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Salamanca J, García-Guimaraes M, Sabaté M, Sanz-Ruiz R, Macaya F, Roura G, Jimenez-Kockar M, Nogales JM, Tizón-Marcos H, Velazquez M, Veiga G, Gamarra A, Aguilar R, Jiménez-Borreguero LJ, Díez-Villanueva P, Bastante T, Núñez-Gil I, Alfonso F. Non-atherosclerotic acute cardiac syndromes: spontaneous coronary artery dissection and Takotsubo syndrome. Comparison of long-term clinical outcomes. Coron Artery Dis 2024; 35:50-58. [PMID: 37990625 DOI: 10.1097/mca.0000000000001304] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two common causes of nonatherosclerotic acute cardiac syndrome particularly frequent in women. Currently, there is no information comparing long-term clinical outcomes in unselected patients with these conditions. METHODS We compared the baseline characteristics, in-hospital outcomes, and the 12-month and long-term clinical outcomes of two large prospective registries on SCAD and TTS. RESULTS A total of 289 SCAD and 150 TTS patients were included; 89% were women. TTS patients were older with a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients, while emotional triggers and depressive disorders were more common in the SCAD group. Left ventricular ejection fraction was lower in TTS patients, but SCAD patients showed higher cardiac biomarkers. In-hospital events (43.3% vs. 5.2%, P <0.01) occurred more frequently in TTS patients. TTS patients also presented more frequent major adverse events at 12-month (14.7% vs. 7.1%, HR 5.3, 95% CI: 2.4-11.7, P <0.01) and long-term (median 36 vs. 31 months, P =0.41) follow-up (25.8% vs. 9.6%, HR 4.5, 95% CI: 2.5-8.2, P <0.01). Atrial fibrillation was also more frequent in TTS patients. Moreover, TTS patients presented a higher 12-month and long-term mortality (5.6% vs. 0.7%, P =0.01; and 12.6% vs. 0.7%, P <0.01) mainly driven by noncardiovascular deaths. CONCLUSION Compared to SCAD, TTS patients are older and present more cardiovascular risk factors but less frequent depressive disorder or emotional triggers. TTS patients have a worse in-hospital, mid-term, and long-term prognosis with higher noncardiac mortality than SCAD patients.
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Affiliation(s)
- Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Marcos García-Guimaraes
- Department of Cardiology, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida
| | - Manel Sabaté
- Department of Cardiology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge
| | | | | | | | - Maite Velazquez
- Department of Cardiology, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBER-CV, Madrid
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria IDIVAL, Santander, Spain
| | - Alvaro Gamarra
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Rio Aguilar
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Luis Jesús Jiménez-Borreguero
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Pablo Díez-Villanueva
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Iván Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
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Jurado-Román A, Freixa X, Cid B, Cruz-González I, Sarnago Cebada F, Baz JA, Lozano Í, Sabaté M, Jiménez J, Íñigo García LA, Subinas Elorriaga A, Berenguer Jofresa A, Novo García E, Pérez Vizcayno MJ, Carrillo Suárez X, Pinar Bermúdez E, Calviño Santos R, Álvarez Antón S, Trillo Nouche R, Ruíz Arroyo JR, Fernández Cisnal A, Amat-Santos IJ, Jerez Valero M, Rama Merchán JC, Vaquerizo B, Tejada Ponce D, Ruiz Nodar JM, Sánchez Pérez I, Tejedor P, Elizaga J, Jiménez Cabrera FM, Bullones Ramírez JA, Sánchez Aquino R, Portero Pérez MP, Roura G, Mohandes M, Sáez Moreno R, Avanzas P, Caballero J, Torres Bosco AM, Merchán Herrera A, Robles Alonso J, Bosa Ojeda F, García San Román K, Agudelo VH, Martin Lorenzo P, Fernández JC, Pérez de Prado A, Ruiz Quevedo V, Cruz González I, Moreu Burgos J, Ruiz García J, Sánchez Burguillos FJ, Núñez Pernas D, Baello Monge P, Hernando Marrupe L, Franco Peláez JA, Jurado Román A, Pomar Domingo F, Fuertes Ferre G, Pimienta González R, Morales Ponce FJ, Sánchez Recalde Á, Ojeda Pineda S, Frutos Garcia A, Millán Segovia R, Fajardo Molina R, Díez Gil JL, Guisado Rasco A, Gómez Menchero AE, Bosch E, Oteo Domínguez JF, Gutiérrez-Barrios A, Cascón Pérez JD, Casanova Sandoval JM, Fernández Portales J, Rivero Crespo F, Gonzalez Caballero E, Ocaranza Sánchez R, Zueco J, García Del Blanco B, Alonso Briales JH, Sánchez Gila J, Vizcaino Arellano M, Carballo Garrido J, Andraka L, Gómez Jaume A, Merino Otermin Á, Artaiz Urdaci M, Arellano Serrano C, Íñigo García LA, García E, Unzué L, Ruiz Nodar JM, Arzamendi D, Freixa X, Mainar V, Usón M, Palazuelos Molinero J, López Palop R, Bethencourt A, Alegría Barrero E, Camacho Freire SJ, Peña G, Vázquez Álvarez ME, Muñoz Camacho JF, Ramírez Moreno A, Larman Tellechea M, García de la Borbolla Fernández R. Spanish cardiac catheterization and coronary intervention registry. 32nd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2022). Rev Esp Cardiol (Engl Ed) 2023; 76:1021-1031. [PMID: 37863184 DOI: 10.1016/j.rec.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. METHODS All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. RESULTS A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. CONCLUSIONS The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.
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Affiliation(s)
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Belén Cid
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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- Hospital Universitario Ramón y Cajal, Hospital Universitario Sanitas La Moraleja, Hospital Universitario Sanitas Zarzuela
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Alfonso F, Sanz-Ruiz R, Sabate M, Roura G, Velazquez M, Macaya F, Veiga G, Camacho-Freire S, Bastante T, García-Guimaraes M. Clinical Implications of TIMI Flow Grade 0/1 in Patients With Spontaneous Coronary Artery Dissection. JACC Cardiovasc Interv 2023; 16:2061-2063. [PMID: 37480894 DOI: 10.1016/j.jcin.2023.06.028] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
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Gomez-Lara J, Gracida M, Rivero F, Gutiérrez-Barrios A, Muntané-Carol G, Romaguera R, Fuentes L, Marcano A, Roura G, Ferreiro JL, Teruel L, Brugaletta S, Alfonso F, Comín-Colet J, Gomez-Hospital JA. Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia: The Randomized RAIN-FLOW Study. J Am Heart Assoc 2023:e030285. [PMID: 37345805 DOI: 10.1161/jaha.123.030285] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background ST-segment-elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 mL/min via a dedicated microcatheter causes (flow-mediated) hyperemia. The objective is to compare the efficacy of pharmacologic versus flow-mediated hyperemia in patients with ST-segment-elevation myocardial infarction complicated with no reflow. Methods and Results In the RAIN-FLOW (Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia) study, 67 patients with ST-segment-elevation myocardial infarction and no reflow were randomized to receive either pharmacologic-mediated hyperemia with intracoronary adenosine or nitroprusside (n=30) versus flow-mediated hyperemia (n=37). The angiographic corrected Thrombolysis in Myocardial Infarction frame count and the minimal microcirculatory resistance, as assessed with intracoronary pressure-thermistor wire, dedicated microcatheter, and thermodilution techniques, were compared after study interventions. Both Thrombolysis in Myocardial Infarction frame count(40.2±23.1 versus 39.2±20.7; P=0.858) and minimal microcirculatory resistance (753.6±661.5 versus 993.3±740.8 Wood units; P=0.174) were similar between groups. Thrombolysis in Myocardial Infarction 3 flow was observed in 26.7% versus 27.0% (P=0.899). Flow-mediated hyperemia showed 2 different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In-hospital death and nonfatal heart failure were observed in 10.4% and 26.9%, respectively. Conclusions Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow-mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in patients with ST-segment-elevation myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04685941.
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Affiliation(s)
- Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Montserrat Gracida
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Fernando Rivero
- Hospital Universtiario La Princesa, Instituto de Investigación Sanitaria-IP (IIS-IP), CIBER-CV Madrid Spain
| | | | - Guillem Muntané-Carol
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Lara Fuentes
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Ana Marcano
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Gerard Roura
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - José Luis Ferreiro
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Luis Teruel
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Salvatore Brugaletta
- Hospital Clínic i Provincial de Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
| | - Fernando Alfonso
- Hospital Universtiario La Princesa, Instituto de Investigación Sanitaria-IP (IIS-IP), CIBER-CV Madrid Spain
| | - Josep Comín-Colet
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
| | - Joan-Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L' Hospitalet de Llobregat Barcelona Spain
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Díez-Villanueva P, García-Guimarães M, Sanz-Ruiz R, Sabaté M, Macaya F, Roura G, Jimenez-Kockar M, Flores-Ríos X, Moreu J, Fuertes-Ferre G, Jimenez-Valero S, Tizón H, Nogales JM, Velázquez M, Lozano Í, Avanzas P, Salamanca J, Bastante T, Alfonso F. Prognostic implications of left ventricular systolic dysfunction in patients with spontaneous coronary artery dissection. Eur Heart J Acute Cardiovasc Care 2023; 12:299-305. [PMID: 37010101 DOI: 10.1093/ehjacc/zuad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome. Clinical features, angiographic findings, management, and outcomes of SCAD patients who present reduced left ventricular ejection fraction (LVEF) remain unknown. METHODS AND RESULTS The Spanish multicentre prospective SCAD registry (NCT03607981), included 389 consecutive patients with SCAD. In 348 of these patients, LVEF could be assessed by echocardiography during the index admission. Characteristics and outcomes of patients with preserved LVEF (LVEF ≥50%, n = 295, 85%) were compared with those with reduced LVEF (LVEF <50%, n = 53, 15%). Mean age was 54 years and 90% of patients in both groups were women. The most frequent clinical presentation in patients with reduced LVEF was ST-segment elevation myocardial infarction (STEMI) (62% vs. 36%, P < 0.001), especially anterior STEMI. Proximal coronary segment and multi-segment involvement were also significantly more frequent in these patients. No differences were found on initial revascularization between groups. Patients with reduced LVEF significantly received more often neurohormonal antagonist therapy, and less frequently aspirin. In-hospital events were more frequent in these patients (13% vs. 5%, P = 0.01), with higher rates of death, cardiogenic shock, ventricular arrhythmia, and stroke. During a median follow-up of 28 months, the occurrence of a combined adverse event did not statistically differ between the two groups (19% vs. 12%, P = 0.13). However, patients with reduced LVEF had higher mortality (9% vs. 0.7%, P < 0.001) and readmission rates for heart failure (HF) (4% vs. 0.3%, P = 0.01). CONCLUSION Patients with SCAD and reduced LVEF show differences in clinical characteristics and angiographic findings compared with SCAD patients with preserved LVEF. Although these patients receive specific medications at discharge, they had higher mortality and readmission rates for HF during follow-up.
