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Cordero A, Rodríguez-Mañero M, Fácila L, Fernández-Olmo MR, Gómez-Martínez MJ, Valle A, Castellano JM, Toro MM, Seijas-Amigo J, Vicedo A, González-Juanatey JR. Prevention of myocardial infarction and stroke with PCSK9 inhibitors treatment: a metanalysis of recent randomized clinical trials. J Diabetes Metab Disord 2020; 19:759-765. [PMID: 33520801 DOI: 10.1007/s40200-020-00557-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
Purpose Proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors treatment induce large reductions in low-density lipoprotein cholesterol (LDLc) and major cardiovascular events. Clinical trials might have been underpowered to test the effect of PSCK9 inhibitors treatment on myocardial infarction and stroke, two of the most relevant cardiovascular events, since all analyzed a combined endpoint. Methods we performed a meta-analysis, with currently available studies involving PCSK9 inhibitors and event rate adjudication, with the aim of assessing treatment effects on myocardial infarction and stroke. Results We included 81,700 patients, 41,979 treated with a PSCK9 inhibitors: 17,244 with evolocumab; 13,720 with bococizumab and 11,015 with alirocumab. A total of 1,319 cases of myocardial infarctions were registered in the treatment group vs. 1,608 in controls, resulting in 19.0% reduction associated with PCSK9 treatment (RR: 0.81, 95% CI 0.76-0.87). Similarly, PCSK9 inhibitors treatment resulted in a 25% reduction of stroke (RR: 0.75, 95% CI 0.65-0.85) when all studies were analyzed together and the statistically significant heterogeneity was not observed in the analysis restricted to end-point based clinical trials. PCSK9 inhibitors treatment had no effect on mortality (RR: 0.95, 95% CI 0.86-1.04). Conclusions PCSK9 inhibitors reduce the incidence of myocardial infarction by 19% and stroke by 25%.
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Cordero A, Rodríguez-Mañero M, Bertomeu-González V, García-Acuña JM, Baluja A, Agra-Bermejo R, Álvarez-Álvarez B, Cid B, Zuazola P, González-Juanatey JR. New-onset heart failure after acute coronary syndrome in patients without heart failure or left ventricular dysfunction. ACTA ACUST UNITED AC 2020; 74:494-501. [PMID: 32448726 DOI: 10.1016/j.rec.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronary heart disease is the leading cause of heart failure (HF). The aim of this study was to assess the risk of readmission for HF in patients with acute coronary syndrome without previous HF or left ventricular dysfunction. METHODS Prospective study of consecutive patients admitted for acute coronary syndrome in 2 institutions. Risk factors for HF were analyzed by competing risk regression, taking all-cause mortality as a competing event. RESULTS We included 5962 patients and 567 (9.5%) experienced at least 1 hospital readmission for acute HF. Median follow-up was 63 months and median time to HF readmission was 27.1 months. The cumulative incidence of HF was higher than mortality in the first 7 years after hospital discharge. A higher risk of HF readmission was associated with age, diabetes, previous coronary heart disease, GRACE score> 140, peripheral arterial disease, renal dysfunction, hypertension and atrial fibrillation; a lower risk was associated with optimal medical treatment. The incidence of HF in the first year of follow-up was 2.73% and no protective variables were found. A simple HF risk score predicted HF readmissions risk. CONCLUSIONS One out of 10 patients discharged after an acute coronary syndrome without previous HF or left ventricular dysfunction had new-onset HF and the risk was higher than the risk of mortality. A simple clinical score can estimate individual risk of HF readmission even in patients without previous HF or left ventricular dysfunction.
