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Aboal J, Pascual J, Loma-Osorio P, Nuñez M, Badosa E, Martín C, Ferrero M, Moral S, Ballesteros E, Pedraza J, Tapia S, Brugada R. Impact of a Cardiogenic Shock Program on Mortality in a Non-Transplant Hospital. Heart Lung Circ 2024; 33:38-45. [PMID: 38151398 DOI: 10.1016/j.hlc.2023.11.010] [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] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 10/29/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Cardiogenic shock is associated with high in-hospital morbidity and mortality. Improvements in this care process could lead to better outcomes. METHODS This retrospective study of patients with cardiogenic shock compared two periods: no specific program to address cardiogenic shock and implementation of a cardiogenic shock program. This program included the establishment of a multidisciplinary team (shock team), early alert to the transplant hospital, initiation of a ventricular assist extracorporeal membrane oxygenation (ECMO) program, and extension of continuous care by acute cardiovascular care specialists. The primary objective was to analyse whether there were differences between in-hospital mortality and mortality during follow-up. Predictors of in-hospital mortality were examined as a secondary objective. RESULTS A total of 139 patients were enrolled: 69 of them in the previous period and 70 in the cardiogenic shock program period. There was a significant reduction in in-hospital mortality (55.1% vs 37.1%; p=0.03) and mortality during follow-up (62.7% vs 44.6%; p=0.03) in the second period. Diabetes mellitus, ejection fraction, out-of-hospital cardiac arrest, and implementation of the cardiogenic shock program were independent predictors of in-hospital mortality. CONCLUSIONS The implementation of a comprehensive cardiogenic shock program in a non-transplanting hospital improved in-hospital and follow-up mortality of patients in cardiogenic shock.
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Affiliation(s)
- Jaime Aboal
- University Hospital Dr. Josep Trueta, Girona, Spain.
| | | | | | - Maria Nuñez
- University Hospital Dr. Josep Trueta, Girona, Spain
| | | | | | | | - Sergio Moral
- University Hospital Dr. Josep Trueta, Girona, Spain
| | - Esther Ballesteros
- Territorial Management of Radiology and Nuclear Medicine of Girona, Girona, Spain; Biomedical Research Institute, Girona (IdIBGi), Girona, Spain
| | | | - Simón Tapia
- University Hospital Dr. Josep Trueta, Girona, Spain
| | - Ramon Brugada
- University Hospital Dr. Josep Trueta, Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain; Biomedical Research Institute, Girona (IdIBGi), Girona, Spain
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Ronco D, Ariza-Solé A, Kowalewski M, Matteucci M, Di Mauro M, López-de-Sá E, Ranucci M, Sionis A, Bonaros N, De Bonis M, Russo CF, Uribarri A, Montero S, Fischlein T, Kowalówka A, Naito S, Obadia JF, Martín-Asenjo R, Aboal J, Thielmann M, Simon C, Andrea-Riba R, Parra C, Folliguet T, Martínez-Sellés M, Sanmartín Fernández M, Al-Attar N, Viana Tejedor A, Serraino GF, Burgos Palacios V, Boeken U, Raposeiras Roubin S, Solla Buceta MA, Sánchez Fernández PL, Scrofani R, Pastor Báez G, Jorge Pérez P, Actis Dato G, Garcia-Rubira JC, de Gea Garcia JH, Massimi G, Musazzi A, Lorusso R. The current clinical practice for management of post-infarction ventricular septal rupture: a European survey. Eur Heart J Open 2023; 3:oead091. [PMID: 37840585 PMCID: PMC10568658 DOI: 10.1093/ehjopen/oead091] [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] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023]
Abstract
Aims Many historical and recent reports showed that post-infarction ventricular septal rupture (VSR) represents a life-threatening condition and the strategy to optimally manage it remains undefined. Therefore, disparate treatment policies among different centres with variable results are often described. We analysed data from European centres to capture the current clinical practice in VSR management. Methods and results Thirty-nine centres belonging to eight European countries participated in a survey, filling a digital form of 38 questions from April to October 2022, to collect information about all the aspects of VSR treatment. Most centres encounter 1-5 VSR cases/year. Surgery remains the treatment of choice over percutaneous closure (71.8% vs. 28.2%). A delayed repair represents the preferred approach (87.2%). Haemodynamic conditions influence the management in almost all centres, although some try to achieve patients stabilization and delayed surgery even in cardiogenic shock. Although 33.3% of centres do not perform coronarography in unstable patients, revascularization approaches are widely variable. Most centres adopt mechanical circulatory support (MCS), mostly extracorporeal membrane oxygenation, especially pre-operatively to stabilize patients and achieve delayed repair. Post-operatively, such MCS are more often adopted in patients with ventricular dysfunction. Conclusion In real-life, delayed surgery, regardless of the haemodynamic conditions, is the preferred strategy for VSR management in Europe. Extracorporeal membrane oxygenation is becoming the most frequently adopted MCS as bridge-to-operation. This survey provides a useful background to develop dedicated, prospective studies to strengthen the current evidence on VSR treatment and to help improving its currently unsatisfactory outcomes.
