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García-Touchard A, Sabaté M, Gonzalo N, Peral V, Vaquerizo B, Ruiz-Salmerón R, García del Blanco B, Jiménez-Mazuecos J, Molina E, Martínez-Romero P, Hernandez-García JM, Ruiz-Quevedo V, Urbano C, Fernández-Portales J, Rumoroso JR, Casanova-Sandoval J, Pinar E, Lopez-Pais J, Oteo JF, Alfonso F. Very long-term efficacy and safety of paclitaxel-eluting balloon after a bare-metal stent for the treatment of ST-elevation myocardial infarction: 8-year results of a randomized clinical trial (PEBSI study). Cardiovasc Diagn Ther 2023; 13:792-804. [PMID: 37941845 PMCID: PMC10628420 DOI: 10.21037/cdt-22-623] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/08/2023] [Indexed: 11/10/2023]
Abstract
Background Drug-eluting stents (DES) are considered the therapy of choice in ST-segment elevation myocardial infarction (STEMI); however, a low persistent rate of revascularizations and stent thrombosis exist over the time. We have previously shown that a paclitaxel (PTX)-drug-coated balloon (DCB) after a bare-metal stent (BMS) implantation (DCB-combined strategy) yields superior angiographic and clinical results compared to BMS in the short term. However, the long-term safety and efficacy of this approach remain uncertain. Methods An 8-year clinical follow-up was conducted on patients enrolled in the randomized PEBSI-1 trial (NCT01839890). The original trial included patients who suffered a STEMI, patients were randomly assigned to receive a DCB-combined strategy or BMS only and the primary endpoint was in-stent late luminal loss (LLL) at 9-month follow-up. After the completion of this study, death, myocardial re-infarction, ischemia-driven repeated revascularizations included target lesion revascularization (TLR) and target vessel revascularization (TVR), and stent thrombosis, were assessed by yearly contact by a clinical visit, telephone or by electronic records. These outcomes were adhered to ARC-2 criteria. Results The rate of incomplete follow-up was very low, with only 3 out of 111 patients (2.7%) in the DCB-combined strategy group and 1 out of 112 patients (0.9%) in the BMS group. At 8 years there were a lower rate of TVR [3.7% vs. 14.3%; hazard ratio (HR): 0.243; 95% confidence interval (CI): 0.081-0.727; P=0.006], and a trend towards lower TLR (2.8% vs. 8.9%; HR: 0.300; 95% CI: 0.083-1.090; P=0.052) in the DCB-combined strategy group. No statistical difference between the DCB-combined strategy and BMS groups were found for all causes of death, deaths from cardiovascular disease, reinfarctions or stent thrombosis. Notably in the DCB-combined strategy group, no episode of stent thrombosis occurred after the first year. Similarly, there were no cardiovascular deaths, TVR and TLR in the DCB-combined strategy group after 5 years. In contrast, during the period from year 5 to 8, the BMS group experienced an additional cardiovascular death, as well as one case of TVR, one case of TLR, and one case of stent thrombosis. Conclusions In STEMI patients, the DCB-combined strategy maintains its safety and clinical efficacy over time. Our rates of TVR, TLR, and very late stent thrombosis (VLST) at very long-term are the lowest ever found in a STEMI trial. Further studies are warranted to assess the potential superiority of this novel strategy as compared with new-generation DES to prevent very late events in these patients. Trial Registration ClinicalTrials.gov; identifier: NCT01839890.
