1
|
Barrios V, Escobar C, Barón Esquivias G, Gómez Doblas JJ, Recalde Del Vigo E, Segura Martínez L, Alvarez Garcia P, Alonso Valladares F, Toril Lopez J, Chopo Alcubilla JM. Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. Rev Clin Esp 2019; 219:285-292. [PMID: 30894251 DOI: 10.1016/j.rce.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/07/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. METHODS We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). RESULTS We analysed 1015 patients (mean age, 73.3±9.4 years; 57% men; CHA2DS2VASc, 3.4±1.5; HAS-BLED, 1.5±1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9±23.5 and 48.6±24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6±24.7 vs. 42.8±22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0±1.2 vs. 6.6±2.2; P<.001). CONCLUSIONS For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA.
Collapse
Affiliation(s)
- V Barrios
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - C Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | | | - J J Gómez Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | | | - P Alvarez Garcia
- Servicio de Cardiología, Fundación Hayge, Viladecans, Barcelona, España
| | | | - J Toril Lopez
- Servicio de Cardiología, Centre Medic Castelldefels, Castelldefels, Barcelona, España
| | | |
Collapse
|
2
|
Martínez-Sellés M, Gómez Doblas JJ, Carro Hevia A, García de la Villa B, Ferreira-González I, Alonso Tello A, Andión Ogando R, Ripoll Vera T, Arribas Jiménez A, Carrillo P, Rodríguez Pascual C, Casares i Romeva M, Borras X, Cornide L, López-Palop R. Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. J Intern Med 2014; 275:608-20. [PMID: 24320176 DOI: 10.1111/joim.12174] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 11/28/2022]
Abstract
OBJECTIVE To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING Transnational registry in Spain. SUBJECTS We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES All-cause death. RESULTS Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis.
Collapse
Affiliation(s)
- M Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón y Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Jiménez-Hoyuela García JM, Robledo Carmona J, Martínez Del Valle Torres MD, Ortega Lozano S, Delgado García A, Gómez Doblas JJ. [Utility of myocardial perfusion scintigraphy in the emergency department for evaluation of patients with chest pain]. Rev Esp Med Nucl 2007; 26:69-76. [PMID: 17386233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. MATERIAL AND METHODS Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. RESULTS Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. CONCLUSION Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification.
Collapse
|
4
|
García-Pinilla JM, Jiménez-Navarro MF, Gómez Doblas JJ, Alonso JH, Hernández García JM, de Teresa Galván E. [Therapeutic attitude after coronariography in elderly patients with ischemic heart disease]. Rev Clin Esp 2006; 205:595-600. [PMID: 16527181 DOI: 10.1016/s0014-2565(05)72652-7] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The incidence of ischemic heart disease in the elderly is high. These patients are increasing referred for coronariography. OBJECTIVES Identify factors associated with coronary revascularization in elderly patients. MATERIAL AND METHODS Retrospective study of 473 patients > or = 75 years who underwent coronariography in relationship with ischemic heart disease. Their clinical-epidemiological characteristics and treatment adopted were analyzed. A multivariate analysis model was used to identify factors associated with revascularization. RESULTS Mean age was 77.6 +/- 2.8 years; 70.4% were men. A total of 36% smoked, 53% were hypertensive, 33% diabetics and 30% dislipidemic. Thirty one % had multivessel disease and 11% involvement of left coronary trunk. There was evidence of anterior descending artery in 68%. Medical treatment was done in 48.4%, percutaneous revascularization in 41.5% and surgical in 10.1%. Patients with lesions of the anterior descending artery were revascularized in greater proportion: 67.7% vs 32.3%; p. 0.001. A logistic regression model was used to identify revascularization predictors, obtaining a direct relationship with the involvement of the anterior descending artery (OR: 4.87; 95% CI: 2.98-7.94; (p < 0.001) and inverse on with the previous revascularization (OR: 0.47; 95% CI: 0.26-0.85; p < 0.02), left ventricular dysfunction (OR: 0.58; 95% CI: 0.39-0.88; p = 0.01) and presence of multivessel disease (OR: 0.51; 95% CI: 0.31-0.84; p < 0.01). CONCLUSIONS The elderly subjects with ischemic heart disease who underwent coronariography received revascularizing treatment in somewhat more than 50% of the cases. A direct relationship was found between involvement of the anterior descending artery and performance of revascularizing treatment and an inverse on between previous revascularization, left ventricular dysfunction and presence of multivessel disease.
