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Mazón P, Marín F, Cosín-Sales J, Cordero A, Roldán I, García-Moll X, Suárez C, Coca A, Escobar C, Barrios V, Vidal R, Díez-Villanueva P, Bonanad C, Esteban A, Zuazola P, Bertomeu V, Abeytua M, Zuazola P, Alfonso F, Ibáñez B, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de la Isla L, Sambola A, Vázquez R, Viana-Tejedor A. Comments on the 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension. Rev Esp Cardiol (Engl Ed) 2019; 72:104-108. [PMID: 30704721 DOI: 10.1016/j.rec.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Miró Ò, Gil V, Rosselló X, Martín-Sánchez FJ, Llorens P, Jacob J, Herrero P, Herrera Mateo S, Richard F, Escoda R, Fuentes M, Martín Mojarro E, Llauger L, Bueno H, Pocock S. Patients with acute heart failure discharged from the emergency department and classified as low risk by the MEESSI score (multiple risk estimate based on the Spanish emergency department scale): prevalence of adverse events and predictability. Emergencias 2019; 31:5-14. [PMID: 30656867] [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
OBJECTIVES To determine the rate of adverse events in patients with acute heart failure (AHF) who were discharged from the emergency department (ED) after classification as low risk according to MEESSI score (multiple risk estimate based on the Spanish ED scale), to analyze the ability of the score to predict events, and to explore variables associated with adverse events. METHODS Patients in the EAHFE registry (Epidemiology of Acute Heart Failure in EDs) were stratified according to risk indicated by MEESSI score in order to identify those considered at low risk on discharge. All-cause 30-day mortality and revisits related to AHF within 7 days and 30 days were recorded. The area under the receiver operating characteristic curve (AUC) was calculated for the MEESSI score's ability to predict these events. Associations between 42 variables and 7-day and 30-day revisits to the ED were analyzed by multivariable logistic regression. RESULTS A total of 1028 patients were included. The 30-day mortality rate was 1.6% (95% CI, 0.9%-2.5%). The 7-day and 30-day revisit rates were 8.0% (95% CI, 6.4%-9.8%) and 24.7% (95% CI, 22.1%-25.7%), respectively. The AUCs for MEESSI score discrimination between patients with and without these outcomes were as follows: 30-day mortality, 0.69 (95% CI, 0.58-0.80); 7-day revisiting, 0.56 (95% CI, 0.49-0.63); and 30-day revisiting, 0.54 (95% CI, 0.50-0.59). Variables associated with 7-day revisits were long-term diuretic treatment (odds ratio [OR], 2.45; 95% CI, 1.01-5.98), hemoglobin concentration less than 110 g/L (OR, 1.68; 95% CI, 1.02-2.75), and intravenous diuretic treatment in the ED (OR, 0.53; 95% CI, 0.31-0.90). Variables associated with 30-day revisits were peripheral artery disease (OR, 1.74; 95% CI, 1.01-3.00), prior history of an AHF episode (OR, 1.42; 95% CI, 1.02-1.98), long-term mineralocorticoid receptor antagonist treatment (OR, 1.71; 95% CI, 1.09-2.67), Barthel index less than 90 points in the ED (OR, 1.48; 95% CI, 1.07-2.06), and intravenous diuretic treatment in the ED (OR, 0.58; 95% CI, 0.40-0.84). CONCLUSION Patients with AHF who are at low risk for adverse events on discharge from our EDs have event rates that are near internationally recommended targets. The MEESSI score, which was designed to predict 30-day mortality, is a poor predictor of 7-day or 30-day revisiting in these low-risk patients. We identified other factors related to these events.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España. Facultad de Medicina, Universidad de Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | - Xavier Rosselló
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, Reino Unido. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España. CIBER de Enfermedades Cardiovasculares, Madrid, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Universidad Miguel Hernández, Elx, Alicante, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | | | | | - Rosa Escoda
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España
| | - Marta Fuentes
- Servicio de Urgencias, Hospital Universitario de Salamanca, España
| | | | - Lluís Llauger
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, Reino Unido. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
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Smolderen KG, Spertus JA, Gosch K, Dreyer RP, D'Onofrio G, Lichtman JH, Geda M, Beltrame J, Safdar B, Bueno H, Krumholz HM. Depression Treatment and Health Status Outcomes in Young Patients With Acute Myocardial Infarction: Insights From the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation 2019; 135:1762-1764. [PMID: 28461419 DOI: 10.1161/circulationaha.116.027042] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Kim G Smolderen
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.).
| | - John A Spertus
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Kensey Gosch
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Rachel P Dreyer
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Gail D'Onofrio
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Judith H Lichtman
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Mary Geda
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - John Beltrame
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Basmah Safdar
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Héctor Bueno
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
| | - Harlan M Krumholz
- From University of Missouri Kansas City (K.G.S., J.A.S.); Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., J.A.S., K.G.); Yale School of Medicine; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (R.P.D., J.H.L., M.G., H.M.K.); Yale University, Department of Emergency Medicine, New Haven, CT (G.D'O., B.S.); University of Adelaide, Queen Elizabeth Hospital, Australia (J.B.); Centro Nacional de Investigaciones Cardiovasculares (H.B.); Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre & Facultad de Medicina, Universidad Complutense de Madrid, Spain (H.B.); and Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine & Yale University School of Medicine; Department of Health Policy and Management, Yale-New Haven Hospital, CT (H.M.K.)
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Navarro-García JA, Delgado C, Fernández-Velasco M, Val-Blasco A, Rodríguez-Sánchez E, Aceves-Ripoll J, Gómez-Hurtado N, Bada-Bosch T, Mérida-Herrero E, Hernández E, Praga M, Salguero R, Solís J, Arribas F, Delgado JF, Bueno H, Kuro-O M, Ruilope LM, Ruiz-Hurtado G. Fibroblast growth factor-23 promotes rhythm alterations and contractile dysfunction in adult ventricular cardiomyocytes. Nephrol Dial Transplant 2019; 34:1864-1875. [DOI: 10.1093/ndt/gfy392] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
Cardiac dysfunction and arrhythmia are common and onerous cardiovascular events in end-stage renal disease (ESRD) patients, especially those on dialysis. Fibroblast growth factor (FGF)-23 is a phosphate-regulating hormone whose levels dramatically increase as renal function declines. Beyond its role in phosphorus homeostasis, FGF-23 may elicit a direct effect on the heart. Whether FGF-23 modulates ventricular cardiac rhythm is unknown, prompting us to study its role on excitation–contraction (EC) coupling.
Methods
We examined FGF-23 in vitro actions on EC coupling in adult rat native ventricular cardiomyocytes using patch clamp and confocal microscopy and in vivo actions on cardiac rhythm using electrocardiogram.
Results
Compared with vehicle treatment, FGF-23 induced a significant decrease in rat cardiomyocyte contraction, L-type Ca2+ current, systolic Ca2+ transients and sarcoplasmic reticulum (SR) load and SR Ca2+-adenosine triphosphatase 2a pump activity. FGF-23 induced pro-arrhythmogenic activity in vitro and in vivo as automatic cardiomyocyte extracontractions and premature ventricular contractions. Diastolic spontaneous Ca2+ leak (sparks and waves) was significantly increased by FGF-23 via the calmodulin kinase type II (CaMKII)-dependent pathway related to hyperphosphorylation of ryanodine receptors at the CaMKII site Ser2814. Both contraction dysfunction and spontaneous pro-arrhythmic Ca2+ events induced by FGF-23 were blocked by soluble Klotho (sKlotho).
Conclusions
Our results show that FGF-23 reduces contractility and enhances arrhythmogenicity through intracellular Ca2+ mishandling. Blocking its actions on the heart by improving sKlotho bioavailability may enhance cardiac function and reduce arrhythmic events frequently observed in ESRD.