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Affiliation(s)
- Daniele Ronco
- Congenital Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Albert Ariza-Solé
- Cardiology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Mariusz Kowalewski
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Department of Cardiac Surgery and Transplantology, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Michele Di Mauro
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Esteban López-de-Sá
- Department of Cardiology, IDIPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Aitor Uribarri
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Adam Kowalówka
- Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Roberto Martín-Asenjo
- Intensive Cardiac Care Unit, Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Germany
| | - Caterina Simon
- Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rut Andrea-Riba
- Acute Cardiac Care Unit, Cardiology Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Parra
- Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Assistance Publique–Hopitaux de Paris Créteil, Paris, France
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañon, CIBERCV, and Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | - Nawwar Al-Attar
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Ana Viana Tejedor
- Department of Cardiology, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - Udo Boeken
- Department of Cardiac Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | - Roberto Scrofani
- Cardiac Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gemma Pastor Báez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Jorge Pérez
- Cardiology Unit, University Hospital of the Canary Islands, La Laguna, Spain
| | | | | | - Jose H de Gea Garcia
- Coronary Care Unit, Department of Intensive Care Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Andrea Musazzi
- Cardiac Surgery Unit, ASST dei Sette Laghi, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Rodríguez A, Aboal J, Loma-Osorio P, Ramos R, Boada I. Design and deployment of ODISEA, an application for the myOcarDial infarction SafEtytrAnsfer of patients. Int J Med Inform 2023; 172:105020. [PMID: 36780790 DOI: 10.1016/j.ijmedinf.2023.105020] [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: 06/28/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Rapid primary angioplasty is the most effective reperfusion strategy for acute ST-elevation myocardial infarction (STEMI) patients. Since not all hospitals have a catheterization laboratory to perform this intervention, adequate coordination of all medical professionals involved in the management of STEMI patients from the emergency room to the hospital catheterization laboratory is necessary. OBJECTIVE Present the design and deployment of ODISEA (acronym of myOcarDial Infarction SafEtytrAnsfer), a web-based environment plus an application created to complement and support the transfer and management of STEMI patients from the first medical contact to the catheterization laboratory where the primary angioplasty will be carried out. METHOD ODISEA is an application that has been designed to improve the coordination of all health personnel involved in the management of STEMI patients, i.e., primary care hospitals, Emergency Medical Services [EMS] and cardiology departments. The application provides: (i) functionalities to register relevant information of the patients' and the administered medications, (ii) a chat to coordinate all involved personnel; (iii) treatment recommendations for the first medical contact; and (iv) a GPS-SATELLITE monitoring system to know the exact position of the ambulance during patient transfer. These features improve the coordination in the catheterization laboratory, and optimize the equipment preparation time, and also the patient accommodation procedures after primary angioplasty. ODISEA registers all treated cases for a proper follow-up. The application has been tested from September 2021 to January 2022 in the context of a pilot study in Girona that involved 98 patients and 42 professionals (11 from hospital without Cath lab availability, 21 from EMS, and 10 from the main hospital). Professionals answered a questionnaire using a five-point Likert scale (satisfaction level from 1 to 5) to assess ODISEA regarding patient management, care quality, transfer coordination, transfer effectiveness, and usefulness. Collected data was analyzed using chi-square or Fisher's exact test. Statistical significance has been considered p < 0.05. To evaluate times of first angioplasty, relevant data from 98 patients was collected and compared with data of 129 STEMI patients not treated with ODISEA. RESULTS For all the questions>70 % of answers are in the 3 to 5 range and from these, almost all the questions have 50 % of answers in the 4 and 5 range. Regarding groups of professionals only in the question related to coordination significant difference has been found for EMS professionals with respect to hospital without Cath lab availability and catheterization hospital professionals. Comparing ODISEA with no ODISEA patients it was observed an improvement in the times of first angioplasty as well as a reduction in the erroneous infarction codes activation. Patients treated with the ODISEA APP were further away from the PCI-capable center. A non-significant tendency was seen towards shorter primary angioplasty times (diagnostic electrocardiogram-guidewire passage) in the ODISEA compared to the NON ODISEA group (112 min vs 122 min; P =.3), a non-significant reduction of cases with times > 120 min (26.2 % vs 35.7 %, respectively; P =.1), and a tendency towards fewer cases eventually diagnosed as non-acute coronary syndrome (7.1 % vs 13.2 %; P =.1). CONCLUSION ODISEA is a very well-accepted application that improves the management of STEMI patients. The application is an appropriate complement to current infarction protocol.
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Affiliation(s)
- Antonio Rodríguez
- Graphics and Imaging Laboratory, University of Girona, Girona, Spain
| | - Jaime Aboal
- Hospital Universitari Josep Trueta, Girona, Spain
| | | | - Rafel Ramos
- Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Imma Boada
- Graphics and Imaging Laboratory, University of Girona, Girona, Spain.
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Ariza-Solé A, Mateus-Porta G, Formiga F, Garcia-Blas S, Bonanad C, Núñez-Gil I, Vergara-Uzcategui C, Díez-Villanueva P, Bañeras J, Badia-Molins C, Aboal J, Carreras-Mora J, Gabaldón-Pérez A, Parada-Barcia JA, Martínez-Sellés M, Comín-Colet J, Raposeiras-Roubin S. Extended use of dual antiplatelet therapy among older adults with acute coronary syndromes and associated variables: a cohort study. Thromb J 2023; 21:32. [PMID: 36944967 PMCID: PMC10031931 DOI: 10.1186/s12959-023-00476-5] [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] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Current guidelines recommend extending the use of dual antiplatelet therapy (DAPT) beyond 1 year in patients with an acute coronary syndrome (ACS) and a high risk of ischaemia and low risk of bleeding. No data exist about the implementation of this strategy in older adults from routine clinical practice. METHODS We conducted a Spanish multicentre, retrospective, observational registry-based study that included patients with ACS but no thrombotic or bleeding events during the first year of DAPT after discharge and no indication for oral anticoagulants. High bleeding risk was defined according to the Academic Research Consortium definition. We assessed the proportion of cases of extended DAPT among patients 65 ≥ years that went beyond 1 year after hospitalisation for ACS and the variables associated with the strategy. RESULTS We found that 48.1% (928/1,928) of patients were aged ≥ 65 years. DAPT was continued beyond 1 year in 32.1% (298/928) of patients ≥ 65; which was a similar proportion as with their younger counterparts. There was no significant correlation between a high bleeding risk and DAPT duration. Contrastingly, there was a strong correlation between the extent of coronary disease and DAPT duration (p < 0.001). Other variables associated with extended DAPT were a higher left ventricle ejection fraction, a history of heart failure and a prior stent thrombosis. CONCLUSION There was no correlation between age and extended use of DAPT beyond 1 year in older patients with ACS. DAPT was extended in about one-third of patients ≥ 65 years. The severity of the coronary disease, prior heart failure, left ventricle ejection fraction and prior stent thrombosis all correlated with extended DAPT.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain.
| | - Gemma Mateus-Porta
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain
| | - Francesc Formiga
- Geriatrics Unit. Internal Medicine Department, Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Garcia-Blas
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Iván Núñez-Gil
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Jordi Bañeras
- Cardiology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Clara Badia-Molins
- Cardiology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | | | - Ana Gabaldón-Pérez
- Cardiology Department, Department of Medicine, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | | | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense, Madrid, Spain
| | - Josep Comín-Colet
- Cardiology Department, Bioheart Grup de Malalties Cardiovasculars, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Feixa Llarga s/n. 08907, Barcelona, Spain
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Aboal J, Ramos R, Boada I, Agudelo V, Palacio y JC, Pérez V. Aplicaci�n de las nuevas tecnolog�as en los traslados de pacientes con IAMCEST. Resultados de la prueba piloto ODISEA APP. RECIC 2022. [DOI: 10.24875/recic.m22000331] [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: 11/17/2022] Open
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Sans Roselló J, Vidal-Burdeus M, Loma-Osorio P, Pons Riverola A, Bonet Pineda G, El Ouaddi N, Aboal J, Ariza Solé A, Scardino C, García-García C, Fernández-Peregrina E, Sionis A. “Impact of age on management and prognosis of resuscitated sudden cardiac death patients”. IJC Heart & Vasculature 2022; 40:101036. [PMID: 35514873 PMCID: PMC9062668 DOI: 10.1016/j.ijcha.2022.101036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Background Sudden cardiac death (SCD) has a great impact on healthcare due to cardiologic and neurological complications. Admissions of elderly people in Cardiology Intensive Care Units have increased. We assessed the impact of age in presentation, therapeutic management and in vital and neurological prognosis of SCD patients. Methods We carried out a retrospective, observational, multicenter registry of patients who were admitted with a SCD in 5 tertiary hospitals from January 2013 to December 2020. We divided our cohort into two groups (patients < 80 years and ≥ 80 years). Clinical, analytical and hemodynamic variables as well as in-hospital management were registered and compared between groups. The degree of neurological dysfunction, vital status at discharge and the influence of age on them were also reviewed. Results We reviewed 1160 patients admitted with a SCD. 11.3% were ≥ 80 years. Use of new antiplatelet agents, performance of a coronary angiography, use of pulmonary artery catheter and temperature control were less carried out in the elderly. Age, non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min, time to ROSC > 20 min and lactate > 2 mmol/L were independent predictors for in-hospital mortality. Non-shockable rhythm, Killip class > 1 at admission, time to CPR initiation > 5 min and time to ROSC > 20 min but not age were independent predictors for poor neurological outcomes. Conclusions Age determined a less aggressive management and it was associated with a worse vital prognosis in patients admitted with a SCD. Nevertheless, age was not associated with worse neurological outcomes.