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Jiménez Navarro M, Castro A, Ballesteros Pradas S, Cruzado Álvarez C, Gómez Doblas JJ, Marzal Martín D, del Prado S, Valencia Serrano F, Bretón I, Gómez Peralta F, Mauricio D, Soto González A, Barrios V, Cordero A, Cosin-Sales J, García-Moll X, García Pinilla JM, Jiménez Quevedo P, Núñez Villota J, Romaguera Torres R, 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, Ibáñez B, Alfonso F. Comments on the 2019 ESC guidelines on diabetes, prediabetes, and cardiovascular disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:354-360. [PMID: 32205102 DOI: 10.1016/j.rec.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
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Cordero A, Bertomeu-González V, González-Juanatey JR. The determinant effect of competing events in the analysis of heart failure incidence after myocardial infarction. Eur J Prev Cardiol 2020; 28:e1. [PMID: 33611491 DOI: 10.1177/2047487320913183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022]
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Núñez J, Llàcer P, García-Blas S, Bonanad C, Ventura S, Núñez JM, Sánchez R, Fácila L, de la Espriella R, Vaquer JM, Cordero A, Roqué M, Chamorro C, Bodi V, Valero E, Santas E, Moreno MDC, Miñana G, Carratalá A, Rodríguez E, Mollar A, Palau P, Bosch MJ, Bertomeu-González V, Lupón J, Navarro J, Chorro FJ, Górriz JL, Sanchis J, Voors AA, Bayés-Genís A. CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction. Am J Med 2020; 133:370-380.e4. [PMID: 31422111 DOI: 10.1016/j.amjmed.2019.07.041] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 06/27/2019] [Accepted: 07/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. RESULTS The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). CONCLUSION A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.
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Baluja A, Rodríguez-Mañero M, Cordero A, Kreidieh B, Iglesias-Alvarez D, García-Acuña JM, Martínez-Gómez A, Agra-Bermejo R, Alvarez-Rodríguez L, Abou-Jokh C, López-Ratón M, Gude-Sampedro F, Alvarez-Escudero J, González-Juanatey JR. Prediction of major adverse cardiac, cerebrovascular events in patients with diabetes after acute coronary syndrome. Diab Vasc Dis Res 2020; 17:1479164119892137. [PMID: 31841030 PMCID: PMC7510367 DOI: 10.1177/1479164119892137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The risk of major adverse cardiac and cerebrovascular events following acute coronary syndrome is increased in people with diabetes. Predicting out-of-hospital outcomes upon follow-up remains difficult, and no simple, well-validated tools exist for this population at present. We aim to evaluate several factors in a competing risks model for actionable evaluation of the incidence of major adverse cardiac and cerebrovascular events in diabetic outpatients following acute coronary syndrome. METHODS Retrospective analysis of consecutive patients admitted for acute coronary syndrome in two centres. A Fine-Gray competing risks model was adjusted to predict major adverse cardiac and cerebrovascular events and all-cause mortality. A point-based score is presented that is based on this model. RESULTS Out of the 1400 patients, there were 783 (55.9%) with at least one major adverse cardiac and cerebrovascular event (417 deaths). Of them, 143 deaths were due to non-major adverse cardiac and cerebrovascular events. Predictive Fine-Gray models show that the 'PG-HACKER' risk factors (gender, age, peripheral arterial disease, left ventricle function, previous congestive heart failure, Killip class and optimal medical therapy) were associated to major adverse cardiac and cerebrovascular events. CONCLUSION The PG-HACKER score is a simple and effective tool that is freely available and easily accessible to physicians and patients. The PG-HACKER score can predict major adverse cardiac and cerebrovascular events following acute coronary syndrome in patients with diabetes.