Collapse
Affiliation(s)
- J M García-Pinilla
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga.
| | | | | | | | | | | |
Collapse
|
5
|
Jiménez-Hoyuela García JM, Campos Arillo V, Rebollo Aguirre AC, Gómez Doblas JJ, Gutiérrez Hurtado A. Alteración precoz de la función adrenérgica cardíaca en los parkinsonismos con cuerpos de Lewy. ACTA ACUST UNITED AC 2005; 24:93-100. [PMID: 15745679 DOI: 10.1157/13071684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy is clinically used to estimate myocardial sympathetic damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify the rate and characteristics of cardiac sympathetic disturbance in Parkinson's disease (PD) and usefulness of 123I-MIBG myocardial scintigraphy to differentiate PD from the Lewy Body Disease (LBD). MATERIAL AND METHODS 108 subjects were studied. There were 70 patients with PD, 21 patients with LBD, and 17 age-matched normal subjects without neurological disease. The clinical parameters evaluated were severity of the process (measured by Hoehn and Yahr Scale), vegetative manifestations, development time and use of medication taken. Myocardial adrenergic function was analyzed by imaging with 123I-MIBG. Early (15 min) and delayed (4 h) images of the thorax in the anterior view were obtained after injection of 123I-MIBG (111 MBq). The qualitative and semiquantitative 123I-MIBG uptake was quantified by calculating a heart-to-mediastinum ratio (HMR) and analyzed in a blind manner. RESULTS The mean H/M ratio in patients with PD and LBD was significantly lower than in controls (p < 0.05). This is independent of development time, process severity, use of medication or vegetative manifestations. The HMR obtained in LBD patients is less clear than in PD. CONCLUSION 123I-MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in PD and LBD.
Collapse
|
6
|
Jiménez-Navarro MF, Curiel E, Alonso Briales J, Hernández García JM, Cabrera F, Gómez Doblas JJ, Ruiz Del Fresno L, Pascual P, Domínguez A, Ruiz Ruiz M, de Teresa E. [Creatine kinase increases after coronary interventions]. Rev Esp Cardiol 2001; 54:282-8. [PMID: 11262368 DOI: 10.1016/s0300-8932(01)76309-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous revascularization has led to an important change in the treatment of patients with symptomatic ischemic heart disease in recent years. There is controversy concerning the incidence and prognostic significance of postprocedural increases in creatine kinase. The aim of this study was to assess the incidence of these elevations and the related factors and to observe the prognosis of patients with and without creatin kinase elevations. METHODS We reviewed 447 patients in whom an angioplasty was done in our department from January 1997 to June 1998, excluding 138 patients with myocardial infarction in the previous four days or unsuccessful angioplasty. Creatine kinase was measured in all patients at 0, 4, 8 and 24 hours after angioplasty. We analyzed the incidence of elevated levels of creatine kinase following coronary surgery and the characteristics of the patients in comparison with a control group made up of patients who, at a similar time had undergone a similar angioplasty procedure including, a similar vessel and type of lesion, and equivalent left ventricular function but without elevated serum levels of creatine kinase. Major adverse coronary events were defined as: cardiac death, nonfatal myocardial infarction, new revascularization and unstable angina in which hospitalization was required. RESULTS Out of 309 patients studied, an elevation in creatine kinase was observed in 24 patients (7.7%). Complications related to the procedure were found in 50% of these elevations, most of which involved side branch occlusion. There were no differences with respect to the demographical or anatomical characteristics of the lesions in the groups studied. During the follow-up of 9.5 months, complications were observed in 37.5% of the group of patients with elevated creatine kinase levels and in 20% of the control group, but this difference did not achieve statistical significance. CONCLUSIONS Creatine kinase elevations are produced in 7.7% of the patients after coronary angioplasty. Complications related to the procedure were observed in 50% of the cases, most being side branch occlusion and no complications were seen in the remaining patients. Continuous measurement of creatine kinase after angioplasty shows a low sensitivity for detecting complications during follow-up. New, more sensitive and specific cardiac markers, such as troponin, could define this group of patients.
Collapse
Affiliation(s)
- M F Jiménez-Navarro
- Servicio de Cardiología. Hospital Clínico Universitario Virgen de la Victoria. Málaga
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Cabrera Bueno F, Gómez Doblas JJ, Ruiz Ruiz M, Jiménez Navarro MF, Rodríguez Bailón I, Espinosa Caliani JS, Pérez Lanzac FJ, Alonso Briales JH, Galván ET. [Quality control and improvement of the care provided to the patient with acute myocardial infarction. Implementation of a quality assurance program]. Rev Esp Cardiol 2001; 54:43-8. [PMID: 11141454 DOI: 10.1016/s0300-8932(01)76263-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Hospital care of patients with acute myocardial infarction involves a series of therapeutic measures and risk stratification which are a must since their efficacy has been clearly demonstrated. The aim of this study was to develop an internal program to guarantee and improve the quality of hospital care to acute myocardial infarction patients. METHODS A medical audit was carried out for evaluation. Seven evaluation criteria considered as class I by the guidelines on the management of acute myocardial infarction patients were analyzed in the discharge report of 163 consecutive patients. Following analysis of the results corrective measures were implemented. In the second phase reevaluation of 40 patients was performed to determine the efficacy of the adopted measures. RESULTS Following the first evaluation the use of AAS, IECAS and the beta-blockers was found to be correctly indicated in 95, 80 and 72% of the patients, respectively. A strategy of the adequate stratification of risk was carried out and ventricular function was evaluated in 93 and 96% of the cases. Correct hypolipemia treatment was indicated in 54% of the cases with an adequate diet being prescribed in 100%. Three months after the intervention, 40 new patients were evaluated with all the criteria analyzed being fulfilled in 100% of the cases. CONCLUSIONS The use of evaluation techniques and improvement in the quality of health care provided to cases of acute myocardial infarction allows the determination of the care undertaken and its correction if necessary in order to follow the guidelines recommended for the care of these patients.
