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Borrayo-Sánchez G, Alcocer-Gamba MA, Araiza-Garaygordobil D, Arias-Mendoza A, Aubanel-Riedel P, Cortés-Lawrenz J, González-Juanatey JR, Gutiérrez-Fajardo P, Martín-Hernández P, Martínez-Ramírez L, Merino-Rajme JA, Muñoz-Carrillo JM, López-Pais J, Parra-Michel R, Piña-Reyna Y, Ortiz-Fernández P, Ramírez-Arias E, Robles-Rangel MA, Rosas-Peralta M, Rangel-Velázquez R, Palami-Antúnez D, López-Ridaura R, Reyes-Terán G. Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction. GAC MED MEX 2021; 156:559-569. [PMID: 33877123 DOI: 10.24875/gmm.m21000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.
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Affiliation(s)
- Gabriela Borrayo-Sánchez
- A Todo Corazón, Código Infarto Program, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Diego Araiza-Garaygordobil
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Alexandra Arias-Mendoza
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Patricia Aubanel-Riedel
- Cardiology Department, Institute of Cardiovascular Sciences, Hospital del Prado, Baja California, Mexico
| | | | | | | | - Patricia Martín-Hernández
- Cardiology Department, Hospital Central Militar, Secretaría de la Defensa Nacional, Mexico City, Mexico
| | - Leonel Martínez-Ramírez
- Emergency Department and Coronary Unit, Hospital de Cardiología Siglo XXI, Instituo Mexicano del Seguro Social, Mexico City, México
| | - José A Merino-Rajme
- Cardiology Department, Hospital 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | | | - Javier López-Pais
- Cardiology Department, Hospital Universitario Santiago de Compostela, Coruña, Spain
| | - Rodolfo Parra-Michel
- Coronary Unit, Hospital de Especialidades, Centro Médico de Especialidades de Occidente, Instituto Mexicano del Seguro Social, Jalisco, Mexico
| | - Yigal Piña-Reyna
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Patricio Ortiz-Fernández
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Erick Ramírez-Arias
- Emergency Department and Coronary Unit, Hospital de Cardiología Siglo XXI, Instituo Mexicano del Seguro Social, Mexico City, México
| | - Marco A Robles-Rangel
- Emergency Department and Coronary Unit, Hospital de Cardiología Siglo XXI, Instituo Mexicano del Seguro Social, Mexico City, México
| | - Martín Rosas-Peralta
- Department of Medical Benefits, Delegación México Poniente, Instituto Mexicano del Seguro Social, State of Mexico, Mexico
| | - Raúl Rangel-Velázquez
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | - Diana Palami-Antúnez
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | - Ruy López-Ridaura
- Strategic Programs, Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaría de Salud, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
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Borrayo-Sánchez G, Alcocer-Gamba MA, Araiza-Garaygordobil D, Arias-Mendoza A, Aubanel-Riedel P, Cortés-Lawrenz J, González-Juanatey JR, Gutiérrez-Fajardo P, Martín-Hernández P, Martínez-Ramírez L, Merino-Rajme JA, Muñoz-Carrillo JM, López-Pais J, Robles-Rangel MA, Rosas-Peralta M, Rangel-Velázquez R, Palami-Antúnez D, López-Ridaura R, Reyes-Terán G. Guía práctica interinstitucional para el tratamiento del infarto agudo de miocardio. GAC MED MEX 2020. [DOI: 10.24875/gmm.20000372] [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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Martín-Hernández P, Gutiérrez-Leonard H, Quintana AR, Ojeda-Delgado JL, Montes-Bautista C, Valdéz-Becerril G, Aguirre-Alvarado A, Hernández-Jiménez L. Hyperbaric Oxygen Therapy Following Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Cardiovasc Revasc Med 2020; 27:14-19. [PMID: 32807666 DOI: 10.1016/j.carrev.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hyperbaric oxygen therapy (HBOT) is a promising treatment modality for ischemic heart disease including myocardial infarction where outcomes are frequently poor despite early revascularization. OBJECTIVE To compare single-photon emission computed tomography (SPECT) findings in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) treated with HBOT vs. control at 6 weeks. METHODS In this pilot study, 24 patients were randomly allocated to HBOT (n = 13) and control groups (n = 11). Both groups underwent PPCI and were treated following the guidelines for STEMI management. The HBOT group received additional 15 and 90-minute HBOT sessions. All participants underwent SPECT at initial presentation (within 48 h of PPCI) and at follow up. RESULTS Baseline characteristics were similar in both groups. The number of affected SPECT segments in the HBOT group at baseline and 6 weeks were 47.1 ± 14.6% vs. 33.7 ± 16.2%, respectively, with p = 0.039, and in the control group, the number of affected segment at these times were 55.5 ± 19.5% vs. 45.9 ± 17.9%, respectively, with p = 0.090. At follow-up, a decrease in the summed rest score was noted in both groups (HBOT: 20 ± 6.0 vs. 12.7 ± 8.1; p = 0.0017; control: 23 ± 8.2 vs. 16.7 ± 6.6; p = 0.031). The left ventricular ejection fraction in the HBOT group improved from 44 ± 22.1% to 57.2 ± 15.4% (p = 0.011) and in the control group from 45.9 ± 18.2% to 55 ± 12.1% (p = 0.044). CONCLUSIONS HBOT use in STEMI patients was associated with an improvement in perfusion and an increase in ejection fraction following PPCI. These observations warrant a larger randomized clinical trial.
