defense Hospital, Madrid, Alcalá University, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Laura Domínguez-Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Pablo Díez-Villanueva
- University Hospital La Princesa, Autonomous University of Madrid, IIS-IP, CIBERCV Madrid, Spain
| | | | - Francisco Marín
- University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Adolfo Villa
- Southeast University Hospital, Arganda del Rey, Madrid, Spain
| | | | - Cinta Llibre
- University Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | - Antoni Carol
- Moisés Broggi Hospital, Sant Joan Despí, Barcelona, Spain
| | - Sergio García-Blas
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Elena Calvo
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jaime Elízaga
- Cardiology Department, University Hospital Gregorio Marañón, CIBERCV, Complutense University, European University, Madrid, Spain
| | - Iván Gómez-Blázquez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Cardiology Department, Universisty Hospital 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, CIBERCV, Madrid, Spain, Complutense University, Madrid, Spain
| | - Fernando Alfonso
- University Hospital La Princesa, Autonomous University of Madrid, IIS-IP, CIBERCV Madrid, Spain
| | | | - Julio Núñez
- Cardiology Department, University Clinic Hospital of València, University of València, INCLIVA, CIBERCV, València, Spain
| | - Francesc Formiga
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, University Hospital of Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
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Rincón LM, Rodríguez-Serrano M, Conde E, Lanza VF, Sanmartín M, González-Portilla P, Paz-García M, Del Rey JM, Menacho M, García Bermejo ML, Zamorano JL. Serum microRNAs are key predictors of long-term heart failure and cardiovascular death after myocardial infarction. ESC Heart Fail 2022; 9:3367-3379. [PMID: 35837763 DOI: 10.1002/ehf2.13919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with acute myocardial infarction (MI) are at high risk of upcoming events, in particular heart failure (HF), but reliable stratification methods are lacking. Our goal was to evaluate the potential role of circulating miRNAs as prognostic biomarkers in patients presenting with MI. METHODS AND RESULTS We conducted a prospective study among 311 consecutive patients hospitalized with MI (65% ST-segment elevation MI & median age of 55 years) with long-term follow-up. An initial screening was conducted to select candidate miRNAs, with subsequent study of 14 candidate miRNAs. The primary outcome was the composite of hospital admission for HF or cardiovascular death. During a mean follow-up of 2.1 years miR-21-5p, miR-23a-3p, miR27b-3p, miR-122-5p, miR210-3p, and miR-221-3p reliably predicted the primary outcome. Multivariate Cox regression analyses highlighted that miR-210-3p [hazard ratio (HR) 2.65 per 1 SD increase, P < 0.001], miR-23a-3p (HR 2.11 per 1 SD increase, P < 0.001), and miR-221-3p (HR 2.03 per 1 SD increase, P < 0.001) were able to accurately predict the primary outcome, as well as cardiovascular death, HF hospitalizations, and long-term New York Heart Association (NYHA) functional class. These three miRNAs clearly improved the performance of multivariate clinical models: ΔC-statistic = 0.10 [95% confidence interval (CI), 0.03-0.17], continuous net reclassification index = 34.8% (95%CI, 5.8-57.4%), and integrated discrimination improvement (P < 0.001). CONCLUSIONS This is the largest study evaluating the prognostic value of circulating miRNAs for HF-related events among patients with MI. We show that several miRNAs predict HF hospitalizations, cardiovascular mortality, and poor long-term NYHA status and improve current risk prediction methods.
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Affiliation(s)
- Luis M Rincón
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, 28034, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Macarena Rodríguez-Serrano
- Biomarkers and Therapeutic Targets Laboratory and Core Facility, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Spanish Renal Research Network (REDinREN), Ctra. Colmenar Km 9100, Madrid, 28034, Spain
| | - Elisa Conde
- Biomarkers and Therapeutic Targets Laboratory and Core Facility, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Spanish Renal Research Network (REDinREN), Ctra. Colmenar Km 9100, Madrid, 28034, Spain
| | - Val F Lanza
- Bioinformatics Core Facility, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marcelo Sanmartín
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, 28034, Spain
| | - Paz González-Portilla
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, 28034, Spain
| | - Marta Paz-García
- Biomarkers and Therapeutic Targets Laboratory and Core Facility, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Spanish Renal Research Network (REDinREN), Ctra. Colmenar Km 9100, Madrid, 28034, Spain
| | - José Manuel Del Rey
- Department of Biochemistry, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Miriam Menacho
- Department of Biochemistry, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - María-Laura García Bermejo
- Biomarkers and Therapeutic Targets Laboratory and Core Facility, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Spanish Renal Research Network (REDinREN), Ctra. Colmenar Km 9100, Madrid, 28034, Spain
| | - José L Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, 28034, Spain
- Hospital La Zarzuela, Madrid, Spain
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Solano-López J, Zamorano JL, Pardo Sanz A, Amat-Santos I, Sarnago F, Gutiérrez Ibañes E, Sanchis J, Rey Blas JR, Gómez-Hospital JA, Santos Martínez S, Maneiro-Melón NM, Mateos Gaitán R, González D'Gregorio J, Salido L, Mestre JL, Sanmartín M, Sánchez-Recalde Á. Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak. Rev Esp Cardiol (Engl Ed) 2020; 73:985-993. [PMID: 32839121 PMCID: PMC7832619 DOI: 10.1016/j.rec.2020.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite advances in treatment, patients with acute myocardial infarction (AMI) still exhibit unfavorable short- and long-term prognoses. In addition, there is scant evidence about the clinical outcomes of patients with AMI and coronavirus disease 2019 (COVID-19). The objective of this study was to describe the clinical presentation, complications, and risk factors for mortality in patients admitted for AMI during the COVID-19 pandemic. METHODS This prospective, multicenter, cohort study included all consecutive patients with AMI who underwent coronary angiography in a 30-day period corresponding chronologically with the COVID-19 outbreak (March 15 to April 15, 2020). Clinical presentations and outcomes were compared between COVID-19 and non-COVID-19 patients. The effect of COVID-19 on mortality was assessed by propensity score matching and with a multivariate logistic regression model. RESULTS In total, 187 patients were admitted for AMI, 111 with ST-segment elevation AMI and 76 with non-ST-segment elevation AMI. Of these, 32 (17%) were diagnosed with COVID-19. GRACE score, Killip-Kimball classification, and several inflammatory markers were significantly higher in COVID-19-positive patients. Total and cardiovascular mortality were also significantly higher in COVID-19-positive patients (25% vs 3.8% [P <.001] and 15.2% vs 1.8% [P=.001], respectively). GRACE score> 140 (OR, 23.45; 95%CI, 2.52-62.51; P=.005) and COVID-19 (OR, 6.61; 95%CI, 1.82-24.43; P=.02) were independent predictors of in-hospital death. CONCLUSIONS During this pandemic, a high GRACE score and COVID-19 were independent risk factors associated with higher in-hospital mortality.
