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Cordero A, Cid-Alvarez B, Monteiro P, García-Acuña JM, Gonçalves F, Escribano D, Trillo R, Alvarez-Alvarez B, Gonçalves L, Bertomeu-Gonzalez V, González-Juanatey JR. Applicability of the Zwolle score for selection of very high-risk ST-elevation myocardial infarction patients treated with primary angioplasty. Angiology 2024; 75:175-181. [PMID: 36408662 DOI: 10.1177/00033197221139915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The Zwolle risk score was designed to stratify in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI) and for decision-making in the unit where patients are admitted. We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation compared with the GRACE score in all patients (n = 4446) admitted for STEMI in 3 university hospitals. Only one fourth of the patients were classified as high-risk by the Zwolle risk score vs 60% by the GRACE score. In-hospital mortality was 10.6%. A statistically significant increase in in-hospital mortality, adjusted by age, gender, and revascularization, was observed with both scores. The assessment of the optimal cut-off points verified the accuracy of Zwolle score ≥4 as optimal threshold for high-risk categorization. In contrast, GRACE score ≥140 had very low specificity as well as percentage of patients correctly classified; GRACE score ≥175 was fairly better. The reclassification index of the Zwolle score after applying the GRACE score was 35.5%. Selection of high-risk STEMI patients treated with pPCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful in clinical practice.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan Alicante, Spain
- Unidad de Investigación de Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Belén Cid-Alvarez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Pedro Monteiro
- Cardiology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Jose M García-Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Fernando Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - David Escribano
- Cardiology Department, Hospital Universitario de San Juan Alicante, Spain
- Unidad de Investigación de Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Spain
| | - Ramiro Trillo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Belén Alvarez-Alvarez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Vicente Bertomeu-Gonzalez
- Cardiology Department, Hospital Universitario de San Juan Alicante, Spain
- Unidad de Investigación de Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
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2
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Cordero A, Cid-Alvarez B, Alegría E, Fernández-Cisnal A, Escribano D, Bautista J, Juskova M, Trillo R, Bertomeu-Gonzalez V, Ferreiro JL. Multicenter and all-comers validation of a score to select patients for manual thrombectomy, the DDTA score. Catheter Cardiovasc Interv 2021; 98:E342-E350. [PMID: 33829625 DOI: 10.1002/ccd.29689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/08/2021] [Accepted: 03/24/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Routine manual thrombectomy (MT) is not recommended in primary percutaneous coronary intervention (P-PCI) but it is performed in many procedures. The objective of our study was validating the DDTA score, designed for selecting patients who benefit most from MT. METHODS Observational and multicenter study of all consecutive patients undergoing P-PCI in five institutions. Results were compared with the design cohort and the performance of the DDTA was analyzed in all patients. Primary end-point of the analyses was TIMI 3 after MT; secondary endpoints were final TIMI 3, no-reflow incidence, in-hospital mortality and in-hospital major cardiovascular events (MACE). In-hospital prognosis was assessed by the Zwolle risk score. RESULTS Three hundred forty patients were included in the validation cohort and no differences were observed as compared to the design cohort (618 patients) except for lower use of MT and higher IIb/IIIa inhibitors or drug-eluting stents. The probability of TIMI 3 after MT decreased as delay to P-PCI was higher. If DDTA score, MT was associated to TIMI 3 after MT (OR: 4.11) and final TIMI 3 (OR: 2.44). There was a linear and continuous relationship between DDTA score and all endpoints. DDTA score ≥ 4 was independently associated to lower no-reflow, in-hospital MACE or mortality. The lowest incidence of in-hospital mortality or MACE was in patients who had DDTA score ≥ 4 and Zwolle risk score 0-3. CONCLUSIONS MT is associated to higher rate of final TIMI3 in patients with the DDTA score ≥ 4. Patients with DDTA score ≥ 4 had lower no-reflow and in-hospital complications.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.,Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Belén Cid-Alvarez
- Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospitalario de Santiago, Santiago de Compostela, Santiago, Spain
| | - Eduardo Alegría
- Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - David Escribano
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
| | - Jenniffer Bautista
- Cardiology Department, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Juskova
- Cardiology Department, Complejo Hospitalario de Santiago, Santiago de Compostela, Santiago, Spain
| | - Ramiro Trillo
- Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospitalario de Santiago, Santiago de Compostela, Santiago, Spain
| | | | - José Luis Ferreiro
- Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Spain
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3
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Solís-Marquínez MN, Rondán-Murillo JJ, Pérez-Otero M, Vegas-Valle JM, Lozano Martínez-Luengas Í, Morís-de la Tassa J. Impact of creating a haemodynamics room, a coronary unit and a primary angioplasty programme on the prognosis of acute coronary syndrome in a district hospital. Rev Clin Esp 2021; 221:187-197. [PMID: 32113647 DOI: 10.1016/j.rce.2019.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program METHODS: We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432). RESULTS There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). CONCLUSIONS With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events and mortality.