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Affiliation(s)
- Arturo García-Touchard
- Department of Interventional Cardiology, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain
| | - Manel Sabaté
- Department of Interventional Cardiology, Hospital Clinic i Provincial, Barcelona, Spain
| | - Nieves Gonzalo
- Department of Interventional Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Vicente Peral
- Department of Interventional Cardiology, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma de Mayorca, Spain
| | - Beatriz Vaquerizo
- Department of Interventional Cardiology, Hospital Del Mar, Barcelona, Spain
| | - Rafael Ruiz-Salmerón
- Department of Interventional Cardiology, Hospital Virgen Macarena, Sevilla, Spain
| | - Bruno García del Blanco
- Department of Interventional Cardiology, Hospital Universitari Vall D’Hebron, Barcelona, Spain
| | - Jesús Jiménez-Mazuecos
- Department of Interventional Cardiology, Complejo Hospitalario Universitario De Albacete, Albacete, Spain
| | - Eduardo Molina
- Department of Interventional Cardiology, Hospital Universitario Virgen De Las Nieves, Granada, Spain
| | | | | | - Valeriano Ruiz-Quevedo
- Department of Interventional Cardiology, Hospital Universitario De Navarra, Pamplona, Spain
| | - Cristóbal Urbano
- Department of Interventional Cardiology, Hospital Carlos Haya, Málaga, Spain
| | | | - José Ramón Rumoroso
- Department of Interventional Cardiology, Hospital De Galdakao, Bizkaia, Spain
| | | | - Eduardo Pinar
- Department of Interventional Cardiology, Hospital Virgen De La Arrixaca, Murcia, Spain
| | - Javier Lopez-Pais
- Department of Interventional Cardiology, Hospital Clínico Universitario De Santiago, La Coruña, Spain
| | - Juan Francisco Oteo
- Department of Interventional Cardiology, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain
| | - Fernando Alfonso
- Department of Interventional Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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Cepas-Guillén PL, Regueiro A, Sanmiguel Cervera D, Blanco Mata R, Francisco Oteo J, Amat-Santos I, Ten F, Manuel Nogales J, Fernández-Nofrerías E, Mainar V, Lasa-Larraya G, Andraka L, Baz-Alonso JA, Cruz Ferrer M, Pinar E, Romaguera R, Cuellas Ramón C, Alfonso F, Urbano-Carrillo CA, García-Blas S, Piñero A, Albarrán A, Ruiz-Salmerón R, Moreu J, Gil Albarova Ó, M. Melero J, Heredia Cambra T, Freixa y X, Sabaté M. Pron�stico de pacientes nonagenarios tras implante percut�neo de v�lvula a�rtica. RECIC 2022. [DOI: 10.24875/recic.m21000216] [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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Jiménez-Quevedo P, Nombela-Franco L, Muñoz-García E, Del Valle-Fernández R, Trillo R, de la Torre Hernández JM, Salido L, Elizaga J, Ojeda S, Sánchez Gila J, García Del Blanco B, Berenguer A, Lasa-Larraya G, Urbano Carrillo C, Albarrán A, Ruiz-Salmerón R, Moreu J, Gheorghe L, Arzamendi D, Yanes-Bowden G, Díaz J, Pérez-Moreiras I, Artaiz M, Vaquerizo B, Cruz-González I, Ruiz-Quevedo V, Blanco-Mata R, Baz JA, Villa M, Ortiz de Salazar Á, Tascón-Quevedo V, Casellas S, Moreno R. Early clinical outcomes after transaxillary versus transfemoral TAVI. Data from the Spanish TAVI registry. ACTA ACUST UNITED AC 2021; 75:479-487. [PMID: 34711513 DOI: 10.1016/j.rec.2021.07.019] [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: 03/25/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transaxillary access (TXA) has become the most widely used alternative to transfemoral access (TFA) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to compare total in-hospital and 30-day mortality in patients included in the Spanish TAVI registry who were treated by TXA or TFA access. METHODS We analyzed data from patients treated with TXA or TFA and who were included in the TAVI Spanish registry. In-hospital and 30-day events were defined according to the recommendations of the Valve Academic Research Consortium. The impact of the access route was evaluated by propensity score matching according to clinical and echocardiogram characteristics. RESULTS A total of 6603 patients were included; 191 (2.9%) were treated via TXA and 6412 via TFA access. After adjustment (n=113 TXA group and n=3035 TFA group) device success was similar between the 2 groups (94%, TXA vs 95%, TFA; P=.95). However, compared with the TFA group, the TXA group showed a higher rate of acute myocardial infarction (OR, 5.3; 95%CI, 2.0-13.8); P=.001), renal complications (OR, 2.3; 95%CI, 1.3-4.1; P=.003), and pacemaker implantation (OR, 1.6; 95%CI, 1.01-2.6; P=.03). The TXA group also had higher in-hospital and 30-day mortality rates (OR, 2.2; 95%CI, 1.04-4.6; P=.039 and OR, 2.3; 95%CI, 1.2-4.5; P=.01, respectively). CONCLUSIONS Compared with ATF, TXA is associated with higher total mortality, both in-hospital and at 30 days. Given these results, we believe that TXA should be considered only in those patients who are not suitable candidates for TFA.