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Álvarez Álvarez B, Abou Jokh Casas C, Cordero A, Gómez ÁM, Álvarez ABC, Bermejo RA, Acuña JMG, Gude Sampedro F, Juanatey JRG. Coronariografía precoz y mortalidad a largo plazo en infarto agudo de miocardio de alto riesgo. Registro CARDIOCHUS-HUSJ. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Huanca W, Garcia K, Huanca WF, Cordero A, Malaga J. 108 Use of seminal plasma as ovulation inductor in alpacas (Vicugna pacos) embryo recipient and its effect on pregnancy rate. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Alpacas, like other camelids, are classified as induced ovulators because an external stimulus is required for the occurrence of ovulation. Recent studies have identified the β-nerve growth factor (β-NGF), a protein present in the seminal plasma (SP), as responsible for inducing ovulation in this species and having potent luteotropic function. We speculate that SP can be used in reproductive biotechnologies, such as embryo transfer (ET), to increase the number of genetically superior animals produced in breeding programs. The objective of this study was to evaluate the effect of inducing ovulation with SP or a gonadotrophin-releasing hormone (GnRH) analogue on pregnancy rate in recipients of an alpaca ET program. Semen from 5 adult male alpacas was collected with an artificial vagina and diluted 1:1 (v/v) with phosphate-buffered saline (PBS; Gibco-BRL). The diluted semen was centrifuged for 30min at 1200g, and the supernatant or SP was decanted and examined for absence of sperm. Then, the SP was centrifuged again for 20min at 1200×g. The SP was stored at −80°C until the use. Female alpacas (n=38; 6-8 years) with a body condition score of 2.5-3.5 (scale 1-5) were used for the experiment. Animals were evaluated daily by transrectal ultrasonography to determine the presence of a dominant follicle ≥7mm and randomly assigned to one of two groups: (1) GnRH (n=20), 0.04mg of Buserelin acetate IM, or (2) SP (n=18): 1.0mL of seminal plasma IM. Seven days after GnRH or SP treatment (Day 0) the recipients received a fresh embryo. Alpaca donors (n=18) were given GnRH (0.04mg IM) and treated 36h later with 700IU of equine chorionic gonadotropin (ECG). Donors were mated with fertile males 5 days after ECG (Day 0 of recipients), and embryos were recovered 7 days later. Embryos of similar quality were assigned to both groups and transferred nonsurgically to the uterine horn ipsilateral to the corpus luteum. Ultrasonography examinations were performed on Day 2 to confirm ovulation and Day 25 to determine pregnancy in all of the recipients. Data was analysed by chi-squared test. Ovulation rate was not different between groups (100% each). Pregnancy rate was 45% (9 out of 20) and 44% (8 of 18) in GnRH and SP groups, respectively (P=0.77). In conclusion, SP was effective to induce ovulation in alpacas and was able to produce a pregnancy rate similar to that of GnRH as an ovulation-inducing treatment. Thus, SP can be used as an alternative for ET programs in alpacas.
Research was funded by the project Role of Seminal Plasma in Reproductive Physiology and Application of Biotechnologies in Camelids (149-2017-CIENCIACTIVA).
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Cordero A, Fácila L, Rodríguez-Mañero M, Gómez-Martínez MJ, Bertomeu-Martínez V, González-Juanatey JR. Experiencia inicial en la práctica clínica con los inhibidores PCSK–9 para las indicaciones actuales de financiación en España. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2019.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gual M, Formiga F, Ariza-Solé A, López-Palop R, Sanchís J, Marín F, Vidán MT, Martínez-Sellés M, Sionis A, Sánchez-Salado JC, Lorente V, Díez-Villanueva P, Vives-Borrás M, Cordero A, Bueno H, Alegre O, Abu-Assi E, Cequier À. Diabetes mellitus, frailty and prognosis in very elderly patients with acute coronary syndromes. Aging Clin Exp Res 2019; 31:1635-1643. [PMID: 30671867 DOI: 10.1007/s40520-018-01118-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/31/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The magnitude of the association between diabetes (DM) and outcomes in elderly patients with acute coronary syndromes (ACS) is controversial. No study assessed the prognostic impact of DM according to frailty status in these patients. METHODS The LONGEVO-SCA registry included unselected ACS patients aged ≥ 80 years. Frailty was assessed by the FRAIL scale. We evaluated the impact of previous known DM on the incidence of death or readmission at 6 months according to status frailty by the Cox regression method. RESULTS A total of 532 patients were included. Mean age was 84.3 years, and 212 patients (39.8%) had previous DM diagnosis. Patients with DM had more comorbidities and higher prevalence of frailty (33% vs 21.9%, p = 0.002). The incidence of death or readmission at 6 months was higher in patients with DM (HR 1.52, 95% CI 1.12-2.05, p 0.007), but after adjusting for potential confounders this association was not significant. The association between DM and outcomes was not significant in robust patients, but it was especially significant in patients with frailty [HR 1.72 (1.05-2.81), p = 0.030, p value for interaction = 0.049]. CONCLUSIONS About 40% of elderly patients with ACS had previous known DM diagnosis. The association between DM and outcomes was different according to frailty status.