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Affiliation(s)
- M N Solís-Marquínez
- Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, España.
| | - J J Rondán-Murillo
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, España
| | - M Pérez-Otero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - J M Vegas-Valle
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, España
| | | | - J Morís-de la Tassa
- Servicio de Medicina Interna, Hospital Universitario de Cabueñes, Gijón, España; Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, España
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4
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Cubero-Gallego H, Avanzas P. Implementation of a primary angioplasty programme in a hospital district: moving towards the future. Rev Clin Esp 2021; 221:226-227. [PMID: 32473726 DOI: 10.1016/j.rce.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/22/2022]
Affiliation(s)
- H Cubero-Gallego
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | - P Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, España; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España; Departamento de Medicina, Universidad de Oviedo, Oviedo, España.
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5
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Impact of creating a hemodynamics room, a coronary care unit, and a primary angioplasty program on the prognosis of acute coronary syndrome in a district hospital. Rev Clin Esp 2021; 221:187-197. [PMID: 33998497 DOI: 10.1016/j.rceng.2019.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/20/2019] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This work aims to analyze the prognosis and mortality of patients hospitalized for acute coronary syndrome before and after the implementation of a coronary care unit, hemodynamics room, and the Código Corazón [Infarction Code] primary angioplasty program. METHODS We conducted an observational, retrospective study that analyzed the epidemiological characteristics, reperfusion strategies, adverse cardiovascular events, and mortality over a follow-up period of five years. The results from the post-code period (March 1 - December 31, 2012; n=471) were compared with those from the pre-code period (March 1 - December 31, 2009; n=432). RESULTS There were no differences in the baseline characteristics of the two groups. However, an increase in ST-elevation acute coronary syndrome (STE-ACS) from 17.6% to 34.8% (p<.001) was observed during the postcode phase. The use of percutaneous coronary intervention was made widespread at the hospital and was used in 64.8% of non-ST-elevation acute coronary syndrome (NSTE-ACS) cases and in 95.5% of STE-ACS cases. A reduction was observed in readmissions (from 38.2% to 25.1% for NSTE-ACS (p=.001) and from 23.7% to 11.0% for STE-ACS (p=.018)), the composite prognostic variable of adverse cardiovascular events and 5-year mortality (from 58.7% to 45% (p=.001) for NSTE-ACS and from 40.8% to 23.8% (p=.009) for STE-ACS), and a decrease in 30-day mortality in STE-ACS (from 11.8% to 3.7%; p=.021). CONCLUSIONS With the structural changes in the hospital, the use of percutaneous coronary intervention was made widespread and improved the prognosis of patients with acute coronary syndrome, decreasing admissions, adverse cardiovascular events, and mortality.
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6
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Cubero-Gallego H, Avanzas P. Implementation of a primary angioplasty program in a district hospital: Moving towards the future. Rev Clin Esp 2021; 221:226-227. [PMID: 33998502 DOI: 10.1016/j.rceng.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Héctor Cubero-Gallego
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain.