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Affiliation(s)
- Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Erika Muñoz-García
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Ramiro Trillo
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - José M de la Torre Hernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Luisa Salido
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jaime Elizaga
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Joaquín Sánchez Gila
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Alberto Berenguer
- Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Agustín Albarrán
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - José Moreu
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Livia Gheorghe
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Geoffrey Yanes-Bowden
- Servicio de Cardiología, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - José Díaz
- Servicio de Cardiología, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain
| | | | - Miguel Artaiz
- Servicio de Cardiología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Instituto de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Ignacio Cruz-González
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | | | - José Antonio Baz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Manuel Villa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Valentín Tascón-Quevedo
- Servicio de Cirugía Cardiaca, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Sandra Casellas
- Servicio de Cirugía Cardiaca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
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Jiménez-Quevedo P, Nombela-Franco L, Muñoz-García E, del Valle-Fernández R, Trillo R, de la Torre Hernández JM, Salido L, Elizaga J, Ojeda S, Sánchez Gila J, García del Blanco B, Berenguer A, Lasa-Larraya G, Urbano Carrillo C, Albarrán A, Ruiz-Salmerón R, Moreu J, Gheorghe L, Arzamendi D, Yanes-Bowden G, Díaz J, Pérez-Moreiras I, Artaiz M, Vaquerizo B, Cruz-González I, Ruiz-Quevedo V, Blanco-Mata R, Baz JA, Villa M, Ortiz de Salazar Á, Tascón-Quevedo V, Casellas S, Moreno R. Resultados clínicos tempranos tras el implante percutáneo de válvula aórtica por acceso transaxilar comparado con el acceso transfemoral. Datos del registro español de TAVI. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.07.013] [Citation(s) in RCA: 2] [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: 12/30/2022]
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5
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Soria-Juan B, Escacena N, Capilla-González V, Aguilera Y, Llanos L, Tejedo JR, Bedoya FJ, Juan V, De la Cuesta A, Ruiz-Salmerón R, Andreu E, Grochowicz L, Prósper F, Sánchez-Guijo F, Lozano FS, Miralles M, Del Río-Solá L, Castellanos G, Moraleda JM, Sackstein R, García-Arranz M, García-Olmo D, Martín F, Hmadcha A, Soria B. Corrigendum: Cost-Effective, Safe, and Personalized Cell Therapy for Critical Limb Ischemia in Type 2 Diabetes Mellitus. Front Immunol 2020; 11:2029. [PMID: 32983148 PMCID: PMC7492973 DOI: 10.3389/fimmu.2020.02029] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2019.01151.].
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Affiliation(s)
| | - Natalia Escacena
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Vivian Capilla-González
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Yolanda Aguilera
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Lucía Llanos
- Fundación Jiménez Díaz Health Research Institute, Madrid, Spain
| | - Juan R Tejedo
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Francisco J Bedoya
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | | | - Antonio De la Cuesta
- Unidad de Isquemia Crónica de Miembros Inferiores, Hospital Victoria Eugenia de la Cruz Roja, Sevilla, Spain
| | | | | | | | | | | | | | - Manuel Miralles
- Department of Surgery, University of Valencia, Valencia, Spain
| | | | - Gregorio Castellanos
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José M Moraleda
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Robert Sackstein
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | | | | | - Franz Martín
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Abdelkrim Hmadcha
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Bernat Soria
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.,ISABIAL and Institute of Bioengineering, University Miguel Hernández de Elche, Alicante, Spain