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Affiliation(s)
- José Alberto Navarro-García
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Delgado
- Biomedical Research Institute Alberto Sols (CSIC-UAM)/CIBER-CV, Madrid, Spain
| | | | | | - Elena Rodríguez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jennifer Aceves-Ripoll
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Teresa Bada-Bosch
- Service of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eduardo Hernández
- Service of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Praga
- Service of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Salguero
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Solís
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Arribas
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Juan F Delgado
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Héctor Bueno
- Service of Cardiology and Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Makoto Kuro-O
- Division of Anti-ageing Medicine, Centre for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Luis Miguel Ruilope
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- School of Doctoral Studies and Research, European University of Madrid, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
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Sambola A, Viana-Tejedor A, Bueno H, Antonio Barrabés, Delgado V, Jiménez P, Jorge Pérez P, Javier Noriega F, Vila M, Aboal J, Bouzas A, Brugaletta S, Durán A, Gómez de Diego JJ, Hernández F, López T, Lozano I, Núñez I, Ojeda S, Rosillo S, Sanchis J, Alfonso F, Ibáñez B, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Sambola A, Vázquez R, Viana-Tejedor A. Comentarios al consenso ESC 2018 sobre la cuarta definición universal del infarto de miocardio. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recomendaciones de la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología para la valoración de la fragilidad en el anciano con cardiopatía. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.06.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Domínguez F, Fuster V, Fernández-Alvira JM, Fernández-Friera L, López-Melgar B, Blanco-Rojo R, Fernández-Ortiz A, García-Pavía P, Sanz J, Mendiguren JM, Ibañez B, Bueno H, Lara-Pezzi E, Ordovás JM. Association of Sleep Duration and Quality With Subclinical Atherosclerosis. J Am Coll Cardiol 2019; 73:134-144. [DOI: 10.1016/j.jacc.2018.10.060] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/22/2022]
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158
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Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Kardiol Pol 2018; 76:229-313. [PMID: 29457615 DOI: 10.5603/kp.2018.0041] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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Rossello X, Bueno H, Pocock SJ, Van de Werf F, Danchin N, Annemans L, Medina J, Zeymer U. Predictors of all-cause mortality and ischemic events within and beyond 1 year after an acute coronary syndrome: Results from the EPICOR registry. Clin Cardiol 2018; 42:111-119. [PMID: 30443916 DOI: 10.1002/clc.23116] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 09/12/2018] [Revised: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patients discharged after an acute coronary syndrome (ACS) have substantial risk of recurrent ischemic events or dying. HYPOTHESIS A difference may exist in risk predictors for all-cause mortality and ischemic events between year 1 and 2 of follow-up post-ACS. METHODS EPICOR (NCT01171404) was a prospective, international, real-world cohort study of consecutive patients hospitalized for ACS within 24 hours of symptom onset and surviving to discharge. Total of 10 568 patients were enrolled (555 hospitals; 20 countries) and followed-up for 2 years. From these, 4943 were admitted with ST-elevation myocardial infarction (STEMI) and 5625 with non-ST-elevation ACS (NSTE-ACS). Potential baseline predictors of major adverse cardiac and cerebrovascular events (MACCE; death, non-fatal myocardial infarction [MI], non-fatal stroke) were evaluated in year 1 and 2 post-discharge. RESULTS MACCE incidence per 100 person-years at risk within and after 1 year was 5.3 vs 3.6, primarily death (4.1 vs 2.3), with no significant differences for MI or stroke. Older age, lack of coronary revascularization, raised creatinine, low hemoglobin, previous cardiac disease, previous chronic obstructive pulmonary disease, raised glucose, male sex, and geographic region were risk factors for MACCE in both year 1 and 2. By contrast, low ejection fraction, poorer quality of life, low body mass index (BMI) <20 kg/m2 , in-hospital cardiac complications, and Killip class lost predictive power after 1 year. CONCLUSION We observed continuous MACCE risk during 2 years of follow-up after discharge for ACS, with greater mortality within the first year. Specific predictors at discharge for events after 1 year could not be identified.
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Affiliation(s)
- Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,London School of Hygiene and Tropical Medicine, London, UK.,CIBER de Enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Hospital 12 de Octubre, Madrid, Spain
| | | | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou, René Descartes University, Paris, France
| | - Lieven Annemans
- Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Jesús Medina
- Global Medical Affairs, CardioVascular, Renal and Metabolism, AstraZeneca, Madrid, Spain
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
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160
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Martín-Asenjo R, Bueno H, Vidán MT. [Anticoagulation in the elderly: is it all about guidelines or there room for the art of medicine?]. Rev Esp Geriatr Gerontol 2018; 53:314-316. [PMID: 30098832 DOI: 10.1016/j.regg.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Roberto Martín-Asenjo
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, España.
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, España; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - María Teresa Vidán
- Universidad Complutense de Madrid, Madrid, España; Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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161
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Arribas F, Barón-Esquivias G, Coll Vinent B, Rodríguez Entem F, Martínez Alday J, Ángel MB, Núria RG, Jiménez Candil J, Ruiz Granell R, José Miguel O, José Luis M, Peinado R, Moya Á, Díez Villanueva P, Bonanad C, García Pardo H, Toquero J, Atienza F, Beiras X, Alfonso F, Ibáñez B, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Manuel JN, Marín F, Leopoldo PDI, Sambola A, Vázquez García R, Viana Tejedor A. Comentarios a la guía ESC 2018 sobre el diagnóstico y el tratamiento del síncope. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2018.06.018] [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: 10/28/2022]
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Arribas F, Barón-Esquivias G, Coll Vinent B, Rodríguez Entem F, Martínez Alday J, Martínez Brotons Á, Rivas Gándara N, Jiménez Candil J, Ruiz Granell R, Miguel Ormaetxe J, Merino JL, Peinado R, Moya Á, Díez Villanueva P, Bonanad C, García Pardo H, Toquero J, Atienza F, Beiras X, Alfonso F, Ibáñez B, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de la Isla L, Sambola A, Vázquez García R, Viana-Tejedor A. Comments on the 2018 ESC Guidelines for the Diagnosis and Management of Syncope. Rev Esp Cardiol (Engl Ed) 2018; 71:787-793. [PMID: 30243611 DOI: 10.1016/j.rec.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. ACTA ACUST UNITED AC 2018; 72:63-71. [PMID: 30269913 DOI: 10.1016/j.rec.2018.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
Abstract
Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frailty in order to include it in the treatment and care plan that best suits each patient.
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Affiliation(s)
| | - Albert Arizá-Solé
- Servicio de Cardiología, Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Vicente Ruiz Ros
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Universidad Complutense de Madrid, Universidad Europea de Madrid, Madrid, Spain
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Vicent L, Ariza-Solé A, Alegre O, Sanchís J, López-Palop R, Formiga F, González-Salvado V, Bueno H, Vidán MT, Díez-Villanueva P, Abu-Assi E, Martínez-Sellés M. Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men. Eur Heart J Acute Cardiovasc Care 2018; 8:252-263. [PMID: 30168725 DOI: 10.1177/2048872618798226] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A worse prognosis has been reported among women with acute coronary syndrome compared to men. Our aim was to address the role of frailty and sex in the management and prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome. METHODS A prospective registry in 44 Spanish hospitals including patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome. Frailty assessment was performed using the FRAIL scale. RESULTS Of a total of 535 patients, 207 (38.7%) were women. Mean age was 84.8±4.0 years, similar in men and women. A prior history of coronary artery disease was more common in men (146, 44.9%) than in women (46, 22.2%), P<0.001. Frailty was less frequent in men (65, 20.2%) than in women (77, 37.8%), P<0.001. Female sex was an independent predictor of death/hospitalisation (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1-2.4) and of hospitalisation at 6 months (HR 1.6, 95% CI 1.04-2.4). In men, compared to non-frail patients, both a prefrail status (HR 3.47, 95% CI 1.22-9.89) and frailty (HR 3.19, 95% CI 1.08-9.43) were independently associated with higher mortality. In women only frailty was independently associated with higher mortality (HR 5.68, 95% CI 1.91-16.18, compared to prefrailty or robustness). Frailty was associated with readmissions in men (HR 3.34, 95% CI 1.79-6.22) but not in women. CONCLUSIONS In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.