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Affiliation(s)
- Jorge Solano-López
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José Luis Zamorano
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Pardo Sanz
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ignacio Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain
| | - Fernando Sarnago
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Enrique Gutiérrez Ibañes
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Juan Ramón Rey Blas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Joan Antoni Gómez-Hospital
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandra Santos Martínez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain
| | | | - Roberto Mateos Gaitán
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jessika González D'Gregorio
- Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Luisa Salido
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José L Mestre
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marcelo Sanmartín
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ángel Sánchez-Recalde
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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5
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Solano-López J, Zamorano JL, Pardo Sanz A, Amat-Santos I, Sarnago F, Gutiérrez Ibañes E, Sanchis J, Rey Blas JR, Gómez-Hospital JA, Santos Martínez S, Maneiro-Melón NM, Mateos Gaitán R, González D'Gregorio J, Salido L, Mestre JL, Sanmartín M, Sánchez-Recalde Á. [Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak]. Rev Esp Cardiol 2020; 73:985-993. [PMID: 32963419 PMCID: PMC7498230 DOI: 10.1016/j.recesp.2020.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 05/14/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite advances in treatment, patients with acute myocardial infarction (AMI) still exhibit unfavorable short- and long-term prognoses. In addition, there is scant evidence about the clinical outcomes of patients with AMI and coronavirus disease 2019 (COVID-19). The objective of this study was to describe the clinical presentation, complications, and risk factors for mortality in patients admitted for AMI during the COVID-19 pandemic. METHODS This prospective, multicenter, cohort study included all consecutive patients with AMI who underwent coronary angiography in a 30-day period corresponding chronologically with the COVID-19 outbreak (March 15 to April 15, 2020). Clinical presentations and outcomes were compared between COVID-19 and non-COVID-19 patients. The effect of COVID-19 on mortality was assessed by propensity score matching and with a multivariate logistic regression model. RESULTS In total, 187 patients were admitted for AMI, 111 with ST-segment elevation AMI and 76 with non-ST-segment elevation AMI. Of these, 32 (17%) were diagnosed with COVID-19. GRACE score, Killip-Kimball classification, and several inflammatory markers were significantly higher in COVID-19-positive patients. Total and cardiovascular mortality were also significantly higher in COVID-19-positive patients (25% vs 3.8% [P < .001] and 15.2% vs 1.8% [P = .001], respectively). GRACE score > 140 (OR, 23.45; 95%CI, 2.52-62.51; P = .005) and COVID-19 (OR, 6.61; 95%CI, 1.82-24.43; P = .02) were independent predictors of in-hospital death. CONCLUSIONS During this pandemic, a high GRACE score and COVID-19 were independent risk factors associated with higher in-hospital mortality.Full English text available from:www.revespcardiol.org/en.
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Affiliation(s)
- Jorge Solano-López
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - José Luis Zamorano
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - Ana Pardo Sanz
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Ignacio Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, España
| | - Fernando Sarnago
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Enrique Gutiérrez Ibañes
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, España
| | - Juan Ramón Rey Blas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - Joan Antoni Gómez-Hospital
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Sandra Santos Martínez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, España
| | | | - Roberto Mateos Gaitán
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Jessika González D'Gregorio
- Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, España
| | - Luisa Salido
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - José L Mestre
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Marcelo Sanmartín
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - Ángel Sánchez-Recalde
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
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6
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Rincón LM, Sanmartín M, Alonso GL, Rodríguez JA, Muriel A, Casas E, Navarro M, Carbonell A, Lázaro C, Fernández S, González P, Rodríguez M, Jiménez-Mena M, Fernández-Golfín C, Esteban A, García-Bermejo ML, Zamorano JL. Una puntuación de riesgo genético predice recurrencias en pacientes jóvenes con infarto agudo de miocardio. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.08.006] [Citation(s) in RCA: 1] [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: 12/15/2022]
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7
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Barrios V, Cosín-Sales J, Bravo M, Escobar C, Gámez JM, Huelmos A, Ortiz Cortés C, Egocheaga I, García-Pinilla JM, Jiménez-Candil J, López-de-Sá E, Torres Llergo J, Obaya JC, Pallares-Carratalá V, Sanmartín M, Vidal-Pérez R, Cequier Á. [Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology]. Rev Esp Cardiol 2020; 73:910-918. [PMID: 32836664 PMCID: PMC7345370 DOI: 10.1016/j.recesp.2020.06.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
La pandemia producida por la infección por el coronavirus SARS-CoV-2 (COVID-19) ha cambiado la forma de entender nuestras consultas. Para reducir el riesgo de contagio de los pacientes más vulnerables (aquellos con cardiopatías) y del personal sanitario, se han suspendido la mayoría de las consultas presenciales y se han puesto en marcha las consultas telemáticas. Este cambio se ha implementado en muy poco tiempo, pero parece que ha venido para quedarse. No obstante, hay grandes dudas sobre aspectos organizativos, legales, posibilidades de mejora, etc. En este documento de consenso de la Sociedad Española de Cardiología, tratamos de dar las claves para mejorar la calidad asistencial en nuestras nuevas consultas telemáticas, revisando las afecciones que el cardiólogo clínico atiende con más frecuencia en su consulta ambulatoria y proponiendo unos mínimos en ese proceso asistencial. Estas enfermedades son la cardiopatía isquémica, la insuficiencia cardiaca y las arritmias. En los 3 escenarios tratamos de clarificar los aspectos fundamentales que hay que revisar en la entrevista telefónica, a qué pacientes habrá que atender en una consulta presencial y cuáles serán los criterios para su seguimiento en atención primaria. El documento también recoge distintas mejoras que pueden introducirse en la consulta telemática para mejorar la asistencia de nuestros pacientes.