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Freixa X, Cruz-González I, Regueiro A, Nombela-Franco L, Estévez-Loureiro R, Ruiz-Salmerón R, Bethencourt A, Gutiérrez-García H, Fernández-Díaz JA, Moreno-Samos JC, Jiménez-Quevedo P, Martin-Yuste V, Arnold R, Millan X, Asmarats L, Ronquillo M, Agudelo-Montañez VH, López-Mínguez JR, Goicolea J, Pérez de Prado A, Arzamendi D. Left Atrial Appendage Occlusion as Adjunctive Therapy to Anticoagulation for Stroke Recurrence. J Invasive Cardiol 2019; 31:212-216. [PMID: 31088992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Stroke recurrence despite optimal oral anticoagulation (OAC) might represent a novel indication for left atrial appendage occlusion (LAAO). The heterogeneity of these patients is generally high, as the presence of valvular atrial fibrillation (VAF) is common. The aim of this study was to explore the role of LAAO as an adjunctive therapy to OAC in patients with recurrent stroke despite optimal OAC. METHODS The study screened consecutive patients who underwent percutaneous LAAO at nine centers between 2009 and 2017. Patients with recurrent stroke despite optimal OAC were selected and those with an absolute or relative contraindication to OAC were not included in the study. RESULTS Among 837 patients who underwent LAAO between the study period, a total of 22 (2.6%) met the inclusion criteria. There was a high percentage of VAF (38%) and 59% presented more than one cardioembolic event before LAAO. All patients underwent successful implantation of the device and no procedural major adverse events were reported. In all but 3 patients, anticoagulation was continued after LAAO. With a median clinical follow-up of 1.8 years (range, 0.7-2.8 years), only 1 stroke and 1 transient ischemic attack were reported, translating into a significant reduction of cerebrovascular events before and after LAAO (2.0 ± 1.0 events vs 0.1 ± 0.3 events; P<.01). Imaging follow-up revealed only 1 case of device thrombosis. CONCLUSIONS LAAO as an adjunctive therapy to OAC seems to be feasible and safe in patients with previous cardioembolic events despite optimal OAC. In our series, this strategy was associated with a low rate of cerebrovascular events after LAAO.
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Affiliation(s)
- Xavier Freixa
- Hospital Clinic de Barcelona, c/ Villarroel 170, Escala 3 Planta 6, 08015 Barcelona, Spain.
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Soria-Juan B, Escacena N, Capilla-González V, Aguilera Y, Llanos L, Tejedo JR, Bedoya FJ, Juan V, De la Cuesta A, Ruiz-Salmerón R, Andreu E, Grochowicz L, Prósper F, Sánchez-Guijo F, Lozano FS, Miralles M, Del Río-Solá L, Castellanos G, Moraleda JM, Sackstein R, García-Arranz M, García-Olmo D, Martín F, Hmadcha A, Soria B. Cost-Effective, Safe, and Personalized Cell Therapy for Critical Limb Ischemia in Type 2 Diabetes Mellitus. Front Immunol 2019; 10:1151. [PMID: 31231366 PMCID: PMC6558400 DOI: 10.3389/fimmu.2019.01151] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 01/15/2019] [Accepted: 05/07/2019] [Indexed: 12/26/2022] Open
Abstract
Cell therapy is a progressively growing field that is rapidly moving from preclinical model development to clinical application. Outcomes obtained from clinical trials reveal the therapeutic potential of stem cell-based therapy to deal with unmet medical treatment needs for several disorders with no therapeutic options. Among adult stem cells, mesenchymal stem cells (MSCs) are the leading cell type used in advanced therapies for the treatment of autoimmune, inflammatory and vascular diseases. To date, the safety and feasibility of autologous MSC-based therapy has been established; however, their indiscriminate use has resulted in mixed outcomes in preclinical and clinical studies. While MSCs derived from diverse tissues share common properties depending on the type of clinical application, they markedly differ within clinical trials in terms of efficacy, resulting in many unanswered questions regarding the application of MSCs. Additionally, our experience in clinical trials related to critical limb ischemia pathology (CLI) shows that the therapeutic efficacy of these cells in different animal models has only been partially reproduced in humans through clinical trials. Therefore, it is crucial to develop new research to identify pitfalls, to optimize procedures and to clarify the repair mechanisms used by these cells, as well as to be able to offer a next generation of stem cell that can be routinely used in a cost-effective and safe manner in stem cell-based therapies targeting CLI.