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Cordero A, Rodriguez Manero M, Bertomeu Gonzalez V, Agra Bermejo R, Garcia Acuna JM, Moreno Arribas J, Moreno MJ, Alvarez B, Martinez Rey-Ranal E, Bertomeu Martinez V, Gonzalez-Juanatey JR. P1223Attributable risk proportion of uncontrolled low-density lipoprotein cholesterol in recurrent acute coronary syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary heart disease is chronic condition that usually has recurrent events. Risk factors for incident coronary heart disease are well known conditions related to recurrences have not been clearly outlined. Attributable risk proportion (ARP) refers to the proportion of incident cases in subjects exposed to risk factors that are attributable to that risk factor so we analysed ARP in wide cohort of patients admitted for an acute coronary syndrome (ACS).
Methods
Cross-sectional analysis of all patients admitted in two hospitals between January 2006 and December 2016. ARP was calculated by the equation: prevalence in exposed – (prevalence in exposed/odds ratio). LDL uncontrolled was codified as >70 mg/dl in patients with previous cardiovascular disease; >100 mg/dl in patients with diabetes without previous cardiovascular disease or; >155 mg/dl in patients without cardiovascular disease.
Results
We included 7,518 patients, mean age 66.9 (12.9) years, 72.5% males, median GRACE score 143.2 (40.3) and 35.3% STEMI. Previous coronary heart disease total was present in 2,032 (23.2%) patients and they had statistically higher mean age (70.6±11.11 vs. 65.8±13.3), prevalence of diabetes (37.9% vs. 25.3%) and hypertension (72.9% vs. 53.3%) and lower smoking habit (15.5% vs. 30.9%). LDLc was lower in patients with previous coronary heart disease (90.3±33.8 vs. 111.7±38.1; p<0.01), as well as HDLc (33.5±14.29 vs. 35.9±35.5; p<0.01) and haemoglobin (13.5±3.7 vs. 14.0±2.4; p<0.01). Uncontrolled LDLc was present in 83.4% of the patients with previous coronary heart disease, in contrast to the 28.7% of patients without previous coronary heart disease; this resulted in an ARP of 13.8%. The ARP for diabetes and hypertension were 1.6% and 1.4%, respectively.
Conclusions
The proportion of attributable risk of uncontrolled LDL on recurrent ACS is 13.8% and, therefore, 1 out of every 7 recurrent ACS could be prevented by an accurate LDLc control.
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Abou Jokh Casas C, Agra Bermejo R, Cordero A, Garcia Acuna JM, Rigueiro Veloso P, Iglesias Alvarez D, Alvarez Alvarez B, Diaz B, Alvarez Rodriguez L, Roman Rego A, Cid Alvarez B, Cinza Sanjurjo S, Gonzalez Juanatey JR. P5503Long term prosnoctic benefit of complete revascularizaction in elderly non ST elevation myocardial infarction patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The benefit of complete or culprit vessel revascularization in elderly patients (>75 years) with Acute Coronary Syndrome without ST-segment elevation (NSTEMI), and multivessel disease (MVD) remains debated.
Purpose
We aimed to study the current long-term prognostic benefit of complete revascularization in an elderly population with NSTEMI and MVD.