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Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Marcos García-Guimarães
- Servicio de Cardiología, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain
| | - Ricardo Sanz-Ruiz
- Servicio de Cardiología, CIBERCV, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manel Sabaté
- Servicio de Cardiología, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fernando Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Xacobe Flores-Ríos
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Jose Moreu
- Servicio de Cardiología, Hospital General Universitario de Toledo, Toledo, Spain
| | | | | | - Helena Tizón
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | | | - Maite Velázquez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Íñigo Lozano
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Pablo Avanzas
- Servicio de Cardiología, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain
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Salamanca J, García-Guimarães M, Sabaté M, Sanz-Ruiz R, Macaya F, Roura G, Jimenez-Kockar M, Nogales JM, Tizón-Marcos H, Velazquez-Martín M, Veiga G, Camacho-Freire S, Pérez-Guerrero A, Flores-Rios X, Alvarado T, Díez-Villanueva P, Del Val D, Bastante T, Alfonso F. Multivessel spontaneous coronary artery dissection: Clinical features, angiographic findings, management, and outcomes. Int J Cardiol 2023; 370:65-71. [PMID: 36370874 DOI: 10.1016/j.ijcard.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Multivessel (MV) SCAD is a challenging clinical presentation that might be associated to a worse prognosis compared with patients with single-vessel (SV) involvement. METHODS The Spanish multicentre nationwide prospective SCAD registry included 389 consecutive patients. Patients were classified, according to the number of affected vessels, in SV or MV SCAD. Major adverse events (MAE) were analyzed during hospital stay and major cardiac or cerebrovascular adverse events (MACCE) at long-term clinical follow-up. RESULTS A total of 41 patients (10.5%) presented MV SCAD. These patients had more frequently a previous history of hypothyroidism (22% vs 11%, p = 0.04) and anxiety disorder (32% vs 16%, p = 0.01). MV SCAD patients presented more often as non-ST segment elevation myocardial infarction (73% vs 52%, p = 0.01) and showed less frequently type 1 angiographic lesions (12% vs 21%, p = 0.04). An impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0-1 was less frequent (14% vs 29%, p < 0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p = NS). No differences were found regarding in-hospital MAE or MACCE at late follow-up (median 29 ± 11 months). However, the rate of stroke was higher in MV SCAD patients, both in-hospital (2.4% vs 0%, p < 0.01) and at follow-up (5.1% vs 0.6%, p = 0.01). CONCLUSIONS Patients with MV SCAD have some distinctive clinical and angiographic features. Although composite clinical outcomes, in-hospital and at long-term follow-up, were similar to those seen in patients with SV SCAD, stroke rate was significantly higher in patients with MV SCAD.
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Affiliation(s)
- Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marcos García-Guimarães
- Department of Cardiology, Hospital del Mar - Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Manel Sabaté
- Department of Cardiology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar - Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), ISCIII, Madrid, Spain
| | - Maite Velazquez-Martín
- Department of Cardiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBER-CV, Madrid, Spain
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario de Marqués de Valdecilla, Cantabria, Spain
| | | | - Ainhoa Pérez-Guerrero
- Department of Cardiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Xacobe Flores-Rios
- Department of Cardiology, Complexo Hospitalario Universitario de A Coruña, Spain
| | - Teresa Alvarado
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pablo Díez-Villanueva
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain.
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Marcano AL, Gracida M, Roura G, Gomez-Lara J, Romaguera R, Teruel L, Fuentes L, Muntané-Carol G, Meroño O, Sosa SG, Gómez-Hospital JA, Comin-Colet J, Ferreiro JL. Antiplatelet efficacy of ticagrelor versus clopidogrel in Mediterranean patients with diabetes mellitus and chronic coronary syndromes: A crossover pharmacodynamic investigation. Front Cardiovasc Med 2022; 9:1057331. [DOI: 10.3389/fcvm.2022.1057331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
IntroductionPatients with diabetes mellitus (DM) have augmented platelet reactivity and diminished responsiveness to clopidogrel. Ticagrelor, a more potent P2Y12 inhibitor, is clinically superior to clopidogrel in acute coronary syndromes, although its role in chronic coronary syndromes (CCS) is still the subject of debate. The aim of this investigation was to compare the pharmacodynamic effectiveness of ticagrelor and clopidogrel in Mediterranean DM patients with CCS.Materials and methodsIn this prospective, randomized, crossover study, patients (n = 20) were randomized (1:1) to receive, on top of aspirin therapy, either ticagrelor 180 mg loading dose (LD)/90 mg maintenance dose (MD) b.i.d. or clopidogrel 600 mg LD/75 mg MD o.d. for 1 week in a crossover fashion with a 2–4 week washout period between regimens. Platelet function measurements were performed at 4 timepoints in each period (baseline, 2 h and 24 h after LD, and 1 week), including light transmission aggregometry (LTA, primary endpoint), VASP assay, Multiplate and VerifyNow P2Y12.ResultsThe ticagrelor LD achieved greater platelet inhibitory effect than clopidogrel LD, assessed with LTA (20 μM ADP as agonist), at 2 h (34.9 ± 3.9% vs. 63.6 ± 3.9%; p < 0.001) and 24 h (39.4 ± 3.5% vs. 52.3 ± 3.8%; p = 0.014). After 1 week of therapy, platelet reactivity was again significantly inferior with ticagrelor compared to clopidogrel (30.7 ± 3.0% vs. 54.3 ± 3.0%; p < 0.001). The results were consistent with the other platelet function assays employed.ConclusionIn Mediterranean patients with DM and CCS, ticagrelor provides a more potent antiplatelet effect than clopidogrel after the LD and during the maintenance phase of therapy.Clinical trial registration[ClinicalTrials.gov], identifier [NCT02457130].
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8
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Salamanca Viloria J, Garcia-Guimaraes M, Sabate M, Sanz-Ruiz R, Macaya F, Roura G, Jimenez-Kockar M, Nogales JM, Tizon H, Velazquez M, Veiga G, Bastante T, Alvarado T, Diez-Villanueva P, Alfonso F. Multivessel spontaneous coronary artery dissection: clinical features, angiographic findings, management, and outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. The rate of SCAD patients with multivessel (MV) involvement varies between series (6–13%)1,2. MV SCAD might be potentially associated to a worse prognosis due to a higher ischemic burden compared with patients with single-vessel (SV) involvement. However, comparative data between patients with MV versus SV SCAD is lacking.
Methods
The Spanish multicentre nationwide SCAD registry prospectively included 389 consecutive patients from 34 university hospitals. Patients were classified according to the number of affected vessels in two groups: SV or MV SCAD. In-hospital major adverse event (MAE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, cardiogenic shock, ventricular arrhythmia or stroke. A major cardiac or cerebrovascular adverse event (MACCE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, SCAD recurrence or stroke.
Results
A total of 41 patients (10.5%) presented MV SCAD (Table 1). There were no significant differences between groups regarding age, sex and distribution of most cardiovascular risk factors, with a non-significant trend towards more hypertension in the MV group (49% vs 34%, p=0.06). MV SCAD patients had more often previous history of hypothyroidism (22% vs 11%, p=0.04) and anxiety disorder (32% vs 16%, p=0.01), with a trend towards more fibromuscular dysplasia (50% vs 29%, p=0.12) among those patients screened. MV SCAD patients presented more often with NSTEMI (73% vs 52%, p=0.01). Regarding angiographic findings, MV SCAD patients presented more frequently focal type 3 lesions (19% vs 6%, p<0.01) and fewer type 1 double-lumen lesions (12% vs 21%, p=0.04). The rate of lesions with an impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0–1 was lower (14% vs 29%, p<0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p=NS). We found no significant differences between groups in MAE during admission. At long-term follow-up (median 29 months), there were no significant differences in MACCE between groups (18% vs 12%, p=0.28). However, the rate of stroke was higher in patients with MV SCAD, both in-hospital (2.4% vs 0%, p<0.01) and at follow-up (5.1% vs 0.6%, p=0.01). This finding could be explained by the basal differences found in hypertension and fibromuscular dysplasia between MV and SV SCAD patients.
Conclusions
Patients with MV SCAD have some distinctive clinical and angiographic features. We found no significant differences in our primary composite outcomes, both in-hospital and at long-term follow-up, between patients with SV and MV SCAD. Rate of stroke was significantly higher in patients with MV SCAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - M Sabate
- Hospital Clinic of Barcelona , Barcelona , Spain
| | - R Sanz-Ruiz
- Gregorio Maranon University General Hospital - Madrid Health Service , Madrid , Spain
| | - F Macaya
- Hospital Clinico San Carlos , Madrid , Spain
| | - G Roura
- University Hospital of Bellvitge , Barcelona , Spain
| | | | - J M Nogales
- University Hospital of Badajoz , Badajoz , Spain
| | - H Tizon
- Hospital del Mar , Barcelona , Spain
| | - M Velazquez
- University Hospital 12 de Octubre , Madrid , Spain
| | - G Veiga
- University Hospital Marques de Valdecilla , Santander , Spain
| | - T Bastante
- University Hospital La Princesa , Madrid , Spain
| | - T Alvarado
- University Hospital La Princesa , Madrid , Spain
| | | | - F Alfonso
- University Hospital La Princesa , Madrid , Spain
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9
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Ribera A, Marsal JR, Faixedas MT, Rosas A, Tizón-Marcos H, Rojas S, Labata C, Cárdenas M, Homs S, Tomás-Querol C, García-Picart J, Roura G, Masotti M, Mauri J, Pijoan JI, Barrabés JA, Ferreira-González I. Revascularized ST-segment elevation myocardial infarction. Temporal trends in contemporary therapies and impact on outcomes. Rev Esp Cardiol (Engl Ed) 2022; 75:659-668. [PMID: 34887210 DOI: 10.1016/j.rec.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES To assess, in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention, the pace of introduction in clinical practice (2010-2017) of drug-eluting stents (DES), ticagrelor, prasugrel, and prolonged dual antiplatelet therapy (DAPT) duration, and their potential impact on the risk of 2-year outcomes. METHODS Prospective and exhaustive community-wide cohort of 14 841 STEMI patients undergoing primary percutaneous intervention between 2010 and 2017. Index episodes were obtained from the Catalan Codi IAM Registry, events during follow-up from the Minimum Data Set and DAPT were defined by pharmacy dispensation. Follow-up was 24 months. The temporal trend for exposures and outcomes was assessed using regression models. RESULTS Age> 65 years, diabetes, renal failure, previous heart failure, and need for anticoagulation at discharge were more frequent in later periods (P <.001). From 2010 to 2017, the use of DES increased from 31.1% to 69.8%, ticagrelor from 0.1% to 28.6%, prasugrel from 1.5% to 23.8%, and the median consecutive months on DAPT from 2 to 10 (P <.001 for all). Adjusted analysis showed a temporal trend to a lower risk of the main outcome over time: the composite of death, acute myocardial infarction, stroke and repeat revascularization (absolute odds reduction 0.005% each quarter; OR, 0.995; 95%CI, 0.99-0.999; P=.028). The odds of all individual components except stroke were reduced, although significance was only reached for revascularization. CONCLUSIONS Despite a strong increase between 2010 and 2017 in the use and duration of DAPT and the use of ticagrelor, prasugrel and DES, there was no substantial reduction in major cardiovascular outcomes.