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Affiliation(s)
| | - Natalia Escacena
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Vivian Capilla-González
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Yolanda Aguilera
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain
| | - Lucía Llanos
- Fundación Jiménez Díaz Health Research Institute, Madrid, Spain
| | - Juan R Tejedo
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Francisco J Bedoya
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | | | - Antonio De la Cuesta
- Unidad de Isquemia Crónica de Miembros Inferiores, Hospital Victoria Eugenia de la Cruz Roja, Sevilla, Spain
| | | | | | | | | | | | | | - Manuel Miralles
- Department of Surgery, University of Valencia, Valencia, Spain
| | | | - Gregorio Castellanos
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José M Moraleda
- Servicio Hematología y Hemoterapia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Robert Sackstein
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | | | | | - Franz Martín
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Abdelkrim Hmadcha
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Bernat Soria
- Department of Regeneration and Cell Therapy, Andalusian Center for Molecular Biology and Regenerative Medicine (CABIMER), University of Pablo de Olavide-University of Seville-CSIC, Seville, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
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López-Mínguez JR, Nogales-Asensio JM, Infante De Oliveira E, De Gama Ribeiro V, Ruiz-Salmerón R, Arzamendi-Aizpurua D, Costa M, Gutiérrez-García H, Fernández-Díaz JA, Martín-Yuste V, Rama-Merchán JC, Moreno-Gómez R, Benedicto-Buendía A, Íñiguez-Romo A. Reducción de eventos a largo plazo tras el cierre de la orejuela izquierda. Resultados del Registro Ibérico II. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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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López-Mínguez JR, Nogales-Asensio JM, Infante De Oliveira E, De Gama Ribeiro V, Ruiz-Salmerón R, Arzamendi-Aizpurua D, Costa M, Gutiérrez-García H, Fernández-Díaz JA, Martín-Yuste V, Rama-Merchán JC, Moreno-Gómez R, Benedicto-Buendía A, Íñiguez-Romo A. Long-term Event Reduction After Left Atrial Appendage Closure. Results of the Iberian Registry II. ACTA ACUST UNITED AC 2018; 72:449-455. [PMID: 29754808 DOI: 10.1016/j.rec.2018.03.017] [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] [Received: 10/17/2017] [Accepted: 03/19/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Many patients with nonvalvular atrial fibrillation are still left without protection due to a contraindication for anticoagulants. This study aimed to establish the occurrence of stroke and major bleeding events in patients with nonvalvular atrial fibrillation and left atrial appendage closure with long-term follow-up and to explore the factors associated with higher long-term mortality. METHODS Analysis of a multicenter single cohort prospectively recruited from 2009 to 2015. Thromboembolic and bleeding events were compared with those expected from CHA2DS2-VASc and HAS-BLED scores. Multivariate analysis examined variables associated with mortality during follow-up. RESULTS A total of 598 patients (1093 patient-years) with a contraindication for anticoagulants were recruited (median 75.4 years). The success rate of left atrial appendage closure device implantation was 95.8%. Thirty patients (5%) experienced periprocedural complications. The rate of events (per 100 patient-years) during follow-up (mean 22.9 months; median 16.1 months) was as follows: death 7.0%; ischemic stroke 1.6% (vs 8.5% expected according to CHA2DS2-VASc; P < .001); intracranial hemorrhage 0.8%; gastrointestinal bleeding 3.2%; severe bleeding 3.9% (vs 6.3% expected by HAS-BLED, P = .002). These results were improved in the subgroup of 176 patients with follow-up > 24 months (mean follow-up 46.6 months, 683 patient-years) for severe bleeding 2.6% (vs 6.3% expected by HAS-BLED, P < .033). The factors significantly associated with higher mortality were age (HR, 1.1), intracranial hemorrhage (HR, 6.8), and stroke during follow-up (HR, 2.7). CONCLUSIONS Left atrial appendage closure significantly reduced the incidence of stroke and bleeding events and the benefit was maintained. Intracranial hemorrhage, age and stroke were associated with higher mortality.