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Affiliation(s)
- Jordi Sans Roselló
- Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain
- Corresponding autor at: Intensive Cardiac Care Unit. Cardiology Department. Hospital de la Santa Creu i Sant Pau, C/Santa Maria Claret 167, Barcelona 08025, Spain (Alessandro Sionis) Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain. Parc Taulí, 1, 08208 Sabadell, Barcelona (Jordi Sans-Roselló).
| | - Maria Vidal-Burdeus
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitari Vall d’Hebrón. Barcelona, Spain
| | - Pablo Loma-Osorio
- Critical Cardiac Care Unit, Cardiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Alexandra Pons Riverola
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Gil Bonet Pineda
- Department of Cardiology, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Rovira i Virgili University, Tarragona, Spain
| | - Nabil El Ouaddi
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jaime Aboal
- Critical Cardiac Care Unit, Cardiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Albert Ariza Solé
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Claudia Scardino
- Department of Cardiology, Joan XXIII University Hospital, Pere Virgili Health Research Institute (IISPV), Rovira i Virgili University, Tarragona, Spain
| | - Cosme García-García
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Estefanía Fernández-Peregrina
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
| | - Alessandro Sionis
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Barcelona, Spain
- Corresponding autor at: Intensive Cardiac Care Unit. Cardiology Department. Hospital de la Santa Creu i Sant Pau, C/Santa Maria Claret 167, Barcelona 08025, Spain (Alessandro Sionis) Cardiology Department. Parc Taulí Hospital Universitari. Sabadell, Spain. Parc Taulí, 1, 08208 Sabadell, Barcelona (Jordi Sans-Roselló).
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7
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Garcia-Garcia C, Andrea R, Sanz E, Sanchez-Salado JC, Aboal J, Pastor P, Buera I, Sionis A, Lopez T, Perez-Rodriguez M, Ariza A, Baneras J, Tomas C, Cediel G, Rueda F. Mortality risk in cardiogenic shock depending on aetiology in a Mediterranean cohort. Prognostic accuracy of CardShock vs IABP score: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1481] [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
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification, although the CS aetiology could influence in this prediction.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients depending on the CS aetiology comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed comparing ACS and non-ACS patients. Cardshock and IABP score have been compared to assess 90-days mortality risk in both groups.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. Patient were classified in ACS (n=232, 60.7%) and non-ACS (n=150, 39.3%). In ACS group, 77.6% were STEMI, reperfussion in 84.7% of cases, all with primary angioplasty, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. Main non-ACS aetiologies were severe heart failure (36.2%), malignant arrhythmias (22.1%), valve disease (8.0%) and myocarditis (7.4%). ACS group had less prevalence of women (17.7% vs 36%, p=0.001) and previous myocardial infarction (13.9% vs 24.8%, p=0.007). Mechanical assistance device was implanted more in ACS patients (43.1% vs 16.7%, p<0.001, mainly intraaortic balloon pump (35.6% vs 9.8%, p<0.001) and ECMO (10.7% vs 3%, p=0.01). Both shock risk scores were higher in ACS patients, Cardshock (4.5 vs 4.0, p=0.006) and IABP (2.4 vs 1.9, p=0.005). In-hospital mortality was higher in ACS (37.1 vs 26.7%, p=0.035) although this difference loss the significance at 90-days (40.9 vs 31.8%, p=0.074) and 6-months (45.2 vs 35.8%, p=0.176). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score in ACS patients (area under the curve -AUC- 0.74 vs 0.66) respectively, p=0.047, although both scores were similar in non-ACS (AUC 0.64 vs 0.62, p=0.693), Figures 1–2.
Conclusions
Cardiogenic shock due to ACS had higher in-hospital mortality than non-ACS CS, although this difference decreased at 90 days and 6 months. IABP score provided better 90-days mortality risk prediction than CardShock score in ACS patients, but both scores are similar in non-ACS cardiogenic shock.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Regiό Sanitaria de Girona, Girona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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8
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Garcia-Garcia C, Lopez T, Sanz E, Sanchez-Salado JC, Aboal J, Tomas C, Baneras J, Sionis A, Andrea R, Perez-Rodriguez M, Ariza A, Pastor P, Buera I, Cediel G, Rueda F. Mortality risk in cardiogenic shock: head to head comparision CardShock vs IABP score in a Mediterranean cohort: the Shock CAT study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1482] [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
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification.
Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort.
Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed. Cardshock and IABP score have been compared to assess 90-days mortality risk in a Mediterranean cohort.
Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. The most common cause of CS was ACS (61%, n=233); of them, 77.6% were STEMI, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. STEMI patients were reperfused in 84.7% of cases, all with primary angioplasty. Main non-ACS aetiologies were severe acute heart failure, malignant arrhythmias and myocarditis. Mechanical assistance device was implanted in one third of patients (n=119), mainly intraaortic balloon pump (26.1%), ECMO in 7.8% and Impella in 4.5%. Average Cardshock score was 4.3 (SD 1.74) and mean IABP score was 2.2 (SD 1.61). In-hospital mortality was 33% (126 patients) and 90-days mortality was 37.3% (141 patients). Receiver-operating characteristic curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score (area under the curve 0.72 vs 0.66) respectively, p=0.042; Figure 1.