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Affiliation(s)
- Lourdes Vicent
- 1 Cardiology Department, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Spain
| | | | - Oriol Alegre
- 3 Cardiology Department, Hospital Universitari Germans Trias i Pujol, Spain
| | - Juan Sanchís
- 4 Cardiology Department, Hospital San Juan, Spain
| | - Ramón López-Palop
- 5 Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Francesc Formiga
- 2 Servei de Cardiologia, Hospital Universitari de Bellvitge, Spain
| | | | - Héctor Bueno
- 6 Cardiology Department, Hospital Doce de Octubre, Spain
| | - María T Vidán
- 1 Cardiology Department, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Spain
| | | | - Emad Abu-Assi
- 8 Cardiology Department, Hospital Alvaro Cunqueiro, Spain
| | - Manuel Martínez-Sellés
- 1 Cardiology Department, Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Spain.,9 Cardiology Department, Universidad Complutense, Universidad Europea, Spain
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165
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Dominguez Rodriguez F, Fernandez Alvira JM, Fernandez Friera L, Lopez-Melgar B, Blanco-Rojo R, Fernandez-Ortiz A, Garcia-Pavia P, Sanz JM, Mendiguren JM, Ibanez B, Bueno H, Fuster V, Lara-Pezzi E, Ordovas JM. P2466Association of actigraphy-measured sleep parameters and subclinical atherosclerotic burden: the PESA study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F Dominguez Rodriguez
- University Hospital Puerta de Hierro Majadahonda, National Centre for Cardiovascular Research (CNIC). CIBERCV, Madrid, Spain
| | | | - L Fernandez Friera
- National Centre for Cardiovascular Research (CNIC), CIBERCV.HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain, Madrid, Spain
| | - B Lopez-Melgar
- National Centre for Cardiovascular Research (CNIC), HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM-CIEC, Madrid, Spain, Madrid, Spain
| | | | - A Fernandez-Ortiz
- National Centre for Cardiovascular Research (CNIC), CIBERCV. Universidad Complutense.Cardiovascular Institute, IDSSC, Hospital Clínico San Carlos, Madrid, Spain
| | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, CIBERCV. Faculty of Health Sciences, University Francisco de Vitoria (UFV), Madrid, Spain
| | - J M Sanz
- Mount Sinai School of Medicine, Zena and Michael A. Wiener Cardiovascular Institute. CNIC (Madrid), New York, United States of America
| | | | - B Ibanez
- National Centre for Cardiovascular Research (CNIC), CIBERCV, IIS-Fundaciόn Jiménez Díaz Hospital, Madrid, Spain
| | - H Bueno
- National Centre for Cardiovascular Research (CNIC), Cardiology Department, Hospital Universitario 12 de Octubre.Universidad Complutense de Madrid, Madrid, Spain
| | - V Fuster
- National Centre for Cardiovascular Research (CNIC), Zena and Michael A. Wiener Cardiovascular Institute. Icahn School of Medicine Mount Sinai, New York, Madrid, Spain
| | - E Lara-Pezzi
- National Centre for Cardiovascular Research (CNIC), CIBERCV, Madrid, Spain
| | - J M Ordovas
- National Centre for Cardiovascular Research (CNIC), IMDEA Food Institute, CEI UAM + CSIC,U.S. Dept of Agriculture HNRCA. Tufts University, Boston, US, Madrid, Spain
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Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van de Werf F, Bucciarelli-Ducci C, Katus HA, Pinto FJ, Antman EM, Hamm CW, De Caterina R, Januzzi JL, Apple FS, Alonso Garcia MA, Underwood SR, Canty JM, Lyon AR, Devereaux PJ, Zamorano JL, Lindahl B, Weintraub WS, Newby LK, Virmani R, Vranckx P, Cutlip D, Gibbons RJ, Smith SC, Atar D, Luepker RV, Robertson RM, Bonow RO, Steg PG, O’Gara PT, Fox KAA, Hasdai D, Aboyans V, Achenbach S, Agewall S, Alexander T, Avezum A, Barbato E, Bassand JP, Bates E, Bittl JA, Breithardt G, Bueno H, Bugiardini R, Cohen MG, Dangas G, de Lemos JA, Delgado V, Filippatos G, Fry E, Granger CB, Halvorsen S, Hlatky MA, Ibanez B, James S, Kastrati A, Leclercq C, Mahaffey KW, Mehta L, Müller C, Patrono C, Piepoli MF, Piñeiro D, Roffi M, Rubboli A, Sharma S, Simpson IA, Tendera M, Valgimigli M, van der Wal AC, Windecker S, Chettibi M, Hayrapetyan H, Roithinger FX, Aliyev F, Sujayeva V, Claeys MJ, Smajić E, Kala P, Iversen KK, El Hefny E, Marandi T, Porela P, Antov S, Gilard M, Blankenberg S, Davlouros P, Gudnason T, Alcalai R, Colivicchi F, Elezi S, Baitova G, Zakke I, Gustiene O, Beissel J, Dingli P, Grosu A, Damman P, Juliebø V, Legutko J, Morais J, Tatu-Chitoiu G, Yakovlev A, Zavatta M, Nedeljkovic M, Radsel P, Sionis A, Jemberg T, Müller C, Abid L, Abaci A, Parkhomenko A, Corbett S. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2018; 40:237-269. [DOI: 10.1093/eurheartj/ehy462] [Citation(s) in RCA: 1047] [Impact Index Per Article: 174.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Alfonso F, Sionis A, Bueno H, Ibáñez B, Sabaté M, Cequier Á, Barrabés J, Sanchis J, Abu-Assi E, Aboal J, López de Sá E, Martín Asenjo R, Pan M, Ojeda S, Pérez de Prado A, Jiménez Quevedo P, Serrador A, Roldán I, Ferreiro JL, Ruiz Nodar JM, López Sendón JL, San Román A, Alfonso F, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Rodríguez Padial L, Sánchez Fernández PL, Sionis A, Vázquez García R. Comments on the 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-segment Elevation. ACTA ACUST UNITED AC 2018; 70:1039-1045. [PMID: 29198431 DOI: 10.1016/j.rec.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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168
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Puerto E, Viana-Tejedor A, Martínez-Sellés M, Domínguez-Pérez L, Moreno G, Martín-Asenjo R, Bueno H. Temporal Trends in Mechanical Complications of Acute Myocardial Infarction in the Elderly. J Am Coll Cardiol 2018; 72:959-966. [DOI: 10.1016/j.jacc.2018.06.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
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Puerto E, Viana A, Martinez-Selles M, Moreno G, Martin-Asenjo R, Bueno H. P3638Time trends in mechanical complications after ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Puerto
- University Hospital 12 de Octubre, Madrid, Spain
| | - A Viana
- University Hospital Gregorio Maranon, Cardiology, Madrid, Spain
| | | | - G Moreno
- University Hospital 12 de Octubre, Madrid, Spain
| | | | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
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170
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Sambola Ayala A, Rello P, Soriano T, Pasupuleti V, Bueno H, Fauchier L, Airaksinen J, Dewilde W, Raber L, Sung-Won J, Bhatt DL, Banach M, Lip GY, Hernandez AV. P5505The efficacy and safety of the use of drug-eluting stents vs bare metal stents stratifying by antithrombotic therapy in atrial fibrillation patients undergoing coronary stenting: a systematic review. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - P Rello
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - T Soriano
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - V Pasupuleti
- Cleveland Clinic Foundation, Caridology, Cleveland, United States of America
| | - H Bueno
- University Hospital 12 de Octubre, Cardiology, Madrid, Spain
| | - L Fauchier
- University Hospital of Tours, Cardiology, Tours, France
| | - J Airaksinen
- Turku University Hospital, Cardiology, Turku, Finland
| | - W Dewilde
- Catharina Hospital, Cardiology, Eindhoven, Netherlands
| | - L Raber
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - J Sung-Won
- Korea University, Cardiology, Seoul, Korea Republic of
| | - D L Bhatt
- Brigham and Women's Hospital, Cardiology, Boston, United States of America
| | - M Banach
- Medical University of Lodz, Cardiology, Lodz, Poland
| | - G Y Lip
- University Hospital Birmingham, Cardiology, Birmingham, United Kingdom
| | - A V Hernandez
- Hartford Hospital, Cardiology, Hartford, United States of America
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171
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Vicent Alaminos L, Ariza-Sole A, Alegre O, Sanchis J, Lopez Palop R, Formiga F, Gonzalez-Salvado V, Bueno H, Vidan MT, Diez Villanueva P, Abu-Assi E, Fernandez-Aviles F, Martinez-Selles M. P2247Elderly females with acute coronary syndrome present frailty and readmissions more frequently than males. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Ariza-Sole
- University Hospital of Bellvitge, Barcelona, Spain
| | - O Alegre
- University Hospital Trias i Pujol, Barcelona, Spain
| | - J Sanchis
- University Hospital San Juan de Alicante, Alicante, Spain
| | - R Lopez Palop
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - F Formiga
- University Hospital of Bellvitge, Barcelona, Spain
| | - V Gonzalez-Salvado
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - H Bueno
- University Hospital 12 de Octubre, Madrid, Spain
| | - M T Vidan
- University Hospital Gregorio Maranon, Cardiology, Madrid, Spain
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172
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Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, Reynolds HR, Geda M, Bueno H, Dziura JD, Krumholz HM, D'Onofrio G. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. J Am Heart Assoc 2018; 7:e009174. [PMID: 29954744 PMCID: PMC6064896 DOI: 10.1161/jaha.118.009174] [Citation(s) in RCA: 224] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI-CAD]) and among patients with MINOCA by sex and subtype. METHODS AND RESULTS Between 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI-CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1- and 12-month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI-CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29-7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI-CAD patients (3.0% versus 1.3%; P=0.036). Women with MI-CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One- and 12-month mortality with MINOCA and MI-CAD was similar (1-month: 1.1% and 1.7% [P=0.43]; 12-month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12-month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06). CONCLUSIONS Young patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI-CAD patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.
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Affiliation(s)
- Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, CT
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, CT
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Rachel P Dreyer
- Department of Emergency Medicine, Yale University, New Haven, CT
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | | | | | - John A Spertus
- University of Missouri Kansas City, Kansas City, MO
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, NY
| | - Mary Geda
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - James D Dziura
- Department of Emergency Medicine, Yale University, New Haven, CT
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, CT
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale University, New Haven, CT
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173
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Miró Ò, Rosselló X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero P, Jacob J, López-Grima ML, Gil C, Lucas Imbernón FJ, Garrido JM, Pérez-Durá MJ, López-Díez MP, Richard F, Bueno H, Pocock SJ. The Usefulness of the MEESSI Score for Risk Stratification of Patients With Acute Heart Failure at the Emergency Department. ACTA ACUST UNITED AC 2018; 72:198-207. [PMID: 29903688 DOI: 10.1016/j.rec.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/25/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings. METHODS We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium- or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort. RESULTS We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs. CONCLUSIONS The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients.