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Affiliation(s)
| | | | | | | | | | | | - Marco Costa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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García-Touchard A, Goicolea J, Sabaté M, Alfonso F, Ruiz-Salmerón R, Bethencourt A, Gonzalo N, Miranda F, García del Blanco B, Jiménez-Mazuecos J, Melgares R, Martínez-Romero P, Hernandez-García J, Lezaún R, Bullones J, Fernández-Portales J, Rumoroso J, Ortas R, Valdés M, Trillo R, Brugaletta S, Otzuki S, Hernández Pérez FJ, Alonso-Pulpón L. A randomised trial of paclitaxel-eluting balloon after bare metal stent implantation vs. bare metal stent in ST-elevation myocardial infarction (the PEBSI study). EUROINTERVENTION 2017; 12:1587-1594. [DOI: 10.4244/eij-d-16-00128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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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11
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Garcia-Dorado D, García-del-Blanco B, Otaegui I, Rodríguez-Palomares J, Pineda V, Gimeno F, Ruiz-Salmerón R, Elizaga J, Evangelista A, Fernandez-Avilés F, San-Román A, Ferreira-González I. Intracoronary injection of adenosine before reperfusion in patients with ST-segment elevation myocardial infarction: A randomized controlled clinical trial. Int J Cardiol 2014; 177:935-41. [DOI: 10.1016/j.ijcard.2014.09.203] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/16/2014] [Accepted: 09/30/2014] [Indexed: 12/12/2022]
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Ferreira-González I, Marsal JR, Ribera A, Permanyer-Miralda G, García-Del Blanco B, Martí G, Cascant P, Masotti-Centol M, Carrillo X, Mauri J, Batalla N, Larrousse E, Martín E, Serra A, Rumoroso JR, Ruiz-Salmerón R, de la Torre JM, Cequier A, Gómez-Hospital JA, Alfonso F, Martín-Yuste V, Sabatè M, García-Dorado D. Double antiplatelet therapy after drug-eluting stent implantation: risk associated with discontinuation within the first year. J Am Coll Cardiol 2012; 60:1333-9. [PMID: 22999716 DOI: 10.1016/j.jacc.2012.04.057] [Citation(s) in RCA: 55] [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] [Received: 03/09/2012] [Revised: 04/23/2012] [Accepted: 04/30/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goal of this study was to assess the risk associated with double antiplatelet therapy (DAT) discontinuation, and specifically, temporary discontinuation, during the first year after drug-eluting stent (DES) implantation. BACKGROUND Doubts remain about the risk of temporary DAT discontinuation within 1 year after DES implantation. METHODS A total of 1,622 consecutive patients undergoing DES implantation at 29 hospitals were followed up at 3, 6, 9, and 12 months to record the 1-year antiplatelet therapy discontinuation (ATD) rate, the number of days without DAT, and the rate of 1-year major cardiac events. Cox regression was used to analyze the association between ATD considered as a time-dependent covariate and 1-year cardiac events. RESULTS One hundred seventy-two (10.6%) patients interrupted at least 1 antiplatelet drug during the first year after DES implantation, although only 1 during the first month. Most (n=111, 64.5%) interrupted DAT temporarily (median: 7 days; range: 5 to 8.5): 79 clopidogrel (31 temporarily), 38 aspirin (27 temporarily), and 55 both drugs (53 temporarily). Discontinuation was followed by acute coronary syndrome in 7 (4.1%; 95% confidence interval [CI]: 1.7 to 8.2), a similar rate of major cardiac events to that in patients without ATD (n=80; 5.5%; 95% CI: 4.4 to 6.8; p=0.23). ATD was not independently associated with 1-year major cardiac events (hazard ratio: 1.32 [95% CI: 0.56 to 3.12]). CONCLUSIONS ATD within the first year and beyond the first month after DES is not exceptional, is usually temporary, and does not appear to have a large impact on risk.
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Affiliation(s)
- Ignacio Ferreira-González
- Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, and Red de Enfermedades Cardiovasculares (RECAVA), Barcelona, Spain.
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Soria B, Bedoya FJ, Tejedo JR, Hmadcha A, Ruiz-Salmerón R, Lim S, Martin F. Cell therapy for diabetes mellitus: an opportunity for stem cells? Cells Tissues Organs 2008; 188:70-7. [PMID: 18305378 DOI: 10.1159/000119407] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Diabetes is a chronic disease characterized by a deficit in beta cell mass and a failure of glucose homeostasis. Both circumstances result in a variety of severe complications and an overall shortened life expectancy. Thus, diabetes represents an attractive candidate for cell therapy. Reversal of diabetes can be achieved through pancreas and islet transplantation, but shortage of donor organs has prompted an intensive search for alternative sources of beta cells. This achievement has stimulated the search for appropriate stem cell sources. Both embryonic and adult stem cells have been used to generate surrogate beta cells or otherwise restore beta cell functioning. In this regard, several studies have reported the generation of insulin-secreting cells from embryonic and adult stem cells that normalized blood glucose values when transplanted into diabetic animal models. Due to beta cell complexity, insulin-producing cells generated from stem cells do not possess all beta cell attributes. This indicates the need for further development of methods for differentiation and selection of completely functional beta cells. While these problems are overcome, diabetic patients may benefit from therapeutic strategies based on autologous stem cell therapies addressing late diabetic complications. In this article, we discuss the recent progress in the generation of insulin-producing cells from embryonic and adult stem cells, together with the challenges for the clinical use of diabetes stem cell therapy.