Conclusions
Even though invasive management with STEMI reperfusion and mechanical assistance devices, cardiogenic shock in-hospital mortality remains 33% in a contemporary Mediterranean cohort. In this population, IABP shock score provided better 90-days mortality risk prediction than CardShock score
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - T Lopez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Sanz
- University Hospital of Taragona Joan XXIII, Tarragona, Spain
| | | | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Girona, Spain
| | - C Tomas
- Hospital Arnau de Vilanova, Lleida, Spain
| | - J Baneras
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - R Andrea
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - A Ariza
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Pastor
- Hospital Arnau de Vilanova, Lleida, Spain
| | - I Buera
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Cediel
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - F Rueda
- Germans Trias i Pujol University Hospital, Barcelona, Spain
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9
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Aboal J, Ramos R, Loma-Osorio P, Núñez M, Comas-Cufi M, Iglesies J, Moral S, Bosch D, Martí-Lluch R, Alves-Cabratosa L, Brugada R. Time from electrocardiographic diagnosis of ST-elevation myocardial infarction to guidewire crossing in patients transferred to a hospital for primary angioplasty: factors associated with delay. Emergencias 2021; 33:195-202. [PMID: 33978333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To identify predictors of primary angioplasty delay in patients with ST-elevation myocardial infarction (STEMI) transported from out-of-hospital sites or from hospitals without percutaneous coronary intervention (PCI) suites. MATERIAL AND METHODS Retrospective cohort study of cases between 2008 and 2018 in a university hospital receiving patients diagnosed with STEMI who required a PCI. We performed linear and multivariate regression analyses to identify factors that predicted delay in interpreting a diagnostic electrocardiogram (ECG) until the guidewire passed the lesion (diagnosis-guidewire-crossing time). RESULTS A total of 1039 cases were studied; 296 patients (28.4%) had delays of more than 120 minutes between STEMI diagnosis and guidewire crossing. Factors associated with PCI delay were advanced age (odds ratio [OR] = 1.02; 95% CI, 1.01-1.04]), severe heart failure on admission (OR = 2.28; 95% CI, 1.23-4.22), history of cardiac bypass surgery (OR = 10.01; 95% CI, 2.60-41.81), out-of-hospital cardiac arrest (OR = 4.34; 95% CI, 1.84-10.32), lateral ischemia (OR, 1.64; 95% CI, 1.06-2.51), first medical attention in a hospital without a PCI suite (OR = 1.52; 95% CI, 1.05-2.21), first medical attention outside regular working hours (OR = 1.46; 95% CI, 1.06-2.02), and distance in kilometers to a PCI suite (OR = 1.04; 95% CI, 1.03-1.05). CONCLUSION Patients with STEMI who required transport to a hospital with a PCI suite experienced primary angioplasty delays. Delays were related to logistical and clinical factors as well as to infarction characteristics.
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Affiliation(s)
- Jaime Aboal
- Hospital Universitario Josep Trueta, Girona, España
| | - Rafel Ramos
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España. Biomedical Research Institute, Girona (IdIBGi). ICS, Girona, España
| | - Pablo Loma-Osorio
- Hospital Universitario Josep Trueta, Girona, España. Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, España
| | - Maria Núñez
- Hospital Universitario Josep Trueta, Girona, España
| | - Marc Comas-Cufi
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España
| | | | - Sergio Moral
- Hospital Universitario Josep Trueta, Girona, España
| | - Daniel Bosch
- Hospital Universitario Josep Trueta, Girona, España
| | - Ruth Martí-Lluch
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España. Biomedical Research Institute, Girona (IdIBGi). ICS, Girona, España
| | - Lia Alves-Cabratosa
- ISV Research Group. Primary Care Services, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP J Gol), Girona, España
| | - Ramon Brugada
- Hospital Universitario Josep Trueta, Girona, España. Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, España. Biomedical Research Institute, Girona (IdIBGi). ICS, Girona, España. Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBER CV), España
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10
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Vilardell P, Moral S, Albert X, Bosch D, Morales M, Frigola JM, Robles R, Pla R, Ramos R, Aboal J, Brugada R. Clinical implications of the morphological features of left ventricular intracavitary thrombi after anterior ST elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.093] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular thrombi (LVT) after an anterior ST elevation myocardial infarction (STEMI) are usually classified as protruding or laminar according to their morphological characteristics. However, it is unknown whether this morphology has any clinical implication.
Purpose
Determine prognostic between laminar or protruding LVT in the community of anterior STEMI.
Methods
An observational cohort study on patients with LVT after anterior STEMI detected by echocardiography between 2008 and 2019 was conducted. Laminar LVT was defined as those protruding <5mm inside the cavity.
Results
Of 1.215 anterior STEMI patients, 121 (10%) cases presented LVT: 86 (71%) were protruding and 35 (29%) laminar. Mean follow-up was 323 ± 116 days. No differences in baseline clinical and echocardiographic characteristics were detected between both groups. However, protruding LVT patients were more frequently treated with triple therapy (71% vs 40%; p < 0.001). Laminar LVT patients presented a lower stroke rate (3% vs 16%; P = 0.042) and embolism-related rate (3% vs 19%; p = 0.024) than protruding LVT cases (see Figure). Laminar LVT was associated with lower embolism-related events during follow-up independently than left ventricular ejection fraction (LVEF) and age (OR = 0.11; 95% CI,0.12-0.94; p = 0.045). No differences were observed in laminar LVT patients in embolism-related events during follow-up between those treated with or without triple therapy (7% vs 0%; p = 0.400).
Conclusions
Laminar LVT after anterior STEMI presented a lower rate of embolism-related complications during follow-up compared with protruding LVT regardless of LVEF, age and even with a lower rate of triple therapy.
Abstract Figure.
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Affiliation(s)
- P Vilardell
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - S Moral
- University Hospital de Girona Dr. Josep Trueta, Radiology, Girona, Spain
| | - X Albert
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - D Bosch
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - M Morales
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - JM Frigola
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Robles
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Pla
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Ramos
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Brugada
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
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11
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Vilardell P, Moral S, Albert X, Bosch D, Morales M, Frigola J, Robles R, Pla R, Ramos R, Aboal J, Brugada R. Clinical implications of the morphological features of left ventricular intracavitary thrombi after anterior ST elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1770] [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: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular thrombi (LVT) after an anterior ST elevation myocardial infarction (STEMI) are usually classified as protruding or laminar according to their morphological characteristics. However, it is unknown whether this morphology has any clinical implication.
Purpose
Determine prognostic between laminar or protruding LVT in the community of anterior STEMI.
Methods
An observational cohort study on patients with LVT after anterior STEMI detected by echocardiography between 2008 and 2019 was conducted. Laminar LVT was defined as those protruding <5mm inside the cavity.
Results
Of 1.215 anterior STEMI patients, 121 (10%) cases presented a LVT: 86 (71%) were protruding and 35 (29%) laminar. Mean follow-up was 323±116 days. No differences in baseline clinical and echocardiographic characteristics were detected between laminar or protruding LVT groups. However, protruding LVT patients were more frequently treated with triple therapy (71% vs 40%; p<0.001). Laminar LVT patients presented a lower stroke rate (3% vs 16%; P=0.042) and embolism-related rate (3% vs 19%; p=0.024) than protruding LVT cases. Kaplan-Meier analysis demonstrated significant differences in embolism-related event rate between the 2 groups (p=0.003) during the follow-up period. Laminar LVT was associated with lower embolism-related events during follow-up independently than left ventricular ejection fraction (LVEF) and age (HR=0.17; 95% CI,0.10–0.29; p<0.001). No differences were observed in laminar LVT patients in embolism-related events during follow-up between those treated with or without triple therapy (7% vs 0%; p=0.400).
Conclusions
Laminar LVT after anterior STEMI presented a lower rate of embolism-related complications during follow-up compared with protruding LVT regardless of LVEF, age and even with a lower rate of triple therapy.