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Affiliation(s)
- Òscar Miró
- Servicio de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain.
| | - Xavier Rosselló
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Víctor Gil
- Servicio de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | | | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Cristina Gil
- Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | | | | | - Fernando Richard
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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174
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Llaó I, Ariza-Solé A, Sanchis J, Alegre O, López-Palop R, Formiga F, Marín F, Vidán MT, Martínez-Sellés M, Sionis A, Vives-Borrás M, Gómez-Hospital JA, Gómez-Lara J, Roura G, Díez-Villanueva P, Núñez-Gil I, Maristany J, Asmarats L, Bueno H, Abu-Assi E, Cequier À. Invasive strategy and frailty in very elderly patients with acute coronary syndromes. EUROINTERVENTION 2018; 14:e336-e342. [PMID: 29616624 DOI: 10.4244/eij-d-18-00099] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 11/23/2022]
Abstract
AIMS Current guidelines recommend an early invasive strategy in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. The aim of this substudy was to assess the impact of an invasive strategy on outcomes according to the degree of frailty in these patients. METHODS AND RESULTS The LONGEVO-SCA registry included unselected NSTEACS patients aged ≥80 years. A geriatric assessment, including frailty, was performed during hospitalisation. During the admission, we evaluated the impact of an invasive strategy on the incidence of cardiac death, reinfarction or new revascularisation at six months. From 531 patients included, 145 (27.3%) were frail. Mean age was 84.3 years. Most patients underwent an invasive strategy (407/531, 76.6%). Patients undergoing an invasive strategy were younger and had a lower proportion of frailty (23.3% vs. 40.3%, p<0.001). The incidence of cardiac events was more common in patients managed conservatively, after adjusting for confounding factors (sub-hazard ratio [sHR] 2.32, 95% confidence interval [CI]: 1.26-4.29, p=0.007). This association remained significant in non-frail patients (sHR 3.85, 95% CI: 2.13-6.95, p=0.001), but was not significant in patients with established frailty criteria (sHR 1.40, 95% CI: 0.72-2.75, p=0.325). The interaction invasive strategy-frailty was significant (p=0.032). CONCLUSIONS An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.
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Affiliation(s)
- Isaac Llaó
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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175
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Martín-Sánchez FJ, Rodríguez-Adrada E, Vidán MT, Díez Villanueva P, Llopis García G, González Del Castillo J, Alberto Rizzi M, Alquézar A, Herrera Mateo S, Piñera P, Sánchez Nicolás JA, Lázaro Aragues P, Llorens P, Herrero P, Jacob J, Gil V, Fernández C, Bueno H, Miró Ò. Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. Emergencias 2018; 30:149-155. [PMID: 29687668] [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: 06/08/2023]
Abstract
OBJETIVE To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). METHODS Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. RESULTS We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0–4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9–3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0–3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0–4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9–11.4; P=.01). CONCLUSIONS Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España
| | - Esther Rodríguez-Adrada
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital Gregorio Marañón, Instituto de Investigación IiSGM, Universidad Complutense de Madrid, España
| | | | | | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España
| | - Miguel Alberto Rizzi
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, España
| | - Aitor Alquézar
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, España
| | - Sergio Herrera Mateo
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, España
| | - Pascual Piñera
- Servicio de Urgencias, Hospital Reina Sofia, Murcia, España
| | | | | | - Pere Llorens
- Servicio de Urgencias, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIALFundación FISABIO), Universidad Miguel Hernández de Alicante, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
| | - Cristina Fernández
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España. Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid; Instituto de Investigación i+12, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid; Universidad Complutense de Madrid, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
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176
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Ibanez B, Halvorsen S, Roffi M, Bueno H, Thiele H, Vranckx P, Neumann FJ, Windecker S, James S. Integrating the results of the CULPRIT-SHOCK trial in the 2017 ESC ST-elevation myocardial infarction guidelines: viewpoint of the task force. Eur Heart J 2018; 39:4239-4242. [DOI: 10.1093/eurheartj/ehy294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/26/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
- Borja Ibanez
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), IIS-Fundación Jiménez Díaz University Hospital, and CIBERCV, Madrid, Spain
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Oslo, Norway
| | - Marco Roffi
- Division of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Instituto de investigación imas12 - Cardiology Department, Hospital Universitario 12 de Octubre, and Universidad Complutense de Madrid, Spain
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, and Hasselt University, Hasselt, Belgium
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjolds vag 14B SE-752 37, Uppsala, Sweden
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177
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Llorens P, Javaloyes P, Martín-Sánchez FJ, Jacob J, Herrero-Puente P, Gil V, Garrido JM, Salvo E, Fuentes M, Alonso H, Richard F, Lucas FJ, Bueno H, Parissis J, Müller CE, Miró Ò. Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure. Clin Res Cardiol 2018; 107:897-913. [PMID: 29728831 DOI: 10.1007/s00392-018-1261-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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: 02/01/2018] [Accepted: 04/24/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To analyse time trends in patient characteristics, clinical course, hospitalisation rate, and outcomes in acute heart failure along a 10-year period (2007-2016). METHODS The EAHFE registry has prospectively collected 13,971 consecutive AHF patients diagnosed in 41 Spanish emergency departments (EDs) at five different time points (2007/2009/2011/2014/2016). Eighty patient-related variables and outcomes were described and statistically significant changes along time were evaluated. We also compared our data with large ED- and hospital-based registries. RESULTS Compared to other large registries, our patients were older [80 (10) years], more frequently women (55.5%), and had a higher prevalence of hypertension (83.5%) and a lower prevalence of ischaemic cardiomyopathy (29.4%). De novo AHF was observed in 39.6%. 63.6% showed some degree of functional dependence and 56.1% had preserved left ventricular ejection fraction (LVEF). 56.8% of the patients arrived at the ED by ambulance, 4.5% arrived hypotensive, and 21.3% hypertensive. Direct discharge from the ED home was seen in 24.9%, and internal medicine (32.5%) and cardiology (15.8%) were the main hospital destinations. Triggers for decompensation were identified in 75.4%, the most being frequent infection (35.2%) and rapid atrial fibrillation (14.7%). The AHF phenotypes were: warm/wet 82.0%, warm/dry 6.2%, cold/wet 11.1%, and cold/dry 0.7%. The length of hospitalisation was 9.3 (8.6) days, and in-hospital, 30-day, and 1-year all-cause mortality were 7.8, 10.2 and 30.3%, respectively; and 30-day re-hospitalisation and ED revisit due to AHF were 16.9 and 24.8%, respectively. Thirty-nine of the eighty characteristics studied showed significant changes over time, while all outcomes remained unchanged along the 10-year period. CONCLUSIONS The EAHFE Registry is the first European ED-based registry describing the characteristics, clinical course, and outcomes of a cohort resembling the universe of patients with AHF. Significant changes were observed over time in some aspects of AHF characteristics and management, but not in outcomes.
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Affiliation(s)
- Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home, ISABIAL-Fundación FISABIO, Hospital Universitario General de Alicante, Alicante, Spain
| | - Patricia Javaloyes
- Emergency Department, Short Stay Unit and Hospitalization at Home, ISABIAL-Fundación FISABIO, Hospital Universitario General de Alicante, Alicante, Spain
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitario Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Madrid, Spain.,The GREAT (Global REsearch on Acute conditions Team) Network, Rome, Italy
| | - Javier Jacob
- Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Pablo Herrero-Puente
- Emergency Department, Grupo de Investigación de Urgencias-HUCA, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Víctor Gil
- "Emergencies: Processes and Pathologies" Research Group, Emergency Department, IDIBAPS, Hospital Clínic, Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | | | - Eva Salvo
- Emergency Department, Hospital Politécnico La Fe, Valencia, Spain
| | - Marta Fuentes
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Héctor Alonso
- Emergency Department, Hospital Marqués de Valdecilla, Santander, Spain
| | - Fernando Richard
- Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Héctor Bueno
- Cardiology Department, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.,National Centre for Cardiovascular Research (CNIC), Madrid, Spain
| | - John Parissis
- Second Department of Cardiology, University of Athens Medical School, Athens, Greece
| | | | - Òscar Miró
- The GREAT (Global REsearch on Acute conditions Team) Network, Rome, Italy. .,"Emergencies: Processes and Pathologies" Research Group, Emergency Department, IDIBAPS, Hospital Clínic, Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,School of Medicine, University of Barcelona, Barcelona, Spain.