Methods
We performed a retrospective cohort study of 1722 consecutive elderly NSTEMI patients. Baseline patient characteristics were examined and a follow-up period was established for the registry of death and first major cardiovascular event (MACE). We performed a propensity-matching analysis to draw up two groups of patients paired according to whether or not they had been completely revascularized. The prognostic value of the revascularization to predict events during follow-up was analyzed using Cox regression.
Results
Among the study participants, 30.4% (n=524) underwent complete revascularization and 69.6% (n=1198) had culprit vessel revascularization performed. Patients in these groups have different clinical and pharmacological profiles. After the propensity score analysis, the population was divided into two groups: complete revascularization (n=353) and culprit vessel revascularization (n=353).The median follow-up was 45.7 months. All cause mortality (52.1% vs 28.6%, p<0.001), cardiovascular mortality (39.1% vs 18.4%, p<0.001) and MACE rates were significantly higher in patients with incomplete revascularization compared with those with complete revascularization.
Kaplan-Meyer curves for main endpoints
Conclusion
In our study, the long-term benefit of complete revascularization in an elderly population with NSTEMI and MVD was observed.
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Martinez Rey-Ranal E, Cordero A, Moreno MJ, Bertomeu Gonzalez V, Moreno Arribas J, Pomares A, Torroba G, Bertomeu Martinez V. P1759Elevated NT-pro BNP predicts Heart Failure re-hospitalizations after an acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
NT pro-BNP is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF) and, also, with acute coronary syndrome (ACS). Nonetheless, there is scarce evidence on the predictive capacity of NT pro-BNP for HF re-admission after an ACS.
Objective
To test whether elevated values of NT pro-BNP can predict subsequent hospitalizations for HF in patients discharged after an ACS.
Methods
We performed a prospective study of all patients discharged after an ACS in a single center. HF re-admission was analysed by competing risk regression, taking all-cause mortality as a competing event, and results are presented as sub-Hazard Ratio (sHR); recurrent hospitalizations were tested by negative binomial regression and results are presented as incidence risk ratio (IRR).
Results
We included 1,679 patients, mean age 70.1 (29.7) year, 71.9% males, 41.4% STEMI and mean GRACE score 151.7 (44.4). Median NT pro-BNP was 948.2 pg/ml (IQ range 274.5–2923) and patients were divided in <300U (27.0%), 300–600 pg/ml (13.4%), 600–1000 pg/ml (10.8%) and >1000 pg/ml (46.7%) A total of 132 (5.9%) died within hospitalization and follow-up was available 98% of the patients, with a median follow-up of 33 months (IQ range 16–59). A total of 220 patients (13.1%) had at least one hospital re-admission of HF and 126 (7.5%) had more than one re-hospitalization for HF. Patients with NT pro-BNP had higher un-adjusted HF re-admissions (22.2% vs. 4.4%; p<0.01). Cardiovascular mortality increased significantly in each category of NT pro-BNP (3.8%; 8.0%; 7.7%; 18.5%) as well as all-cause mortality (0.1%; 12.4%; 11.6%; 25.3%), first HF readmission (2.7%; 7.1%; 5.5%; 23.5%); patients with NT pro-BNP had higher rates of recurrent HF readmissions: 11.6/1000 vs. 2.4/1000 patients/years (p<0.01). Multivariate analyses, adjusted by age, gender, GRACE score, left ventricle ejection fraction, revascularization and medical treatments at discharge, identified that NT pro-BNP >1000 pg/ml was associated to HF re-hospitalization (sHR: 2.60 95% CI 1.12–5.95) and recurrent hospitalizations (IRR: 1.10 95% CI 1.04–1.14).
Conclusions
NT pro-BNP >1000 pg/ml is an accurate risk factor for first and recurrent HF rehospitalisations after an ACS.