Figure 1. Kaplan-Meier curve showing cumulative probability of embolism-related event rate after anterior STEMI according to LVT morphology at 1 year.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Vilardell
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - S Moral
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - X Albert
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - D Bosch
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - M Morales
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - J.M Frigola
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Robles
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Pla
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Ramos
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Brugada
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
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12
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Aboal J, Llaó I, García García C, Sans-Roselló J, Sambola A, Andrea R, Tomás C, Bonet G, Ariza-Solé A, Viñas D, Oliveras Vilà T, Montero S, Cantalapiedra J, Pujol-López M, Hernández I, Pérez-Rodriguez M, Loma-Osorio P, Sánchez-Salado JC. Comorbidity and low use of new antiplatelets in acute coronary syndrome. Aging Clin Exp Res 2020; 32:1525-1531. [PMID: 31542850 DOI: 10.1007/s40520-019-01348-7] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Despite the use of the new generation P2Y12 inhibitors (Ticagrelor and Prasugrel) with aspirin is the recommended therapy in acute NSTE-ACS patients, their current use in clinical practice remains quite low and might be related, among several variables, with increased comorbidity burden. We aimed to assess the prevalence of these treatments and whether their use could be associated with comorbidity. METHOD A multicentric prospective registry was conducted at 8 Cardiac Intensive Care Units (October 2017-April 2018) in patients admitted with non ST elevation myocardial infarction. Antithrombotic treatment was recorded and the comorbidity risk was assessed using the Charlson Comorbidity Index. We created a multivariate model to identify the independent predictors of the use of new inhibitors of P2Y12. RESULTS A total of 629 patients were included, median age 67 years, 23.2% women, 359 patients (57.1%) treated with clopidogrel and 40.6% with new P2Y12 inhibitors: ticagrelor (228 patients, 36.2%) and prasugrel (30 patients, 4.8%). Among the patients with very high comorbidity (Charlson Score > 6) clopidogrel was the drug of choice (82.6%), meanwhile in patients with low comorbility (Charlson Score 0-1) was the ticagrelor or prasugrel (63.6%). Independent predictors of the use of ticagrelor or prasugrel were a low Charlson Comorbidity Index, a low CRUSADE score and the absence of prior bleeding. CONCLUSION Antiplatelet treatment with Ticagrelor or Pasugrel was low in patients admitted with NSTE-ACS. Comorbidity calculated with Charlson Comorbidity Index was a powerful predictor of the use of new generation P2Y12 inhibitors in this population.
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Affiliation(s)
- Jaime Aboal
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain.
| | - Isaac Llaó
- Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jordi Sans-Roselló
- Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica IIB Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Rut Andrea
- Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Gil Bonet
- Hospital Joan XXIII, Tarragona, Spain
| | - Albert Ariza-Solé
- Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Viñas
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain
| | | | - Santiago Montero
- Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica IIB Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | | | | | | | - Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain
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13
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Rigau PV, Moral S, Bosch D, Morales M, Frigola JM, Albert X, Robles R, Ballesteros E, Roqué M, Aboal J, Brugada R. Clinical Prognosis of Right-Sided Infective Endocarditis not Associated with Cardiac Devices or Intravenous Drug use: a Cohort Study and Meta-Analysis. Sci Rep 2020; 10:7179. [PMID: 32346051 PMCID: PMC7188839 DOI: 10.1038/s41598-020-64220-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/07/2020] [Indexed: 11/09/2022] Open
Abstract
Right-sided infective endocarditis (RSIE), classically associated with intravenous drug use or intracardiac devices, is considered a good-prognosis infective endocarditis (IE) form. However, predisposing factors and prognosis for "NODID" RSIE (NOt associated with cardiac Devices or Intravenous Drug use) remain unclear. The aim of this study was to evaluate predisposing factors and prognosis of NODID RSIE compared to other RSIE forms. A retrospective cohort study (January 2008-January 2019) was conducted in a reference center on 300 patients diagnosed with IE. Endocarditis-related events were defined as related to IE in mortality or open-heart surgery during follow-up. A review and meta-analysis of associated literature (January 2008-January 2019) were also performed. Fifty-seven patients presented RSIE (19%), 22 of which were NODID RSIE (39%). Use of intravascular catheters (23% vs 3%; p = 0.027) and congenital heart diseases (18% vs 0%; p = 0.019) were associated with NODID RSIE. This group had a higher in-hospital mortality (23% vs 3%; p = 0.027) and endocarditis-related event rates (41% vs 6%; p = 0.001) than non-NODID RSIE. Furthermore, NODID RSIE was independently associated with in-hospital endocarditis-related events (OR = 19.29; 95%CI:2.23-167.16; p = 0.007). Our meta-analysis evaluated four studies and identified 96 cases (30%) of NODID RSIE from 320 total RSIE cases. NODID RSIE patients demonstrated higher in-hospital mortality (RR = 2.81; 95%CI:1.61-4.90; p < 0.001; I2 = 0.0%) and necessity of open-heart surgery (RR = 13.89; 95%CI:4.14-46.60; p < 0.001; I2 = 0.0%) than non-NODID RSIE cases. Our study suggests that NODID RSIE has the highest endocarditis-related event rate and in-hospital mortality among RSIE cases and therefore should not be considered a good-prognosis IE.
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Affiliation(s)
- Pau Vilardell Rigau
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Sergio Moral
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain.
| | - Daniel Bosch
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Manel Morales
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Josep Maria Frigola
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Xavier Albert
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Rocío Robles
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Esther Ballesteros
- Radiology Department, Centre d´Atenció Primaria Pare Claret, Institut Català de la Salut, Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
| | - Ramon Brugada
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona, Spain
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14
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Rodríguez-Queraltó O, Formiga F, Carol A, Llibre C, Martínez-Sellés M, Marín F, Díez-Villanueva P, Sanchis J, Bonanad C, Corbí M, Aboal J, Angel Perez-Rivera J, Alegre O, Bernal E, Vicent L, Ariza-Solé A. Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes. J Nutr Health Aging 2020; 24:723-729. [PMID: 32744568 DOI: 10.1007/s12603-020-1409-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. DESIGN Observational prospective study. SETTING Multicenter registry conducted in 44 hospitals in Spain. PARTICIPANTS Consecutive patients with ACS aged 80≥years. MEASUREMENTS A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. RESULTS A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p<0.001). In contrast, DM was not significantly associated to a higher rate of outcomes (HR 1.23, p=0.060) in the whole cohort. Among non-frail patients, patients with DM had a similar incidence of mortality or readmission (p=0.959). In contrast, among frail patients, DM was significantly associated with a higher incidence of events (HR 1.51, p=0.034). CONCLUSIONS Unlike frailty status, DM was not associated to poorer long-term outcome in elderly patients with ACS. Among frail patients the presence of DM seems to provide additional prognostic information.