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Affiliation(s)
- Aida Ribera
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Josep R Marsal
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Alba Rosas
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Sergio Rojas
- Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - Carlos Labata
- Servicio de Cardiología, Hospital German Trias i Pujol, Barcelona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Josep Trueta, Girona, Spain
| | - Silvia Homs
- Servicio de Cardiología, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
| | | | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital de Bellvitge, Barcelona, Spain
| | - Mónica Masotti
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Josepa Mauri
- Servicio de Cardiología, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universidad Rovira Virgili, Tarragona, Spain
| | - José Ignacio Pijoan
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Unidad de Epidemiología Clínica, Hospital Universitario Cruces/Instituto de Investigación BioCruces-Bizkaia, Barakaldo, Bizkaia, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Ignacio Ferreira-González
- Servicio de Cardiología, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
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10
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Garcia-Guimaraes M, Masotti M, Sanz-Ruiz R, Macaya F, Roura G, Nogales JM, Tizón-Marcos H, Velázquez-Martin M, Veiga G, Flores-Ríos X, Abdul-Jawad Altisent O, Jimenez-Kockar M, Camacho-Freire S, Moreu J, Ojeda S, Santos-Martinez S, Sanz-Garcia A, Del Val D, Bastante T, Alfonso F. Clinical outcomes in spontaneous coronary artery dissection. Heart 2022; 108:1530-1538. [PMID: 35410894 DOI: 10.1136/heartjnl-2022-320830] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/22/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort. METHODS The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analysed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. RESULTS After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47-60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17-38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE. CONCLUSIONS In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE. TRIAL REGISTRATION NUMBER NCT03607981.
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Affiliation(s)
- Marcos Garcia-Guimaraes
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Monica Masotti
- Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Helena Tizón-Marcos
- Department of Cardiology, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Maite Velázquez-Martin
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Xacobe Flores-Ríos
- Department of Cardiology, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Omar Abdul-Jawad Altisent
- Department of Cardiology, Hospital Clínic, Barcelona, Spain.,Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Jose Moreu
- Department of Cardiology, Hospital General Universitario de Toledo, Toledo, Spain
| | - Soledad Ojeda
- Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain
| | - Sandra Santos-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ancor Sanz-Garcia
- Data Analysis Unit, Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain .,Instituto de Investigación Sanitaria del Hospital de la Princesa (IIS-IP), Madrid, Spain
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11
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De Luca G, Nardin M, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov ZD, Cercek M, Jensen LO, Loh PH, Calmac L, Roura G, Quadros AS, Milewski M, Uccio FSD, von Birgelen C, Pessah G, Tuccillo B, Cortese G, Parodi G, Bouragdha M, Kedhi E, Lamelas P, Suryapranata H, Verdoia M. IMPACT OF RENIN-ANGIOTENSIN SYSTEM INHIBITORS ON MORTALITY DURING THE COVID PANDEMIC AMONG DIABETIC PATIENTS WITH STEMI UNDERGOING MECHANICAL REPERFUSION: INSIGHT FROM AN INTERNATIONAL STEMI REGISTRY. J Am Coll Cardiol 2022. [PMCID: PMC8972610 DOI: 10.1016/s0735-1097(22)03090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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De Luca G, Nardin M, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov ZD, Cercek M, Jensen LO, Loh PH, Calmac L, Roura G, Quadros AS, Milewski M, Uccio FSD, von Birgelen C, Pessah G, Tuccillo B, Cortese G, Parodi G, Bouragdha M, Kedhi E, Lamelas P, Suryapranata H, Verdoia M. IMPACT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON SHORT-TERM OUTCOME IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION DURING COVID-19 PANDEMIC: INSIGHTS FROM THE INTERNATIONAL MULTICENTER ISACS-STEMI REGISTRY. J Am Coll Cardiol 2022. [PMCID: PMC8972453 DOI: 10.1016/s0735-1097(22)03084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Alfonso F, García-Guimaraes M, Alvarado T, Sanz-Ruiz R, Roura G, Amat-Santos IJ, Abdul-Jawad Altisent O, Tizón-Marcos H, Flores-Ríos X, Masotti M, Pérez-de Prado A, Ferre GF, Ruiz-Poveda FL, Valero E, Portero-Portaz JJ, Diez-Villanueva P, Salamanca J, Bastante T, Rivero F. Clinical implications of arterial hypertension in patients with spontaneous coronary artery dissection. Coron Artery Dis 2022; 33:75-80. [PMID: 33878074 DOI: 10.1097/mca.0000000000001043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown. OBJECTIVE This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD. METHODS The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension. RESULTS One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension. CONCLUSION Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).
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Affiliation(s)
- Fernando Alfonso
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Marcos García-Guimaraes
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Teresa Alvarado
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Ricardo Sanz-Ruiz
- Cardiac Department, Hospital General Universitario Gregorio Marañón, IIS-GM, CIBERCV, Madrid
| | - Gerard Roura
- Cardiac Department, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona
| | | | | | - Helena Tizón-Marcos
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Xacobe Flores-Ríos
- Cardiac Department, Complexo Hospitalario Universitario de A Coruña, A Coruña
| | - Mónica Masotti
- Cardiac Department, Hospital Clinic de Barcelona, Barcelona
| | | | | | | | | | | | - Pablo Diez-Villanueva
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Jorge Salamanca
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Teresa Bastante
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
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Romaguera R, Ojeda S, Cruz-González I, Moreno R, Guisado Rasco A, Gutiérrez-Barrios A, Gómez-Menchero A, Morales Ponce FJ, Sánchez Burguillos FJ, Oneto J, Caballero Borrego J, Sánchez Gila J, Bullones Ramírez JA, Fernández JC, Alonso Briales JH, Íñigo García LA, Vizcaíno Arellano M, Fajardo Molina R, Ojeda S, Ramírez-Moreno A, Suárez de Lezo J, García-Borbolla Fernández R, Camacho Freire SJ, Ballesteros Pradas SM, Lozano I, Avanzas P, Bango MJ, Bosa Ojeda F, Jiménez Cabrera FM, Martin Lorenzo P, Pimienta González R, Rihawi ZK, Zueco J, Sánchez Pérez I, Jiménez-Mazuecos J, Novo García E, Moreu Burgos J, Pérez de Prado A, Cruz-González I, Amat-Santos IJ, Robles Alonso J, Vaquerizo B, García del Blanco B, Bosch Peligero E, Roura G, Mohandes M, Bassaganyas J, Casanova-Sandoval JM, Sabaté M, Carrillo Suárez X, García Picart J, Muñoz Camacho JF, Carballo Garrido J, Sanchis J, Berenguer Jofresa A, Planas del Viejo AM, Frutos García A, Pomar Domingo F, Torres Saura F, Díez Gil JL, Ruiz Nodar JM, Jerez Valero M, Aguar P, Tejedor P, López Palop R, Mainar V, Merchán Herrera A, Fernández Portales J, Rama Merchán JC, Baz JA, Trillo Nouche R, Calviño Santos R, Ocaranza R, Peña G, Gómez Jaume A, Bethencourt A, Vera Pernasetti L, Portero Pérez MP, Sánchez-Recalde Á, Rivero Crespo F, Sarnago Cebada F, Elízaga J, Franco Peláez JA, Oteo Domínguez JF, García JR, Hernando Marrupé L, Pérez Vizcayno MJ, Moreno R, Sánchez-Aquino González R, Álvarez Antón S, Rubio Alonso B, Macaya C, Alegría Barrero E, García E, Hernández Hernández F, Palazuelos Molinero J, Unzué L, Vázquez Álvarez ME, Pinar Bermúdez E, Lacunza Ruiz FJ, Ruiz Quevedo V, Artaiz Urdaci M, Torres Bosco AM, Subinas Elorriaga A, Garcia San Román K, Saez Moreno R, Andraka L, Larman Tellechea M, Diarte de Miguel JA, Ruiz Arroyo JR. Spanish Cardiac Catheterization and Coronary Intervention Registry. 30th Official Report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2020) in the year of the COVID-19 pandemic. Revista Española de Cardiología (English Edition) 2021; 74:1095-1105. [PMID: 34782287 PMCID: PMC8552543 DOI: 10.1016/j.rec.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022]
Abstract
Introduction and objectives The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2020, the year of the coronavirus disease (COVID-19) pandemic. Methods All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC. Results A total of 123 centers participated (4 more than 2019), of which 83 were public and 40 were private. Diagnostic coronary angiograms decreased by 9.4%, percutaneous coronary interventions by 10.1%, primary percutaneous coronary interventions by 4.1%, transcatheter aortic valve replacements by 0.9%, and left atrial appendage closure by 8.3%. The only procedures that increased with respect to previous years were edge-to-edge mitral valve repair (13.8%) and patent foramen ovale closure (19.4%). The use of pressure wire (5.5%), intravascular imaging devices and plaque preparation devices decreased (with the exception of lithotripsy, which increased by 62%). Conclusions In the year of the COVID-19 pandemic, the registry showed a marked drop in activity in all procedures except for percutaneous mitral valve repair and patent foramen ovale closure. This decrease was less marked than previously described, suggesting a rebound in interventional activity after the first wave.
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15
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Gomez-Lara J, Oyarzabal L, Ortega-Paz L, Brugaletta S, Romaguera R, Salvatella N, Roura G, Rivero F, Fuentes L, Alfonso F, Otaegui I, Vandeloo B, Vaquerizo B, Sabate M, Comin-Colet J, Gomez-Hospital JA. Coronary Endothelium-Dependent Vasomotor Function After Drug-Eluting Stent and Bioresorbable Scaffold Implantation. J Am Heart Assoc 2021; 10:e022123. [PMID: 34729992 PMCID: PMC8751934 DOI: 10.1161/jaha.121.022123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early generation drug-eluting stents (DESs) showed a high grade of coronary endothelial dysfunction that was attributed to lack of stent reendothelialization. Endothelium-dependent vasomotor response of current DESs and bioresorbable scaffolds (BRSs) remains unknown. This study sought to assess the device-related endothelial function of current devices and to correlate neointima healing with endothelial function. Methods and Results A total of 206 patients from 4 randomized trials treated with the durable-polymer everolimus-eluting Xience (n=44), bioresorbable-polymer sirolimus-eluting Orsiro (n=35), polymer-free biolimus-eluting Biofreedom (n=24), bioactive endothelial-progenitor cell-capturing sirolimus-eluting Combo DES (n=25), polymer-based everolimus-eluting Absorb (n=44), and Mg-based sirolimus-eluting Magmaris BRS (n=34) underwent endothelium-dependent vasomotor tests and optical coherence tomography imaging, as per protocol, at follow-up. Crude vasomotor responses of distal segments to low-dose acetylcholine (10-6 mol/L) were different between groups: bioresorbablepolymer DEShad the worst (-8.4%±12.6%) and durable-polymer DES had the most physiologic (-0.4%±11.8%; P=0.014). High-dose acetylcholine (10-4 mol/L) showed similar responses between groups (ranging from -10.8%±11.6% to -18.1%±15.4%; P=0.229). Device healing was different between devices. Uncovered struts ranged from 6.3%±7.1% (bioresorbable-polymer DES) to 2.5%±4.5% (bioactive DES; P=0.056). In multivariate models, endothelium-dependent vasomotor response was associated with age, bioresorbable-polymer DES, and angiographic lumen loss, but not with strut coverage nor plaque type. Endothelial dysfunction (defined as ≥4% vasoconstriction) was observed in 46.6% of patients with low-dose and 68.9% with high-dose acetylcholine, without differences between groups. Conclusions At follow-up, endothelial dysfunction was frequently observed in distal segments treated with current stents without remarkable differences between devices. Although neointima healing was different between devices, poor healing was not associated with endothelial dysfunction.
