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Moreno R, Baptista SB, Valencia J, Gomez-Menchero A, Bouisset F, Ruiz-Arroyo JR, Bento A, Besutti M, Jimenez-Valero S, Rivero-Santana B, Olhmann P, Santos M, Vaquerizo B, Cuissetm T, Lemoine J, Pinar E, Fiarresga A, Urbano C, Marliere S, Braga C, Amat-Santos I, Morgado G, Sarnago F, Telleria M, Van Belle E, Díaz-Fernandez J, Borrego JC, Amabile N, Meneveau N. OPTImized coronary interventions eXplaIn the bEst cliNical outcomEs (OPTI-XIENCE) study. Rationale and study design. Cardiovasc Revasc Med 2024; 59:93-98. [PMID: 37723011 DOI: 10.1016/j.carrev.2023.08.011] [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: 07/22/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Clinical events may occur after percutaneous coronary intervention (PCI), particularly in complex lesions and complex patients. The optimization of PCI result, using pressure guidewire and intracoronary imaging techniques, may reduce the risk of these events. The hypothesis of the present study is that the clinical outcome of patients with indication of PCI and coronary stent implantation that are at high risk of events can be improved with an unrestricted use of intracoronary tools that allow PCI optimization. METHODS AND ANALYSIS Observational prospective multicenter international study, with a follow-up of 12 months, including 1064 patients treated with a cobalt‑chromium everolimus-eluting stent. Inclusion criteria include any of the following: Lesion length > 28 mm; Reference vessel diameter < 2.5 mm or > 4.25 mm; Chronic total occlusion; Bifurcation with side branch ≥2.0 mm;Ostial lesion; Left main lesion; In-stent restenosis; >2 lesions stented in the same vessel; Treatment of >2 vessels; Acute myocardial infarction; Renal insufficiency; Left ventricular ejection fraction <30 %; Staged procedure. The control group will be comprised by a similar number of matched patients included in the "extended risk" cohort of the XIENCE V USA study. The primary endpoint will be the 1-year rate of target lesion failure (TLF) (composite of ischemia-driven TLR, myocardial infarction (MI) related to the target vessel, or cardiac death related to the target vessel). Secondary endpoints will include overall mortality, cardiovascular mortality, acute myocardial infarction, TVR, TLR, target vessel failure, and definitive or probable stent thrombosis at 1 year. IMPLICATIONS The ongoing OPTI-XIENCE study will contribute to the growing evidence supporting the use of intra-coronary imaging techniques for stent optimization in patients with complex coronary lesions.
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Affiliation(s)
- Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | - Patrick Olhmann
- Centres Hospitaliers et Universitaires of Strasbourg, France
| | - Miguel Santos
- Professor Doutor Fernando Fonseca Hospital, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Van Belle
- Centre Hospitalier Regional Universitaire de Lille, France
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Rivero-Santana B, Jimenez-Valero S, Jurado-Roman A, Galeote G, Lopez-Fernandez T, Moreno R. The BALTO Registry: Long-term results of percutaneous BALloon pericardioTomy in oncological patients. Catheter Cardiovasc Interv 2024; 103:482-489. [PMID: 38204382 DOI: 10.1002/ccd.30953] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to analyze the efficacy and safety of percutaneous balloon pericardiotomy (PBP) in oncological patients who present with a malignant pericardial effusion (MPE). BACKGROUND The use of PBP as a treatment for MPE is not standardized due to the limited evidence. Furthermore, the performance of a second PBP for a recurrence after a first procedure is controversial. METHODS The BALTO Registry (BALloon pericardioTomy in Oncological patients) is a prospective, single-center, observational registry that includes consecutive PBP performed for MPE from October 2007 to February 2022. Clinical and procedural, characteristics, as well as clinical outcome were analyzed. RESULTS Seventy-six PBP were performed in 61 patients (65% female). Mean age was of 66.4 ± 11.2 years. In 15 cases, a second PBP procedure was performed due to recurrence despite the first PBP. The procedure could be performed effectively in all cases with only two serious complications. Ninety-five percent of cases were discharged alive from the hospital. During a median follow-up of 6.3 months (interquartile range [IQR], 0.9-10.8), MPE recurred in 24.5% cases although no recurrences were reported after the second procedure. No evidence of malignant pleural effusion developed on follow-up. The median overall survival time was 5.8 months (IQR, 0.8-10.2) and the time to recurrence after the first PBP was 2.4 months (IQR, 0.7-4.5). CONCLUSIONS PBP is a safe and effective treatment for MPE. It could be considered an acceptable therapy in most MPE, even in those who recur after a first procedure.
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Affiliation(s)
- Borja Rivero-Santana
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Santiago Jimenez-Valero
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Alfonso Jurado-Roman
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Teresa Lopez-Fernandez
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
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Díez-Villanueva P, García-Guimarães M, Sanz-Ruiz R, Sabaté M, Macaya F, Roura G, Jimenez-Kockar M, Flores-Ríos X, Moreu J, Fuertes-Ferre G, Jimenez-Valero S, Tizón H, Nogales JM, Velázquez M, Lozano Í, Avanzas P, Salamanca J, Bastante T, Alfonso F. Prognostic implications of left ventricular systolic dysfunction in patients with spontaneous coronary artery dissection. Eur Heart J Acute Cardiovasc Care 2023; 12:299-305. [PMID: 37010101 DOI: 10.1093/ehjacc/zuad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome. Clinical features, angiographic findings, management, and outcomes of SCAD patients who present reduced left ventricular ejection fraction (LVEF) remain unknown. METHODS AND RESULTS The Spanish multicentre prospective SCAD registry (NCT03607981), included 389 consecutive patients with SCAD. In 348 of these patients, LVEF could be assessed by echocardiography during the index admission. Characteristics and outcomes of patients with preserved LVEF (LVEF ≥50%, n = 295, 85%) were compared with those with reduced LVEF (LVEF <50%, n = 53, 15%). Mean age was 54 years and 90% of patients in both groups were women. The most frequent clinical presentation in patients with reduced LVEF was ST-segment elevation myocardial infarction (STEMI) (62% vs. 36%, P < 0.001), especially anterior STEMI. Proximal coronary segment and multi-segment involvement were also significantly more frequent in these patients. No differences were found on initial revascularization between groups. Patients with reduced LVEF significantly received more often neurohormonal antagonist therapy, and less frequently aspirin. In-hospital events were more frequent in these patients (13% vs. 5%, P = 0.01), with higher rates of death, cardiogenic shock, ventricular arrhythmia, and stroke. During a median follow-up of 28 months, the occurrence of a combined adverse event did not statistically differ between the two groups (19% vs. 12%, P = 0.13). However, patients with reduced LVEF had higher mortality (9% vs. 0.7%, P < 0.001) and readmission rates for heart failure (HF) (4% vs. 0.3%, P = 0.01). CONCLUSION Patients with SCAD and reduced LVEF show differences in clinical characteristics and angiographic findings compared with SCAD patients with preserved LVEF. Although these patients receive specific medications at discharge, they had higher mortality and readmission rates for HF during follow-up.