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Cordero A, Facila L, Rodriguez-Manero M, Gomez-Martinez M, Bertomeu-Gonzalez V, Martinez R, Seijas S, Valle A, Moreno-Arribas J, Agra-Bermejo R, Martin Toro M, Bertomeu Martinez V, Gonzalez Juanatey JR. 5132Effect of PCSK9 inhibitors treatment on acute coronary syndrome and stroke incidence: a metanalysis of currently available clinical trials. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors have demonstrated to induce large reductions in low-density lipoprotein cholesterol (LDLc) and major cardiovascular events but none of the studies was statistically powered to demonstrate reductions in specific endpoints rather than a combined end-point of major cardiovascular events.
Methods
We performed an intention-to-treat meta-analysis in line with recommendations from the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement using currently available studies involving PCSK9 inhibitors. The endpoint assessed were acute coronary syndrome (ACS) and stroke.
Results
We included 81,544 patients, 41,147 treated with a PSCK9 inhibitors: 17,179 with evolocumab; 13,718 with bococizumab and 10,250 with alirocumab (table 1). A total of 1,316 ACS were registered in the treatment group vs. 1,608 in controls, resulting in 18.0% reduction associated with PCSK9 treatment (figure 1). This result was reproduced exactly in the EBCT althougt a non-significant heterogeneity was detected (p=0.052). Metaregression analyses did not demonstrate the implication of the study (p=0.45), study drugs (p=0.26), age (p=0.89), hypertension (p=0.81) or diabetes (p=0.81) on such result.
Results on stroke incidence are presented in figure 2. PCSK9 inhibitors treatment resulted in a 24% reduction of stroke when all studies were analyzed together; heterogeneity was statistically significant (p=0.021) but it was not observed in the EBCT analysis where PCSK9 inhibitors were associated with 24% stroke incidence reduction.
Conclusions
The meta-analysis of currently available studies demonstrates that PCSK9 inhibitors treatment reduces the incidence of ACS by 18% and stroke by 24%.
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Cordero A, Bertomeu-González V, Moreno-Arribas J, Marco A, Sánchez A, Pomares A, Torroba G, Martínez Rey-Rañal E, Moreno MJ, Quiles J, Valero R, Bertomeu-Martínez V. Ventajas de la guardia de cardiología en un hospital secundario en el tratamiento de los pacientes con síndrome coronario agudo. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.rccl.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Cordero A, Bertomeu Martínez V. Causes of Higher In-hospital Mortality Due to ACS in the Canary Islands and Possible Solutions. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:443-444. [PMID: 30862428 DOI: 10.1016/j.rec.2018.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
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Raposeiras Roubín S, Cordero A. La relación bidireccional entre el cáncer y la ateroesclerosis. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Cordero A, Fácila L, Galve E, González Juanatey JR. Estimación del porcentaje de pacientes con enfermedad coronaria estable candidatos a recibir inhibidores de la PCSK9. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cordero A, Bertomeu Martínez V. Causas de la mayor mortalidad hospitalaria por IAM en Canarias y sus posibles soluciones. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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95
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Álvarez Álvarez B, Abou Jokh Casas C, Cordero A, Martínez Gómez Á, Cid Álvarez AB, Agra Bermejo R, García Acuña JM, Gude Sampedro F, González Juanatey JR. Early revascularization and long-term mortality in high-risk patients with non-ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry. ACTA ACUST UNITED AC 2019; 73:35-42. [PMID: 31122784 DOI: 10.1016/j.rec.2019.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/27/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. METHODS This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. RESULTS Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The darly strategy showed a nonsignificant inverse tendency in patients with GRACE score <140. CONCLUSIONS In high-risk (GRACE score≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.