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Affiliation(s)
- Josep Gomez-Lara
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Loreto Oyarzabal
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Luis Ortega-Paz
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Salvatore Brugaletta
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Rafael Romaguera
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Neus Salvatella
- Heart Disease Research Group Mar Hospital, Biomedical Research Institute of Mar Hospital (IMIM) Barcelona Spain
| | - Gerard Roura
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Fernando Rivero
- University Hospital of La Princesa Health Resaerch Institute of La Princesa; CIBER-CV Madrid Spain
| | - Lara Fuentes
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Fernando Alfonso
- University Hospital of La Princesa Health Resaerch Institute of La Princesa; CIBER-CV Madrid Spain
| | - Imanol Otaegui
- Interventional Cardiology Department University Hospital of Vall Hebron Barcelona Spain
| | - Bert Vandeloo
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain.,Department of Cardiology Heart and Vascular Disease Center, Universty Hospital of Brussels Brussels Belgium
| | - Beatriz Vaquerizo
- Heart Disease Research Group Mar Hospital, Biomedical Research Institute of Mar Hospital (IMIM) Barcelona Spain
| | - Manel Sabate
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Josep Comin-Colet
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Joan-Antoni Gomez-Hospital
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
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16
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Romaguera R, Salinas P, Gomez-Lara J, Brugaletta S, Gómez-Menchero A, Romero MA, García-Blas S, Ocaranza R, Bordes P, Kockar MJ, Salvatella N, Jiménez-Díaz VA, Alameda M, Trillo R, Lee DH, Martín P, López-Benito M, Freites A, Pascual-Tejerino V, Hernández-Hernández F, García Del Blanco B, Mohandes M, Bosa F, Pinar E, Roura G, Comin-Colet J, Fernández-Ortiz A, Macaya C, Rossello X, Sabate M, Pocock SJ, Gómez-Hospital JA. Amphilimus- versus zotarolimus-eluting stents in patients with diabetes mellitus and coronary artery disease (SUGAR trial). Eur Heart J 2021; 43:1320-1330. [PMID: 34735004 PMCID: PMC8970998 DOI: 10.1093/eurheartj/ehab790] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
Aim Patients with diabetes mellitus are at high risk of adverse events after percutaneous revascularization, with no differences in outcomes between most contemporary drug-eluting stents. The Cre8 EVO stent releases a formulation of sirolimus with an amphiphilic carrier from laser-dug wells, and has shown clinical benefits in diabetes. We aimed to compare Cre8 EVO stents to Resolute Onyx stents (a contemporary polymer-based zotarolimus-eluting stent) in patients with diabetes. Methods and results We did an investigator-initiated, randomized, controlled, assessor-blinded trial at 23 sites in Spain. Eligible patients had diabetes and required percutaneous coronary intervention. A total of 1175 patients were randomly assigned (1:1) to receive Cre8 EVO or Resolute Onyx stents. The primary endpoint was target-lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target-lesion revascularization at 1-year follow-up. The trial had a non-inferiority design with a 4% margin for the primary endpoint. A superiority analysis was planned if non-inferiority was confirmed. There were 106 primary events, 42 (7.2%) in the Cre8 EVO group and 64 (10.9%) in the Resolute Onyx group [hazard ratio (HR): 0.65, 95% confidence interval (CI): 0.44–0.96; P
non-inferiority < 0.001; P
superiority = 0.030]. Among the secondary endpoints, Cre8 EVO stents had significantly lower rate than Resolute Onyx stents of target-vessel failure (7.5% vs. 11.1%, HR: 0.67, 95% CI: 0.46–0.99; P = 0.042). Probable or definite stent thrombosis and all-cause death were not significantly different between groups. Conclusion In patients with diabetes, Cre8 EVO stents were non-inferior to Resolute Onyx stents with regard to target-lesion failure composite outcome. An exploratory analysis for superiority at 1 year suggests that the Cre8 EVO stents might be superior to Resolute Onyx stents with regard to the same outcome. Clinical trial registration ClinicalTrials.gov: NCT03321032.
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Affiliation(s)
- Rafael Romaguera
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | - Pablo Salinas
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Josep Gomez-Lara
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | - Sergio García-Blas
- Hospital Clínico Universitario de Valencia, Valencia, Spain. INCLIVA. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)
| | | | | | | | | | | | - Mar Alameda
- Hospital Universitario Son Espases - IDISBA, Mallorca, Spain
| | | | - Dae Hyun Lee
- Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | - Gerard Roura
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | - Josep Comin-Colet
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | - Antonio Fernández-Ortiz
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Hospital Universitario Son Espases - IDISBA, Mallorca, Spain.,Centro Nacional de Investigaciones Cardiovaculares (CNIC), Madrid, Spain.,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Manel Sabate
- Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Stuart J Pocock
- Centro Nacional de Investigaciones Cardiovaculares (CNIC), Madrid, Spain
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17
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Díez-Villanueva P, García-Guimaraes M, Sanz-Ruiz R, Roura G, Macaya F, Barahona Alvarado JC, Tizón-Marcos H, Flores-Ríos X, Masotti M, Lezcano-Pertejo C, Cortés C, Fuertes-Ferre G, Becerra-Muñoz VM, Lozano Ruiz-Poveda F, Valero E, Portero-Portaz JJ, Vera A, Salamanca J, Alfonso F. Spontaneous coronary artery dissection in old patients: clinical features, angiographic findings, management and outcome. Eur Heart J Acute Cardiovasc Care 2021; 10:926-932. [PMID: 33620451 DOI: 10.1093/ehjacc/zuaa029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/20/2020] [Accepted: 10/29/2020] [Indexed: 06/12/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome. Clinical features, angiographic findings, management and outcomes of SCAD in old patients (>65 years of age) remain unknown. METHODS AND RESULTS The Spanish multicentre prospective SCAD registry (NCT03607981), included 318 consecutive patients with SCAD. Data were collected between June 2015 and April 2019. All angiograms were analysed in a centralized corelab. For the purposes of this study, patients were classified according to age in two groups <65 and ≥65 years old and in-hospital outcomes were analysed. Fifty-five patients (17%) were ≥65 years old (95% women). Older patients had more often hypertension (76% vs. 29%, P < 0.01) and dyslipidaemia (56% vs. 30%, P < 0.01), and less previous (4% vs. 18%, P < 0.001) or current smoking habit (4% vs. 33%, P < 0.001). An identifiable trigger was less often present in old patients (27% vs. 43%, P = 0.028). They also had more often severe coronary tortuosity (36% vs. 11%, P = 0.036) and showed more frequently coronary ectasia (24% vs. 9%, P < 0.01). Older patients were more often managed conservatively (89% vs. 75%, P = 0.025), with no significant differences in major adverse cardiac events during index admission (7% vs. 8%, P = 0.858). There were no differences between groups in terms of in-hospital stay, new acute myocardial infarction, unplanned coronary angiography or heart failure. CONCLUSION Older patients with SCAD show different clinical and angiographic characteristics compared with younger patients. Initial treatment strategy was different between groups, though in-hospital outcomes do not significantly differ (NCT03607981).
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Affiliation(s)
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar - Parc de Salut Mar, Barcelona, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Ricardo Sanz-Ruiz
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, Spain
| | - Fernando Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, IdISSC and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar - Parc de Salut Mar, Barcelona, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
| | - Xacobe Flores-Ríos
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Mónica Masotti
- Servicio de Cardiología, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Carlos Cortés
- Servicio de Cardiología, Hospital San Pedro de Logroño, Logroño, Spain
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Víctor Manuel Becerra-Muñoz
- Unidad de Gestión Clínica Área del Corazón, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Málaga, Spain
| | | | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | | | - Alberto Vera
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Madrid, Spain
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18
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Romaguera R, Roura G, Ruiz-Majoral A, Sánchez-Recalde Á, Díez-López C, Fontes-Caramé D, Comin-Colet J, Gómez-Hospital JA. First Bicaval Valve Implantation in a Heart Transplant Patient to Treat Severe Symptomatic Tricuspid Regurgitation. Circ Heart Fail 2021; 14:e008491. [PMID: 34657439 DOI: 10.1161/circheartfailure.121.008491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rafael Romaguera
- Cardiology Department, Bellvitge University Hospital-Bellvitge Biomedical Research Institute, University of Barcelona, Spain (R.R., G.R., A.R.-M., C.D.-L., J.C.-C., J.A.G.-H.)
| | - Gerard Roura
- Cardiology Department, Bellvitge University Hospital-Bellvitge Biomedical Research Institute, University of Barcelona, Spain (R.R., G.R., A.R.-M., C.D.-L., J.C.-C., J.A.G.-H.)
| | - Alex Ruiz-Majoral
- Cardiology Department, Bellvitge University Hospital-Bellvitge Biomedical Research Institute, University of Barcelona, Spain (R.R., G.R., A.R.-M., C.D.-L., J.C.-C., J.A.G.-H.)
| | | | - Carles Díez-López
- Cardiology Department, Bellvitge University Hospital-Bellvitge Biomedical Research Institute, University of Barcelona, Spain (R.R., G.R., A.R.-M., C.D.-L., J.C.-C., J.A.G.-H.)
| | | | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital-Bellvitge Biomedical Research Institute, University of Barcelona, Spain (R.R., G.R., A.R.-M., C.D.-L., J.C.-C., J.A.G.-H.)
| | - Joan A Gómez-Hospital
- Cardiology Department, Bellvitge University Hospital-Bellvitge Biomedical Research Institute, University of Barcelona, Spain (R.R., G.R., A.R.-M., C.D.-L., J.C.-C., J.A.G.-H.)
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19
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Garcia Guimaraes M, Diez-Villanueva P, Macaya Ten F, Masotti M, Sanz-Ruiz R, Roura G, Nogales JM, Abdul-Jawad Altisent O, Flores-Rios X, Jimenez-Kockar M, Veiga G, Camacho-Freire SJ, Velazquez M, Alfonso F. In-hospital and one-year outcomes in spontaneous coronary artery dissection. Insights from the Spanish registry on SCAD (SR-SCAD). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Spontaneous coronary artery dissection (SCAD) is a relatively infrequent but well-known cause of acute coronary syndrome (ACS). Information about in-hospital evolution and adverse event during follow-up is still scarce and comes mostly from cohorts outside the European context.
Purpose
The aim of the present work was to evaluate in-hospital and one-year follow-up adverse events in a nationwide large prospective cohort of patients with SCAD.
Methods
The Spanish Registry on SCAD (NCT03607981) prospectively included patients with a diagnosis of SCAD from 34 Spanish university hospitals. All coronary angiograms were carefully reviewed by two experts at a corelab to confirm the diagnosis of SCAD. In-hospital major adverse event (MAE) was defined as a composite of death, cardiogenic shock, myocardial re-infarction (MI), unplanned revascularization, ventricular arrhythmias (ventricular tachycardia or ventricular fibrillation) or stroke. A predefined 12-month major cardiovascular adverse event (MACE) was defined as a composite of death, MI, unplanned revascularization, SCAD recurrence or stroke.