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178
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Domínguez-Pérez L, Martín-Asenjo R, Bueno H. Early to bed and early to rise makes a patient healthy, a hospital wealthy, and a doctor wise, or not? Eur J Prev Cardiol 2018; 25:804-806. [PMID: 29658299 DOI: 10.1177/2047487318771775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laura Domínguez-Pérez
- 1 Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Roberto Martín-Asenjo
- 1 Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Héctor Bueno
- 1 Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,2 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,3 Facultad de Medicina, Universidad Complutense de Madrid, Spain
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179
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Bueno H, Rossello X, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Vega A, Huo Y. Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol 2018; 107:836-844. [PMID: 29663124 DOI: 10.1007/s00392-018-1254-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 01/25/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Therapeutic variability not explained by patient clinical characteristics is a potential source of avoidable morbidity and mortality. We aimed to explore regional variability in the management and mortality of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS AND RESULTS 11,931 NSTE-ACS hospital survivors enrolled in two prospective registries: EPICOR [5625 patients, 555 hospitals, 20 countries in Europe (E) and Latin America (LA), September 2010-March 2011] and EPICOR Asia (6306 patients, 218 hospitals, 8 countries, June 2011-May 2012) were compared among eight pre-defined regions: Northern E (NE), Southern E (SE), Eastern E (EE); Latin America (LA); China (CN), India (IN), South-East Asia (SA), and South Korea, Hong Kong and Singapore (KS). Patient characteristics differed between regions: mean age (lowest 59 years, IN; highest 65.9 years, SE), diabetes (21.4% NE; 35.5% IN) and smoking (32% NE; 62% IN). Variations in dual antiplatelet therapy at discharge (lowest 83.1%, IN; highest 97.5%, SA), coronary angiography (53.9% SA; 90.6% KS), percutaneous coronary intervention (35.8% SA; 78.6% KS) and coronary artery bypass graft (0.7% KS; 5.7% NE) were observed. Unadjusted 2-year mortality ranged between 3.8% in KS and 11.7% in SE. Two-year, risk-adjusted mortality rates ranged between 5.1% (95% confidence interval 2.9-7.3%) in KS to 10.5% (8.3-12.7%) in LA. CONCLUSION Wide regional variations in patient features, hospital care, coronary revascularization and post-discharge mortality are present among patients hospitalized for NSTE-ACS. Focused regional interventions to improve the quality of care for NSTE-ACS patients are still needed.
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Affiliation(s)
- Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain. .,Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain. .,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain.,London School of Hygiene and Tropical Medicine, London, UK.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou and René Descartes University, Paris, France
| | | | - Jesús Medina
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Ana Vega
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Yong Huo
- Beijing University First Hospital, Beijing, China
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180
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Zeymer U, Annemans L, Danchin N, Pocock S, Newsome S, Van de Werf F, Medina J, Bueno H. Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry. European Heart Journal: Acute Cardiovascular Care 2018; 8:121-129. [DOI: 10.1177/2048872618769057] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Atrial fibrillation (AF) is associated with increased morbidity in acute coronary syndrome patients, but impact on outcomes beyond 1 year is unclear. Methods: This was a post-hoc analysis from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) registry (NCT01171404), a prospective, observational study conducted in Europe and Latin America, which enrolled acute coronary syndrome survivors at discharge. Antithrombotic management patterns, mortality, a composite endpoint of death/new non-fatal myocardial infarction/stroke and bleeding events were assessed after 2 years of follow-up in patients with or without AF. Results: Of 10,568 patients enrolled, 397 (4.7%) had prior AF and 382 (3.6%) new-onset AF during index hospitalisation. Fewer patients with AF underwent percutaneous coronary intervention (52.1% vs. 66.6%; P<0.0001). At discharge, fewer AF patients received dual antiplatelet therapy (71.6% vs. 89.5%; P<0.0001); oral anticoagulant use was higher in AF patients but was still infrequent (35.0% vs. 2.5%; P<0.0001). Use of dual antiplatelet therapy and oral anticoagulants declined over follow-up with over 50% of all AF/no AF patients remaining on dual antiplatelet therapy (55.6% vs. 60.6%), and 23.3% (new-onset AF) to 42.1% (prior AF) on oral anticoagulants at 2 years. At 2 years, mortality, composite endpoint and bleeding rates were higher in AF patients (all P<0.0001) compared to patients without AF. On multivariable analysis, the risk of mortality or the composite endpoint was significant for prior AF ( P=0.003, P=0.001) but not new-onset AF ( P=0.88, P=0.92). Conclusions: Acute coronary syndrome patients with AF represent a high-risk group with increased event rates during long-term follow-up. Prior AF is an independent predictor of mortality and/or ischaemic events at 2 years. Use of anticoagulants in AF after acute coronary syndrome is still suboptimal.
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Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Germany
| | - Lieven Annemans
- I-CHER Interuniversity Centre for Health Economics Research UGent, Vrije Universiteit Brussel, Belgium
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou, and René Descartes University, France
| | | | | | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Jesús Medina
- Medical Evidence and Observational Research, AstraZeneca, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Spain
- Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain
- Universidad Complutense de Madrid, Spain
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181
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Abstract
In 2011, for the first time in the history of humankind, non-communicable diseases became the leading cause of death worldwide. This change in trend is obviously multifactorial and very complex, as it is the paradoxical result of social, economic and health system growth worldwide. Vaccination and infectious diseases control, changing dietary habits worldwide, sedentary behaviour, globalisation, industrialisation (resulting in a shift from manual to sedentary labour), tobacco and sugary beverage surges in low- and middle-income countries and rapid urbanisation have all played a role in this epidemic transition. At the same time, the increase in cardiovascular risk factors, together with a decline in mortality in high-income countries in the past two decades, has led to a significant upsurge in the prevalence of secondary prevention of ischaemic heart disease. With this, the effect that non-adherence to cardioprotective drugs is having has become progressively clear, both in terms of clinical outcomes and as a driver of increased healthcare expenditure. The cardiovascular polypill, which was originally proposed as a strategy to improve accessibility to cardioprotective drugs worldwide, has proven to be a mainstay therapeutic approach for improving medication adherence in cardiovascular disease. In the current paper, we aim to review the need for a polypill strategy in the present scenario of cardiovascular disease, the available data that support such a strategy and the various clinical trials that are in progress that will help further shape future indications for the cardiovascular polypill.
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Affiliation(s)
- José M Castellano
- 1 Centro Nacional de Investigaciones Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.,2 Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario Montepríncipe, HM Hospitales, Madrid, Spain.,3 Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain
| | - Valentín Fuster
- 1 Centro Nacional de Investigaciones Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.,4 Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA.,5 Marie-Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Catriona Jennings
- 6 National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Eva Prescott
- 7 Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Héctor Bueno
- 1 Centro Nacional de Investigaciones Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.,8 Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,9 Facultad de Medicina, Universidad Complutense de Madrid, Spain
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Aboyans V, Björck M, Brodmann M, Collet JP, Czerny M, De Carlo M, Naylor AR, Roffi M, Tendera M, Vlachopoulos C, Ricco JB, Document Reviewers, Widimsky P, Kolh P, Dick F, Vega de Ceniga M, Piepoli MF, Sievert H, Sulzenko J, Esc Committee For Practice Guidelines Cpg, Windecker S, Aboyans V, Agewall S, Barbato E, Bueno H, Coca A, Collet JP, Coman IM, Dean V, Delgado V, Fitzsimons D, Gaemperli O, Hindricks G, Iung B, Jüni P, Katus HA, Knuuti J, Lancellotti P, Leclercq C, McDonagh T, Piepoli MF, Ponikowski P, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Zamorano JL. Questions and Answers on Diagnosis and Management of Patients with Peripheral Arterial Diseases: A Companion Document of the 2017 ESC Guidelines for the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:457-464. [PMID: 29628287 DOI: 10.1016/j.ejvs.2017.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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183
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Ferrari R, Bueno H, Chioncel O, Cleland JG, Stough WG, Lettino M, Metra M, Parissis JT, Pinto F, Ponikowski P, Ruschitzka F, Tavazzi L. Acute heart failure: lessons learned, roads ahead. Eur J Heart Fail 2018. [DOI: 10.1002/ejhf.1169] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Roberto Ferrari
- Department of Cardiology and LTTA Centre; University Hospital of Ferrara; Ferrara Italy
- Maria Cecilia Hospital, GVM Care & Research; E.S. Health Science Foundation; Cotignola Italy
| | - Héctor Bueno
- Department of Cardiology; Hospital 12 de Octubre; Madrid Spain
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucuresti; Institutul de Urgente Boli Cardiovasculare CC; Iliescu Romania
| | - John G. Cleland
- National Heart & Lung Institute; Harefield Hospital, Imperial College; London UK
| | - Wendy Gattis Stough
- Departments of Pharmacy Practice and Clinical Research; Campbell University College of Pharmacy and Health Sciences; Cary NC USA
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Brescia Italy
| | | | - Fausto Pinto
- Departamento de Cardiologia, CCUL, CAML, Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Piotr Ponikowski
- Medical University, Centre for Heart Disease; Clinical Military Hospital; Wroclaw Poland
| | - Frank Ruschitzka
- Department of Cardiology; University Heart Center; Zürich Switzerland
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research; E.S. Health Science Foundation; Cotignola Italy
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184
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Sanchis J, Ariza-Solé A, Abu-Assi E, Alegre O, Alfonso F, Barrabés JA, Baz JA, Carol A, Díez Villanueva P, García Del Blanco B, Elízaga J, Fernandez E, García Del Egido A, García Picard J, Gómez Blázquez I, Gómez Hospital JA, Hernández-Antolín R, Llibre C, Marín F, Martí Sánchez D, Martín R, Martínez Sellés M, Miñana G, Morales Gallardo MJ, Núñez J, Pérez de Prado A, Pinar E, Sanmartín M, Sionis A, Villa A, Marrugat J, Bueno H. Invasive Versus Conservative Strategy in Frail Patients With NSTEMI: The MOSCA-FRAIL Clinical Trial Study Design. ACTA ACUST UNITED AC 2018. [PMID: 29525724 DOI: 10.1016/j.rec.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI. METHODS This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale. Participants will be randomized to an invasive (coronary angiogram and revascularization if anatomically amenable) or conservative (medical treatment and coronary angiogram only if persistent clinical instability) strategy. The primary endpoint will be the number of days alive out of hospital during the first year. The coprimary endpoint will be the time until the first cardiac event (cardiac death, reinfarction or postdischarge revascularization). We estimate a sample size of 178 patients (89 per arm), considering an increase of 20% in the proportion of days alive out of hospital with the invasive management. RESULTS The results of this study will add important knowledge to inform the management of frail elderly patients hospitalized with NSTEMI. CONCLUSIONS We hypothesize that the invasive strategy will improve outcomes in frail elderly patients with NSTEMI. If this is confirmed, frailty status should not dissuade physicians from implementing an invasive management strategy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov.Identifier: NCT03208153.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain.