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7
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Cordero A, Freites A, Escribano D, Bertomeu-Martínez V, Zuazola P, Badimon L. A simple score to select patients for manual thrombectomy in emergent percutaneous coronary interventions: the DDTA score. J Cardiovasc Med (Hagerstown) 2020; 21:595-602. [PMID: 32520860 DOI: 10.2459/jcm.0000000000000992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of manual thrombectomy is the removal of occlusive thrombus to improve the results of primary angioplasty. The better understanding of the factors associated with successful manual thrombectomy may provide relevant information regarding thrombus formation and resolution. METHODS Observational study of all consecutive patients remitted for emergent percutaneous coronary intervention (PCI) in a single centre. Successful manual thrombectomy was considered when TIMI 3 was achieved after using the device and a score to predict successful manual thrombectomy was designed. RESULTS We included 618 patients, 65.1% treated with manual thrombectomy. No relevant differences in clinical features or time delays were observed between patients treated with vs. without manual thrombectomy, but manual thrombectomy treated patients received more often dual antiplatelet treatment (DAPT) before PCI. Final TIMI flow 3 was achieved in most patients and more frequently in manual thrombectomy treated patients (94.8 vs. 86.6%; P < 0.01). The successful manual thrombectomy rate was 81.3% and it was higher in patients pretreated with DAPT (89.0 vs. 73.3%; P < 0.01). The time delay to first medical contact was not related to the final TIMI 3, but it was significantly and negatively related to successful manual thrombectomy. According to the multivariate analysis, we designed the DDTA score: DAPT pretreatment (2), delay less than 2 h (3) or 2-4 h (2), TIMI flow improvement after wiring the lesion (2) and age less than 55 years (3). Patients with DDTA score at least 4 had lower no-reflow, mortality and major cardiovascular complications incidence. CONCLUSION The DDTA score (DAPT pretreatment, time delays, TIMI flow improvement after wiring the lesion and age) identifies patients who benefit mostly from manual thrombectomy.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid
| | - Alfonso Freites
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante
| | - David Escribano
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante
| | | | - Pilar Zuazola
- Cardiology Department, Hospital Universitario de San Juan, San Juan de Alicante, Alicante
| | - Lina Badimon
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid.,Institut Català de Ciències Cardiovasculars (ICCC), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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8
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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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9
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Martín Cabeza MM, Jorge Pérez P, García González MJ. In-hospital Mortality Due to Acute Myocardial Infarction in the Canary Islands. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:516-517. [PMID: 30448027 DOI: 10.1016/j.rec.2018.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/27/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Marta María Martín Cabeza
- Servicio de Cardiología, Complejo Hospitalario Universitario de Canarias, La Laguna, Tenerife, Spain.
| | - Pablo Jorge Pérez
- Servicio de Cardiología, Complejo Hospitalario Universitario de Canarias, La Laguna, Tenerife, Spain
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10
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Martín Cabeza MM, Jorge Pérez P, García González MJ. Mortalidad hospitalaria por infarto agudo de miocardio en Canarias. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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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]
Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Vicente Bertomeu Martínez
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
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12
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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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13
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Prevalence, long-term prognosis and medical alternatives for patients admitted for acute coronary syndromes and prasugrel contraindication. Int J Cardiol 2018; 270:36-41. [DOI: 10.1016/j.ijcard.2018.06.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 02/07/2023]
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14
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Agra-Bermejo R, Cordero A, Rodríguez-Mañero M, García Acuña JM, Álvarez Álvarez B, Martínez Á, Álvarez Rodríguez L, Abou-Jokh C, Cid Álvarez B, González-Juanatey JR. Clinical impact of mineralocorticoid receptor antagonists treatment after acute coronary syndrome in the real world: A propensity score matching analysis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:652-659. [PMID: 30117745 DOI: 10.1177/2048872618795422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent studies suggest that the benefit of mineralocorticoid receptor antagonists in the acute coronary syndrome setting is controversial. The aim of this study was to examine the current long-term prognostic benefit of mineralocorticoid receptor antagonists in patients with acute coronary syndrome. MATERIAL AND METHODS We conducted a retrospective cohort study of 8318 consecutive acute coronary syndrome patients. Baseline patient characteristics were examined and a follow-up period was established for registry of death, major cardiovascular adverse events and heart failure re-hospitalization. We performed a propensity-matching analysis to draw up two groups of patients paired according to whether or not they had been treated with mineralocorticoid receptor antagonists. The prognostic value of mineralocorticoid receptor antagonists to predict events during follow-up was analysed using Cox regression. RESULTS Among the study participants, only 524 patients (6.3%) were discharged on mineralocorticoid receptor antagonists. Patients on mineralocorticoid receptor antagonists had a different clinical and pharmacological profile. These differences disappeared after the propensity score analysis. The median follow-up was 40.7 months. After the propensity score analysis, the cardiovascular mortality and heart failure readmission rates were similar between patients who were discharged on mineralocorticoid receptor antagonists and those whose not. The use of mineralocorticoid receptor antagonists was only associated with a reduction in major cardiovascular adverse events (hazard ratio=0.83, 95% confidence interval 0.69-0.97, p=0.001). CONCLUSIONS Our results do not corroborate the long-term benefit of mineralocorticoid receptor antagonists to improve survival after acute coronary syndrome in a large cohort of patients with heart failure or reduced left ventricular ejection fraction and diabetes. Their prescription was associated with a significantly lower incidence of major cardiovascular adverse events during the long-term follow-up without effect on heart failure development.