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Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Marcos García-Guimarães
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Ricardo Sanz-Ruiz
- Servicio de Cardiología, CIBERCV, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manel Sabaté
- Servicio de Cardiología, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fernando Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Xacobe Flores-Ríos
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Jose Moreu
- Servicio de Cardiología, Hospital General Universitario de Toledo, Toledo, Spain
| | | | | | - Helena Tizón
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | | | - Maite Velázquez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Íñigo Lozano
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Pablo Avanzas
- Servicio de Cardiología, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
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Rivero-Santana B, Jurado-Roman A, Jimenez-Valero S, Galeote G, Moreno R, Merino JL. Chronic Total Occlusion Techniques to Recanalize an Occluded Pulmonary Vein After Atrial Fibrillation Ablation. J Invasive Cardiol 2023; 35:E223-E224. [PMID: 37029998] [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] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Cardiac computed tomography (CT) scan was performed in a 69-year-old male with atrial fibrillation radiofrequency ablation who was admitted for transcatheter angioplasty of left inferior pulmonary vein (LIPV) stenosis due to recurrent hemoptysis. CT showed complete ostial occlusion in the area of the LIPV. Occlusion of the pulmonary vein ostium is a rare complication. We describe the successful use of chronic occlusion techniques in the treatment of this patient.
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Rivero-Santana B, Galeote G, Valbuena S, Jimenez-Valero S, Moreno R, Jurado-Roman A. "Water Gun:" A New Morphology of Left Atrial Appendage. J Invasive Cardiol 2023; 35:E110-E111. [PMID: 36735875] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An 86-year-old patient with non-valvular atrial fibrillation was referred to our institution to undergo a left atrial appendage (LAA) closure for recurrent gastrointestinal bleeding on direct oral anticoagulants. The transesophageal echocardiogram (TEE) performed the previous day evaluated the morphology and dimensions of the LAA and ruled out any thrombus. During the procedure, a pigtail catheter was inserted into the LAA, observing an unusual image we describe as a culde- sac, without an anomalous connection with any drainage in other vessel or cavity. After additional imaging studies, we concluded that it was morphology related to LAA, which we have termed the "water-gun" morphology. Four morphologies have been described based on the shape of the central and secondary lobes. To the best of our knowledge, this is the first description of a fifth type, which was shown to be effectively closed with current closure devices.
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Cobarro L, García-Escobar A, Ramírez U, Moreno-Gómez I, Jurado-Román A, Galeote G, Jimenez-Valero S, Poveda D, Moreno R. Cardiogenic shock secondary to ostial compromise of left main immediately after bentall surgical intervention and aortic valve replacement. Ann Card Anaesth 2023; 26:113-114. [PMID: 36722603 PMCID: PMC9997475 DOI: 10.4103/aca.aca_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Lucía Cobarro
- Department of Interventional Cardiology, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Artemio García-Escobar
- Department of Interventional Cardiology, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Ulises Ramírez
- Department of Cardiac Surgery, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Isidro Moreno-Gómez
- Department of Cardiothoracic Anaesthesia, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Alfonso Jurado-Román
- Department of Interventional Cardiology, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Guillermo Galeote
- Department of Interventional Cardiology, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | | | - Dolores Poveda
- Department of Interventional Cardiology, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Raúl Moreno
- Department of Interventional Cardiology, IdiPAZ, University Hospital La Paz, Madrid, Spain
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Tébar Márquez D, Moreno R, Galeote G, Jurado-Roman A, Jimenez-Valero S, García-Escobar A, Vera S, Moreno-Gómez I, Lopez de Sa E. Transcatheter aortic valve with a novel self-expandable device in patients with previous mechanical mitral valve prosthesis. Catheter Cardiovasc Interv 2022; 100:1286-1290. [PMID: 36273418 DOI: 10.1002/ccd.30449] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The aim of this study was to describe the procedural and early outcomes of patients with mechanical mitral valve prosthesis (MVP) undergoing transcatheter aortic valve replacement (TAVR) with a novel self-expandable retrievable device. BACKGROUND TAVR in patients with prior MVP may have an increased risk of complications related to device positioning and interference between both prosthetic valves. METHODS An observational study was conducted, including eight patients with severe symptomatic aortic stenosis and prior mechanical MVP who underwent TAVR with the novel device AllegraTM (Biosensors). No transesophageal monitoring was used. RESULTS The mean age of the study population was 75 years. The mean distance between MVP and aortic annulus was 3.8 mm. Procedural success was achieved in all patients with no major intraprocedural, in-hospital, or follow-up complications. CONCLUSIONS TAVR with Allegra TAVI system in patients with prior MVP offers good procedural and clinical outcomes.