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Affiliation(s)
- O Rodríguez-Queraltó
- Albert Ariza Solé. Cardiology Department. Bellvitge University Hospital, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat. Barcelona. Spain, Email address: , Fax Number +34932607618; Telephone number +34932607924
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15
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Moral S, Panaro A, Ballesteros E, Morales M, Frigola JM, Robles R, Albert X, Trucco E, Aboal J, Vilardell P, Palet J, Carballo J, Brugada R, Evangelista A. P917 Additional value of atrial parameters evaluated by echocardiography on the scales of cardioembolic risk in atrial fibrillation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.553] [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
Atrial morphological parameters may influence the presence of atrial thrombus, a factor strongly associated with cardiac thromboembolism, independently of those included in the CHA2DS2-VASc risk estimation scale in patients with a history of atrial fibrillation (AF). The aim of our study was to evaluate this possible association by transthoracic echocardiography (TTE).
Methods
Prospective multicenter study including 401 patients with a history of AF, in which a TTE and a transesophageal echocardiogram (TEE) were performed for evaluation of atrial thrombus between 2016-2019. The parameters included in the CHA2DS2-VASc scale, the heart rhythm at the time of the study and the anticoagulant treatment performed, as well as the atrial morphological parameters were collected.
Results
Twenty-three patients (6%) presented with atrial thrombus in TEE. The left atrial area (28 ± 6cm2 vs 33 ± 6cm2; p < 0.001), the presence of AF during the study (83% vs 17%; p = 0.002) and CHA2DS2-VASc (1.7 ± 1.5cm2 vs 3.0 ± 1.3cm2; p < 0.001) were associated with the presence of atrial thrombus. The left atrial area was a diagnostic predictor of atrial thrombus (area under the curve = 73%; p = 0.001): a value >30cm2 presented a sensitivity of 79% and a specificity of 70% to detect its presence. Logistic regression analysis, including heart rhythm during the study and anticoagulant treatment, showed that CHA2DS2-VASc (OR = 1.5; CI95%=1.1-1.9; p = 0.003) and left atrial area >30cm2 (OR = 5.2;CI 95% =1.7-16.0; p = 0.004) were independent predictors of atrial thrombus presence.
Conclusions
The left atrial area is associated with the presence of atrial thrombus in patients with a history of AF independently of the CHA2DS2-VASc scale, heart rhythm during the study, and anticoagulant treatment. This parameter should be evaluated to be included in the cardioembolic risk scales.
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Affiliation(s)
- S Moral
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - A Panaro
- Centre Cardiovascular Sant Jordi / Hospital el Pilar, Cardiology, Barcelona, Spain
| | - E Ballesteros
- Centre d"Atenció Primaria Pare Claret, ICS., Radiology Department, Barcelona, Spain
| | - M Morales
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - J M Frigola
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - R Robles
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - X Albert
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - E Trucco
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - J Aboal
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - P Vilardell
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
| | - J Palet
- Centre Cardiovascular Sant Jordi / Hospital el Pilar, Cardiology, Barcelona, Spain
| | - J Carballo
- Centre Cardiovascular Sant Jordi / Hospital el Pilar, Cardiology, Barcelona, Spain
| | - R Brugada
- Hospital Universitari Doctor Josep Trueta, Barcelona, Spain
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Vilardell P, Moral S, Bosch D, Morales M, Frigola JM, Albert X, Robles R, Aboal J, Ballesteros E, Brugada R. P2763Clinical prognosis of pure right-sided infective endocarditis without association to cardiac devices or intravenous drug abuse. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1080] [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
Pure right-sided infective endocarditis (RSIE) without association with cardiac devices or intravenous drug users (IVDUs) is an entity with unclear predisposing factors and prognosis.
Purpose
To evaluate predisposing factors and prognosis of pure RSIE compared tothose associated to cardiac devices or IVDUs.
Methods
280 consecutive patients with endocarditis were included retrospectively in a protocol of clinical and imaging follow-up. Endocarditis-related event was defined as endocarditis mortality or open-surgery requirement. Besides, a review and meta-analysis of the literature between january 2000 and december 2018 were performed.
Results
Fifty-two (19%) patients presented RSIE: 20 of them (39%) were pure RSIE. Intravascular catheters carriers (25% vs 3%; p=0.026) and congenital heart diseases (20% vs 0%; p=0.018) were associated to pure RSIE. These patients demonstrated the worst clinical prognosis, with the highest in-hospital mortality (25% vs 3%; p=0.026) and endocarditis-related event rate (45% vs 6%; p=0.001), being pure RSIE independently associated with in-hospital endocarditis-related events (OR=8.40; 95% CI, 1.13–62.68; p=0.038). Four studies, including ours, with 315 participants diagnosed of RSIE were evaluated in meta-analysis: 94 individuals (30%) presented pure RSIE.This group demonstrated a higher in-hospital mortality than those with cardiac devices or IVDUs (RR=2.854; 95% CI, 1.640–4.965; P<0.001; I2=0.0%; Figure 1).
Figure 1. RSIE and in-hospital mortality based on groups: cases with pure RSIE versus those with cardiac devices or IVDUs.
Conclusions
Pure RSIE is the worst prognosis group among RSIE with the highest endocarditis-related event rate and in-hospital mortality. This growing group should stake out the benign impression and recommendations given to RSIE among IE patients.
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Affiliation(s)
- P Vilardell
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - S Moral
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - D Bosch
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - M Morales
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - J M Frigola
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - X Albert
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Robles
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - E Ballesteros
- Institut Catala de la Salut, Radiology department. CAP Pare Claret, Barcelona, Spain
| | - R Brugada
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
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Vilardell P, Moral S, Bosch D, Morales M, Frigola JM, Albert X, Robles R, Kassem H, Aboal J, Brugada R. 3328Relationship between streptococcal infective endocarditis and pre-neoplastic colorectal lesions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0080] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Colorectal cancer is associated with infective endocarditis (IE), due to specific gut pathogens like streptococcus Gallolyticus that use the tumor presence as a point of blood entry. However, the association between streptococcal IE and pre-cancerous lesions such as dysplastic adenomas is unknown.
Objectives
To determine the association with pre-neoplastic colorectal lesions and streptococcal IE.
Methods
Two hundred eighty consecutive patients with IE were included retrospectively in a protocol of clinical, microbiological and imaging follow-up, between January 2008 and December 2018. Pre-cancerous lesions were divided as high and low-grade dysplasia based on World Health Organization criteria. Colorectal cancer was defined as the presence of malignant cell beyond the muscularis mucosa.
Results
Fifty patients (18%) presented neoplastic or pre-neoplastic lesions, and 26 of them (52%) were colorectal: 10 (38%) colorectal cancer and 16 (62%) precancerous lesions (12% high degree (n=2); 88% low degree (n=14)). Both, colorectal cancer (20% vs 5%; p=0.03) and pre-neoplastic lesions (44% vs 3%; p<0.05) were associated with higher incidence of streptococcus Gallolyticus IE (Figure 1). Additionally, 42% (n=11) of colorectal lesions were diagnosed in the IE event. No significant differences were found about cardiac surgery and in-hospital mortality in these patients.