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Affiliation(s)
- Rosa Agra-Bermejo
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.,Cardiology Department, Hospital Universitario de San Juan, Spain
| | - Moisés Rodríguez-Mañero
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jose M García Acuña
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Belén Álvarez Álvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Álvaro Martínez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain
| | | | - Charigan Abou-Jokh
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain
| | - Belén Cid Álvarez
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jose Ramón González-Juanatey
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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15
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Cordero A, Bertomeu-González V, Moreno-Arribas J, Castillo J, Quiles J, Bertomeu-Martinez V. Prognosis and lipid profile improvement by a specialized outpatient clinic for acute coronary syndrome patients. Atherosclerosis 2018; 275:28-34. [PMID: 29852402 DOI: 10.1016/j.atherosclerosis.2018.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/19/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Prognosis variations in patients discharged after an acute coronary syndrome (ACS) according to the professionals involved has not been clearly outlined. The aim of our study was to assess the impact on a specific outpatient clinic (SOC). METHODS We included all consecutive patients admitted for an ACS in a single center. We performed a propensity score matching with all patients discharged from hospital according to whether they were referred to the SOC or not. RESULTS From the 1822 patients discharged, 260 couples of well-balanced ACS patients were obtained after propensity score matching. Median follow-up was 43.3 months and cardiovascular mortality rate was 10.4%, all-cause mortality was 13.9% and any MACE 38.2%. Patients attended the SOC had significantly lower rates at all three endpoints. Multivariate analysis results showed how the follow-up in the SOC was associated with significantly lower risk at all endpoints. SOC patients also had significantly lower rate at hospital readmissions and the multivariate analysis identified a negative association between the first cardiovascular readmission and SOC (sHR: 0.26 95%CI 0.18-0.367; p < 0.01). Mean LDLc levels at the time of ACS admission was 99.0 (36.7) mg/dl and no difference was observed in patients referred to SOC vs. non-referred. Patients followed at the SOC achieved significantly lower LDLc and higher percentage of LDLc <70 mg/dl (56.7% vs. 36.7%; p < 0.01). SOC follow-up was associated with 44% higher probability of final LDLc <70 mg/dl. CONCLUSIONS An SOC for ACS patients was independently associated with higher LDLc control and long-term survival.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Vicente Bertomeu-González
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Moreno-Arribas
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jesús Castillo
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Juan Quiles
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
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Cordero A, López-Palop R, Carrillo P, Frutos A, Bertomeu-Martínez V. Adición de antianginosos y complicaciones cardiovasculares recurrentes asociadas a la revascularización incompleta en el síndrome coronario agudo. Rev Esp Cardiol (Engl Ed) 2018. [DOI: 10.1016/j.recesp.2017.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Seguridad y eficacia clínica con prasugrel y ticagrelor en síndrome coronario agudo. Resultados de un registro multicéntrico en el mundo real. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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18
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Asociación de la presencia de placa carotídea en la aparición de eventos cardiovasculares en pacientes con hipercolesterolemias genéticas. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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19
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Safety and Efficacy of Prasugrel and Ticagrelor in Acute Coronary Syndrome. Results of a "Real World" Multicenter Registry. ACTA ACUST UNITED AC 2017; 70:952-959. [PMID: 28576388 DOI: 10.1016/j.rec.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/07/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the "real world" remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). METHODS A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015. In-hospital rates of major cardiovascular events and bleeding with NAA vs clopidogrel were analyzed using propensity score matching and multivariate regression models. RESULTS The study included 2906 patients: 55% received clopidogrel and 45% NAA. A total of 60% had ST-segment elevation ACS. Use of NAA significantly increased throughout the study. Patients receiving clopidogrel were older and were more likely to have comorbidities. Total mortality, ischemic stroke, and stent thrombosis were lower with NAA (2% vs 9%, P < .0001; 0.1% vs 0.5%, P = .025; 0.07% vs 0.5%, P = .025, respectively). There were no differences in the rate of total bleeding (3% vs 4%; P = NS). After propensity score matching, the mortality reduction with NAA persisted (OR, 0.37; 95%CI, 0.13 to 0.60; P < .0001) with no increase in total bleeding (OR, 1.07; 95%CI, 0.18 to 2.37; P = .094). CONCLUSIONS In a "real world" setting, NAA are selectively used in younger patients with less comorbidity and are associated with a reduction in major cardiac events, including mortality, without increasing bleeding compared with clopidogrel.