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Affiliation(s)
| | - Raul Moreno
- Cardiology Department, University Hospital La Paz, Madrid, Spain
| | | | | | | | | | - Silvio Vera
- Cardiology Department, University Hospital La Paz, Madrid, Spain
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Cobarro L, Galeote G, Tébar D, Rosillo S, Jurado-Román A, Jimenez-Valero S, García-Escobar A, Vera S, López de Sá E, Moreno R. A Floating Coil. JACC Cardiovasc Interv 2022; 15:e237-e238. [DOI: 10.1016/j.jcin.2022.09.044] [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] [Received: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022]
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Vera-Vera S, Garcia A, Jimenez-Valero S, Galeote G, Moreno R, Jurado-Roman A. Excimer Laser Coronary Atherectomy to Treat Calcified Lesions. Interv Cardiol 2022; 17:e14. [PMID: 36304066 PMCID: PMC9585644 DOI: 10.15420/icr.2022.10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/27/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Silvio Vera-Vera
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Artemio Garcia
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Santiago Jimenez-Valero
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Guillermo Galeote
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Alfonso Jurado-Roman
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
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Estévez-Loureiro R, Sánchez-Recalde A, Amat-Santos IJ, Cruz-González I, Baz JA, Pascual I, Mascherbauer J, Abdul-Jawad Altisent O, Nombela-Franco L, Pan M, Trillo R, Moreno R, Delle Karth G, Salido-Tahoces L, Santos-Martinez S, Núñez JC, Moris C, Goliasch G, Jimenez-Quevedo P, Ojeda S, Cid-Álvarez B, Santiago-Vacas E, Jimenez-Valero S, Serrador A, Martín-Moreiras J, Strouhal A, Hengstenberg C, Zamorano JL, Puri R, Íñiguez-Romo A. Six-Month Outcomes of the TricValve® System in Patients with Tricuspid Regurgitation: TRICUS EURO Study. JACC Cardiovasc Interv 2022; 15:1366-1377. [PMID: 35583363 DOI: 10.1016/j.jcin.2022.05.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is frequently associated with significant morbidity and mortality; such patients often deemed to be at high surgical risk. Heterotopic bi-caval stenting is an emerging, attractive transcatheter solution for these patients. OBJECTIVES To evaluate the 30-day safety and 6-month efficacy outcomes of specifically designed bioprosthetic valves for the superior and inferior vena cava. METHODS TRICUS EURO is a non-blinded, non-randomized, single-arm, multicenter, prospective trial that enrolled patients from 12 European centers between December 2019 to February 2021. High risk individuals with severe symptomatic TR despite optimal medical therapy were included. Primary end point was quality of life (QOL) improvement measured by Kansas City Cardiomyopathy Questionnaire (KCCQ12) and New York Heart Association functional class (NYHA) improvement at 6-month follow-up. RESULTS 35 patients (mean age 76±6.8 years; 83% women) were treated with TricValve® system. All patients at baseline were at NYHA ≥ 3 status. At 30-days, procedural success was 94% with no procedural deaths or conversions to surgery. A significant increase in QOL at 6-months follow-up was observed (baseline and 6-month KCCQ: 42.01±22.3 vs. 59.7±23.6 respectively; p=0.004), correlating with a significant improvement in NYHA functional class with 79.4% of patients noted to be in class I or II at 6 months (p=0.0006). The 6-month all-cause mortality and heart failure hospitalization rates were 8.5% and 20%, respectively. CONCLUSIONS The dedicated bi-caval system for treating severe, symptomatic TR was associated with high procedural success rate and significant increase in both, QOL and functional improvements at 6-months follow-up.
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Affiliation(s)
| | | | | | | | - Jose A Baz
- Complejo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julia Mascherbauer
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Ramiro Trillo
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Jean C Núñez
- Hospital Clinico Universitario de Salamanca, CIBERCV. IBSAL. Salamanca, Spain
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Georg Goliasch
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | | | - Belén Cid-Álvarez
- Hospital Clinico Universitario de Santiago de Compostela, CIBERCV, Santiago, Spain
| | | | | | - Ana Serrador
- CIBERCV. Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Christian Hengstenberg
- Division of Cardiology, Department for Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Jurado-Roman A, Gonzalvez A, Jimenez-Valero S, Galeote G, Moreno R, de Sa EL. What have we learnt from the use of papyrus covered stent in France and Spain? Catheter Cardiovasc Interv 2021; 98:410. [PMID: 33484045 DOI: 10.1002/ccd.29469] [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] [Received: 11/12/2020] [Accepted: 12/30/2020] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ariana Gonzalvez
- Department of Cardiology, La Paz University Hospital, Madrid, Spain
| | | | | | - Raul Moreno
- Department of Cardiology, La Paz University Hospital, Madrid, Spain
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Ruiz-Ares G, Jimenez-Valero S, Fernández-Prieto A, Arbas-Redondo E, Díaz-Pollán B, Navia P, Meras P, Alonso de Leciñana M, de Donebún JR, Rigual R, Fuentes B, Díez-Tejedor E. Concurrent Stroke and Myocardial Infarction After Mild COVID-19 Infection. Neurologist 2021; 26:86-89. [PMID: 33942789 PMCID: PMC8143152 DOI: 10.1097/nrl.0000000000000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The concurrency of both, acute stroke and acute myocardial infarction in normal conditions, outside the pandemic is rare. Coagulopathy has been associated with the inflammatory phase of coronavirus disease (COVID-19) and might be involved in this concurrency. CASES REPORT We describe 2 patients with previous mild or no symptoms of COVID-19, admitted for acute stroke with recent/simultaneous myocardial infarction in whom admission polymerase chain reaction was negative but serologic testing diagnosed COVID-19. In these patients, concurrent stroke and myocardial infarction could have been promoted by COVID-19 infection. Management and evolution are detailed, and their contacts to confirm the COVID-19 infection. Pathogenic analysis of possible hypercoagulation state is described suggesting the hypothesis of endothelial dysfunction as the strongest mechanism involved in thrombus formation after the acute phase of COVID-19 infection. CONCLUSIONS Our experience with these cases suggests that patients with mild symptoms can also present thromboembolic complications once the acute phase of COVID-19 infection has passed.
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Affiliation(s)
| | | | | | | | - Beatriz Díaz-Pollán
- Infectious Diseases Unit, Internal Medicine Service; La Paz University Hospital − IdiPaz Health Research Institute, Autonoma University of Madrid, Madrid, Spain
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Diez Villanueva P, Garcia-Guimaraes M, Vera A, Moreu J, Ojeda S, Nogales J, Salamanca J, Veiga G, Masotti M, Camacho-Freire S, Jimenez-Valero S, Jimenez-Kockar M, Lozano I, Bastante T, Alfonso F. Spontaneous coronary artery dissection in the elderly: clinical features, angiographic findings, management and outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Clinical features, angiographic findings, management and outcomes of SCAD in elderly patients remain unknown.
Methods
The Spanish multicenter prospective SCAD registry included 318 consecutive patients with SCAD diagnosis. Patients were classified according to age in two groups: <65 and ≥65 years old.