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Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, España
| | - Marisol Bravo
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - José M Gámez
- Servicio de Cardiología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - Ana Huelmos
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Carolina Ortiz Cortés
- Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | | | - José Manuel García-Pinilla
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | | | | | | | | | | | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - Rafael Vidal-Pérez
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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Sánchez-Recalde Á, Solano-López J, Miguelena-Hycka J, Martín-Pinacho JJ, Sanmartín M, Zamorano JL. [COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality]. Rev Esp Cardiol 2020; 73:669-672. [PMID: 32355394 PMCID: PMC7190477 DOI: 10.1016/j.recesp.2020.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jorge Solano-López
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Javier Miguelena-Hycka
- Servicio de Cirugía Cardiovascular, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - José L Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
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Sánchez-Recalde Á, Solano-López J, Miguelena-Hycka J, Martín-Pinacho JJ, Sanmartín M, Zamorano JL. COVID-19 and cardiogenic shock. Different cardiovascular presentations with high mortality. ACTA ACUST UNITED AC 2020; 73:669-672. [PMID: 32499016 PMCID: PMC7184000 DOI: 10.1016/j.rec.2020.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/21/2022]
Affiliation(s)
| | - Jorge Solano-López
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José L Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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10
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Sanmartín M, Bellmunt S, Cosín-Sales J, García-Moll X, Riera-Mestre A, Almendro-Delia M, Hernández JL, Lozano F, Mazón P, Suarez Fernández C. Role of rivaroxaban in the prevention of atherosclerotic events. Expert Rev Clin Pharmacol 2019; 12:771-780. [DOI: 10.1080/17512433.2019.1637732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Sergi Bellmunt
- Vascular Surgery Department, Hospital General Vall d´Hebron, Barcelona, Spain
| | - Juan Cosín-Sales
- Cardiology Department, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Antoni Riera-Mestre
- Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - José Luis Hernández
- Internal Medicine Department, Hospital Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Francisco Lozano
- Department of Surgery, Hospital Clinico de Salamanca, Salamanca, Spain
| | - Pilar Mazón
- Cardiology Department, Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, Spain
| | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Affiliation(s)
- David Martí
- Cardiology Department, Central Defense Hospital, Alcalá University, 28049 Madrid, Spain.
| | - Marcelo Sanmartín
- Cardiology Department, Ramón y Cajal Hospital, Alcalá University, 28049 Madrid, Spain
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12
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Pascual Izco M, Ramírez-Carracedo R, Hernández Navarro I, Osorio Ruiz Á, Castejón Navarro B, Cuadrado Berrocal I, Largo Aramburu C, Alonso Salinas GL, Díez J, Saura Redondo M, Zamorano JL, Zaragoza C, Sanmartín M. Ivabradine in acute heart failure: Effects on heart rate and hemodynamic parameters in a randomized and controlled swine trial. Cardiol J 2018; 27:62-71. [PMID: 30155868 PMCID: PMC8086495 DOI: 10.5603/cj.a2018.0078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/14/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute heart failure patients could benefit from heart rate reduction, as myocardial consumption and oxidative stress are related to tachycardia. Ivabradine could have a clinical role attenuating catecholamine-induced tachycardia. The aim of this study was to evaluate hemodynamic effects of ivabradine in a swine model of acute heart failure. METHODS Myocardial infarction was induced by 45 min left anterior descending artery balloon occlusion in 18 anesthetized pigs. An infusion of dobutamine and noradrenaline was maintained aiming to preserve adequate hemodynamic support, accompanied by fluid administration to obtain a pulmonary wedged pressure ≥ 18 mmHg. After reperfusion, rhythm and hemodynamic stabilization, the animals were randomized to 0.3 mg/kg ivabradine intravenously (n = 9) or placebo (n = 9). Hemodynamic parameters were observed over a 60 min period. RESULTS Ivabradine was associated with a significant reduction in heart rate (88.4 ± 12.0 bpm vs. 122.7 ± 17.3 bpm after 15 min of ivabradine/placebo infusion, p < 0.01) and an increase in stroke volume (68.8 ± 13.7 mL vs. 52.4 ± 11.5 mL after 15 min, p = 0.01). There were no significant differences in systemic or pulmonary arterial pressure, or significant changes in pulmonary capillary pressure. However, after 15 min, cardiac output was significantly reduced with ivabradine (-5.2% vs. +15.0% variation in ivabradine/placebo group, p = 0.03), and central venous pressure increased (+4.2% vs. -19.7% variation, p < 0.01). CONCLUSIONS Ivabradine reduces heart rate and increases stroke volume without modifying systemic or left filling pressures in a swine model of acute heart failure. However, an excessive heart rate reduction could lead to a decrease in cardiac output and an increase in right filling pressures. Future studies with specific heart rate targets are needed.
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Affiliation(s)
- Marina Pascual Izco
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
| | - Rafael Ramírez-Carracedo
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Ignacio Hernández Navarro
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Álvaro Osorio Ruiz
- Vascular Surgery Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | | | | | | | - Gonzalo Luis Alonso Salinas
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Javier Díez
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marta Saura Redondo
- Physiology Unit, Systems Biology Department, University of Alcalá de Henares, Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Carlos Zaragoza
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marcelo Sanmartín
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain.
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
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13
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Ramírez R, Díez J, Sanmartín M, Saura M, Zamorano JL, Zaragoza C. Nanotechnology Applied to Preserve Extracelular Matrix as Teranostic Tool in Acute Myocardial Infarction. ACTA ACUST UNITED AC 2018; 72:171-174. [PMID: 29650448 DOI: 10.1016/j.rec.2017.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/11/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Rafael Ramírez
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier Díez
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
| | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain
| | - Marta Saura
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain
| | - Carlos Zaragoza
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain.
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Sanchis J, Ariza-Solé A, Abu-Assi E, Alegre O, Alfonso F, Barrabés JA, Baz JA, Carol A, Díez Villanueva P, García Del Blanco B, Elízaga J, Fernandez E, García Del Egido A, García Picard J, Gómez Blázquez I, Gómez Hospital JA, Hernández-Antolín R, Llibre C, Marín F, Martí Sánchez D, Martín R, Martínez Sellés M, Miñana G, Morales Gallardo MJ, Núñez J, Pérez de Prado A, Pinar E, Sanmartín M, Sionis A, Villa A, Marrugat J, Bueno H. Invasive Versus Conservative Strategy in Frail Patients With NSTEMI: The MOSCA-FRAIL Clinical Trial Study Design. ACTA ACUST UNITED AC 2018. [PMID: 29525724 DOI: 10.1016/j.rec.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI. METHODS This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale. Participants will be randomized to an invasive (coronary angiogram and revascularization if anatomically amenable) or conservative (medical treatment and coronary angiogram only if persistent clinical instability) strategy. The primary endpoint will be the number of days alive out of hospital during the first year. The coprimary endpoint will be the time until the first cardiac event (cardiac death, reinfarction or postdischarge revascularization). We estimate a sample size of 178 patients (89 per arm), considering an increase of 20% in the proportion of days alive out of hospital with the invasive management. RESULTS The results of this study will add important knowledge to inform the management of frail elderly patients hospitalized with NSTEMI. CONCLUSIONS We hypothesize that the invasive strategy will improve outcomes in frail elderly patients with NSTEMI. If this is confirmed, frailty status should not dissuade physicians from implementing an invasive management strategy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov.Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain.