Results
From June 2015 to December 2020, a total of 388 patients (440 lesions) with SCAD were included in the present analysis. Most patients were women (89%), with median age of 53 years old (IQR 47–60). Systemic hypertension (36%), hyperlipidemia (33%) and history of smoking habit (44%) were frequently seen in our cohort. Fifty-six percent of the patients included were postmenopausal. Peripartum context was rare (1.3%). Most patients presented as non-ST-segment-elevation myocardial infarction (NSTEMI) (55%) followed by ST-segment-elevation myocardial infarction (41%). Only 3% of the cohort presented as sudden cardiac death. Left anterior descending coronary artery was most frequently affected (44%), with SCAD lesions predominantly affecting distal (38%) segments and secondary branches (55%). Multivessel involvement was present in 11% of the patients. A long intramural hematoma (type 2 lesion) was the most frequent angiographic pattern (62%). In a vast majority of patients, an initial conservative management was selected (78%). Only in 22% of the SCAD patients the initial strategy was percutaneous coronary intervention.
Twenty-four patients (6.2%) had an MAE during admission. The composite was mainly driven by unplanned revascularizations (4.4%) and reinfarctions (2.8%). Only 6 patients (1.6%) died during index admission. At 12-months, 37 patients (10.8%) presented MACE, mainly driven by reinfarctions (5.8%) and unplanned revascularizations (5.8%). Only 1 patient presented SCAD recurrence during 12-month follow-up and 8 patients (2.3%) died.
Conclusion
In a large prospective cohort of patients with SCAD, in-hospital and 12 months follow-up prognosis were good. Survival was excellent. A large proportion of the adverse events occurred during the index admission, mainly related to reinfarction and need for revascularization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - P Diez-Villanueva
- University Hospital De La Princesa, Interventional Cardiology Department, Madrid, Spain
| | | | - M Masotti
- Barcelona Hospital Clinic, Barcelona, Spain
| | - R Sanz-Ruiz
- University Hospital Gregorio Maranon, Madrid, Spain
| | - G Roura
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J M Nogales
- Hospital Infanta Cristina de Badajoz, Badajoz, Spain
| | | | - X Flores-Rios
- Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - G Veiga
- University Hospital Marques de Valdecilla, Santander, Spain
| | | | - M Velazquez
- University Hospital 12 de Octubre, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Interventional Cardiology Department, Madrid, Spain
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20
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Gómez-Lara J, Oyarzabal L, Brugaletta S, Salvatella N, Romaguera R, Roura G, Fuentes L, Pérez Fuentes P, Ortega-Paz L, Ferreiro JL, Teruel L, Gracida M, Vaquerizo B, Sabaté M, Comín-Colet J, Gómez-Hospital JA. Coronary endothelial and microvascular function distal to polymer-free and endothelial cell-capturing drug-eluting stents. The randomized FUNCOMBO trial. ACTA ACUST UNITED AC 2021; 74:1013-1022. [PMID: 33640311 DOI: 10.1016/j.rec.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The vasomotor function of new-generation drug-eluting stents designed to enhance stent healing and reendothelialization is unknown. This study aimed to compare the endothelial function of the infarct-related artery (IRA) treated with bioactive circulating endothelial progenitor cell-capturing sirolimus-eluting stents (COMBO) vs polymer-free biolimus-eluting stents (BioFreedom) in ST-segment elevation myocardial infarction patients at 6 months. Secondary objectives were to compare the microcirculatory function of the IRA and stent healing at 6 months. METHODS Sixty patients were randomized to bioactive sirolimus-eluting stent vs polymer-free biolimus-eluting stents implantation. At 6 months, patients underwent coronary angiography with vasomotor, microcirculatory and optical coherence tomography examinations. Endothelial dysfunction of the distal coronary segment was defined as ≥ 4% vasoconstriction to intracoronary acetylcholine infusion. RESULTS Endothelial dysfunction was similarly observed between groups (64.0% vs 62.5%, respectively; P=.913). Mean lumen diameter decreased by 16.0 ±20.2% vs 16.1 ±21.6% during acetylcholine infusion (P=.983). Microcirculatory function was similar in the 2 groups: coronary flow reserve was 3.23 ±1.77 vs 3.23±1.62 (P=.992) and the index of microcirculatory resistance was 24.8±16.8 vs 21.3±12.0 (P=.440). Optical coherence tomography findings were similar: uncovered struts (2.3% vs 3.2%; P=.466), malapposed struts (0.1% vs 0.3%; P=.519) and major evaginations (7.1% vs 5.6%; P=.708) were observed in few cases. CONCLUSIONS Endothelial dysfunction of the IRA was frequent and was similarly observed with new-generation drug-eluting stents designed to enhance stent reendothelialization at 6 months. Endothelial dysfunction was observed despite almost preserved microcirculatory function and complete stent coverage. Larger and clinically powered studies are needed to assess the role of residual endothelial dysfunction in ST-segment elevation myocardial infarction patients. Registered in ClinicalTrials.gov: NCT04202172.
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Affiliation(s)
- Josep Gómez-Lara
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Loreto Oyarzabal
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Salvatore Brugaletta
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Neus Salvatella
- Departament de Cardiologia Intervencionista, Hospital del Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Rafael Romaguera
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gerard Roura
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lara Fuentes
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Pérez Fuentes
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Ortega-Paz
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José L Ferreiro
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Teruel
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Gracida
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Vaquerizo
- Departament de Cardiologia Intervencionista, Hospital del Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Manel Sabaté
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Comín-Colet
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan-Antoni Gómez-Hospital
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Romaguera R, Roura G, Gómez-Hospital JA. Fractura de bioprótesis aórtica quirúrgica: valoración mediante TC seriada. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Salamanca Viloria J, Garcia-Guimaraes M, Diez-Villanueva P, Macaya F, Sanz R, Roura G, Barahona-Alvarado J, Tizon H, Flores-Rios X, Lezcano-Pertejo C, Portero-Portaz J, Alvarado Casas T, Aguilar Torres R, Bastante Valiente T, Alfonso Manterola F. Spontaneous coronary artery dissection and takotsubo syndrome: comparison of baseline clinical and angiographic characteristics and in-hospital outcomes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two relatively common non-atherosclerotic causes of acute cardiac syndrome particularly frequent in women.
Methods
Herein we compared the baseline clinical and angiographic characteristics and in-hospital outcomes of 2 large prospective registries on SCAD and TTS.
Results
A total of 318 SCAD and 106 TTS patients were included (88% women). Patients in the TTS group were older (Table) and presented a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients (42% vs. 56%, P=0.009) but emotional stress was more common in the SCAD group (25% vs. 15%, P=0.037). SCAD patients had higher troponin and creatine-kinase levels. The left anterior descending coronary artery was the most frequently involved vessel (44%). Left ventricular dysfunction (ejection fraction 57±10 vs. 40±10%, P<0.001) was more frequently in TTS patients. Major adverse cardiovascular events (including death, myocardial infarction, ischemia-driven revascularization, development of heart failure and stroke during hospitalization) (4.7% vs. 12.3%, P<0.001) occurred more frequently in TTS patients, that also developed more frequently heart failure (<1% vs. 10%, P<0.001) and atrial fibrillation (1% vs. 11%, P<0.001). No differences were found in the rate of stroke in the 2 groups.
Conclusions
TTS patients are older and present a higher prevalence of cardiovascular risk factors than SCAD patients. They also present a worse in-hospital prognosis with higher mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | - F Macaya
- Hospital Clinico San Carlos, Madrid, Spain
| | - R Sanz
- University Hospital Gregorio Maranon, Madrid, Spain
| | - G Roura
- University Hospital of Bellvitge, Hospitalet De Llobregat, Spain
| | | | - H Tizon
- Hospital del Mar, Barcelona, Spain
| | | | - C Lezcano-Pertejo
- Hospital of Leon (Complejo Asistencial Universitario de Leon), Leon, Spain
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Romaguera R, Roura G, Gómez-Hospital JA. Bioprosthetic aortic valve fracture: evaluation by serial cardiac CT. Rev Esp Cardiol (Engl Ed) 2020; 73:949. [PMID: 32595051 DOI: 10.1016/j.rec.2020.03.022] [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: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Rafael Romaguera
- Servicio de Cardiología, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Gerard Roura
- Servicio de Cardiología, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan A Gómez-Hospital
- Servicio de Cardiología, Hospital Universitario de Bellvitge-IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Di Marco A, Ruiz‐Cueto M, Salazar‐Mendiguchía J, Claver E, Roura G, Dallaglio PD, Anguera I. Genotype-phenotype correlation of LMNA variants involving the Arg541 residue: a case report with multimodality imaging and literature review. ESC Heart Fail 2020; 7:3169-3173. [PMID: 32667740 PMCID: PMC7524116 DOI: 10.1002/ehf2.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022] Open
Abstract
We present a case of atypical LMNA cardiomyopathy associated with the pathogenic variant p.Arg541Ser. The patient had early-onset severe ventricular arrhythmias but atrioventricular conduction was normal. Segmental motion abnormalities and a large transmural scar, mainly apical and lateral, were found at cardiac magnetic resonance, corresponding to areas of severe wall thinning at computed tomography and of low voltages at electroanatomic mapping. Ventricular tachycardia ablation was successful in controlling ventricular arrhythmias. Few other cases described patients with pathogenic variants in the Arg541 residue, and they displayed similar atypical features, suggesting a genotype-phenotype correlation which may have specific prognostic and therapeutic implications.
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Affiliation(s)
- Andrea Di Marco
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | - María Ruiz‐Cueto
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | | | - Eduard Claver
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | - Gerard Roura
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | | | - Ignasi Anguera
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
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Marcano AL, Lugo LM, Besteiro A, Gomez-Lara J, Roura G, Fuentes L, Gracida M, Teruel L, Romaguera R, Sosa SG, Cequier Á, Gómez-Hospital JA, Comin-Colet J, Ferreiro JL. Association of fractalkine with functional severity of heart failure and impact on clopidogrel efficacy in patients with ischemic heart disease. Thromb Res 2020; 196:215-221. [PMID: 32916563 DOI: 10.1016/j.thromres.2020.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with heart failure (HF) display elevated levels of soluble fractalkine, a chemokine involved in inflammation processes, atherosclerosis and platelet activation. Further, fractalkine has been associated with reduced pharmacodynamic (PD) responsiveness to clopidogrel. The aim of this study was to investigate the association of fractalkine with the severity of HF and its impact on platelet activation and clopidogrel response in patients with coronary artery disease (CAD) with and without HF. MATERIALS AND METHODS This prospective PD study included 116 stable CAD patients on DAPT with aspirin and clopidogrel. Subjects were classified in two groups: patients with HF and reduced (<40%) left ventricular ejection fraction (HFrEF group, n = 56) and patients without HF (no HF group, n = 60). Clinical severity of HF was graded according to NYHA classification. Platelet function assays included vasodilator-stimulated phosphoprotein assay, multiple electrode aggregometry and light transmittance aggregometry. Fractalkine and P-selectin concentrations were determined by ELISA. RESULTS Fractalkine levels progressively increased with the severity of the disease in the HFrEF group (NYHA I: 471.2 ± 52.4 pg/ml, NYHA II: 500.5 ± 38.4 pg/ml, NYHA III: 638.9 ± 54.3 pg/ml, p for linear trend 0.023). Numerically higher concentrations of fractalkine were observed in the HFrEF group compared to the no HF group with borderline significance (p = 0.052). No significant differences in clopidogrel-induced platelet inhibition according to fractalkine values were observed in any of the groups. CONCLUSIONS Fractalkine levels were increased in patients with HFrEF and positively associated with the functional severity of the disease. No evident impact of fractalkine on clopidogrel PD efficacy was found.