Results
A total of 55 patients (17%) were 65 or older (Table). Elderly patients had more often hypertension (29% vs 76%, p<0.01) and dyslipidemia (30% vs 56%, p<0.01), and less smoking history (51% vs 7%, p<0.01). Previous history of coronary artery disease was also more frequent in older patients (4% vs 11%, p=0.044). Interestingly, an identifiable trigger was more often found among patients under 65. Coronary artery tortuosity (1±0.99 vs 1.4±1, p=0.027) and coronary artery ectasia (9% vs 24%, p<0.01) were both more frequent in elderly patients, who were more often managed conservatively (75% vs 89%, p=0.025). A trend toward a higher mortality rate was found among patients ≥65, with no differences in terms of in hospital stay, new acute myocardial infarction, unplanned coronariography or heart failure.
Conclusions
Elderly patients with SCAD show different clinical and angiographic characteristics and they receive distinct management. Short-term outcomes do not significantly differ from those seen in younger patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - A Vera
- Hospital Universitario La Princesa, Madrid, Spain
| | - J Moreu
- Hospital Virgen de la Salud, Cardiology, Toledo, Spain
| | - S Ojeda
- University Hospital Reina Sofia, Cardiology, Cordoba, Spain
| | - J.M Nogales
- Hospital Infanta Cristina de Badajoz, Cardiology, Badajoz, Spain
| | - J Salamanca
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - G Veiga
- University Hospital Marques de Valdecilla, Cardiology, Santander, Spain
| | - M Masotti
- Barcelona Hospital Clinic, Cardiology, Barcelona, Spain
| | | | | | - M Jimenez-Kockar
- Hospital de la Santa Creu i Sant Pau, Cardiology, Barcelona, Spain
| | - I Lozano
- Hospital de Cabuenes, Cardiology, Gijon, Spain
| | - T Bastante
- University Hospital De La Princesa, Cardiology, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Cardiology, Madrid, Spain
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Irazusta FJ, Galeote G, Jimenez-Valero S, Caro-Codon J, Sanchez-Recalde A, Moreno R. Optimal Approach for Uncrossable Stent Restenosis: Laser and Rotational Atherectomy Assessed by 3-Dimensional Optical Coherence Tomography. JACC Cardiovasc Interv 2018; 11:e49-e50. [PMID: 29550089 DOI: 10.1016/j.jcin.2017.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Guillermo Galeote
- Interventional Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Juan Caro-Codon
- Interventional Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Raul Moreno
- Interventional Cardiology Department, La Paz University Hospital, Madrid, Spain
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15
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Carrizo S, Peinado RP, Sanchez-Recalde A, Ruiz-Garcia J, Jimenez-Valero S, Galeote G, Garcia-Blas S, Trucco G, Orbe LC, Lopez-De-Sa E, Moreno R, Lopez-Sendon JL. Clinical and angiographic characteristics of patients with acute coronary syndrome associated with sudden cardiac death. Hellenic J Cardiol 2015; 56:136-141. [PMID: 25854442] [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: 06/04/2023] Open
Abstract
INTRODUCTION Sudden death (SD) is in most cases due to cardiac causes, mainly secondary to ischemic heart disease. However, the angiographic characteristics in SD survivors in the context of an acute coronary syndrome (ACS) remain controversial. The aim of this study was to evaluate the clinical and angiographic characteristics of patients who suffered cardiac arrest during an ACS. METHODS We evaluated 46 patients with SD related to ACS, who were divided into two groups according to their presentation: an ST-elevation myocardial infarction (SD-STEMI) group and a non ST-elevation myocardial infarction (SD-NSTEMI) group. Consecutive STEMI patients without SD served as a double size-matched control group. We compared the clinical and angiographic characteristics and the in-hospital mortality between groups. RESULTS Patients in the SD-NSTEMI group (n=13) were older and had a higher incidence of hypertension. The left anterior descending coronary artery was the most frequent culprit vessel in all groups. SD-STEMI patients (n=33) had a higher prevalence of proximal coronary culprit segment involvement than did the nonSD STEMI group (75% vs. 36.3%, p<0.001). The SD-NSTEMI group was characterized by multivessel and multi-segment disease. Outcomes were similar for both SD groups. CONCLUSION SD in patients with NSTEMI occurred in patients who were older, with more cardiovascular risk factors, diffuse and multivessel coronary disease, complex coronary lesions, and a lower rate of angioplasty success as compared with the STEMI group. SD STEMI patients had a significant higher association with proximal coronary acute occlusion than STEMI patients without SD.
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Arroyo-Úcar E, Moreno R, García E, Teles R, Rumoroso JR, Carvalho HC, Goicolea FJ, Moreu J, Mauri J, Sabaté M, Mainar V, Patricio L, Valdés M, Fernández-Vázquez F, Sánchez-Recalde A, Galeote G, Jimenez-Valero S, Almeida M, López de Sa E, Calvo L, Plaza I, Lopez-Sendón JL, Martín JLR. Drug-eluting stent thrombosis in the treatment of chronic total coronary occlusions: Incidence, presentation and related factors. Data from the CIBELES trial. Revista Portuguesa de Cardiologia (English Edition) 2015. [DOI: 10.1016/j.repce.2015.03.005] [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: 11/26/2022] Open
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17
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Arroyo-Úcar E, Moreno R, García E, Teles R, Rumoroso JR, Carvalho HC, Goicolea FJ, Moreu J, Mauri J, Sabaté M, Mainar V, Patricio L, Valdés M, Fernández-Vázquez F, Sánchez-Recalde A, Galeote G, Jimenez-Valero S, Almeida M, López de Sa E, Calvo L, Plaza I, Lopez-Sendón JL, Martín JLR. Drug-eluting stent thrombosis in the treatment of chronic total coronary occlusions: incidence, presentation and related factors. Data from the CIBELES trial. Rev Port Cardiol 2015; 34:193-9. [PMID: 25686520 DOI: 10.1016/j.repc.2014.08.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/16/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to analyze the incidence of drug-eluting stent thrombosis (sirolimus or everolimus) in patients with chronic total coronary occlusions (CTO) and to determine its clinical implications and related factors. METHODS Data from the 12-month follow-up of the 207 patients included in the CIBELES trial with CTO were analyzed. RESULTS Stent thrombosis occurred in three patients, two definite and one probable (overall thrombosis rate: 1.4%). However, there were no cases of death or Q-wave myocardial infarction. In univariate analysis, patients with a higher incidence of stent thrombosis were those in whom the target vessel was the left anterior descending, who had single-vessel disease, were assigned to treatment with sirolimus-eluting stents, and those with smaller minimum luminal diameter immediately after the procedure. In multivariate analysis, the only independent predictor of stent thrombosis was minimal luminal diameter immediately after the procedure. CONCLUSIONS The rate of drug-eluting stent thrombosis in patients with CTO is relatively low (1.4%). The only independent predictor of stent thrombosis in this context was minimal luminal diameter after the procedure and the clinical presentation was in all cases relatively benign.