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Oriol Alegre
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - José Antonio Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, CIBERCV, Barcelona, Spain
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Antonio Carol
- Servicio de Cardiología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | - Jaime Elízaga
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Eduard Fernandez
- Servicio de Cardiología, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | | | | | | | | | - Cinta Llibre
- Servicio de Cardiología, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | - Francisco Marín
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | | | - Roberto Martín
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | - Eduardo Pinar
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Ramon y Cajal, CIBERCV, Madrid, Spain
| | - Alessandro Sionis
- Servicio de Cardiología, Hospital Sant Pau, CIBERCV, Barcelona, Spain
| | - Adolfo Villa
- Servicio de Cardiología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Jaume Marrugat
- Grupo de Epidemiología y Genética Cardiovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), CIBERCV, Barcelona, Spain
| | - Héctor Bueno
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
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Pascual Izco M, Castejón B, Piedras MJ, Zamorano JL, Sanmartín M, Zaragoza C. Efectos de la ivabradina en la frecuencia cardiaca y los parámetros hemodinámicos en un modelo porcino de shock cardiogénico. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ortiz M, Llamas P, Sanmartín M, Egido J, del Toro J, Egocheaga M, Estévez M, Navarro I, Mira J. Unnecessary overuse. Study of “inadvisable practices” for patients with atrial fibrillation. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.02.003] [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: 10/19/2022]
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17
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Ortiz MM, Llamas P, Sanmartín M, Egido JA, Del Toro J, Egocheaga MI, Estévez MS, Navarro IM, Mira JJ. Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation. Rev Clin Esp 2017; 217:181-187. [PMID: 28363610 DOI: 10.1016/j.rce.2017.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/20/2016] [Revised: 02/07/2017] [Accepted: 02/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. METHOD The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. RESULTS We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. CONCLUSION The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients.
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Affiliation(s)
- M M Ortiz
- Unidad de Calidad, Hospital Universitario de Fuenlabrada, Madrid, España; Asociación Madrileña de Calidad Asistencial, Madrid, España
| | - P Llamas
- Hematología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Sanmartín
- Cardiología, Hospital Ramón y Cajal, Madrid, España
| | - J A Egido
- Neurología, Hospital Clínico San Carlos, Madrid, España
| | - J Del Toro
- Medicina Interna, Hospital Gregorio Marañón, Madrid, España
| | - M I Egocheaga
- Medicina de Familia, Centro de Salud Isla de Oza, Madrid, España
| | - M S Estévez
- Enfermería, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - I M Navarro
- Universidad Miguel Hernández de Elche, Alicante, España.
| | - J J Mira
- Universidad Miguel Hernández de Elche, Alicante, España; Departamento de Salud Alicante-Sant Joan, Alicante, España; REDISSEC Red Enfermedades crónicas, Madrid, España
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Pascual Izco M, Castejón B, Piedras MJ, Zamorano JL, Sanmartín M, Zaragoza C. Effects of Ivabradine on Heart Rate and Hemodynamic Parameters in a Swine Model of Cardiogenic Shock. ACTA ACUST UNITED AC 2017; 70:1139-1141. [PMID: 28363707 DOI: 10.1016/j.rec.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/05/2016] [Indexed: 10/19/2022]
Affiliation(s)
- Marina Pascual Izco
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain
| | - Borja Castejón
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
| | - María José Piedras
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain
| | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain.
| | - Carlos Zaragoza
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
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Marín F, Anguita-Sánchez M, Sanmartín M. Direct oral anticoagulants and cardiovascular prevention in patients with nonvalvular atrial fibrillation. Expert Opin Pharmacother 2016; 18:67-77. [PMID: 27924633 DOI: 10.1080/14656566.2016.1267140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/17/2023]
Abstract
INTRODUCTION Patients with atrial fibrillation have an increased risk for stroke, systemic embolism and cardiovascular events, including myocardial infarction and cardiovascular death. However, the majority of studies that have analyzed the efficacy of anticoagulants have been focused only on their effects on the risk of stroke. Areas covered: The available evidence about the association between atrial fibrillation and cardiovascular disease as well as the effects of oral anticoagulation on cardiovascular death and myocardial infarction, with a particular focus on direct oral anticoagulants, was updated in this review. Expert opinion: The management of patients with atrial fibrillation should not be limited to the prevention of stroke, but should also include the prevention of cardiovascular events. Despite treatment with vitamin K antagonists, many patients with atrial fibrillation still develop cardiovascular complications, particularly individuals whose anticoagulation is difficult to control. Direct oral anticoagulants overcome the majority of limitations of vitamin K antagonists and compared with warfarin, they lead to a greater reduction in the risk of stroke or systemic embolism, all-cause mortality, and intracranial hemorrhage. Although these drugs can only be compared indirectly, it seems that not all direct oral anticoagulants are equal with regard to the prevention of myocardial infarction.
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Affiliation(s)
- Francisco Marín
- a Department of Cardiology , Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca , Murcia , Spain
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Rodríguez-Pascual C, Paredes-Galán E, Ferrero-Martínez AI, Baz-Alonso JA, Durán-Muñoz D, González-Babarro E, Sanmartín M, Parajes T, Torres-Torres I, Piñón-Esteban M, Calvo-Iglesias F, Olcoz-Chiva MT, Rodríguez-Artalejo F. The frailty syndrome and mortality among very old patients with symptomatic severe aortic stenosis under different treatments. Int J Cardiol 2016; 224:125-131. [DOI: 10.1016/j.ijcard.2016.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/20/2016] [Accepted: 09/12/2016] [Indexed: 12/28/2022]
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Marti D, Mestre JL, Salido L, Esteban MJ, Casas E, Pey J, Sanmartín M, Hernández-Antolín R, Zamorano JL. PREDICTORS OF FAILED REPERFUSION IN UNCERTAIN CANDIDATES FOR CATHETER THROMBUS ASPIRATION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30047-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanmartín M, Del Val D. Ischemic heart disease in women: A pending issue? Rev Clin Esp 2015; 216:19-21. [PMID: 26708227 DOI: 10.1016/j.rce.2015.11.006] [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: 11/03/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M Sanmartín
- Hospital Universitario Ramón y Cajal, Madrid, España.