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Affiliation(s)
- Ana Lucrecia Marcano
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Leslie Marisol Lugo
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit/Medical Research Foundation, University of Western Australia, Perth, Australia
| | - Adrián Besteiro
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Gomez-Lara
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gerard Roura
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lara Fuentes
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Gracida
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Teruel
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Romaguera
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Silvia Gabriela Sosa
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ángel Cequier
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, CIBER-CV, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan A Gómez-Hospital
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, CIBER-CV, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Ferreiro
- Department of Cardiology, Hospital Universitario de Bellvitge - IDIBELL, CIBER-CV, L'Hospitalet de Llobregat, Barcelona, Spain.
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Gomez-Lara J, Salvatella N, Romaguera R, Brugaletta S, Ñato M, Roura G, Ferreiro JL, Teruel L, Gracida M, Sabate M, Vaquerizo B, Cequier À, Gomez-Hospital JA. Coronary vasomotor function and myocardial flow with bioresorbable vascular scaffolds or everolimus-eluting metallic stents: a randomised trial. EUROINTERVENTION 2020; 16:e155-e163. [PMID: 31217148 DOI: 10.4244/eij-d-18-01203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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 The aim of this study was to compare the hyperaemic flow and vasomotor response to endothelium-dependent stimuli between bioresorbable vascular scaffolds (BVS) and metallic everolimus-eluting stents (EES) at 13 months. METHODS AND RESULTS Seventy non-diabetic patients aiming to achieve complete revascularisation were randomised 1:1 to BVS or EES implantation. At 13 months, invasive coronary angiography was performed using intracoronary pressure and Doppler ultrasound measurements at rest and maximal hyperaemia. A vasomotor test to endothelium-dependent (acetylcholine) and independent (nitroglycerine) stimuli and optical coherence tomography (OCT) were also performed. Fifty-nine patients (30 BVS and 29 EES) underwent 13-month examination. Doppler ultrasound average peak velocity (49.0±17.5 vs 49.3±18.3 cm/sec; p=0.95), coronary blood flow (97.4±53.5 vs 88.3±46.7 ml/min; p=0.51), coronary flow reserve (2.6±0.9 vs 2.7±0.8; p=0.84) and fractional flow reserve (0.92±0.06 vs 0.94±0.04; p=0.17) were similar between the groups. The vasomotor test showed vasoconstriction response to acetylcholine in 75.6% proximal and 72.2% distal peri-scaffold segments without differences between study devices. BVS had larger in-scaffold vasoconstriction than EES (60.0% vs 27.6%; p=0.01) despite similar neointima response as assessed by OCT. CONCLUSIONS BVS and EES had similar microcirculatory response to hyperaemia and predominant vasoconstrictive response in the peri-scaffold segments to endothelium-dependent stimuli. However, BVS exhibited larger vasoconstriction to endothelium-dependent stimuli in the scaffold segment.
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Affiliation(s)
- Josep Gomez-Lara
- Grup de Recerca en Malalties del Cor, Hospital Universitari de Bellvitge; Institut d´Investigacio Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
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García-Guimaraes M, Bastante T, Macaya F, Roura G, Sanz R, Barahona Alvarado JC, Tizón H, Flores-Ríos X, Moreu J, Ojeda S, Nogales JM, Veiga G, Masotti M, Camacho-Freire SJ, Jiménez-Valero S, Jiménez-Kockar M, Lozano Í, González-Ferreiro R, Velázquez M, Avanzas P, Rivero F, Alfonso F. Spontaneous coronary artery dissection in Spain: clinical and angiographic characteristics, management, and in-hospital events. ACTA ACUST UNITED AC 2020; 74:15-23. [PMID: 32418854 DOI: 10.1016/j.rec.2020.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome. The characteristics and in-hospital clinical course of patients with SCAD in Spain remain unknown. METHODS We present data from consecutive patients included in the national prospective SCAD registry. Angiographic analysis was performed in a centralized core laboratory. RESULTS Between June 2015 and April 2019, we included 318 patients with SCAD (358 lesions) from 31 centers. Median age was 53 years, and 88% were women. The most frequent presentation was non-ST-segment elevation acute myocardial infarction (53%). The most frequently involved artery was the left anterior descending coronary artery (44%), predominantly affecting the distal segments (39%) and secondary branches (54%). Most lesions (62%) appeared on angiography as intramural hematoma, without double lumen. Conservative management was selected as the initial approach in most patients (78%). During the index admission, 6% of patients had a major adverse event and 4 patients (1.3%) died. Independent predictors of adverse events were initial management with percutaneous coronary intervention (OR, 5.97; P=.004) and angiographic presentation as intramural hematoma (OR, 4.96; P=.028). CONCLUSIONS In Spain, SCAD affects mainly middle-aged women. In most patients, the initial management strategy was conservative with excellent in-hospital survival. Initial management with percutaneous coronary intervention and angiographic presentation as intramural hematoma were related to the presence of in-hospital adverse events. Registered at ClnicalTrials.gov (Identifier: NCT03607981).
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Affiliation(s)
- Marcos García-Guimaraes
- Servicio de Cardiología, Hospital Universitario de La Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de La Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Fernando Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
| | - Gerard Roura
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ricardo Sanz
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Helena Tizón
- Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Xacobe Flores-Ríos
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - José Moreu
- Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Gabriela Veiga
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Mónica Masotti
- Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Íñigo Lozano
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | | | - Maite Velázquez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Avanzas
- Servicio de Cardiología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Fernando Rivero
- Servicio de Cardiología, Hospital Universitario de La Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Romaguera R, Salinas P, Brugaletta S, Gomez-Lara J, Díaz JF, Romero MA, García-Blas S, Ocaranza R, Borde P, Jiménez Kockar M, Millan Segovia R, Íñiguez A, Alameda M, Trillo R, Lee DH, Martín P, López-Benito M, Frutos A, Moreu J, Hernández-Hernández F, García Del Blanco B, Roura G, Rossello X, Pocock SJ, Fernández-Ortiz A, Sabate M, Gómez-Hospital JA. Second-Generation Drug-Eluting Stents in Diabetes (SUGAR) trial: Rationale and study design. Am Heart J 2020; 222:174-182. [PMID: 32087418 DOI: 10.1016/j.ahj.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/19/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Rafael Romaguera
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain.
| | - Pablo Salinas
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Josep Gomez-Lara
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Mar Alameda
- Hospital Universitario Son Espases, Mallorca, Spain
| | | | - Dae Hyun Lee
- Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | - José Moreu
- Hospital Virgen de la Salud, Toledo, Spain
| | | | | | - Gerard Roura
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
| | - Xavier Rossello
- Clinical Trials Coordination Unit, Centro Nacional de Investigaciones Cardiovaculares (CNIC), Madrid, Spain
| | - Stuart J Pocock
- Department of Biostatistics, London, School of Hygiene & Tropical Medicine, London, UK
| | - Antonio Fernández-Ortiz
- Hospital Clínico San Carlos and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manel Sabate
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J A Gómez-Hospital
- Hospital de Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain
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Salas M, Roura G, Arzamendi D, Berdejo J, Manito N, Gómez-Hospital JA. Implante de MitraClip en el tratamiento percutáneo de la insuficiencia mitral grave en pacientes con trasplante cardiaco. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cubero-Gallego H, Romaguera R, Gómez-Lara J, Gómez-Hospital JA, Sabaté M, Pinar E, Gracida M, Roura G, Ferreiro JL, Teruel L, Tebé-Codorni C, Jiménez-Quevedo P, Montanya E, Alfonso F, Cequier Á. Evaluación del efecto sinérgico de la metformina y los inhibidores mTOR sobre la endotelización de los stents farmacoactivos en pacientes diabéticos. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hernández-Enríquez M, Regueiro A, Romaguera R, Andrea R, Gómez-Hospital JA, Pujol-López M, Ferreiro-Gutiérrez JL, Brugaletta S, Roura G, Freixa X, Gómez-Lara J, Martín-Yuste V, Gracida M, Cequier Á, Sabaté M. Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon-expandable and self-expanding valves. Catheter Cardiovasc Interv 2018; 93:1344-1351. [PMID: 30244545 DOI: 10.1002/ccd.27907] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/07/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Thrombocytopenia after transcatheter aortic valve implantation (TAVI) is common and has been related to higher mortality and major complications. No comparison between balloon-expandable (BEV) and self-expanding valves (SEV) regarding drop platelet count (DPC) has been reported to date. The objectives of this study were to analyze the differences in DPC between BEVs or SEVs and their prognostic implications in clinical outcomes. METHODS We retrospectively analyzed patients undergoing TAVI. Platelet counts after TAVI were collected. Two groups were created: DPC ≤ 30% and DPC > 30%. VARC-2 criteria were used to define outcomes. RESULTS Study population was composed of 195 patients (age 77.5 ± 6.7, 57.4% males). All of them but one experienced DPC (mean DPC 31.9 ± 15.3%). DPC was significantly higher among the patients treated with BEV compared to those treated with SEV (36.3 ± 15.1% vs 27.7 ± 14.4, P < 0.001). After multivariate analysis, the use of BEV was independently associated with a higher rate of DPC > 30% (67.4% vs 36.0%; OR 3.4; 95% CI, 1.42-8.16). At 30 days, the DPC > 30% was associated with a higher rate of life-threatening/major bleeding, major vascular complications, in-hospital sepsis and mortality. At one year, there were no statistically significant differences in the mortality rate between groups (6.35% vs 10.0%, HR 1.54; 95% CI, 0.56-4.25). CONCLUSIONS In this study, the use of BEV was associated with a higher risk of DPC after TAVI. A DPC rate > 30% was associated with an increased risk of major complications at 30 days.