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Affiliation(s)
| | - Raul Moreno
- Hospital Universitario La Paz, Madrid, Spain.
| | | | - Rui Teles
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | | | | | - José Moreu
- Hospital Virgen de la Salud, Toledo, Spain
| | | | - Manel Sabaté
- Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Luis Calvo
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Jose-Luis R Martín
- Research Manager, School of Biomedical and Health Sciences, Universidad Europea de Madrid, Spain
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18
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Sánchez-Recalde A, Moreno R, Galeote G, Jimenez-Valero S, Calvo L, Sevillano JH, Arroyo-Ucar E, López T, Mesa JM, López-Sendón JL. Evolución inmediata y a medio plazo de las dehiscencias paravalvulares cerradas percutáneamente. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Sánchez-Recalde A, Moreno R, Galeote G, Jimenez-Valero S, Calvo L, Sevillano JH, Arroyo-Ucar E, López T, Mesa JM, López-Sendón JL. Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage. ACTA ACUST UNITED AC 2014; 67:615-23. [PMID: 25037540 DOI: 10.1016/j.rec.2014.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/30/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. METHODS We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. RESULTS Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. CONCLUSIONS Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage.
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Affiliation(s)
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Guillermo Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Luis Calvo
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Teresa López
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - José M Mesa
- Servicio de Cirugía Cardiovascular, Hospital Universitario La Paz, Madrid, Spain
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21
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Moreno R, García E, Teles R, Rumoroso JR, Cyrne Carvalho H, Goicolea FJ, Moreu J, Mauri F, Sabaté M, Mainar V, Patricio L, Valdés M, Cuellas C, Almeida M, Sánchez-Recalde A, Galeote G, Jimenez-Valero S, Calvo L, Plaza I, Lopez-Sendón JL, Martín JLR. Techniques and material used in the percutaneous treatment of chronic coronary occlusions. Data from the CIBELES study. Rev Port Cardiol 2013; 32:593-9. [PMID: 23896301 DOI: 10.1016/j.repc.2012.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/01/2012] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In recent years, various specific techniques and materials have been developed for the treatment of coronary chronic total occlusions (CTO). OBJECTIVE To evaluate the current situation in the treatment of CTO (techniques and material) in our setting. METHODS We evaluated data on techniques and material used in the CIBELES (ChronIc coronary occlusion treated By EveroLimus Eluting Stent) trial, a randomized comparison of sirolimus- and everolimus-eluting stents in 207 patients with CTO in 13 centers in Spain and Portugal. RESULTS A radial approach was used in 23% of patients, and retrograde techniques were used in only 5%. A high number of balloons were used (2.2±0.9 per patient). Microcatheters were used in 33% of patients, and post-dilatation balloons in only 25%. The mean number of stents implanted per patient was 2.1±1.0, with a mean total stent length of 49±24 mm. Other devices and techniques used were: Tornus penetration catheter in 4% of patients, rotational atherectomy in 2%, and cutting balloon in 1%. Intracoronary ultrasound was used in only 6% of patients. In 34% of cases, operators used guidewires that were not specifically for CTO. Considerable variability between centers was detected in the use of different techniques, the highest and lowest variability being observed in the use of intracoronary ultrasound and the use of CTO guidewires, respectively. CONCLUSIONS In the CIBELES trial, techniques and devices specifically designed for the treatment of CTO were used in a relatively low proportion of patients. Considerable variability between centers was detected.
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Affiliation(s)
- Raul Moreno
- Interventional cardiology, University Hospital La Paz, Madrid, Spain.
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Moreno R, García E, Teles R, Rumoroso JR, Cyrne Carvalho H, Goicolea FJ, Moreu J, Mauri F, Sabaté M, Mainar V, Patricio L, Valdés M, Cuellas C, Almeida M, Sánchez-Recalde A, Galeote G, Jimenez-Valero S, Calvo L, Plaza I, Lopez-Sendón JL, Martín JLR. Techniques and material used in the percutaneous treatment of chronic coronary occlusions. Data from the CIBELES study. Revista Portuguesa de Cardiologia (English Edition) 2013. [DOI: 10.1016/j.repce.2013.10.006] [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: 10/26/2022] Open
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23
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Carrizo S, Salinas P, Jimenez-Valero S, Moreno R. Utility of optical coherence tomography to assess a hazy intracoronary image after percutaneous coronary intervention. Korean Circ J 2013; 43:44-7. [PMID: 23407580 PMCID: PMC3569566 DOI: 10.4070/kcj.2013.43.1.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/11/2012] [Accepted: 08/06/2012] [Indexed: 11/11/2022] Open
Abstract
Although its use in daily practice is not common, optical coherence tomography (OCT) is a powerful research tool in invasive cardiology. This report describes a hazy angiography image after percutaneous coronary intervention that has been assessed using OCT. Based on the results of the OCT, the patient underwent an elective coronary angioplasty with standard anticoagulation. After implantation of the stent, an intracoronary hazy image was seen on angiography. The use of OCT permitted a correct diagnosis and a successful treatment. This paper provides a discussion of the advantages and disadvantages of OCT, and a comparison with intravascular ultrasound.