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Addition of Antiangina Drugs and Recurrent Cardiovascular Events Associated With Incomplete Revascularization in Acute Coronary Syndrome. ACTA ACUST UNITED AC 2017; 71:217-219. [PMID: 28461148 DOI: 10.1016/j.rec.2017.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/27/2017] [Indexed: 11/23/2022]
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21
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Association Between the Presence of Carotid Artery Plaque and Cardiovascular Events in Patients With Genetic Hypercholesterolemia. ACTA ACUST UNITED AC 2017; 70:551-558. [PMID: 28215923 DOI: 10.1016/j.rec.2017.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/17/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES The equations used in the general population to calculate cardiovascular risk are not useful in genetic hypercholesterolemia (GH). Carotid plaque detection has proved useful in cardiovascular prediction and risk reclassification but there have been no studies of its usefulness in GH. The aim of this study was to determine the association between the presence of carotid artery plaque and the occurrence of cardiovascular events in patients with GH. METHODS This study included 1778 persons with GH. The mean follow-up until the occurrence of cardiovascular events was 6.26 years. At presentation, the presence of carotid artery plaque was studied by high-resolution ultrasound. RESULTS Carotid artery plaque was found in 661 (37.2%) patients: 31.9% with familial hypercholesterolemia, 39.8% with familial combined hyperlipidemia, 45.5% with dysbetalipoproteinemia, and 43.2% with polygenic hypercholesterolemia. During follow-up, 58 patients had a cardiovascular event. Event rates were 6354/100 000 (95%CI, 4432.4-8275.6) in the group with plaque and 1432/100 000 (95%CI, 730.6-2134.3) in the group without plaque, with significant differences between the 2 groups (P < .001). The relative risk of an event was 4.34 (95CI%, 2.44-7.71; P < .001) times higher in patients with plaque and was 2.40 (95%CI, 1.27-4.56; P = .007) times higher after adjustment for major risk factors. The number of carotid artery plaques was positively associated with the risk of cardiovascular events. CONCLUSIONS Most cardiovascular events occur in a subgroup of patients who can be identified by carotid plaque detection. These results support the use of plaque screening in this population and should help in risk stratification and treatment in GH.
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Cordero A, Carrillo P, López-Palop R. Letter by Cordero et al Regarding Article, "Regional Systems of Care Demonstration Project: American Heart Association Mission: Lifeline STEMI Systems Accelerator". Circulation 2016; 134:e700-e701. [PMID: 27956406 DOI: 10.1161/circulationaha.116.025304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alberto Cordero
- From Cardiology Department, Interventional Cardiology Division, Hospital Universitario de San Juan, Alicante, Spain
| | - Pilar Carrillo
- From Cardiology Department, Interventional Cardiology Division, Hospital Universitario de San Juan, Alicante, Spain
| | - Ramón López-Palop
- From Cardiology Department, Interventional Cardiology Division, Hospital Universitario de San Juan, Alicante, Spain
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¿La implantación del código infarto implica cambios en el tratamiento y el pronóstico de los pacientes con síndrome coronario agudo sin elevación del ST? Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jurado Román A, Sánchez Pérez I, López Lluva MT, Lozano Ruiz-Poveda F. Does Implementation of the Infarction Code Lead to Changes in the Treatment and Prognosis of Patients With Non-ST Elevation Acute Coronary Syndrome? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:1236-1237. [PMID: 28134097 DOI: 10.1016/j.rec.2016.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/23/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Alfonso Jurado Román
- Unidad de Hemodinámica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | - Ignacio Sánchez Pérez
- Unidad de Hemodinámica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - María T López Lluva
- Unidad de Hemodinámica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Cordero A, Carrillo P, Frutos A, López-Palop R. Does Implementation of the Infarction Code Lead to Changes in the Treatment and Prognosis of Patients With Non-ST Elevation Acute Coronary Syndrome? Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:1237. [PMID: 28134098 DOI: 10.1016/j.rec.2016.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
| | - Pilar Carrillo
- Departamento de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Araceli Frutos
- Departamento de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Ramón López-Palop
- Departamento de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
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Cordero A, Carrillo P, Frutos A, López-Palop R. ¿La implantación del código infarto implica cambios en el tratamiento y el pronóstico de los pacientes con síndrome coronario agudo sin elevación del ST? Respuesta. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2016.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Efecto dominó en la calidad asistencial: mejorar un aspecto de una enfermedad puede mejorar todo el espectro. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lidón RM. Domino Effect in Quality of Care: Improving One Aspect of a Disease Can Improve Its Entire Spectrum. ACTA ACUST UNITED AC 2016; 69:730-1. [PMID: 27349878 DOI: 10.1016/j.rec.2016.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/27/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Rosa-Maria Lidón
- Servicio de Cardiología, Hospital General Universitario Vall d'Hebron, Barcelona, Spain.
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