Figure 1. Relationship between S. Gallolyticus IE and colorectal lesions. (a) Statistical significance between colorectal cancer and S. Gallolyticus IE. (b) Statistical significance between pre-neoplastic colorectal lesions and S. Gallolyticus IE.
Conclusions
Pre-cancerous colorectal lesions are also associated with streptococcus Gallolyticus IE, even low-grade lesions. Hence, it is necessary to rule out occult neoplastic and also pre-neoplastic colorectal lesions with colonoscopy in these patients.
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Affiliation(s)
- P Vilardell
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - S Moral
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - D Bosch
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - M Morales
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - J M Frigola
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - X Albert
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Robles
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - H Kassem
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - J Aboal
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
| | - R Brugada
- University Hospital de Girona Dr. Josep Trueta, Cardiology, Girona, Spain
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Vicent L, Ariza-Solé A, Díez-Villanueva P, Alegre O, Sanchís J, López-Palop R, Formiga F, González-Salvado V, Bueno H, Marín F, Llibre C, Llaó I, Vidán M, Abu-Assi E, Aboal J, Martínez-Sellés M. Statin Treatment and Prognosis of Elderly Patients Discharged after Non-ST Segment Elevation Acute Coronary Syndrome. Cardiology 2019; 143:14-21. [DOI: 10.1159/000500824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/02/2019] [Indexed: 01/05/2023]
Abstract
Background: Statins are recommended for secondary prevention. Our aims were to describe the proportion of very elderly patients receiving statins after non-ST segment elevation acute coronary syndrome (NST-ACS) and to determine the prognostic implications of statins use. Methods: This prospective registry was performed in 44 hospitals that included patients ≥80 years discharged after a NST-ACS from April 2016 to September 2016. Results: We included 523 patients, the mean age was 84.2 ± 4.0 years and 200 patients (38.2%) were women. Previous statin treatment was recorded in 282 patients (53.4%), and 135 (32.5%) had LDL cholesterol levels >2.6 mmol/L. Mean LDL cholesterol levels during admission were 2.3 ± 0.9 mmol/L. Statins were prescribed at discharge to 474 patients (90.6%). Compared with patients discharged on statins, those that did not receive statins were more often frail (22 [47.8%] vs. 114 [24.4%], p < 0.01) and underwent an invasive approach less frequently (30 [61.2%] vs. 374 [78.9%], p = 0.01). During a 6-month follow-up, 50 patients died (9.5%). There was a nonsignificant trend to higher mortality in patients not treated with statins (6 [15%] vs. 44 [9.6%], p = 0.30), but statins were not independently associated with lower mortality (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.30–2.11, p = 0.65), nor with a reduction in the combined endpoint mortality/hospitalizations (HR 0.89; 95% CI 0.52–1.55, p = 0.69). Conclusions: Although most octogenarians presenting a NST-ACS are already on statins before the episode, their LDL cholesterol is frequently >2.6 mmol/L. Octogenarians who do not receive statins have a high-risk profile, with significant frailty and comorbidity.
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Llaó I, Gómez-Hospital JA, Aboal J, Garcia C, Montero S, Sambola A, Ortiz J, Tomás C, Bonet G, Viñas D, Oliveras T, Sans-Roselló J, Cantalapiedra J, Andrea R, Hernández I, Pérez-Rodriguez M, Gual M, Cequier A, Ariza-Solé A. Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units. Med Intensiva 2019; 44:475-484. [PMID: 31362838 DOI: 10.1016/j.medin.2019.06.006] [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: 03/26/2019] [Revised: 05/27/2019] [Accepted: 06/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU). DESIGN A prospective cohort study was carried out. SETTING The ICCUs of 8 hospitals in Catalonia (Spain). PATIENTS Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria. INTERVENTIONS EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients. OUTCOME VARIABLES Mortality or readmission at 6 months. RESULTS A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035). CONCLUSIONS The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes.
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Affiliation(s)
- I Llaó
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - J A Gómez-Hospital
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - J Aboal
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - C Garcia
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - S Montero
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica IIB Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - A Sambola
- Unidad de Cuidados Intensivos cardiológicos. Hospital Universitari de la Vall d'Hebron, Barcelona, España
| | - J Ortiz
- Unidad de Cuidados Intensivos cardiológicos. Hospital Clínic i Provincial, Barcelona, España
| | - C Tomás
- Unidad de Cuidados Intensivos cardiológicos. Hospital Arnau de Vilanova, Lleida, España
| | - G Bonet
- Unidad de Cuidados Intensivos cardiológicos. Hospital Joan XXIII, Tarragona, España
| | - D Viñas
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - T Oliveras
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - J Sans-Roselló
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica IIB Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - J Cantalapiedra
- Unidad de Cuidados Intensivos Cardiolígicos, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - R Andrea
- Unidad de Cuidados Intensivos cardiológicos. Hospital Arnau de Vilanova, Lleida, España
| | - I Hernández
- Unidad de Cuidados Intensivos cardiológicos. Hospital Arnau de Vilanova, Lleida, España
| | - M Pérez-Rodriguez
- Unidad de Cuidados Intensivos cardiológicos. Hospital Joan XXIII, Tarragona, España
| | - M Gual
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - A Cequier
- Servicio de Cardiología. Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - A Ariza-Solé
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
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Lorente V, Ariza-Solé A, Jacob J, Formiga F, Marín F, Martínez-Sellés M, Viana-Tejedor A, Bardají A, Sionis A, Palau-Vendrell A, Díez-Villanueva P, Aboal J, González-Salvado V, Bueno H. Criteria for admitting elderly patients with acute coronary syndrome to critical care units from Spanish hospital emergency departments: a LONGEVO-SCA cohort study. Emergencias 2019; 31:154-160. [PMID: 31210446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Information on criteria for admitting elderly patients with acute coronary syndrome (ACS) to intensive care units (ICUs) is scarce. We aimed to describe factors associated with ICU admission in unselected older patients with ACS in Spain. MATERIAL AND METHODS The prospective LONGEVO-SCA registry (Impact of Frailty and Other Geriatric Syndromes on the Management of and Mortality in Elderly Patients With Non-ST-segment Elevation Acute Coronary Syndrome) included unselected patients over the age of 80 years with non-ST-segment elevation SCA. A geriatric assessment of each patient was done in the hospital. Clinical outcomes at 6 months were analyzed. Bivariate logistic regression analysis was applied to identify ICU admission criteria. RESULTS Of 508 patients with a mean age of 84.3 years, 150 (29.5%) were admitted to the ICU. The admitted patients were younger and more often had acute heart failure, elevated troponin levels, and poor left ventricular function. They also scored higher on the Acute Coronary Treatment and Intervention Outcomes Network-ICU (ACTION-ICU) and Global Registry of Acute Coronary Events (GRACE) risk scales. These patients had higher functional status scores and a lower prevalence of frailty and had more often undergone coronary angiography (P < .001). No differences in hospital mortality or outcomes at 6 months were detected between patients admitted or not admitted to ICUs. The following variables were independent predictors of ICU admission: no history of a previous episode of heart failure, an elevated troponin level on arrival, left ventricular dysfunction, high GRACE score and high Charlson Comorbidity Index, and absence of frailty. CONCLUSION Around a third of elderly patients with non-ST-segment elevation ACS are admitted to an ICU. Admitted patients have a higher risk profile on arrival and a lower prevalence of geriatric syndromes.