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Affiliation(s)
- Sebastian Carrizo
- University Hospital La Paz, Interventional Cardiology Department, Madrid, Spain
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24
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Moreno R, García E, Teles R, Rumoroso JR, Cyrne Carvalho H, Goicolea FJ, Moreu J, Mauri J, Sabaté M, Mainar V, Patricio L, Valdés M, Fernández Vázquez F, Sánchez-Recalde A, Galeote G, Jimenez-Valero S, Almeida M, Lopez de Sa E, Calvo L, Plaza I, Lopez-Sendón JL, Martín JLR. Randomized comparison of sirolimus-eluting and everolimus-eluting coronary stents in the treatment of total coronary occlusions: results from the chronic coronary occlusion treated by everolimus-eluting stent randomized trial. Circ Cardiovasc Interv 2013; 6:21-8. [PMID: 23403384 DOI: 10.1161/circinterventions.112.000076] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with coronary total occlusions are at especially high risk for restenosis and new revascularizations. Sirolimus-eluting stents dramatically improved the clinical outcome of this subset of patients in randomized trials, but other drug-eluting stents, mainly the everolimus-eluting stent (currently the most frequently used stent), have not yet been evaluated in patients with coronary total occlusions. The objective was to compare the second-generation everolimus-eluting stent with the first-generation sirolimus-eluting stent in patients with coronary total occlusions. METHODS AND RESULTS A total of 207 patients with coronary total occlusions and estimated time since occlusion >2 weeks were randomized to everolimus- or sirolimus-eluting stent. The primary end point was in-stent late loss at 9-month angiographic follow-up (noninferiority trial). Clinical follow-up was performed at 1 and 12 months. In-stent late loss at 9 months was 0.29±0.60 versus 0.13±0.69 mm in patients allocated to sirolimus- and everolimus-eluting stent, respectively. The observed difference in in-stent late loss between both groups was -0.16 mm (95% confidence interval, 0.04 to -0.36 mm; P for noninferiority <0.01). The rate of binary angiographic restenosis was 10.8% and 9.1% in patients allocated to sirolimus- and everolimus-eluting stent, respectively (P=0.709), whereas the rate of vessel reocclusion was 3.2% and 1.1%, respectively (P=0.339). At 12 months, the rate of major adverse events was 15.9% versus 11.1% with sirolimus- and everolimus-eluting stent, respectively (P=0.335), and probable or definitive stent thrombosis occurred in 3.0% and 0.0% of patients, respectively (P=0.075). CONCLUSIONS In patients with coronary total occlusions, everolimus-eluting stent is as effective as sirolimus-eluting stent. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00793221.
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Affiliation(s)
- Raul Moreno
- Hospital Universitario La Paz, 28046 Madrid, Spain.
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Salinas P, Jimenez-Valero S, Moreno R, Sanchez-Recalde A, Galeote G, Calvo L, Ruiz-Garcia J, Carrizo S, Trucco G, Lopez-Sendon J. Update in pharmacological management of coronary no-reflow phenomenon. Cardiovasc Hematol Agents Med Chem 2012; 10:256-64. [PMID: 22827250 DOI: 10.2174/187152512802651024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 11/22/2022]
Abstract
The no-reflow phenomenon (NRP) is defined as the lack of adequate myocardial tissue perfusion despite a patent epicardial coronary artery. The incidence of NRP varies between 2-5% of elective percutaneous coronary interventions (PCI) and 30% in primary PCI. Clinically, it is an independent predictor of myocardial infarction, in-hospital mortality, and long-term mortality. It may be categorized in interventional (after PCI, especially in saphenous venous grafts) or reperfusion NRP (after re-opening of a totally occluded coronary artery, usually during primary PCI or thrombolysis). There are many physiopathological factors implicated: distal microembolization, interstitial and intracellular edema, coronary spasm and capillary plugging. Although reperfusion and no reflow is a field of intense research, no single mechanical or pharmacological therapy has demonstrated a clear efficacy against NRP, probably due to its multifactorial nature. Once established, the treatment of NRP is based on vasodilators like adenosine, verapamil, nitroprusside or nicorandil. However, the efficacy of these measures is poor, so every effort should be made to prevent the apparition of NRP. The objective of this report is to provide an update of the pharmacological armamentarium available for the prevention and treatment of NRP, and suggest a systematic approach of the management of NRP according to the different possible clinical scenarios.
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Affiliation(s)
- Pablo Salinas
- Interventional Cardiology, Department of Cardiology, La Paz University Hospital, Paseo de la Castellana 261. 28046, Madrid, Spain
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Salinas P, Moreno R, Sanchez-Recalde A, Jimenez-Valero S, Galeote G, Calvo L, Plaza I, Lopez-Sendon J. Does New Onset Atrial Fibrillation Have a True Impact on the Incidence of Stroke After Transcatheter Aortic Valve Implantation? J Am Coll Cardiol 2012; 60:236-7; author reply 238. [DOI: 10.1016/j.jacc.2012.02.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
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Moreno R, Jimenez-Valero S, Sanchez-Recalde A, Galeote G, Calvo L, Martin-Reyes R, Sabate M, Plaza I, Macaya C, Lopez-Sendon JL. Periprocedural (30-day) risk of myocardial infarction after drug-eluting coronary stent implantation: a meta-analysis comparing cobalt-chromium and stainless steel drug-eluting coronary stents. EUROINTERVENTION 2011; 6:1003-10. [PMID: 21330250 DOI: 10.4244/eijv6i8a173] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS Because of the reduction in the rate events related with in-stent restenosis, most events after drug-eluting stent implantation occur shortly after coronary stenting. Cobalt-chromium alloys allow to reduce strut thickness and improve flexibility and deliverability of coronary stent platforms, and thus could be associated with lower short-term events after stenting. The aim of this study was to test the hypothesis that drug-eluting coronary stents with a cobalt-chromium platform reduce the incidence of periprocedural (30-day) myocardial infarction in comparison with stainless steel drug-eluting coronary stents. METHODS AND RESULTS A meta-analysis from nine randomised trials comparing cobalt-chromium and stainless steel drug-eluting coronary stents that overall included 11,313 patients was performed. The incidence of myocardial infarction, stent thrombosis, and cardiac death at 30 days was compared between both types of stents. At 30 days, the incidence of acute myocardial infarction was significantly lower in patients allocated to cobalt-chromium drug-eluting stents (2.3% vs. 3.9%, respectively; p=0.006; odds ratio 0.72, 95% confidence interval 0.58-0.91), due to a significant reduction in the rate of non-Q-wave myocardial infarction (odds ratio 0.67, 95% confidence interval 0.51-0.88). The incidence of stent thrombosis was similar between both groups of patients, (0.5% vs. 0.5%, p=0.76; odds ratio 1.09, 95% confidence interval 0.63-1.89). CONCLUSIONS Drug-eluting coronary stents that use cobalt-chromium stent platforms have a better safety profile at 30 days in comparison with stainless steel drug-eluting stents, due to a significant reduction in the rate of myocardial infarction.