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Oriol Alegre
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - José Antonio Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, CIBERCV, Barcelona, Spain
| | - José Antonio Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Antonio Carol
- Servicio de Cardiología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | | | - Jaime Elízaga
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Eduard Fernandez
- Servicio de Cardiología, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | | | | | | | | | | | - Cinta Llibre
- Servicio de Cardiología, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Barcelona, Spain
| | - Francisco Marín
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | | | - Roberto Martín
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Valencia, Spain
| | | | - Eduardo Pinar
- Servicio de Cardiología, Hospital Virgen de la Arrixaca, CIBERCV, El Palmar, Murcia, Spain
| | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Ramon y Cajal, CIBERCV, Madrid, Spain
| | - Alessandro Sionis
- Servicio de Cardiología, Hospital Sant Pau, CIBERCV, Barcelona, Spain
| | - Adolfo Villa
- Servicio de Cardiología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
| | - Jaume Marrugat
- Grupo de Epidemiología y Genética Cardiovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), CIBERCV, Barcelona, Spain
| | - Héctor Bueno
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
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185
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Walker DM, Gale CP, Lip G, Martin-Sanchez FJ, McIntyre HF, Mueller C, Price S, Sanchis J, Vidan MT, Wilkinson C, Zeymer U, Bueno H. Editor's Choice - Frailty and the management of patients with acute cardiovascular disease: A position paper from the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care 2018; 7:176-193. [PMID: 29451402 DOI: 10.1177/2048872618758931] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frailty is increasingly seen among patients with acute cardiovascular disease. A combination of an ageing population, improved disease survival, treatable long-term conditions as well as a greater recognition of the syndrome has accelerated the prevalence of frailty in the modern world. Yet, this has not been matched by an expansion of research. National and international bodies have identified acute cardiovascular disease in the frail as a priority area for care and an entity that requires careful clinical decisions, but there remains a paucity of guidance on treatment efficacy and safety, and how to manage this complex group. This position paper from the Acute Cardiovascular Care Association presents the latest evidence about frailty and the management of frail patients with acute cardiovascular disease, and suggests avenues for future research.
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Affiliation(s)
| | - C P Gale
- 2 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - G Lip
- 3 Institute for Cardiovascular Sciences, University of Birmingham, UK.,4 Aalborg Thrombosis Research Unit, Aalborg University, Denmark
| | | | | | - C Mueller
- 6 Cardiovascular Research Institute Basel, University of Basel, Switzerland
| | - S Price
- 7 Royal Brompton Hospital, UK
| | - J Sanchis
- 8 Department of Cardiology, University of Valencia, Spain.,9 University of Valencia, CIBER CV, Spain
| | - M T Vidan
- 10 Department of Geriatrics, Universidad Complutense de Madrid Dr Esquerdo, Spain
| | - C Wilkinson
- 2 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - U Zeymer
- 11 Klinikum Ludwigshafen und Institut for Herzinfarktforschung, Germany
| | - H Bueno
- 12 National Centre for Cardiovascular Research, Spain
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186
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Baumgartner ADGDTH, Falk V, Bax JJ, Bonis MD, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Mas PT, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, Roffi RDDM, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H, Collet JP, Coman IM, Czerny M, Delgado V, Fitzsimons D, Folliguet T, Gaemperli O, Habib G, Harringer W, Haude M, Hindricks G, Katus HA, Knuuti J, Kolh P, Leclercq C, McDonagh TA, Piepoli MF, Pierard LA, Ponikowski P, Rosano GM, Ruschitzka F, Shlyakhto E, Simpson IA, Sousa–Uva M, Stepinska J, Tarantini G, Tchétché D, Aboyans V. Guía ESC/EACTS 2017 sobre el tratamiento de las valvulopatías. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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187
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Ariza-Solé A, Guerrero C, Formiga F, Aboal J, Abu-Assi E, Marín F, Bueno H, Alegre O, López-Palop R, Vidán MT, Martínez-Sellés M, Díez-Villanueva P, Vilardell P, Sionis A, Vives-Borrás M, Sanchís J, Bañeras J, Rafecas A, Llibre C, López J, González-Salvado V, Cequier À. Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry. Thromb Haemost 2018. [PMID: 29536466 DOI: 10.1055/s-0038-1623532] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. METHODS The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). RESULTS Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). CONCLUSION Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Guerrero
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Emad Abu-Assi
- Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Francisco Marín
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital Doce de Octubre, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Oriol Alegre
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón López-Palop
- Cardiology Department, Hosptal Universitario San Juan, Alicante, Spain
| | - María T Vidán
- Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | | | - Pau Vilardell
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Vives-Borrás
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sanchís
- Cardiology Department, Hospital Clínico de Valencia, INCLIVA, Universidad de Valencia, CIBER CV, Valencia, Spain
| | - Jordi Bañeras
- Cardiology Department, Hospital de la Vall d'Hebron, CIBER CV, Barcelona, Spain
| | - Agnès Rafecas
- Cardiology Department, Hospital de la Vall d'Hebron, CIBER CV, Barcelona, Spain
| | - Cinta Llibre
- Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Javier López
- Cardiology Department, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Violeta González-Salvado
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Àngel Cequier
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Valgimigli ADGDTM, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann FJ, Petricevic M, Roffi M, Steg PG, Windecker S, Zamorano JL, Levine CAGN, Badimon RDDL, Vranckx P, Agewall S, Andreotti F, Antman E, Barbato E, Bassand JP, Bugiardini R, Cikirikcioglu M, Cuisset T, De Bonis M, Delgado V, Fitzsimons D, Gaemperli O, Galiè N, Gilard M, Hamm CW, Ibáñez B, Iung B, James S, Knuuti J, Landmesser U, Leclercq C, Lettino M, Lip G, Piepoli MF, Pierard L, Schwerzmann M, Sechtem U, Simpson IA, Uva MS, Stabile E, Storey RF, Tendera M, Van de Werf F, Verheugt F, Aboyans V. Actualización ESC 2017 sobre el tratamiento antiagregante plaquetario doble en la enfermedad coronaria, desarrollada en colaboración con la EACTS. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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189
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Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Eur Heart J 2018; 39:119-177. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 5936] [Impact Index Per Article: 989.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
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190
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Fernández-Friera L, Fuster V, López-Melgar B, Oliva B, García-Ruiz JM, Mendiguren J, Bueno H, Pocock S, Ibáñez B, Fernández-Ortiz A, Sanz J. Normal LDL-Cholesterol Levels Are Associated With Subclinical Atherosclerosis in the Absence of Risk Factors. J Am Coll Cardiol 2017; 70:2979-2991. [PMID: 29241485 DOI: 10.1016/j.jacc.2017.10.024] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [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: 09/05/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Absence of cardiovascular risk factors (CVRFs) is traditionally considered low risk for atherosclerosis; however, individuals without CVRFs, as currently defined, still have events. OBJECTIVES This study sought to identify predictors of subclinical atherosclerosis in CVRF-free individuals. METHODS Participants from the PESA (Progression of Early Subclinical Atherosclerosis) study (n = 4,184) without conventional CVRFs were evaluated (n = 1,779; 45.0 ± 4.1 years, 50.3% women). CVRF freedom was defined as no current smoking and untreated blood pressure <140/90 mm Hg, fasting glucose <126 mg/dl, total cholesterol <240 mg/dl, low-density lipoprotein cholesterol (LDL-C) <160 mg/dl, and high-density lipoprotein cholesterol ≥40 mg/dl. A subgroup with optimal CVRFs (n = 740) was also defined as having blood pressure <120/80 mm Hg, fasting glucose <100 mg/dl, glycosylated hemoglobin <5.7%, and total cholesterol <200 mg/dl. We evaluated ultrasound-detected carotid, iliofemoral, and abdominal aortic plaques; coronary artery calcification; serum biomarkers; and lifestyle. Adjusted odds ratios (with 95% confidence interval) and ordinal logistic regression models were used. RESULTS Subclinical atherosclerosis (plaque or coronary artery calcification) was present in 49.7% of CVRF-free participants. Together with male sex and age, LDL-C was independently associated with atherosclerosis presence and extent, in both the CVRF-free and CVRF-optimal groups (odds ratio [×10 mg/dl]: 1.14 to 1.18; p < 0.01 for all). Atherosclerosis presence and extent was also associated in the CVRF-free group with glycosylated hemoglobin levels. CONCLUSIONS Many CVRF-free middle-aged individuals have atherosclerosis. LDL-C, even at levels currently considered normal, is independently associated with the presence and extent of early systemic atherosclerosis in the absence of major CVRFs. These findings support more effective LDL-C lowering for primordial prevention, even in individuals conventionally considered at optimal risk. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318).