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Affiliation(s)
- Marco Hernández-Enríquez
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rafael Romaguera
- Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Rut Andrea
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Margarida Pujol-López
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Salvatore Brugaletta
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Gerard Roura
- Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Gómez-Lara
- Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Victoria Martín-Yuste
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Montserrat Gracida
- Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Ángel Cequier
- Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Ferreira Gonzalez I, Ribera AR, Marsal JR, Faixedas M, Rosas A, Tizon-Marcos HT, Rojas S, Labata C, Cardenas M, Homs S, Tomas-Querol C, Garcia-Picart J, Roura G, Masotti M, Mauri J. P1719Validity of DAPT score to predict late ischemic and hemorrhagic events in patients with ST-segment-elevation acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1719] [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)
| | - A R Ribera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - J R Marsal
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | - A Rosas
- Department of Health, Barcelona, Spain
| | - H T Tizon-Marcos
- Hospital del Mar Medical Research Institute (IMIM), Departament de Salut. Generalitat de Cataluña, Barcelona, Spain
| | - S Rojas
- Hospital Joan XXIII, Barcelona, Spain
| | - C Labata
- University Hospital Trias i Pujol, Barcelona, Spain
| | - M Cardenas
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - S Homs
- University Hospital Mutua de Terrassa, Terrassa, Spain
| | | | | | - G Roura
- University Hospital of Bellvitge, Barcelona, Spain
| | - M Masotti
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - J Mauri
- University Hospital Trias i Pujol, Barcelona, Spain
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Gomez-Lara J, Brugaletta S, Ortega-Paz L, Vandeloo B, Moscarella E, Salas M, Romaguera R, Roura G, Ferreiro JL, Teruel L, Gracida M, Windecker S, Serruys PW, Gomez-Hospital JA, Sabaté M, Cequier A. Long-Term Coronary Functional Assessment of the Infarct-Related Artery Treated With Everolimus-Eluting Bioresorbable Scaffolds or Everolimus-Eluting Metallic Stents. JACC Cardiovasc Interv 2018; 11:1559-1571. [DOI: 10.1016/j.jcin.2018.04.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/10/2018] [Accepted: 04/24/2018] [Indexed: 11/16/2022]
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Cainzos-Achirica M, Di Carlo PA, Handy CE, Quispe R, Roura G, Pinto X, Blumenthal RS, Comin-Colet J, Corbella X, Blaha MJ. Coronary Artery Calcium Score: the "Mammogram" of the Heart? Curr Cardiol Rep 2018; 20:70. [PMID: 29987623 DOI: 10.1007/s11886-018-1020-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To discuss the classic analogy of "coronary artery calcium (CAC) as a mammogram of the heart", by evaluating the conceptual strengths, weaknesses, opportunities, and threats of a potential cardiovascular disease (CVD) screening strategy using CAC in apparently healthy adults. RECENT FINDINGS CAC is typically used for further CVD risk assessment. CAC is also currently being used as a screening test in specific subgroups of individuals, particularly in some Asian countries. Although this has yielded valuable insights on the determinants and pathophysiology of CVD, whether this approach results in improved clinical outcomes compared to other assessment and management approaches is currently unclear. Although CAC and mammograms share a number of characteristics, there are also important conceptual differences. The evidence supporting CAC, which is a robust CVD risk assessment tool, for CVD screening purposes is currently very limited, and further research is needed.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), 19th Floor, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,School of Medicine and Medical Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. .,RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain.
| | - Philip A Di Carlo
- Breast Imaging Division, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Catherine E Handy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Gerard Roura
- Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), 19th Floor, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Pinto
- Cardiovascular Risk Unit, Department of Internal Medicine, Bellvitge University Hospital, 7th Floor, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), 19th Floor, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Corbella
- Cardiovascular Risk Unit, Department of Internal Medicine, Bellvitge University Hospital, 7th Floor, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Internal Medicine, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Hestia Chair in Integrated Health and Social Care, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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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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Paoletti G, Gomez-Lara J, Brugaletta S, Ñato M, Romaguera R, Roura G, Ferreiro JL, Teruel L, Gracida M, Ortega-Paz L, Gomez-Hospital JA, Sabaté M, Cequier À. Association between coronary atherosclerosis progression and in-stent neoatherosclerosis in patients with ST-elevation myocardial infarction at five-year follow-up. EUROINTERVENTION 2018; 14:206-214. [DOI: 10.4244/eij-d-17-00255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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Ñato M, Gomez-Lara J, Romaguera R, Roura G, Ferreiro JL, Teruel L, Gracida M, Fuentes L, Vandeloo B, Gomez-Hospital JA, Cequier A. One-year optical coherence tomography findings in patients with late and very-late stent thrombosis treated with intravascular imaging guided percutaneous coronary intervention. Int J Cardiovasc Imaging 2018; 34:1511-1520. [DOI: 10.1007/s10554-018-1372-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
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Fuentes L, Gómez-Lara J, Salvatella N, Gonzalo N, Hernández-Hernández F, Fernández-Nofrerias E, Sánchez-Recalde Á, Alfonso F, Romaguera R, Ferreiro JL, Roura G, Teruel L, Gracida M, Marcano AL, Gómez-Hospital JA, Cequier Á. Hallazgos por IVUS en trombosis de stent tardía y muy tardía. Comparación entre stents metálicos y farmacoactivos. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.07.024] [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: 10/18/2022]
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Roura G, Gomez-Lara J, Fuentes Castillo L, Ferreiro JL, Romaguera R, Teruel L, Gracida Blancas M, Carreño E, Gomez-Hospital JA, Cequier A. Long-term prognostic impact of non-invasive follow-up with computed tomography angiography in patients with left main coronary artery stenting. Minerva Cardioangiol 2018; 66:528-535. [PMID: 29687696 DOI: 10.23736/s0026-4725.18.04567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Left main coronary artery (LMCA) stenting is an evolving technique. Whether follow-up computed tomography angiography (CTA) might have clinical impact in these patients is controversial. The aim of present study is to compare clinical outcomes of patients with LMCA stenting followed with CTA versus patients with conventional clinical follow-up. METHODS From 2003 to 2014 all consecutive patients with unprotected LMCA stenosis treated with single DES implantation were prospectively included. Since 2009 all patients underwent CTA at 6-month after LMCA stenting. Therefore, the non-CTA group included all patients treated from 2003 to 2009 and the CTA group included patients treated from 2009 to 2014. Patients with 6-month cardiac events, renal dysfunction or atrial fibrillation were excluded. All patients underwent at least 2-year clinical follow-up. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, and LMCA revascularization. RESULTS A total of 236 patients were included (119 in the non-CTA and 117 in the CTA group). Nine event-free patients presented with in-stent restenosis as assessed by CTA at 6 months; 5 had angiographic confirmation and were revascularized. At 2 years, the primary end-point was observed in 15.1% and 7.3% of patients of the non-CTA and CTA groups, respectively (P=0.07). All-cause mortality was higher in the non-CTA group (8.4% vs. 2.6%; P=0.05). Euroscore and CTA were found independent predictors of the primary end-point in the multivariate analysis. CONCLUSIONS Elective 6-month CTA after LMCA stenting is associated with better outcomes compared to conventional clinical follow-up.
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Affiliation(s)
- Gerard Roura
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain -
| | - Josep Gomez-Lara
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Lara Fuentes Castillo
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - José L Ferreiro
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Rafael Romaguera
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Luis Teruel
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Montserrat Gracida Blancas
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Elena Carreño
- Department of Radiology, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Joan A Gomez-Hospital
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Angel Cequier
- Unit of Interventional Cardiology, Heart Disease Institute, IDIBELL - Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain
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Fernández-Cisnal A, Romaguera R, Ñato M, Gómez-Lara J, Ferreiro JL, Teruel L, Roura G, Muntané-Carol G, González-Costello J, Jacobi F, Gracida M, Gómez-Hospital JA, Cequier Á. Temporal trends in frequency, management and outcomes of coronary perforations. Minerva Cardioangiol 2018; 66:361-367. [PMID: 29393600 DOI: 10.23736/s0026-4725.18.04433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Coronary perforations (CP) have been described as a rare but potentially fatal complication in percutaneous coronary interventions (PCI). Our aim is to compare temporal trends in frequency, management and outcomes of coronary perforations (CP). METHODS All cases of CP recorded in our prospective institutional percutaneous coronary intervention (PCI) registry from 2003 to 2015 were included. Patients were divided in 2 groups according to the time frame in which the CP occurred: the early period (before 2009, when the chronic total occlusions and primary PCI programs started) and the current period. The primary endpoint was the composite of in-hospital serious adverse events, including final TIMI flow 0-1, cardiac tamponade, emergent cardiac surgery or death. RESULTS Overall, 88 CP occurred in 17,566 procedures (0.50%). Of these, 17 (0.26%) occurred during the early period and 71 (0.64%) during the current period (P<0.001). CP management differed between groups, with less CP sealed by intracoronary devices in the early period than in the current one (23.5% vs. 47.9%, P=0.068). Moreover, patients with CP during the early period experienced more in-hospital serious adverse events (69% vs. 31% respectively, OR 3.18, 95% CI: 1.07-9.45, P=0.037). CONCLUSIONS Expansion of indications and complexity of PCI in the current era may be associated with an increased frequency of CP. However, progress in technical and device management of CP have led to an improvement in the prognosis of this feared complication.
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Affiliation(s)
- Agustín Fernández-Cisnal
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Rafael Romaguera
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain -
| | - Marcos Ñato
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Josep Gómez-Lara
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - José L Ferreiro
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Luis Teruel
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Gerard Roura
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Guillem Muntané-Carol
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - José González-Costello
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Francisco Jacobi
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Montserrat Gracida
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Joan A Gómez-Hospital
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Ángel Cequier
- Heart Disease Institute, Bellvitge University Hospital (IDIBELL), University of Barcelona, Barcelona, Spain
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Muñoz-Esquerre M, Ferreiro JL, Huertas D, Marcano AL, López-Sánchez M, Roura G, Gómez-Hospital JA, Dorca J, Cequier A, Santos S. Impact of acute exacerbations on platelet reactivity in chronic obstructive pulmonary disease patients. Int J Chron Obstruct Pulmon Dis 2017; 13:141-148. [PMID: 29343953 PMCID: PMC5749392 DOI: 10.2147/copd.s152660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A higher risk of atherothrombotic cardiovascular events, which are platelet-driven processes, has been described during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, the relevance of platelet reactivity during AECOPD and whether this is affected by antiplatelet agents are not fully elucidated to date. This study aimed to evaluate whether platelet reactivity is augmented during an exacerbation in COPD patients with and without antiplatelet therapy and its association with systemic inflammatory parameters. Materials and methods Prospective, observational, ex vivo investigation was conducted in consecutive patients suffering an exacerbation of COPD. Platelet reactivity was assessed during AECOPD and at stable state. Platelet function assays included: 1) vasodilator-stimulated phosphoprotein assay expressed as P2Y12 reactivity index (PRI), 2) multiple electrode aggregometry and 3) optical aggregometry. Systemic inflammatory parameters such as leukocyte count, interleukin-6 and fibrinogen were also assessed. Results Higher platelet reactivity was observed during AECOPD compared to stability measured by vasodilator-stimulated phosphoprotein (PRI: 75.2%±1.9% vs 68.8%±2.4%, p=0.001). This augmented platelet aggregability was also observed in the subset of patients on antiplatelet therapy (PRI: 72.8%±3.1% vs 61.7%±7.5%, p=0.071). Consistent findings were observed with all other platelet function tests. Patients with greater enhancement of inflammatory markers during AECOPD were more likely to present a higher increase in platelet reactivity. Conclusion Platelet reactivity is increased during AECOPD, which may contribute to the augmented cardiovascular risk of these patients. Additionally, the increase in platelet reactivity might be associated with an increment in inflammatory markers during exacerbations.