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Affiliation(s)
- B Soria
- CABIMER (Andalusian Center for Molecular Biology and Regenerative Medicine), Isla de la Cartuja, Seville, 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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Jiménez Borreguero LJ, Ruiz-Salmerón R. [Assessment of myocardial viability in patients before revascularization]. Rev Esp Cardiol 2003; 56:721-33. [PMID: 12855155] [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: 03/03/2023]
Abstract
Information on myocardial viability can be useful to decide when coronary artery revascularization is indicated for patients with acute myocardial infarction (AMI) and left regional or global ventricular dysfunction. Difficulties in assessing viability arise because the same part of the ventricular wall can have a mixture of necrotic tissue and viable myocardium. Diagnostic markers of myocardial viability are: the preservation of wall thickness, the presence of contractility reserve, the presence of blood perfusion reserve, integrity of the wall cells, and preservation of cellular metabolism. Echocardiography and thallium or technetium imaging are methods currently used to assess myocardial viability because of their availability and relatively low cost. Although positron emission tomography (PET) has been considered the gold standard, its unavailability may limit its clinical use. Recent publications have demonstrated the accuracy of cardiac magnetic resonance imaging (cardiac MRI) in assessing myocardial viability, together with noninvasive procedures to study the markers of viability noted above. Late contrast enhancement with gadolinium is the most accurate and simplest method. The late open artery hypothesis recommends, on the basis of scant evidence, systematic revascularization of the culprit artery. Although no large randomized studies focused on prognosis are available yet, several small studies provide sufficient evidence of functional recovery of viable myocardium after coronary artery revascularization of the culprit artery in patients with global or regional ventricular dysfunction. The assessment of myocardial viability to decide whether culprit artery revascularization is indicated is a strategy currently based on more evidence than the more indiscriminate recommendations based on the late open artery hypothesis.
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Affiliation(s)
- Luis Jesús Jiménez Borreguero
- Servicio de Cardiología. Hospital Universitario Príncipe de Asturias. Alcalá de Henares. Madrid. España. Unidad de Cardio-RM. Clínica y Hospital Ruber. Madrid. España
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Sanmartín M, Goicolea J, Meneses D, Ruiz-Salmerón R, Mantilla R, Claro R, Bravo M, Quintela S, Calvo F. [Coronary angiography with 4 f catheters by the radial: minimally invasive catheterization]. Rev Esp Cardiol 2003; 56:145-51. [PMID: 12605759 DOI: 10.1016/s0300-8932(03)76838-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Experience with 4 F catheters in cardiac catheterization is limited. These devices appear to be more suitable for the radial artery approach than conventional 6 F catheters. METHODS We analyze our preliminary experience with diagnostic catheterization of the radial artery with 4 F catheters. Angiographic images were evaluated using a predefined scale (1. poor; 2. acceptable; 3. optimal). In a subgroup of patients who underwent coronary angioplasty, the quantitative angiographic data obtained with the 4 F catheter were compared to those obtained with the 6 F guide catheter. In all cases the patients were clinically followed-up at 24 h and 7 days. RESULTS Two hundred and six studies performed over a 12-month period were reviewed. In 6 cases (2.9%) the femoral vein had to be used instead and in 4 cases (1.9%) the 4 F catheters were replaced by 6 F catheters. The left coronary angiography was graded as optimal in 83% and as acceptable in 15%. Right coronary artery images were considered optimal in 93% and acceptable in 7%. There was an excellent correlation between the reference diameter obtained by quantitative angiography with the 4 F catheter and values obtained with a 6 F guide catheter (r = 0.92; p < 0.01). No major vascular complications occurred. CONCLUSION 4 F catheters are appropriate for systematic use in diagnostic procedures using the radial access.
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Affiliation(s)
- Marcelo Sanmartín
- Unidad de Cardiología Intervencionista, Medtec, Hospital Meixoeiro, Vigo, Pontevedra, Spain.