Collapse
Affiliation(s)
- F Cabrera Bueno
- Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. Málaga
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Rueda Calle E, Barrera Cordero A, Alzueta J, Burgos J, Gómez Doblas JJ, Jiménez Navarro M. [An adult male with an old inferior myocardial infarct, normal global ventricular function and repetitive episodes of sustained wide-QRS tachycardia]. Rev Clin Esp 2000; 200:173-5. [PMID: 10804768 DOI: 10.1016/s0014-2565(00)70595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E Rueda Calle
- Unidad de Arritmias, Hospital Universitario Virgen de la Victoria, Málaga
| | | | | | | | | | | |
Collapse
|
9
|
Montiel Trujillo A, Ruiz Ruiz M, Jiménez Navarro M, Gómez Doblas JJ, Rueda Calle E, de Teresa E. [Pneumopericardium in an asthmatic patient. A case report and review of the bibliography]. Rev Esp Cardiol 1999; 52:1015-8. [PMID: 10611811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Pneumopericardium is an uncommon but potentially serious condition of which leading cause is mechanical ventilation in infants suffering respiratory distress syndrome. In adults, however, the most common causes are iatrogenic in diagnostic and therapeutic procedures, as well as traumatic lesions. We describe a case of pneumopericardium in a teenager suffering an asthma crisis. A review of the literature is presented, stressing the most relevant findings of the physical examination and habitual laboratory tests.
Collapse
Affiliation(s)
- A Montiel Trujillo
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga.
| | | | | | | | | | | |
Collapse
|
10
|
Hernández García JM, Castillo Castro JL, Alonso Briales JH, Alvarez de Cienfuegos Rivera F, Bullones Ramírez J, Alvarez Rubiera J, Rubio Alcaide A, Gómez Doblas JJ, de Mora Martín M, Zafra Sánchez J, Urda Valcárcel T, Conejo Muñoz L, Malpartida de Torres F. [Actuarial follow-up after percutaneous mitral valvulotomy. Incidence and event-predicting factors]. Rev Esp Cardiol 1999; 52:503-11. [PMID: 10439674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The goal of this study is to analyse the follow-up of patients who underwent percutaneous mitral valvuloplasty and the predicting factors of event-free survival. METHODS We analysed 220 consecutive valvuloplasty performed between 1988 and 1996 in order to establish the incidence of events (death, restenosis, mitral valve surgery, New York Heart Association class IV, new valvuloplasty or systemic embolia) and the baseline and postprocedural characteristics predicting events, during a mean follow-up of 42 months (range 1-96 months). RESULTS Overall survival was 94.7%, and event-free survival was 59.2% at 96 months. We analyzed the baseline characteristics in order to predict the mid-term outcome (actuarial survival Kaplan-Meier method) that atrial fibrillation (p < 0.01), age > or = 56 years (p < 0.005), and echocardiographic score > or = 9 (p < 0.005) were baseline characteristics related to adverse events in follow up. An index based on the number of adverse factors in the baseline characteristics provided a significant difference in concerning the number of follow up to even-free between the group without baseline adverse characteristics and the group with two (p = 0.008, OR = 4.5), or three adverse characteristics (p = 0.005, OR 6.4). Among the postprocedural characteristics, while patients with mitral valve area after valvuloplasty > or = 1.5 cm2 had an event-free survival of 72.9% at 96 months, those with postprocedural mitral valve area < 1.5 cm2 had an event-free survival of 10.5% (log-rank test p < 0.0001). CONCLUSIONS Mid-term event-free survival after percutaneous mitral balloon valvuloplasty can be predicted by baseline and postprocedural characteristics. Age > or = 56, echocardiographic score > or = 9 and atrial fibrillation are baseline factors related with adverse events. Patients with 0 or 1 baseline adverse factors do not have significant differences concerning mid-term outcome while, those with 2, and above all, 3 adverse baseline characteristics have a poorer event-free survival. Mitral valve area > or = 1.5 cm2 is the only postprocedural independent predictor of event-free survival.