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Affiliation(s)
- Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Beatriz López-Melgar
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares, Madrid, Spain
| | - Belén Oliva
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - José M García-Ruiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain; ISPA-Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; i+12 Research Institute and Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Stuart Pocock
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain; IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de enfermedades CardioVasculares, Madrid, Spain; Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
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191
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Alfonso F, Sionis A, Bueno H, Ibáñez B, Sabaté M, Cequier Á, Barrabés J, Sanchis J, Abu-Assi E, Aboal J, López de Sá E, Martín Asenjo R, Pan M, Ojeda S, Pérez de Prado A, Jiménez Quevedo P, Serrador A, Roldán I, Ferreiro JL, Ruiz Nodar JM, López Sendón JL, San Román A, Alfonso F, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Rodríguez Padial L, Sánchez Fernández PL, Sionis A, Vázquez García R. Comentarios a la guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.10.049] [Citation(s) in RCA: 5] [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: 10/18/2022]
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192
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Ibánez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. ACTA ACUST UNITED AC 2017; 70:1082. [PMID: 29198432 DOI: 10.1016/j.rec.2017.11.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/31/2017] [Indexed: 01/10/2023]
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Ibáñez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio AL, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsk P, Collet JP, Kristensen SD, Aboyans V, Baumbach A, Bugiardini R, Mircea Coman I, Delgado V, Fitzsimons D, Gaemperli O, Gershlick AH, Gielen S, Harjola VP, Katus HA, Knuuti J, Kolh P, Leclercq C, Lip GY, Morais J, Neskovic AN, Neumann FJ, Niessner A, Piepoli MF, Richter DJ, Shlyakhto E, Simpson IA, Steg G, Terkelsen CJ, Thygesen K, Windecker S, Zamorano JL, Zeymer U. Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.10.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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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Fernández-Alvira JM, Fuster V, Pocock S, Sanz J, Fernández-Friera L, Laclaustra M, Fernández-Jiménez R, Mendiguren J, Fernández-Ortiz A, Ibáñez B, Bueno H. Predicting Subclinical Atherosclerosis in Low-Risk Individuals: Ideal Cardiovascular Health Score and Fuster-BEWAT Score. J Am Coll Cardiol 2017; 70:2463-2473. [PMID: 29145946 DOI: 10.1016/j.jacc.2017.09.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 07/17/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ideal cardiovascular health score (ICHS) is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT (blood pressure [B], exercise [E], weight [W], alimentation [A], and tobacco [T]) score (FBS), are also available. OBJECTIVES The purpose of this study was to compare the effectiveness of ICHS and FBS in predicting the presence and extent of subclinical atherosclerosis. METHODS A total of 3,983 participants 40 to 54 years of age were enrolled in the PESA (Progression of Early Subclinical Atherosclerosis) cohort. Subclinical atherosclerosis was measured in right and left carotids, abdominal aorta, right and left iliofemoral arteries, and coronary arteries. Subjects were classified as having poor, intermediate, or ideal cardiovascular health based on the number of favorable ICHS or FBS. RESULTS With poor ICHS and FBS as references, individuals with ideal ICHS and FBS showed lower adjusted odds of having atherosclerotic plaques (ICHS odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.31 to 0.55 vs. FBS OR 0.49; 95% CI: 0.36 to 0.66), coronary artery calcium (CACS) ≥1 (CACS OR: 0.41; 95% CI: 0.28 to 0.60 vs. CACS OR 0.53; 95% CI: 0.38 to 0.74), higher number of affected territories (OR: 0.32; 95% CI: 0.26 to 0.41 vs. OR: 0.39; 95% CI: 0.31 to 0.50), and higher CACS level (OR: 0.40; 95% CI: 0.28 to 0.58 vs. OR: 0.52; 95% CI: 0.38 to 0.72). Similar levels of significantly discriminating accuracy were found for ICHS and FBS with respect to the presence of plaques (C-statistic: 0.694; 95% CI: 0.678 to 0.711 vs. 0.692; 95% CI: 0.676 to 0.709, respectively) and for CACS ≥1 (C-statistic: 0.782; 95% CI: 0.765 to 0.800 vs. 0.780; 95% CI: 0.762 to 0.798, respectively). CONCLUSIONS Both scores predict the presence and extent of subclinical atherosclerosis with similar accuracy, highlighting the value of the FBS as a simpler and more affordable score for evaluating the risk of subclinical disease.
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Affiliation(s)
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Stuart Pocock
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital Universitario HM Montepríncipe, Centro Integral de Enfermedades Cardiovasculares (CIEC), Madrid, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares, Spain
| | - Martín Laclaustra
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Aragon Institute for Health Research, Translational Research Unit, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares, Spain
| | | | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares, Spain; Departamento de Cardiología, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Instituto de Investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Miró Ò, Rossello X, Gil V, Martín-Sánchez FJ, Llorens P, Herrero-Puente P, Jacob J, Bueno H, Pocock SJ. Predicting 30-Day Mortality for Patients With Acute Heart Failure in the Emergency Department: A Cohort Study. Ann Intern Med 2017; 167:698-705. [PMID: 28973663 DOI: 10.7326/m16-2726] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [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: 11/22/2022] Open
Abstract
BACKGROUND Physicians in the emergency department (ED) need additional tools to stratify patients with acute heart failure (AHF) according to risk. OBJECTIVE To predict mortality using data that are readily available at ED admission. DESIGN Prospective cohort study. SETTING 34 Spanish EDs. PARTICIPANTS The derivation cohort included 4867 consecutive ED patients admitted during 2009 to 2011. The validation cohort comprised 3229 patients admitted in 2014. MEASUREMENTS 88 candidate risk factors and 30-day mortality. RESULTS Thirteen independent risk factors were identified in the derivation cohort and were combined into an overall score, the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score. This score predicted 30-day mortality with excellent discrimination (c-statistic, 0.836) and calibration (Hosmer-Lemeshow P = 0.99) and provided a steep gradient in 30-day mortality across risk groups (<2% for patients in the 2 lowest risk quintiles and 45% in the highest risk decile). These characteristics were confirmed in the validation cohort (c-statistic, 0.828). Multiple sensitivity analyses did not find important amounts of confounding or bias. LIMITATIONS The study was confined to a single country. Participating EDs were not selected randomly. Many patients had missing data. Measurement of some risk factors was subjective. CONCLUSION This tool has excellent discrimination and calibration and was validated in a different cohort from the one that was used to develop it. Physicians can consider using this tool to inform clinical decisions as further studies are done to determine whether the tool enhances physician decision making and improves patient outcomes. PRIMARY FUNDING SOURCE Instituto de Salud Carlos III, Spanish Ministry of Health; Fundació La Marató de TV3; and Catalonia Govern.