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Jesús Jiménez Borreguero L, Ruiz-Salmerón R. Valoración de la viabilidad miocárdica en pacientes prerrevascularización. Rev Esp Cardiol (Engl Ed) 2003. [DOI: 10.1016/s0300-8932(03)76943-7] [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: 11/28/2022]
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Sanmartín Fernández M, Goicolea Ruigómez J, Mantilla González R, Ruiz-Salmerón R, Calvo Iglesias F, Bravo Amaro M. [Percutaneous thrombin injection for closure of femoral pseudoaneurysms: preliminary experience]. Rev Esp Cardiol 2002; 55:771-4. [PMID: 12113707 DOI: 10.1016/s0300-8932(02)76698-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/22/2022]
Abstract
An arterial pseudoaneurysm is an uncommon complication of cardiovascular procedures associated with considerable morbidity and increased hospital costs. Percutaneous thrombin injection is one approach to therapy. We describe our initial experience with this technique in 3 patients, with special attention to the utility of sonographic guidance. In all cases complete closure was achieved, although one patient required additional brief extrinsic compression with the ultrasound probe.
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Affiliation(s)
- Marcelo Sanmartín Fernández
- Servicio de Cardiología Intervencionista y Sección de Cardiología, Hospital Meixoeiro, Vigo, Pontevedra, Spain
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Sanmartín M, Goicolea J, Ruiz-Salmerón R, Mantilla R, Sterling J, Meneses D, Calvo F. Coronary perforation as a potential complication derived from coronary thrombectomy with the X-Sizer device. Catheter Cardiovasc Interv 2002; 56:378-82. [PMID: 12112893 DOI: 10.1002/ccd.10204] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/07/2022]
Abstract
We report a case of coronary perforation after failed atherectomy with a 2 mm X-Sizer catheter in recent totally occluded right coronary artery. The perforation was successfully managed with a polytetrafluoroethylene-covered stent with satisfactory final angiographic results. Possible predictors of this complication with this new device are discussed.
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Affiliation(s)
- Marcelo Sanmartín
- Interventional Cardiology Department, Medtec, Hospital Meixoeiro, Vigo, Pontevedra, Spain.
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22
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Ruiz-Salmerón R, Ponce de León E, López A, Guitián R, Romeo D, del Campo V, Mantilla R, Pasalodos J. [Validation of the three-dimensional method of sestamibi gated-SPECT in the calculation of the left ventricular ejection fraction in patients with ischemic heart disease. Comparison with contrast ventriculography]. Rev Esp Cardiol 1999; 52:671-80. [PMID: 10523879 DOI: 10.1016/s0300-8932(99)74988-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE Tomography with acquisition synchronized with electrocardiography, gated-tomography, allows the assessment of left ventricular contractile function. The accuracy of a new method of gated-tomography, based on the three dimensional representation of the left ventricle to calculate the ejection fraction was validated by means of comparison with contrast ventriculography. METHODS We studied 85 patients with ischemic cardiopathy, and ejection fraction was calculated by contrast ventriculography and sestamibi-gated-tomography, at rest and throughout 10 micrograms/kg/min of dobutamine. Furthermore, we assessed the extent of perfusion defect, as well as the number of segments with activity below 50% of the total 13 segments in which the tomographic slices were divided. RESULTS Gated-tomography was significantly correlated to contrast ventriculography in the calculation of ejection fraction, both with acquisition at rest (r = 0.80) and throughout Dobutamine (r = 0.82). The average underestimation of gated-tomography calculation of ejection fraction was significantly greater for the rest study (-0.12 [IC 95% 0.04, -0.30]) than the dobutamine study (-0.07 [IC 95% 0.09, -0.24]). Patients with greater perfusion defects (4 o more segments) had no differences in underestimation of ejection fraction (-0.13 [IC 95% 0.03, -0.30] versus -0.11 [IC 95% 0.07, -0.29]). CONCLUSIONS The three-dimensional method of gated-tomography accurately assesses the ejection fraction. The underestimation determined by this method was lower in the study done with viable doses of dobutamine. The extent of perfusion defect had no deleterious effect on gated-tomography in the calculation of ejection fraction.
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Affiliation(s)
- R Ruiz-Salmerón
- Departamento de Cardiología Intervencionista, Hospital do Meixoeiro, Vigo, Pontevedra.
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