| | - D Del Val
- Hospital Universitario Ramón y Cajal, Madrid, España
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Affiliation(s)
- J Couceiro
- Hand Surgery Unit, Povisa Hospital, Vigo, Spain
| | - E Moledo
- Plastic Reconstructive and Aesthetic Surgery Department, Povisa Hospital, Vigo, Spain
| | - M Sanmartín
- Hand Surgery Unit, Povisa Hospital, Vigo, Spain
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Martí D, Mestre JL, Salido L, Esteban MJ, Casas E, Pey J, Sanmartín M, Hernández-Antolín R, Zamorano JL. Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction. Am Heart J 2014; 168:884-90. [PMID: 25458652 DOI: 10.1016/j.ahj.2014.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/02/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Borderline electrocardiograms represent a challenge in ST-segment elevation myocardial infarction (STEMI) management and are associated with inappropriate discharges and delays to intervention. OBJECTIVES To assess angiographic characteristics and outcomes of patients presenting with subtle ST-elevation (STE) myocardial infarction. METHODS A total of 504 consecutive patients with suspected STEMI treated by systematic primary percutaneous coronary intervention were prospectively included. Subtle STE was defined as a maximal preinterventional STE of 0.1 to 1 mm. Angiograms were interpreted by investigators unaware of the electrocardiographic data. RESULTS The proportion of patients with subtle STE was 18.3%, 86% of them presented with Thrombolysis In Myocardial Infarction flow grade 0/1 and 91% underwent percutaneous coronary intervention. Despite having smaller infarcts, subtle STE patients associated more frequent multivessel disease (57% vs 44%, P = .02) and larger delays to reperfusion. During a follow-up of 19.0 ± 4.9 months, the rates of death or reinfarction were similar among groups (10.0% vs 12.6%, P = .467). Subtle STE was not associated with better outcomes neither in univariate nor after adjustment in a multivariate analysis (adjusted hazard ratio 0.79, 95% CI 0.37-1.69, P = .546). CONCLUSIONS Subtle STEMI is frequent in clinical practice and is usually associated with acute total coronary occlusion. Therefore, it should be diagnosed and treated in the same expeditiously manner as marked STEMI.
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Couceiro J, Gómez B, Sanmartín M. [Alagille's syndrome associated with proximal radio-ulnar synostosis: Clinical case and a literature review]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 60:81-5. [PMID: 25037110 DOI: 10.1016/j.recot.2014.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/25/2014] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 11/16/2022] Open
Abstract
Alagille's syndrome is an infrequent genetic condition with autosomal inheritance and variable expression. The complete form exhibits 5 clinical signs, chronic intrahepatic cholestasis, characteristic facies, cardiovascular anomalies, posterior embryotoxon, and vertebral defects. If only 3 or 4 of these are present the case is considered as an incomplete form. The association of Alagille's syndrome with radio-ulnar synostosis is extremely rare. There is only one case described in the indexed literature. A case is presented of Alagille's syndrome with bilateral proximal radioulnar synostosis. To the best of our knowledge this is the second reported case of this association.
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Affiliation(s)
- J Couceiro
- Unidad de Mano, Servicio de Ortopedia y Traumatología, Hospital POVISA, Vigo, España.
| | - B Gómez
- Servicio de Cirugía Plástica y Reparadora, Hospital POVISA, Vigo, España
| | - M Sanmartín
- Unidad de Mano, Servicio de Ortopedia y Traumatología, Hospital POVISA, Vigo, España
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Galve E, Castro A, Cordero A, Dalmau R, Fácila L, García-Romero A, Mazón P, Sanmartín M, Alonso García A. Update in cardiology: Vascular risk and cardiac rehabilitation. ACTA ACUST UNITED AC 2013; 66:124-30. [PMID: 24775386 DOI: 10.1016/j.rec.2012.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/08/2012] [Indexed: 11/17/2022]
Abstract
Atherosclerotic cardiovascular disease remains the major cause of premature death in developed and developing countries. Nevertheless, surveys show that most patients still do not achieve the lifestyles, risk factor levels, and therapeutic targets recommended in primary and secondary prevention. The present update reflects the most recent novelties in risk classification and estimation of risk and documents the latest changes in fields such as smoking, diet and nutrition, physical activity, lipids, hypertension, diabetes, and cardiovascular rehabilitation, based on experimental trials and population-based observational studies.
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Affiliation(s)
- Enrique Galve
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain.
| | | | - Alberto Cordero
- Departamento de Cardiología, Hospital de San Juan, San Juan de Alicante, Alicante, Spain
| | - Regina Dalmau
- Servicio de Cardiología, Hospital La Paz, Madrid, Spain
| | - Lorenzo Fácila
- Departamento de Cardiología, Hospital General de Valencia, Valencia, Spain
| | | | - Pilar Mazón
- Servicio de Cardiología, Hospital de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Sanmartín M, Fraguela Fraga F, Martín-Santos Á, Moix Blázquez P, García-Ruiz A, Vázquez-Caamaño M, Vilar M. Una campaña de información y diagnóstico de la fibrilación auricular: la «Semana del Pulso». Rev Esp Cardiol 2013; 66:34-8. [DOI: 10.1016/j.recesp.2012.05.012] [Citation(s) in RCA: 16] [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] [Received: 04/18/2012] [Accepted: 05/27/2012] [Indexed: 11/30/2022]
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Diaz-Buschmann I, Castro A, Galve E, Calero MJ, Dalmau R, Guzmán G, Cordero A, Fácila L, Quiles J, Arrarte V, Diaz-Buschmann I, Alonso Gómez ÁM, Cequier Á, Comín J, Fernández-Ortiz A, Pan M, Fernández Lozano FWEI, Fernández-Ortiz A, Sanmartín M, Ferreira I, Brotons C, López Sendón JL, Mazón P, Alonso J, Abeytua M, González Juanatey JR, de Pablo C, Worner F, Castro-Beiras A. Comments on the ESC guidelines on cardiovascular disease prevention (version 2012). A report of the Task Force of the Clinical Practice Guidelines Committee of the Spanish Society of Cardiology. Rev Esp Cardiol 2012; 65:869-73. [PMID: 22999109 DOI: 10.1016/j.recesp.2012.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 08/02/2012] [Indexed: 11/21/2022]
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Piazzón C, Lamas J, Castro R, Budiño B, Cabaleiro S, Sanmartín M, Leiro J. Antigenic and cross-protection studies on two turbot scuticociliate isolates. Fish Shellfish Immunol 2008; 25:417-424. [PMID: 18602012 DOI: 10.1016/j.fsi.2008.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 05/14/2008] [Accepted: 05/18/2008] [Indexed: 05/26/2023]
Abstract
The protection induced in turbot by inactivated vaccines containing either of two isolates (I(1) and C(1)) of the scuticociliate parasite Philasterides dicentrarchi, which causes important mortalities in turbot cultures, was evaluated in the present study. The results obtained after challenging the fish with the two isolates show that vaccination protected fish only against the homologous isolate, but did not confer cross-protection. The two isolates constitute two serotypes, as shown in the immobilization tests with mouse and turbot anti-I(1) and anti-C(1) antisera, in which only the homologous antisera immobilized the ciliates. ELISA assays, using total antigen free of proteases (TAWP), cytosolic antigens (CYA), ciliar antigens (CA) or membrane protein fraction (MPF), were also carried out. Differences in the levels of antibodies produced in mouse against the homologous and heterologous antigens were observed; these differences were significantly different when the antigen preparations used in the ELISA were TAWP, CYA or CA. Nevertheless, ELISA assays using turbot sera against TAWP did not show significant differences in the levels of antibodies against the homologous and heterologous antigens. Antigenic cross-reactivity was also detected in the Western blot assays, as well as significant differences in the patterns of antigenic recognition in the two isolates - in both reduced and non-reduced TAWP antigens, but which was noteworthy when mouse antisera were used. The results obtained in the present study demonstrate for the first time the existence of serotypes of the ciliate parasite of turbot Philasterides dicentrarchi that display clear antigenic differences, which must be taken into consideration in the future development of a vaccine against scuticociliatosis.