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Cordero A, Fácila L, Rodríguez-Mañero M, Gómez-Martínez MJ, Bertomeu-Martínez V, González-Juanatey JR. Initial Real-World Experience With PCSK-9 Inhibitors in Current Indications for Reimbursement in Spain. ACTA ACUST UNITED AC 2019; 72:968-970. [PMID: 31103377 DOI: 10.1016/j.rec.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/25/2019] [Indexed: 10/26/2022]
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Raposeiras Roubín S, Cordero A. The Two-way Relationship Between Cancer and Atherosclerosis. ACTA ACUST UNITED AC 2019; 72:487-494. [PMID: 31053376 DOI: 10.1016/j.rec.2018.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/14/2018] [Indexed: 01/10/2023]
Abstract
In the last few years, there has been growing interest in the relationship between cancer and cardiovascular disease. The increase in life expectancy in both diseases has led to their frequent coexistence in the same patient, which can lead to adverse drug reactions that increase patient risk. This is especially relevant in the case of atherosclerosis, which seems to share a common pathophysiological substrate with cancer. In this review, we analyze these common risk factors, and specifically analyze the relationship between different cancer treatments with the risk of coronary or cerebrovascular disease, as well as the current scientific evidence on the possible relationship between antiplatelet therapy and cancer risk. We also review the incidence and prognosis of cancer in patients with atherosclerosis and vice versa, based on the information reported in the most recently published studies in the field of cardio-oncology.
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Cordero A, Fácila L, Galve E, González Juanatey JR. Estimated Percentage of Patients With Stable Coronary Heart Disease Candidates for PCSK9 Inhibitors. ACTA ACUST UNITED AC 2019; 72:518-519. [PMID: 30981589 DOI: 10.1016/j.rec.2018.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/25/2022]
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99
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Rodríguez-Mañero M, López-Pardo E, Cordero A, Ruano-Ravina A, Novo-Platas J, Pereira-Vázquez M, Martínez-Gómez Á, García-Seara J, Martínez-Sande JL, Peña-Gil C, Mazón P, García-Acuña JM, Valdés-Cuadrado L, González-Juanatey JR. A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population. Int J Chron Obstruct Pulmon Dis 2019; 14:371-380. [PMID: 30863038 PMCID: PMC6388772 DOI: 10.2147/copd.s174443] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Patients with COPD are at higher risk of presenting with atrial fibrillation (AF). Information about clinical outcomes and optimal medical treatment of AF in the setting of COPD remains missing. We aimed to describe the prevalence of COPD in a sizeable cohort of real-world AF patients belonging to the same healthcare area and to examine the relationship between comorbid COPD and AF prognosis. Methods Prospective analysis performed in a specific healthcare area. Data were obtained from several sources within the “data warehouse of the Galician Healthcare Service” using multiple analytical tools. Statistical analyses were completed using SPSS 19 and STATA 14.0. Results A total of 7,990 (2.08%) patients with AF were registered throughout 2013 in our healthcare area (n=348,985). Mean age was 76.83±10.51 years and 937 (11.7%) presented with COPD. COPD patients had a higher mean CHA2DS2-VASc (4.21 vs 3.46; P=0.02) and received less beta-blocker and more digoxin therapy than those without COPD. During a mean follow-up of 707±103 days, 1,361 patients (17%) died. All-cause mortality was close to two fold higher in the COPD group (28.3% vs 15.5%; P<0.001). Independent predictive factors for all-cause mortality were age, heart failure, diabetes, previous thromboembolic event, dementia, COPD, and oral anticoagulation (OA). There were nonsignificant differences in thromboembolic events (1.7% vs 1.5%; P=0.7), but the rate of hemorrhagic events was significantly higher in the COPD group (3.3% vs 1.9%; P=0.004). Age, valvular AF, OA, and COPD were independent predictive factors for hemorrhagic events. In COPD patients, age, heart failure, vasculopathy, lack of OA, and lack of beta-blocker use were independent predictive factors for all-cause mortality. Conclusion AF patients with COPD have a higher incidence of adverse events with significantly increased rates of all-cause mortality and hemorrhagic events than AF patients without COPD. However, comorbid COPD was not associated with differences in cardiovascular death or stroke rate. OA and beta-blocker treatment presented a risk reduction in mortality while digoxin use exerted a neutral effect.
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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. Comentarios a la guía ESC/ESH 2018 sobre el diagnóstico y tratamiento de la hipertensión arterial. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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