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Gutierrez-Leonard H, Martín-Hernández P, Ojeda-Delgado JL, Corona-Perezgrovas MA, Hernández-Jiménez L, Fagoaga-Valdivia J, Blázquez-Cruz MDR, Rebollo-Hurtado V, Echeverría-Béliz P. Initial experience in Mexico with the Evolut™ R valve with direct aortic Access. Arch Cardiol Mex 2019; 89:105-110. [PMID: 31702726 DOI: 10.24875/acme.m19000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Aortic stenosis (AS) is one of the most frequent valvulopathies in elderly patients. The treatment for AS is heart surgery; however, many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve implantation (TAVI) was developed for these patients. Objective To disseminate the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to the rapid growth in technology and knowledge, there is a lot of experience with TAVI already. Methodology One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought after, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar, and easy to learn for cardiac surgeons. Results In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding and risk of myocardial injury) and shorter length of stay in the intensive care unit compared to surgery or transapical access. Conclusions Our center successfully implanted the self-expandable aortic valve Evolut™ through direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.
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Affiliation(s)
- Hugo Gutierrez-Leonard
- Department of Invasive Radiology, Cardiac Catheterization Laboratory. Hospital Central Militar, Mexico City, Mexico
| | - Patricia Martín-Hernández
- Department of Invasive Radiology, Cardiac Catheterization Laboratory. Hospital Central Militar, Mexico City, Mexico
| | - Jose L Ojeda-Delgado
- Department of Invasive Radiology, Cardiac Catheterization Laboratory. Hospital Central Militar, Mexico City, Mexico
| | | | - Lázaro Hernández-Jiménez
- Department of Invasive Radiology, Cardiac Catheterization Laboratory. Hospital Central Militar, Mexico City, Mexico
| | | | | | | | - Pedro Echeverría-Béliz
- International Proctor for the Transcatheter Aortic Valve Implantation, Panama City, Panama
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Gutiérrez-Leonard H, Martín-Hernández P, Ojeda-Delgado JL, Corona-Perezgrovas MA, Hernández-Jiménez L, Fagoaga-Valdivia J, Blázquez-Cruz MDR, Rebollo-Hurtado V, Echeverría-Béliz P. Experiencia inicial en México con la prótesis aórtica transcatéter Evolut™ R por abordaje aórtico directo. Arch Cardiol Mex 2019; 89:117-122. [PMID: 31314003 DOI: 10.24875/acm.m19000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Aortic stenosis is one of the most frequent valvulopathies in the elderly patient. The treatment for aortic stenosis is heart surgery, however many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve (TAVI) was developed for these patients. Objective To make known the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to rapid growth in technology and know-how, TAVI is already very experienced. Methodology One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar and easy to learn for cardiac surgeons. Results In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding, risk of myocardial injury) and shorter length of stay in the Intensive Care Unit compared to surgery or transapical access. Conclusion Our center successfully implanted the self-expandable aortic valve Evolut™ via direct aortic for presenting a dissection in transverse aorta with possibilities of embolization.