Collapse
|
11
|
Gómez Doblas JJ, de Teresa E, Lamas GA. [Ventricular geometry and heart failure]. Rev Esp Cardiol 1999; 52:47-52. [PMID: 9989138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In the last years there has been an appreciation of the importance of left ventricular geometry. After a period, in the sixties and seventies, that the interest was focused on cardiac physiology and the left ventricular geometry role about this subject, new studies are available on clinical significance of normal or distorted left ventricular shape. New assessment methods of ventricular geometry have been described. The use of simple measurements to assess ventricular geometry has allowed to know the clinical value of the shape distortion in patients with heart failure. The suspicion that left ventricular shape change to sphericity has prognosis value, has raised the interest about this subject. Whether distortion of left ventricular shape is an even better parameter than cardiac function indices normally used is under consideration. Moreover, new surgical therapies have been developed in an attempt to improve the ventricular geometry and to get better clinical prognosis in patients with heart failure.
Collapse
Affiliation(s)
- J J Gómez Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga.
| | | | | |
Collapse
|
12
|
Gómez Doblas JJ, Jiménez Navarro M, Rodríguez Bailón I, Alonso Briales JH, Hernández García JM, Montiel Trujillo A, Rueda Calle E, Barrera Cordero A, Castillo Castro JL, Alvarez de Cienfuegos Rivera F, de Teresa Galván E. [Preoperative coronarography in heart valve disease patients. A probability analysis of coronary lesion]. Rev Esp Cardiol 1998; 51:756-61. [PMID: 9803802 DOI: 10.1016/s0300-8932(98)74819-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES The indication of preoperative coronary angiography is routinely performed for patients who are going to valve replacement surgery. The need of coronary angiography is based on age, gender and previous angina, but it is not usually based on risk factors. The purpose of this study has been to find markers to predict the probability of coronary lesion in this group of patients. PATIENTS AND METHODS We studied retrospectively a population of 541 patients with valvular heart disease who underwent preoperative coronary angiography from 1989 to 1994. Mean age was 61.8 (range 34-82). There were 301 men and 240 women. We analyzed in each patient different variables such as age, gender, previous angina, hypertension, diabetes mellitus, tobacco and familial predisposition. We correlated these variables with the presence of coronary lesion by multivariate analysis. RESULTS There were 73 patients with coronary lesion greater than 50%. The prevalence of significant coronary artery disease was 13.4%. Angina was present in 34.6%. The risk of coronary lesion was defined as odds ratio: previous angina 3.3; tobacco 2.6; diabetes 2.2; hypertension 1.8 and age 1.4. The others variables were not predictor of coronary lesion. The probability of coronary lesion in patients without those variables (angina, tobacco, diabetes, hypertension) was 4%. If we analyzed age, the probability of coronary lesion was 3% in patients under 65 years and 6% above 65 years. CONCLUSIONS The lack of previous angina and at least the three risk factors described as predictors of coronary lesion (hypertension, tobacco and diabetes) can define a group of patients with a very low prevalence of coronary lesion, especially if they are under 65 years. It can allow us to avoid preoperatory coronary angiography in patients who undergo valve replacement.
Collapse
Affiliation(s)
- J J Gómez Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Gómez Doblas JJ, Rodríguez Bailón I, Jiménez Navarro M, de Teresa Galván E. [Prevention of infective endocarditis: does the risk population know the preventive measures?]. Med Clin (Barc) 1997; 108:598. [PMID: 9280796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
14
|
Sánchez-Chaparro MA, Jiménez-Navarro MF, Gómez Doblas JJ, Montiel Trujillo A, Rueda Calle E, González-Santos P. [A young woman with right hemiparesia, diplopia and familial antecedents of neurologic disease]. Rev Clin Esp 1996; 196:723-4. [PMID: 9005479] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M A Sánchez-Chaparro
- Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria de Málaga
| | | | | | | | | | | |
Collapse
|
15
|
de Teresa E, Espinosa JS, Gómez Doblas JJ. [Cardiovascular pharmacology (IX). Angiotensin-converting enzyme inhibitors in hypertension and heart failure]. Rev Esp Cardiol 1995; 48:128-41. [PMID: 7886264] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- E de Teresa
- Servicio de Cardiología, Hospital Universitario, Málaga
| | | | | |
Collapse
|
16
|
Gómez Doblas JJ, López Madroñero T, Rubio Olmo A, Narbona Carrión GF. [Spontaneous pneumomediastinum: management in primary care]. Aten Primaria 1994; 13:465-6. [PMID: 8038374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
|