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Affiliation(s)
- C Piazzón
- Departamento de Biología Celular y Ecología, Facultad de Biología, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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del Piñal F, García-Bernal F, Delgado J, Sanmartín M, Regalado J, Igual Pérez B. Injerto osteocondral vascularizado de la base del tercer metatarsiano para los callos viciosos intraarticulares del extremo distal del radio. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)74815-x] [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: 10/21/2022] Open
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del Piñal F, García-Bernal F, Delgado J, Sanmartín M, Regalado J, Igual Pérez B. Use of a vascularized osteochondral graft from the base of the third metastarsal to address intraarticular malunions of the distal radius. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70090-7] [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: 10/19/2022] Open
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Sanmartín M, Baz JA, Claro R, Asorey V, Durán D, Pradas G, Iñiguez A. Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease. Am J Cardiol 2007; 100:970-3. [PMID: 17826380 DOI: 10.1016/j.amjcard.2007.04.037] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [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: 02/14/2007] [Revised: 04/15/2007] [Accepted: 04/24/2007] [Indexed: 01/21/2023]
Abstract
This study was conducted to compare the clinical outcomes of drug-eluting stents (DESs) with those of standard bypass surgery for the treatment of patients with left main lesions in a single-center experience. From January 2000 to October 2005, a total of 96 patients with significant unprotected left main disease were treated with DES implantation, and 245 with bypass surgery. Baseline features, such as Euroscore, were similar between groups, except for diabetes and hypertension, which were more frequent in the surgical group. The combination of death, Q-wave myocardial infarction, stroke, and repeated revascularization (major adverse cardiac and cerebrovascular events [MACCEs]) at 30 days occurred in 2.1% after DES implant and 9.0% after surgery (p=0.03). At 1 year, DES-treated patients more frequently needed repeat revascularization (5.2% vs 0.8%; p=0.02), although combined MACCE rates were similar (10.4% for DES, 11.4% for surgery; p=0.50). Moreover, after a mean follow-up of 1.3+/-0.8 and 3.2+/-1.6 years for the DES and surgical groups, there were no significant differences in MACCEs, respectively. In conclusion, in our experience, percutaneous treatment of patients with unprotected left main disease with DESs provided similar clinical results compared with surgical revascularization at a midterm follow-up.
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Affiliation(s)
- Marcelo Sanmartín
- Unidad de Cardiología Intervencionista, Complexo Hospitalario Universitario de Vigo, Medtec, Vigo, Spain.
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Sanmartín M, Pereira B, Rúa R, Vázquez S, Hervert F, Baz JA, Iñiguez A. Seguridad del cateterismo diagnóstico transradial en pacientes anticoagulados de forma crónica con dicumarínicos. Rev Esp Cardiol 2007; 60:988-91. [PMID: 17915157 DOI: 10.1157/13109654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the safety of transradial catheterization without prior withdrawal of oral anticoagulation. In total, 183 patients on long-term acenocoumarol treatment who underwent transradial catheterization were included in a prospective study. In 135 patients, the coumarin derivative was continued without interruption before and during catheterization and, in 48, the drug was stopped 48 hours in advance. No severe thromboembolic or hemorrhagic complications occurred. At 7-day follow-up, the rate of occurrence of hematomas >3 cm in size was 5.5% in the group that continued anticoagulant treatment, and 10.4% in the group that stopped oral anticoagulation (P=.31). The transradial approach appears to be a safe option for patients receiving long-term coumarin treatment and could be the technique of choice because it avoids the drawbacks and complications associated with the withdrawal of oral anticoagulation.
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Affiliation(s)
- Marcelo Sanmartín
- Unidad de Cardiología Intervencionista. Medtec. Hospital Meixoeiro. Vigo. Pontevedra. España.