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Salinas P, Galeote G, Martin-Reyes R, Perez-Vizcayno M, Hernandez-Antolin R, Mainar V, Moreu J, de la Torre J, Zueco J, Tello A, Jimenez-Valero S, Sanchez-Recalde A, Calvo L, Plaza I, Alfonso F, Mariscal F, Lopez de Sa E, Macaya C, Lopez-Sendon JL, Moreno R. Primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction in nonagenarian patients: results from a Spanish multicentre registry. EUROINTERVENTION 2011; 6:1080-1084. [DOI: 10.4244/eijv6i9a188] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Sanchez-Recalde A, García S, López T, Jimenez-Valero S, Moreno R. Multiple spontaneous coronary artery dissections postpartum. Serial follow-up of intravascular ultrasound findings. Can J Cardiol 2010; 26:215-7. [PMID: 20548988 DOI: 10.1016/s0828-282x(10)70406-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Angel Sanchez-Recalde
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain.
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Moreno R, Garcia E, Teles RC, Almeida MS, Carvalho HC, Sabate M, Martin-Reyes R, Rumoroso JR, Galeote G, Goicolea FJ, Moreu J, Mainar V, Mauri J, Ferreira R, Valdes M, Perez de Prado A, Martin-Yuste V, Jimenez-Valero S, Sanchez-Recalde A, Calvo L, Lopez de Sa E, Macaya C, Lopez-Sendon JL. A randomised comparison between everolimus-eluting stent and sirolimus-eluting stent in chronic coronary total occlusions. Rationale and design of the CIBELES (non-acute Coronary occlusion treated by EveroLimus-Eluting Stent) trial. EUROINTERVENTION 2010; 6:112-116. [PMID: 20542806] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Chronic total coronary occlusions constitute a sub-group of lesions at very high risk of restenosis after successful percutaneous coronary intervention. The sirolimus-eluting coronary stent is the only drugeluting stent that has demonstrated to reduce angiographic restenosis and the need for new revascularisation procedures in comparison with bare-metal stents in randomised clinical trials focusing on these lesions. Everolimus-eluting stents have shown to offer optimal angiographic and clinical outcomes in comparison with bare-metal stents and paclitaxel-eluting stents, but no randomised trials have tested the device in chronic total occlusions. The CIBELES (non-acute Coronary occlusIon treated By EveroLimus- Eluting Stent) will randomise 208 patients with chronic total coronary occlusions in 13 centres from Portugal and Spain to receive everolimus- or sirolimus-eluting coronary stents. The primary endpoint will be angiographic in-stent late loss.
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Moreno R, Garcia E, Teles R, Almeida M, Carvalho H, Sabate M, Martin-Reyes R, Rumoroso J, Galeote G, Goicolea F, Moreu J, Mainar V, Mauri J, Ferreira R, Valdes M, Perez de Prado A, Martin-Yuste V, Jimenez-Valero S, Sanchez-Recalde A, Calvo L, Lopez de Sa E, Macaya C, Lopez-Sendon JL. A randomised comparison between everolimus-eluting stent and sirolimus-eluting stent in chronic coronary total occlusions. Rationale and design of the CIBELES (non-acute Coronary occlusion treated by EveroLimus-Eluting Stent) trial. EUROINTERVENTION 2010; 6:112-116. [DOI: 10.4244/eijv6i1a17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Moreno R, Martin-Reyes R, Jimenez-Valero S, Sanchez-Recalde A, Galeote G, Calvo L, Plaza I, Lopez-Sendon JL. Determining clinical benefits of drug-eluting coronary stents according to the population risk profile: a meta-regression from 31 randomized trials. Int J Cardiol 2009; 148:23-9. [PMID: 19962771 DOI: 10.1016/j.ijcard.2009.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 07/24/2009] [Accepted: 10/18/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of drug-eluting stents (DES) in unfavourable patients has been associated with higher rates of clinical complications and stent thrombosis, and because of that concerns about the use of DES in high-risk settings have been raised. OBJECTIVE This study sought to demonstrate that the clinical benefit of DES increases as the risk profile of the patients increases. METHODS A meta-regression analysis from 31 randomized trials that compared DES and bare-metal stents, including overall 12,035 patients, was performed. The relationship between the clinical benefit of using DES (number of patients to treat [NNT] to prevent one episode of target lesion revascularization [TLR]), and the risk profile of the population (rate of TLR in patients allocated to bare-metal stents) in each trial was evaluated. RESULTS The clinical benefit of DES increased as the risk profile of each study population increased: NNT for TLR=31.1-1.2 (TLR for bare-metal stents); p<0.001. The use of DES was safe regardless of the risk profile of each study population, since the effect of DES in mortality, myocardial infarction, and stent thrombosis, was not adversely affected by the risk profile of each study population (95% confidence interval for β value 0.09 to 0.11, -0.12 to 0.19, and -0.03 to-0.15 for mortality, myocardial infarction, and stent thrombosis, respectively). CONCLUSIONS The clinical benefit of DES increases as the risk profile of the patients increases, without affecting safety.
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Dobarro D, Gómez-Rubín MC, Sanchez-Recalde A, Moreno R, Galeote G, Jimenez-Valero S, Calvo L, López de Sá E, López-Sendón JL. Current pharmacological approach to restore endothelial dysfunction. Cardiovasc Hematol Agents Med Chem 2009; 7:212-222. [PMID: 19689260 DOI: 10.2174/187152509789105480] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Endothelial dysfunction is characterized by an impairment of endothelium-dependent vasodilatation. It has been linked to each of the known atherogenic risk factors, including diabetes mellitus, hypertension, dyslipidaemia, cigarette smoking, menopause, etc. A number of recent studies have shown that the severity of endothelial dysfunction correlates with the development of coronary artery disease and predicts future cardiovascular events. Therefore, these findings strengthen the hypothesis that endothelial dysfunction may be an early stage of coronary atherosclerosis. This phenomenon primarily reflects an imbalance between the vasodilating (nitric oxide) and vasoconstrictor agents (endothelin-1). Several invasive (intracoronary or intrabrachial infusions of vasoacting agents) and non-invasive techniques (assessment of flow mediated vasodilatation in the brachial artery by ultrasound) have been developed during the last few years to evaluate endothelial function in the coronary and peripheral circulation. This new methodology has allowed assessing the severity of the abnormalities in vascular function and their regression by several pharmacological and non-pharmacological interventions. It is likely that restoration of endothelial function can regress the atherosclerotic disease process and prevent future cardiovascular events. Most pharmacological interventions attempting to improve endothelial dysfunction targeted the risk factors linked to endothelial dysfunction: hypertension (ACE-inhibitors, calcium antagonists), dyslipidaemia (lipid-lowering agents) and menopause (estrogens). Nevertheless, several pharmacological agents have been suggested to achieve vascular protection through different mechanisms beyond their primary therapeutic actions: ACE-inhibitors, statins, third generation of beta-blockers (nebivolol), endothelium-derived nitric oxide synthesis (tetrahydrobiopterin, BH4) and antioxidants agents. In this review we will focus on the current pharmacological management of the endothelial dysfunction.