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Affiliation(s)
- Mariana Muñoz-Esquerre
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - José Luis Ferreiro
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Daniel Huertas
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat.,Biomedical Research Networking Centre Consortium Respiratory Diseases, CIBERES, Barcelona, Spain
| | - Ana Lucrecia Marcano
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Marta López-Sánchez
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Gerard Roura
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Joan Antoni Gómez-Hospital
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Jordi Dorca
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Angel Cequier
- Heart Diseases Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat
| | - Salud Santos
- Department of Pulmonary Medicine, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat.,Biomedical Research Networking Centre Consortium Respiratory Diseases, CIBERES, Barcelona, Spain
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Cubero-Gallego H, Vandeloo B, Gomez-Lara J, Romaguera R, Roura G, Gomez-Hospital JA, Cequier A. Early Collapse of a Magnesium Bioresorbable Scaffold. JACC Cardiovasc Interv 2017; 10:e171-e172. [DOI: 10.1016/j.jcin.2017.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 10/18/2022]
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Fuentes L, Gómez-Lara J, Salvatella N, Gonzalo N, Hernández-Hernández F, Fernández-Nofrerias E, Sánchez-Recalde Á, Alfonso F, Romaguera R, Ferreiro JL, Roura G, Teruel L, Gracida M, Marcano AL, Gómez-Hospital JA, Cequier Á. IVUS Findings in Late and Very Late Stent Thrombosis. A Comparison Between Bare-metal and Drug-eluting Stents. ACTA ACUST UNITED AC 2017; 71:335-343. [PMID: 28870640 DOI: 10.1016/j.rec.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/03/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Stent thrombosis (ST) is a life-threatening complication after stent implantation. Intravascular ultrasound is able to discern most causes of ST. The aim of this study was to compare intravascular ultrasound findings between bare-metal stents (BMS) and drug-eluting stents (DES) in patients with late (31 days to 1 year) or very late ST (> 1 year). METHODS Of 250 consecutive patients with late or very late ST in 7 Spanish institutions, 114 patients (45.5% BMS and 54.5% DES) were imaged with intravascular ultrasound. Off-line intravascular ultrasound analysis was performed to assess malapposition, underexpansion, and neoatherosclerosis. RESULTS The median time from stent implantation to ST was 4.0 years with BMS and 3.4 years with DES (P = .04). Isolated malapposition was similarly observed in both groups (36.5% vs 46.8%; P = .18) but was numerically lower with BMS (26.6% vs 48.0%; P = .07) in patients with very late ST. Isolated underexpansion was similarly observed in both groups (13.5% vs 11.3%; P = .47). Isolated neoatherosclerosis occurred only in patients with very late ST and was more prevalent with BMS (22.9%) than with DES (6.0%); P = .02. At 2.9 years' follow-up, there were 0% and 6.9% cardiac deaths, respectively (P = .06) and recurrent ST occurred in 4.0% and 5.2% of patients, respectively (P = .60). CONCLUSIONS Malapposition was the most common finding in patients with late and very late ST and is more prevalent with DES in very late ST. In contrast, neoatherosclerosis was exclusively observed in patients with very late ST and mainly with BMS.
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Affiliation(s)
- Lara Fuentes
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Gómez-Lara
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Neus Salvatella
- Departamento de Cardiología Intervencionista, Hospital del Mar, Barcelona, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Eduard Fernández-Nofrerias
- Departamento de Cardiología Intervencionista, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Fernando Alfonso
- Departamento de Cardiología Intervencionista, Hospital de La Princesa, Madrid, Spain
| | - Rafael Romaguera
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Ferreiro
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gerard Roura
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Teruel
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Gracida
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Lucrecia Marcano
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan-Antoni Gómez-Hospital
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ángel Cequier
- Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Marcano A, Ferreiro J, Gracida M, Lugo L, Romaguera R, Gomez-Lara J, Roura G, Teruel L, Gomez-Hospital J, Tello A, Vivas D, Cequier A. 2868Greater pharmacodynamic efficacy of ticagrelor compared to clopidogrel in patients with diabetes mellitus and stable coronary artery disease: a randomized investigation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marcano A, Gracida M, San Jose P, Lugo L, Guerrero M, Roura G, Gomez-Lara J, Gomez-Hospital J, Ferreiro J, Montanya E, Cequier A. P5357Lack of impact on responsiveness to clopidogrel and aspirin of improving glycaemic control in patients with type 2 diabetes mellitus and stable coronary artery disease on dual antiplatelet therapy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Garay A, Ariza-Solé A, Formiga F, Lorente V, Sánchez-Salado JC, Salazar-Mendiguchía J, Roura G, Muntané G, Alegre O, Fuentes L, Gómez-Hospital JA, Cequier A. Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes? Revista Portuguesa de Cardiologia (English Edition) 2016. [DOI: 10.1016/j.repce.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gomez-Lara J, Salvatella N, Gonzalo N, Hernández-Hernández F, Fernandez-Nofrerias E, Sánchez-Recalde A, Bastante T, Marcano A, Romaguera R, Ferreiro JL, Roura G, Teruel L, Ariza-Solé A, Miranda-Guardiola F, Rodríguez García-Abad V, Gomez-Hospital JA, Alfonso F, Cequier A. IVUS-guided treatment strategies for definite late and very late stent thrombosis. EUROINTERVENTION 2016; 12:e1355-e1365. [DOI: 10.4244/eijy15m12_08] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Garay A, Ariza-Solé A, Formiga F, Lorente V, Sánchez-Salado JC, Salazar-Mendiguchía J, Roura G, Muntané G, Alegre O, Fuentes L, Gómez-Hospital JA, Cequier A. Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes? Rev Port Cardiol 2016; 35:637-644. [PMID: 27865674 DOI: 10.1016/j.repc.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. METHODS All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). RESULTS We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). CONCLUSIONS Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia.
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Affiliation(s)
- Alberto Garay
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victoria Lorente
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Gerard Roura
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Guillem Muntané
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lara Fuentes
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Angel Cequier
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Romaguera R, Gómez-Hospital JA, Gomez-Lara J, Brugaletta S, Pinar E, Jiménez-Quevedo P, Gracida M, Roura G, Ferreiro JL, Teruel L, Montanya E, Fernandez-Ortiz A, Alfonso F, Valgimigli M, Sabate M, Cequier A. A Randomized Comparison of Reservoir-Based Polymer-Free Amphilimus-Eluting Stents Versus Everolimus-Eluting Stents With Durable Polymer in Patients With Diabetes Mellitus: The RESERVOIR Clinical Trial. JACC Cardiovasc Interv 2016; 9:42-50. [PMID: 26762910 DOI: 10.1016/j.jcin.2015.09.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 09/09/2015] [Accepted: 09/24/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare the efficacy of amphilimus-eluting stents (AES) with that of everolimus-eluting stents (EES) in patients with diabetes mellitus (DM). BACKGROUND The AES is a polymer-free drug-eluting stent that elutes sirolimus formulated with an amphiphilic carrier from laser-dug wells. This technology could be associated with a high efficacy in patients with DM. METHODS This was a multicenter, randomized, noninferiority trial. Patients with DM medically treated with oral glucose-lowering agents or insulin and de novo coronary lesions were randomized in a 1:1 fashion to AES or EES. The primary endpoint was the neointimal (NI) volume obstruction assessed by optical coherence tomography at 9-month follow-up. RESULTS A total of 116 lesions in 112 patients were randomized. Overall, 40% were insulin-treated patients, with a median HbA1c of 7.3% (interquartile range: 6.7% to 8.0%). The primary endpoint, NI volume obstruction, was 11.97 ± 5.94% for AES versus 16.11 ± 18.18% for EES, meeting the noninferiority criteria (p = 0.0003). Pre-specified subgroup analyses showed a significant interaction between stent type and glycemic control (p = 0.02), with a significant reduction in NI hyperplasia in the AES group in patients with the higher HbA1c (p = 0.03). By quantitative coronary angiography, in-stent late loss was 0.14 ± 0.24 for AES versus 0.24 ± 0.57 mm for EES (p = 0.27), with a larger minimal lumen diameter at follow-up for AES (p = 0.02), mainly driven by 2 cases of occlusive restenosis in the EES group. CONCLUSIONS AES are noninferior to EES for the coronary revascularization of patients with DM. These results suggest a high efficacy of the AES and may support the potential benefit of this stent in patients with DM. (A Randomized Comparison of Reservoir-Based Polymer-Free Amphilimus-Eluting Stents Versus Everolimus-Eluting Stents With Durable Polymer in Patients With Diabetes Mellitus [RESERVOIR]; NCT01710748).
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Affiliation(s)
- Rafael Romaguera
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain.
| | - Joan A Gómez-Hospital
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Josep Gomez-Lara
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | | | - Eduardo Pinar
- Department of Cardiology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Montserrat Gracida
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Gerard Roura
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Jose L Ferreiro
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Luis Teruel
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
| | - Eduard Montanya
- Endocrine Unit, Hospital de Bellvitge-IDIBELL, CIBERDEM, University of Barcelona, Barcelona, Spain
| | | | | | | | - Manel Sabate
- Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Angel Cequier
- Heart Diseases Institute, Hospital de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
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Gomez-Lara J, Brugaletta S, Jacobi F, Ortega-Paz L, Ñato M, Roura G, Romaguera R, Ferreiro JL, Teruel L, Gracida M, Martin-Yuste V, Freixa X, Masotti M, Gomez-Hospital JA, Sabate M, Cequier A. Five-Year Optical Coherence Tomography in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.003670. [DOI: 10.1161/circinterventions.116.003670] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/01/2016] [Indexed: 11/16/2022]
Abstract
Background—
The main causes of late (>1 month) stent thrombosis (ST) are stent uncoverage, malapposition, and neoatherosclerosis. First-generation drug-eluting stents were associated with higher rate of late ST compared with bare-metal stents (BMS), especially in patients with ST-segment–elevation myocardial infarction. Second-generation everolimus-eluting stents (EES) have shown similar rate of late ST than BMS. The aims of the study are to compare the ratio of uncovered to total struts per cross-section ≥30% and other optical coherence tomographic findings associated with ST between EES and BMS in patients with ST-segment–elevation myocardial infarction at 5 years.
Methods and Results—
One hundred and sixty-nine consecutive event-free patients of the randomized EXAMINATION study (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) were screened for optical coherence tomographic imaging at 5 years. Patients with target vessel–related events or life-threatening comorbidities were excluded. Finally, 64 patients (32 EES and 32 BMS) underwent optical coherence tomographic imaging. At 5 years, uncovered struts (4.1% versus 1.0%;
P
<0.01), length of uncoverage (3.4 versus 1.4 mm;
P
=0.02), and ratio of uncovered to total struts per cross-section ≥30% (35.5% versus 9.7%;
P
=0.02) were larger with EES than that with BMS. Malapposed struts (1.2% versus 0.3%;
P
=0.02) and malapposition length (1.3 versus 0.4 mm;
P
=0.06) were also larger with EES. Neoatherosclerotic plaques (16.1% versus 25.8%;
P
=0.35) and macrophage accumulations (19.4% versus 48.4%;
P
=0.02) were numerically more frequent with BMS.
Conclusions—
Despite substantial dropout of patients, the healing pattern in event-free ST-segment–elevation myocardial infarction patients differs between EES and BMS at 5 years. EES presented with larger amount of uncovered and malapposed struts and similar rate of neoatherosclerosis as compared with BMS. The clinical relevance of these findings warrants longer follow-up.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00828087.
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Affiliation(s)
- Josep Gomez-Lara
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Salvatore Brugaletta
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Francisco Jacobi
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Luis Ortega-Paz
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Marcos Ñato
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Gerard Roura
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Rafael Romaguera
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Jose-Luis Ferreiro
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Luis Teruel
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Montserrat Gracida
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Victoria Martin-Yuste
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Xavier Freixa
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Monica Masotti
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Joan-Antoni Gomez-Hospital
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Manel Sabate
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
| | - Angel Cequier
- From the Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge, Universitat de Barcelona, L’ Hospitalet de Llobregat, Spain (J.G.-L., F.J., M.Ñ., G.R., R.R., J.-L.F., L.T., M.G., J.-A.G.-H., A.C.); and Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Spain (S.B., L.O.-P., V.M.-Y., X.F., M.M., M.S.)
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