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del Piñal F, García-Bernal F, Delgado J, Sanmartín M, Regalado J, Cagigal L, González B. Colgajo microvascular corticoperióstico de cóndilo femoral para las pseudoartrosis diafisarias recalcitrantes de extremidad superior. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0482-5985(07)74569-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gómez M, Sanmartín M, Martínez M, Rumoroso JR, Pereira B, Iñiguez A, Sábada M, Luquín R. 1321: Role of nursing care in the prevention of the radial artery occlusion after transradial cardiac catheterization. Eur J Cardiovasc Nurs 2007. [DOI: 10.1016/j.ejcnurse.2007.01.020] [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: 10/23/2022]
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del Piñal F, García-Bernal F, Delgado J, Sanmartín M, Regalado J, Cagigal L, González B. Microvascular Corticoperiosteal Flap of the Femoral Condyle in the Treatment of Recalcitrant Shaft Nonunions in the Upper limb. Rev Esp Cir Ortop Traumatol (Engl Ed) 2007. [DOI: 10.1016/s1988-8856(07)70013-5] [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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del Piñal F, García-Bernal F, Delgado J, Sanmartín M, Regalado J, Santamaría C. Metacarpal Hand Reconstruction by Combined Second and Third Toe Transfer. Rev Esp Cir Ortop Traumatol (Engl Ed) 2007. [DOI: 10.1016/s1988-8856(07)70004-4] [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: 10/19/2022] Open
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Jiménez-Quevedo P, Sabaté M, Angiolillo DJ, Alfonso F, Hernández-Antolín R, Gómez-Hospital JA, Sanmartín M, Bañuelos C, Moreno R, Escaned J, Fernández C, Costa MA, Fernández-Avilés F, Macaya C. Eficacia de la implantación del stent recubierto de rapamicina en pacientes diabéticos con vasos muy pequeños (≤ 2,25 mm). Subanálisis del estudio DIABETES. Rev Esp Cardiol 2006; 59:1000-7. [PMID: 17125709 DOI: 10.1157/13093976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES Diabetic patients frequently have small-diameter vessels, which increases their risk of restenosis. The aim of this study was to determine the efficacy of sirolimus-eluting stent implantation in these high-risk patients following percutaneous coronary intervention. METHODS Our study population comprised a subset of 85 diabetic patients from the DIABETES (DIABETes and sirolimus Eluting Stent) trial who had very small vessels, defined as those with a reference diameter < or =2.25 mm. In the 100 lesions treated, 49 sirolimus-eluting stents and 51 bare-metal stents were used. Glycoprotein IIb/IIIa inhibitors were used as recommended by the protocol and dual antiplatelet therapy was administered for 1 year. RESULTS Baseline clinical and angiographic characteristics were comparable in the two groups. The patients' mean age was 66 (9) years, 42% were women, and 37% were insulin-dependent. On average, the lesion length was 15.0 (9.0) mm and the reference diameter was 1.9 (0.2) mm. At 9-month follow-up, both late lumen loss and the restenosis rate were significantly lower in the sirolimus-eluting stent group than in the bare-metal stent group, at -0.03 (0.3) mm vs 0.44 (0.5) mm (P< .001), and 9.1% vs 39.1% (P=.001), respectively. These differences were also observed in the subgroup of insulin-dependent patients. At 1-year follow-up, the stent thrombosis rate was 0% in the sirolimus-eluting stent group, whereas two patients in the bare-metal stent group presented with stent thrombosis. CONCLUSIONS Sirolimus-eluting stent implantation in diabetics with very small vessels is safe and effective, even in insulin-dependent patients.
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Del Pinal F, G F, Delgado J, Sanmartín M, Regalado J, Martín M. Onycho-Osteocutaneous Defects of the Thumb Reconstructed by Partial Toe-to-Thumb Procedure in Manual Workers. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-949069] [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: 10/19/2022]
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Moxica J, Sanmartín M, Vázquez S. Combinación de protección distal y trombectomía en un injerto de safena. Rev Esp Cardiol (Engl Ed) 2006. [DOI: 10.1157/13087902] [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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Sanmartín M, Goicolea J, García C, García J, Crespo A, Rodríguez J, Goicolea JM. [Influence of shear stress on in-stent restenosis: in vivo study using 3D reconstruction and computational fluid dynamics]. Rev Esp Cardiol 2006; 59:20-7. [PMID: 16434000] [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: 05/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Local factors may influence neointimal proliferation following conventional stent implantation. In this study, the relationship between wall shear stress and luminal loss after coronary stenting was assessed using a combination of angiography, intravascular ultrasound, and computational fluid dynamics. PATIENTS AND METHOD Seven patients with de novo right coronary lesions treated with conventional (i.e., bare metal) stents were included. Realistic three-dimensional geometric reconstructions were generated offline from angiographic and intravascular ultrasound data both immediately after stenting and at 6-month follow-up. A finite-volume model was used to calculate local wall shear stress within the stent and 4 mm proximally and distally to the stent. The mean coronary ostium entry flow velocity was assumed to be 25 cm/s in all cases. RESULTS The mean neointimal thickness was 0.29 (0.21) mm. In five cases, weak negative correlations between wall shear stress and neointimal thickness were found: maximum r value = -0.34, minimum r value = -0.11 (P < .001). The neointimal thickness in segments in which the level of wall shear stress was in the lowest quartile was greater than that in segments in which it was in highest quartile, at 0.34 (0.21) mm and 0.27 (0.24) mm (P < .001) for quartiles 1 and 4, respectively. CONCLUSIONS Low wall shear stress after stenting favors neointimal proliferation both within the stent and at the stent's edges.
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Affiliation(s)
- Marcelo Sanmartín
- Unidad de Cardiología Intervencionista, Hospital Meixoeiro, Vigo, Spain.
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García J, Crespo A, Goicolea J, Sanmartín M, García C. Study of the evolution of the shear stress on the restenosis after coronary angioplasty. J Biomech 2006; 39:799-805. [PMID: 16488219 DOI: 10.1016/j.jbiomech.2005.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Accepted: 02/07/2005] [Indexed: 11/29/2022]
Abstract
In this article, we analyze the influence of fluid dynamics variables on the development of obstructive coronary artery disease in the medium term after percutaneous coronary intervention with stent implantation. We have analyzed a group of seven patients and the study is focused on the mid-right coronary artery. In these patients we have studied the relationship between wall shear stress and arterial wall thickness both immediately after stent implantation and six months later. The realistic three-dimensional (3D) reconstruction of the arteries is performed with the data obtained with intravascular ultrasound (IVUS) and angiography. The commercial code Fluent is used to solve the Navier-Stokes equations. Special attention is paid to the shear stress on the wall arteries and the corresponding thickness. The results show that there is a negative correlation for most of the cases between the wall shear stress and increase in wall thickness. A model is proposed to study the instability at the wall, and qualitative agreement is found.
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Affiliation(s)
- J García
- Dpto. Ingeniería Energética y Fluidomecánica, Universidad Politécnica de Madrid, C/José Gutiérrez Abascal, 2. 28006 Madrid, Spain.