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Affiliation(s)
- D Dobarro
- Interventional Cardiology Unit, Planta 1a Diagonal, University Hospital La Paz, 28046 Madrid, Spain
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Jimenez-Valero S, Moreno R, Sanchez-Recalde A, Galeote G, Calvo L, Viana A, Lopez de Sá E, López-Sendón J. Avoiding restenosis: is there a role for glucocorticoids in the drug-eluting stent era? Ther Adv Cardiovasc Dis 2009; 2:137-46. [PMID: 19124417 DOI: 10.1177/1753944708090573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Restenosis is an important limitation of percutaneous coronary interventions (PCI). In-stent restenosis is mainly due to neointimal hyperplasia, a proliferative process modulated by inflammatory mechanisms. Numerous technical and pharmacological means have been tested to reduce restenosis rates, with frequently disappointing clinical results. Drug-eluting stents (DES) have demonstrated a high efficacy in reducing restenosis, but there are some associated problems that limit its generalized utilization. Glucocorticoids (GC), as potent anti-inflammatory agents, may exert beneficial effects on neointimal proliferation. Clinical studies with oral and intracoronary GC therapy have demonstrated reduction in restenosis rates in selected patients. Although further investigations are warranted, GC might have a potential role for restenosis prevention in selected cases.
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Sanchez-Recalde A, Moreno R, Barreales L, Rivero F, Galeote G, Jimenez-Valero S, Calvo L, López de Sá E, López-Sendón JL. Risk of late-acquired incomplete stent apposition after drug-eluting stent versus bare-metal stent. A meta-analysis from 12 randomized trials. J Invasive Cardiol 2008; 20:417-422. [PMID: 18688067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Incomplete stent apposition (ISA) is an unusual finding of intravascular ultrasound (IVUS) that may occur both after drug-eluting stent (DES) or bare-metal stent (BMS) implantation and could be associated with late stent thrombosis. Controversy still remains about whether the risk of late-acquired ISA is increased after DES implantation. This meta-analysis aimed to clarify whether DES implantation is associated with an increased risk of late-acquired ISA. METHODS We performed a meta-analysis from 12 randomized trials that compared DES and BMS and included IVUS follow up: TAXUS II (n = 469), TAXUS IV (n = 187), TAXUS V (n = 213) and VI (n = 147), ASPECT (n = 81), DELIVER (n = 65), SIRIUS (n = 141), DIABETES (n = 140), ENDEAVOR II (n = 250), FUTURE I and II (n = 83), and SPIRIT-I (n = 58). In these trials, 1,834 patients (972 DES, and 862 BMS) underwent immediate and follow-up IVUS examination. RESULTS There was no heterogeneity among the trials (Q-test for heterogeneity: Chi2: 7.69; (p = 0.26), I2: 22%. Out of the 1,834 patients undergoing serial IVUS examination, 85 developed late-acquired ISA (4.6%). This incidence was significantly higher in DES compared with BMS (6.5% vs. 2.6%, respectively; odds ratio [OR] 2.48, 95% confidence interval [CI] 1.26 to 4.87; p = 0.008). That means that the risk of developing late-acquired ISA is 2.5 times higher after DES versus BMS implantation. No stent thrombosis occurred in the patients diagnosed with ISA over a period up to 12 months. CONCLUSION DES implantation could be associated with an increased risk of late ISA in comparison with BMS. The clinical implication of late ISA in the long term remains to be clarified.
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Affiliation(s)
- Angel Sanchez-Recalde
- Sección de Hemodinámica y Cardiología Intervencionista (1 planta diagonal), Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
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Rivero F, Moreno R, Barreales L, Galeote G, Sánchez-Recalde A, Calvo L, Jimenez-Valero S, Villate A, Vanegas M, López-Sendón JL. Lower levels of in-stent late loss are not associated with the risk of stent thrombosis in patients receiving drug-eluting stents. EUROINTERVENTION 2008; 4:124-32. [DOI: 10.4244/eijv4i1a20] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jimenez-Valero S, Santos B, Pajin F, Canton T, Lazaro E, Moreu J, Hernandez G, Padial LR. Clinical outcomes of dexamethasone-eluting stent implantation in ST-elevation acute myocardial infarction. Catheter Cardiovasc Interv 2007; 70:492-7. [PMID: 17896411 DOI: 10.1002/ccd.21131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of our study was to evaluate the safety and midterm clinical results of dexamethasone-eluting stent (DexES) implantation in ST-segment elevation acute myocardial infarction (STEMI). BACKGROUND Inflammation plays a pivotal role in both inestabilization of coronary atherosclerotic plaques and development of restenosis after stent placement. Antiinflammatory agents may attenuate those mechanisms and improve clinical outcomes. There is little information about clinical results of DexES and no data are available about their utilization during percutaneous coronary intervention (PCI) in STEMI. METHODS Consecutive patients with STEMI that underwent primary or rescue PCI in our institution were treated with DexES. Clinical follow-up with routine realization of noninvasive test for detection of myocardial ischemia and coronariography if necessary, were performed. The objective of the study was to evaluate the rate of MACE (death, reinfarction, or target lesion revascularization) during midterm follow-up. RESULTS The procedure was successful in 96.7% of cases. There were no in-hospital deaths or reinfarctions. One acute stent thrombosis occurred and no subacute thrombosis were observed. During a mean follow-up period of 384 days, cardiac-related death was 1.1%, there were no reinfarctions or late stent thrombosis and target lesion revascularization rate was 4.2%. CONCLUSION We conclude that utilization of DexES for PCI in STEMI is safe and provides good midterm clinical outcomes.
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