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Affiliation(s)
- Òscar Miró
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Xavier Rossello
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Víctor Gil
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Francisco Javier Martín-Sánchez
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pere Llorens
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pablo Herrero-Puente
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Javier Jacob
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Héctor Bueno
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Stuart J Pocock
- From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
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196
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Barrabés JA, Gupta A, Porta-Sánchez A, Strait KM, Acosta-Vélez JG, D'Onofrio G, Lidón RM, Geda M, Dreyer RP, Lorenze NP, Lichtman JH, Spertus JA, Bueno H, Krumholz HM. Comparison of Electrocardiographic Characteristics in Men Versus Women ≤ 55 Years With Acute Myocardial Infarction (a Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients Substudy). Am J Cardiol 2017; 120:1727-1733. [PMID: 28865896 DOI: 10.1016/j.amjcard.2017.07.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/16/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
Young women with acute myocardial infarction (AMI) have a worse prognosis than their male counterparts. We searched for differences in the electrocardiographic presentation of men and women in a large, contemporary registry of young adults with AMI that could help explain gender differences in outcomes. The qualifying electrocardiogram was blindly assessed by a central core lab in 3,354 patients (67% women) aged 18 to 55 years included in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study. Compared with men, women did not have a different frequency of sinus rhythm, and they had shorter PR and QRS intervals and longer QTc intervals. Intraventricular conduction disturbances were not different among genders. Notably, women were more likely than men to have abnormal Q waves in anterior leads and a lower frequency of Q waves in other territories. ST-segment elevation myocardial infarction (STEMI) diagnosis was less frequent in women than in men (44.6% vs 55.1%, p < 0.001). Among patients with STEMI, women had less magnitude and extent of ST-segment elevation than men. In patients with non-STEMI, the frequency, magnitude, and extent of ST-segment depression were not different among genders, but women had anterior ST-segment depression less frequently and anterior negative T waves more frequently compared with men. These differences remained statistically significant after adjusting for baseline characteristics. In conclusion, there are significant gender differences in the electrocardiographic presentation of AMI among young patients. Further studies are warranted to evaluate their impact on gender-related differences in the management and outcomes of AMI.
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Affiliation(s)
- José A Barrabés
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain.
| | - Aakriti Gupta
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Columbia University Medical Center, New York, New York
| | - Andreu Porta-Sánchez
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - J Gabriel Acosta-Vélez
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rosa-Maria Lidón
- Coronary Unit, Cardiology Service, Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | - Mary Geda
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rachel P Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy P Lorenze
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - John A Spertus
- University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Instituto de Investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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197
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de Lorenzo-Pinto A, Bueno H. Initiatives to Achieve Excellence in the Care of Acute Coronary Syndrome. Response. Rev Esp Cardiol (Engl Ed) 2017; 70:1027-1028. [PMID: 28887125 DOI: 10.1016/j.rec.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ana de Lorenzo-Pinto
- Servicio de Farmacia, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Grupo de Farmacia Hospitalaria y Farmacogenómica, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Héctor Bueno
- Servicio de Cardiología e Instituto de investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Investigación Cardiovascular Traslacional Multidisciplinaria, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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198
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de Lorenzo-Pinto A, Bueno H. Iniciativas para conseguir una atención excelente en el síndrome coronario agudo. Respuesta. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2017.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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199
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Uzhova I, Fuster V, Fernández-Ortiz A, Ordovás JM, Sanz J, Fernández-Friera L, López-Melgar B, Mendiguren JM, Ibáñez B, Bueno H, Peñalvo JL. The Importance of Breakfast in Atherosclerosis Disease: Insights From the PESA Study. J Am Coll Cardiol 2017; 70:1833-1842. [PMID: 28982495 DOI: 10.1016/j.jacc.2017.08.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 07/24/2017] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Daily habits, including the number and quality of eating occasions, are potential targets for primary prevention strategies with large health impacts. Skipping breakfast is considered a frequent and unhealthy habit associated with an increased cardiovascular (CV) risk. OBJECTIVES The study sought to explore the association between different breakfast patterns and CV risk factors and the presence, distribution, and extension of subclinical atherosclerosis. METHODS Cross-sectional analysis was performed within the PESA (Progression of Early Subclinical Atherosclerosis) study, a prospective cohort of asymptomatic (free of CV events at baseline) adults 40 to 54 years of age. Lifestyle and multivascular imaging data along with clinical covariates were collected from 4,052 participants. Multivariate logistic regression models were used in the analysis. RESULTS Three patterns of breakfast consumption were studied: high-energy breakfast, when contributing to >20% of total daily energy intake (27% of the population); low-energy breakfast, when contributing between 5% and 20% of total daily energy intake (70% of the population); and skipping breakfast, when consuming <5% of total daily energy (3% of the population). Independent of the presence of traditional and dietary CV risk factors, and compared with high-energy breakfast, habitual skipping breakfast was associated with a higher prevalence of noncoronary (odds ratio: 1.55; 95% confidence interval: 0.97 to 2.46) and generalized (odds ratio: 2.57; 95% confidence interval: 1.54 to 4.31) atherosclerosis. CONCLUSION Skipping breakfast is associated with an increased odds of prevalent noncoronary and generalized atherosclerosis independently of the presence of conventional CV risk factors. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).
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Affiliation(s)
- Irina Uzhova
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de Enfermedades CardioVasculares, Madrid, Spain; Universidad Complutense, Madrid, Spain; Cardiovascular Institute, IDISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - José M Ordovás
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de Enfermedades CardioVasculares, Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares, Madrid, Spain
| | - Beatriz López-Melgar
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; HM Hospitales-Centro Integral de Enfermedades Cardiovasculares, Madrid, Spain
| | | | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; CIBER de Enfermedades CardioVasculares, Madrid, Spain; IIS-Fundación Jiménez Díaz Hospital, Universidad Autónoma, Madrid, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Universidad Complutense, Madrid, Spain; i+12 Research Institute and Cardiology Department, Hospital 12 de Octubre, Madrid, Spain
| | - José L Peñalvo
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
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200
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Martín-Sánchez FJ, Rodríguez-Adrada E, Vidan MT, Llopis García G, González del Castillo J, Rizzi MA, Alquezar A, Piñera P, Lázaro Aragues P, Llorens P, Herrero P, Jacob J, Gil V, Fernández C, Bueno H, Miró Ò, Pérez-Durá MJ, Gil PB, Miró Ó, Espinosa VG, Sánchez C, Aguiló S, Vall MÀP, Aguirre A, Piñera P, Aragues PL, Bordigoni MAR, Alquezar A, Richard F, Jacob J, Ferrer C, Llopis F, Sánchez FJM, del Castillo JG, Rodríguez-Adrada E, García GL, Salgado L, Mandly EA, Ortega JS, de los Ángeles Cuadrado Cenzual M, de Heredia MDIO, Soriano PL, Fernández-Cañadas JM, Carratalá JM, Javaloyes P, Puente PH, García IR, Coya MF, Fernández JAS, Andueza J, Pareja RR, del Arco C, Martín A, Torres R, Miranda BR, Martín VS, Guillén CB, Puig RP. Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure. Am J Cardiol 2017; 120:1151-1157. [PMID: 28826899 DOI: 10.1016/j.amjcard.2017.06.059] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/12/2017] [Accepted: 06/29/2017] [Indexed: 12/16/2022]
Abstract
The objectives were to determine the impact of frailty and disability on 30-day mortality and whether the addition of these variables to HFRSS EFFECT risk score (FBI-EFFECT model) improves the short-term mortality predictive capacity of both HFRSS EFFECT and BI-EFFECT models in older patients with acute decompensated heart failure (ADHF) atended in the emergency department. We performed a retrospective analysis of OAK Registry including all consecutive patients ≥65 years old with ADHF attended in 3 Spanish emergency departments over 4 months. FBI-EFFECT model was developed by adjusting probabilities of HFRSS EFFECT risk categories according to the 6 groups (G1: non frail, no or mildly dependent; G2: frail, no or mildly dependent; G3: non frail, moderately dependent; G4: frail, moderately dependent; G5: severely dependent; G6: very severely dependent).We included 596 patients (mean age: 83 [SD7]; 61.2% females). The 30-day mortality was 11.6% with statistically significant differences in the 6 groups (p < 0.001). After adjusting for HFRSS EFFECT risk categories, we observed a progressive increase in hazard ratios from groups G2 to G6 compared with G1 (reference). FBI-EFFECT had a better prognostic accuracy than did HFRSS EFFECT (log-rank p < 0.001; Net Reclassification Improvement [NRI] = 0.355; p < 0.001; Integrated Discrimination Improvement [IDI] = 0.052; p ;< 0.001) and BI-EFFECT (log-rank p = 0.067; NRI = 0.210; p = 0.033; IDI = 0.017; p = 0.026). In conclusion, severe disability and frailty in patients with moderate disability are associated with 30-day mortality in ADHF, providing additional value to HFRSS EFFECT model in predicting short-term prognosis and establishing a care plan.
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