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Sanmartín M, Goicolea J, García C, García J, Crespo A, Rodríguez J, Goicolea JM. Influencia de la tensión de cizallamiento en la reestenosis intra-stent: estudio in vivo con reconstrucción 3D y dinámica de fluidos computacional. Rev Esp Cardiol 2006. [DOI: 10.1157/13083645] [Citation(s) in RCA: 28] [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] [Indexed: 11/21/2022]
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Ruiz-Salmerón RJ, Goicolea J, Claro R, Mantilla R, Sanmartín M. Relación entre flujo coronario y viabilidad en pacientes con infarto que reciben angioplastia con stent. Análisis con guía intracoronaria Doppler. Rev Esp Cardiol 2005. [DOI: 10.1016/s0300-8932(05)74072-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ruiz-Salmerón RJ, Goicolea J, Claro R, Mantilla R, Sanmartín M. [Relationship between coronary flow and viability in patients with myocardial infarction submitted to revascularization with stent. Assessment by Doppler guidewire]. Rev Esp Cardiol 2005; 58:1420-7. [PMID: 16371201] [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: 05/05/2023]
Abstract
UNLABELLED Introduction and objectives. Intracoronary Doppler guidewire measurement provides information about the state of the myocardial microcirculation. Our aim was to assess the relationship between the pattern of coronary flow and myocardial viability. Patients and method. The study included 19 patients who had had a recent myocardial infarction (< 1 month), who underwent percutaneous revascularization of the responsible vessel, and who agreed to angiographic follow-up. Patients were divided into two groups according to the extent of the akinetic area observed at follow-up responsible (149 [40] days) in the myocardial region supplied by the responsible artery: one group (n=11) had preserved regional contractility (i.e., an akinetic area less than 30%); the other group (n=8) had impaired regional contractility (i.e., an akinetic area equal to or greater than 30%). Coronary flow in the artery was responsible assessed after revascularization and at follow-up using the Doppler guidewire method. RESULTS After revascularization, patients with preserved regional contractility had a higher diastolic deceleration half-time than those with impaired regional contractility (628 [188] ms vs 376 [131] ms, P=.02). At follow-up, the difference in coronary flow between the groups had disappeared. Patients in whom regional contractility was preserved demonstrated a significant increase in coronary flow reserve at follow-up (1,8 [0,5] vs 2,3 [0,5], P=.01). CONCLUSIONS After timely revascularization (within one month) of the vessel responsible for a myocardial infarction, the pattern of coronary flow observed in patients with viable myocardium differed from that in those with non-viable myocardium. The differences disappeared during follow-up.
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Affiliation(s)
- Rafael J Ruiz-Salmerón
- Departamento de Cardiología Intervencionista, Hospital Clínic i Provincial, Barcelona, Spain.
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Del Piñal F, García-Bernal FJ, Delgado J, Regalado J, Pisani D, Sanmartín M. Técnica para el tratamiento de la malunión intra-articular del radio mediante osteotomías con control artroscópico. Rev Iberoam Cir Mano 2005. [DOI: 10.1055/s-0037-1606676] [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: 10/18/2022] Open
Abstract
El propósito de este trabajo es presentar un método para realizar las osteotomías intraarticulares con control visual.
Método: Utilizamos los abordajes dorsales clásicos de artroscopia (3-4, 6-R) además de un portal volar radial (VR). Para visualizar la articulación radiocarpiana recurrimos sólo a la tracción sin irrigar con agua. Las osteotomías se efectuaron con osteotomos de 4 mm introducidos por los portales y bajo control visual por la óptica del artroscopio. Una vez finalizada la refractura se movilizaron y fijaron los fragmentos desplazadas mediante tornillos o placas, obteniendo en todos los casos escalones próximos a 0mm.
Conclusiones: Este procedimiento permite realizar la partición de los fragmentos por los trazos originales de fractura. La clave de esta intervención es realizar la artroscopia sin agua (técnica seca) que permite una visión nítida y la ejecución de las osteotomías sin extravasación de agua, ni pérdidas de visión.
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Affiliation(s)
- F. Del Piñal
- Instituto de Cirugía Plástica y de la Mano. Medicina Privada y Hospital Mutua Montañesa. Santander. España
| | - F. J. García-Bernal
- Instituto de Cirugía Plástica y de la Mano. Medicina Privada y Hospital Mutua Montañesa. Santander. España
| | - J. Delgado
- Instituto de Cirugía Plástica y de la Mano. Medicina Privada y Hospital Mutua Montañesa. Santander. España
| | - J. Regalado
- Instituto de Cirugía Plástica y de la Mano. Medicina Privada y Hospital Mutua Montañesa. Santander. España
| | - D. Pisani
- Médico Visitante. Servicio de Cirugía de la Mano (Prof. G. Pajardi). Hospital Multimédica. Universidad de milán. Italia
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Mantilla R, Legarra JJ, Pradas G, Bravo M, Sanmartín M, Goicolea J. [Percutaneous coronary intervention for iatrogenic occlusion of the circumflex artery after mitral anuloplasty]. Rev Esp Cardiol 2004; 57:702-4. [PMID: 15274857] [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: 04/30/2023]
Abstract
We describe a patient with obstruction of the dominant circumflex artery after surgical repair of the mitral valve, repaired successfully with percutaneous coronary intervention during the immediate postoperative period. We discuss the etiology, prevention and management of this complication with special emphasis on percutaneous intervention.
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Affiliation(s)
- Ramón Mantilla
- Area de Cardiología, Instituto Galego de Medicina Técnica, Hospital do Meixoeiro, Vigo, Pontevedra, Spain
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Sanmartín M, Cuevas D, Goicolea J, Ruiz-Salmerón R, Gómez M, Argibay V. [Vascular complications associated with radial artery access for cardiac catheterization]. Rev Esp Cardiol 2004; 57:581-4. [PMID: 15225506] [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: 04/30/2023]
Abstract
Cardiac catheterization via the radial artery is associated with vascular complications, albeit less frequently than with the femoral approach. However, the management of these complications differs and is poorly described in the literature. We present our experience with vascular complications secondary to transradial access, with emphasis on their specific treatment. From January 2001 to October 2003 a total of 8159 cardiac catheterizations were performed, of which 3369 (41.3%) were done by radial artery approach. In 21 cases (0.06%) severe vascular hemorrhagic complications were observed (hematomas > 6 cm, n = 13; fistulas, n = 2; perforations, n = 5; pseudoaneurysm, n = 1). All patients were treated conservatively and none needed blood transfusions. A detailed description of the hemostasis techniques is provided.
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Affiliation(s)
- Marcelo Sanmartín
- Unidad de Cardiología Intervencionista, Hospital Meixoeiro, Vigo, Pontevedra, España.
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Sanmartín M, Cuevas D, Goicolea J, Ruiz-Salmerón R, Gómez M, Argibay V. Complicaciones vasculares asociadas al acceso transradial para el cateterismo cardíaco. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77150-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mantilla R, Legarra JJ, Pradas G, Bravo M, Sanmartín M, Goicoleaa J. Intervencionismo coronario en la oclusión iatrogénica de circunfleja tras anuloplastia mitral. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77173-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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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