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Affiliation(s)
- Hugo Gutiérrez-Leonard
- Laboratorio de Cateterismo Cardíaco, Departamento de Radiología Invasiva, Ciudad de México, México
| | | | - José L Ojeda-Delgado
- Laboratorio de Cateterismo Cardíaco, Departamento de Radiología Invasiva, Ciudad de México, México
| | | | - Lázaro Hernández-Jiménez
- Laboratorio de Cateterismo Cardíaco, Departamento de Radiología Invasiva, Ciudad de México, México
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Corona-Perezgrovas MA, Fagoaga-Valdivia J, Fuentes-Durán M, Martín-Hernández P, Alcocer Macías JJ, Payró Hernández LE. Primera explantación de válvula aórtica transcatéter en México. Cirugía Cardiovascular 2017. [DOI: 10.1016/j.circv.2016.10.014] [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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Martín-Hernández P, Gutiérrez-Leonard H, Ojeda-Delgado JL, Fagoaga-Valdivia J, Barrios-Nanni R, Rodríguez-Somarriba ME, Páez-Lizárraga LM, Berúmen-Domínguez LE, Hernández-Jiménez L, Rebollo-Hurtado V, Blázquez-Cruz MDR. [Experience of transcatheter aortic valve implantation in the Central Military Hospital]. Arch Cardiol Mex 2015; 85:296-306. [PMID: 26337913 DOI: 10.1016/j.acmx.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 07/14/2015] [Accepted: 07/23/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Transcatheter aortic valve implantation (TAVI) is an alternative treatment for patients with severe symptomatic aortic stenosis, inoperable or at high surgical risk. The purpose of this communication is to report the results of the experience of this new technique and compare them with literature. METHODS Review of 17 patients data with symptomatic severe aortic stenosis at high surgical risk or inoperable, treated with a transcatheter implantation aortic valve (TAVI) via femoral surgical access with Core Valve (Medtronic, EE.UU.) between September 2013 and July 2014. RESULTS All patients had severe aortic stenosis with a mean gradient of 46̊æ14 mmHg received CoreValveTM (Medtronic, USA). Half of patients was performed under general anesthesia, the other half with regional and local anesthesia. In-hospital mortality was 11.7% and one death in follow-up from September 2013 until the time of preparing this report (5.9%).Total mortality at one year follow-up was 17.6%. The technical success rate was 82.4%, with an immediate post-implantation gradient of 5.4̊æ3.4 mmHg. Aortic regurgitation I degree was observed in 5 patients (29.4%); 2 patients (11.7%) had aortic regurgitation grade II. Post dilatation was made in 6 patients (35.2%). We did not have any vascular complications. Permanent pacemaker implantation was needed in 6 patients (35.2%). One patient complicated with acute renal failure, 2 had in-hospital ischemic stroke (11.7%), none had need for cardiac surgery; 2 patients had major bleeding complications that required transfusion. CONCLUSIONS In patients with high surgical risk or inoperable, TAVI is a treatment option that improves life quality, survival and diminsh the need of hospitalizations. There can be some complications and even death, so that a proper patient selection and a multidisciplinary team is needed and fundamental for a successful procedure.
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García E, Unzué L, Martín-Hernández P, Hernández-Antolín RA. Implicaciones del sellado vascular en el implante percutáneo transfemoral de válvula aórtica. Respuesta. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2014.06.007] [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: 10/24/2022]
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García E, Unzué L, Martín-Hernández P, Hernández-Antolín RA. Vascular sealing implications in transfemoral transcatheter aortic valve implantation. Response. ACTA ACUST UNITED AC 2014; 67:870. [PMID: 25205648 DOI: 10.1016/j.rec.2014.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/23/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Eulogio García
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Leire Unzué
- Servicio de Cardiología, Hospital Universitario Madrid-Montepríncipe, Madrid, Spain
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Martín-Hernández P, Hernández-Antolín R, García-Fernández E. [Implantation transfemoral aortic valve Edwards SAPIEN XT in a patient with extreme tortuous aorta]. Arch Cardiol Mex 2014; 84:138-40. [PMID: 24831431 DOI: 10.1016/j.acmx.2013.08.005] [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: 03/25/2013] [Revised: 07/31/2013] [Accepted: 08/20/2013] [Indexed: 11/30/2022] Open
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García E, Martín-Hernández P, Unzué L, Hernández-Antolín RA, Almería C, Cuadrado A. Usefulness of placing a wire from the contralateral femoral artery to improve the percutaneous treatment of vascular complications in TAVI. ACTA ACUST UNITED AC 2014; 67:410-2. [PMID: 24774738 DOI: 10.1016/j.rec.2013.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/16/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Eulogio García
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | | | - Leire Unzué
- Servicio de Cardiología, Hospital Universitario Madrid Montepríncipe, Madrid, Spain
| | | | - Carlos Almería
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Ana Cuadrado
- Servicio de Anestesia, Hospital Universitario Clínico San Carlos, Madrid, Spain
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