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Affiliation(s)
- Victòria Lorente
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Francisco Marín
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Universidad de Murcia, Murcia, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense de Madrid, Madrid, España
| | - Ana Viana-Tejedor
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, España
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Joan XXIII, Tarragona, España
| | - Alessandro Sionis
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Violeta González-Salvado
- Servicio de Cardiología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Héctor Bueno
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, España
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Iglesies J, Loma-Osorio P, Aboal J, Núñez M, Brugada R. Lesiones traumáticas por el uso de compresiones torácicas mecánicas para la parada cardiaca extrahospitalaria: ¿hay un precio que pagar? Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Sambola A, Viana-Tejedor A, Bueno H, Antonio Barrabés, Delgado V, Jiménez P, Jorge Pérez P, Javier Noriega F, Vila M, Aboal J, Bouzas A, Brugaletta S, Durán A, Gómez de Diego JJ, Hernández F, López T, Lozano I, Núñez I, Ojeda S, Rosillo S, Sanchis J, Alfonso F, Ibáñez B, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Sambola A, Vázquez R, Viana-Tejedor A. Comentarios al consenso ESC 2018 sobre la cuarta definición universal del infarto de miocardio. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
BACKGROUND Elderly patients with acute coronary syndromes (ACS) are at higher risk both for ischemic and bleeding complications. Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting, but no study assessed its applicability in elderly patients. This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice. METHODS The IFFANIAM registry included prospectively patients aged ≥ 75 years with ST segment elevation myocardial infarction (STEMI). Main outcome measured was the incidence of relevant bleeding after discharge (bleeding leading to hospital readmission, need for transfusion, intervention, stop of antithrombotic drugs or death). Bleeding risk was classified: (A) according to PRECISE-DAPT values above or not the recommended cut-off point (≥ 25); and (B) according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series (Q1: < 30; Q2: 30-35; Q3: 36-44; Q4: ≥ 45). RESULTS A total of 208 patients were included. Mean age was 81.9 ± 4.5 years. Most patients (92.6%) had a PRECISE-DAPT value > 25. A total of 25 patients (12.0%) had bleeding events and 49 patients (23.6%) died. No significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point ≥ 25. However, a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series (P = 0.038). CONCLUSIONS The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk. Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.
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Affiliation(s)
- Carme Guerrero
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona
| | - Albert Ariza-Solé
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona
| | - Francesc Formiga
- Geriatrics Medicine Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona
| | | | - María T Vidán
- Geriatrics Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid
| | - Jaime Aboal
- Department of Cardiology, Hospital Universitari Josep Trueta, Girona
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Aboal J, Núñez M, Bosch D, Tirón C, Brugada R, Loma-Osorio P. Authors' reply. Emergencias 2018; 30:366-367. [PMID: 30260135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jaime Aboal
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - María Núñez
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Daniel Bosch
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Coloma Tirón
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Ramón Brugada
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
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25
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Vilardell P, Brugada J, Aboal J, Loma-Osorio P, Falces C, Andrea R, Figueras-Coll M, Brugada R. Characterization of electrocardiographic findings in young students. ACTA ACUST UNITED AC 2018; 73:139-144. [PMID: 30287239 DOI: 10.1016/j.rec.2018.06.036] [Citation(s) in RCA: 2] [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: 05/15/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The resting 12-lead electrocardiogram (ECG) has been used in the evaluation of young asymptomatic individuals to detect pre-existing heart disease, but systematic ECG use is controversial and there are no data on this population in our environment. We aimed to determine the prevalence and spectrum of electrocardiographic findings in a population of secondary school students. METHODS We conducted an observational, cross-sectional study of resting ECG findings in all 13 to 14-year-old secondary school students in a region of the province of Gerona between 2009 and 2017. ECG findings were classified into 3 groups according to the modified criteria of Corrado et al.: normal ECG findings, ECG findings suggestive of adaptive changes, and pathologic findings. Students with pathologic ECG findings were referred to a tertiary hospital, and complementary tests were performed according to a pre-established protocol. RESULTS A total of 1911 ECGs were obtained, with a participation rate of 79% of all high school students. In all, 1321 students (69%) had a normal ECG, 554 (29%) showed ECG findings suggestive of adaptive changes, and 36 (2%) had pathologic ECG findings. Among the group with pathologic findings, 5 (14%) had cardiovascular disease. The prevalence of heart disease in this group of asymptomatic secondary school students was 0.3%. CONCLUSIONS One third of the students had ECG findings that were mostly suggestive of physiological adaptation. One seventh of the students with pathologic ECG findings had pre-existing heart disease, although the overall prevalence of pre-existing heart disease was low.
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Affiliation(s)
- Pau Vilardell
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain.
| | - Josep Brugada
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Carlos Falces
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Rut Andrea
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Marc Figueras-Coll
- Servicio de Pediatría, Hospital Universitario Josep Trueta de Girona, Girona, Spain
| | - Ramon Brugada
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro de Genética Cardiovascular, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
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Alfonso F, Sionis A, Bueno H, Ibáñez B, Sabaté M, Cequier Á, Barrabés J, Sanchis J, Abu-Assi E, Aboal J, López de Sá E, Martín Asenjo R, Pan M, Ojeda S, Pérez de Prado A, Jiménez Quevedo P, Serrador A, Roldán I, Ferreiro JL, Ruiz Nodar JM, López Sendón JL, San Román A, Alfonso F, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Rodríguez Padial L, Sánchez Fernández PL, Sionis A, Vázquez García R. Comments on the 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-segment Elevation. ACTA ACUST UNITED AC 2018; 70:1039-1045. [PMID: 29198431 DOI: 10.1016/j.rec.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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Aboal J, Núñez M, Bosch D, Tirón C, Brugada R, Loma-Osorio P. [Primary angioplasty versus fibrinolysis in patients at a distance from a hospital with a catheterization laboratory]. Emergencias 2018; 29:99-104. [PMID: 28825251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Long distance from a hospital with a catheterization laboratory is associated with a poorer prognosis in patients who undergo primary angioplasty for ST-elevation myocardial infarction (STEMI). An invasive pharmacologic strategy could offer an alternative treatment for these patients. We aimed to establish whether prognosis was better with primary angioplasty or fibrinolysis for reperfusion in cases of STEMI occurring far from a catheterization laboratory. MATERIAL AND METHODS Prospective registry study of patients with STEMI admitted to our cardiology critical care unit. Patients were included over a 5-year period if they received reperfusion therapy and had required transport of more than 50 km to reach a hospital with a catheterization laboratory. We recorded characteristics of the STEMI event, treatment times, and short- and long-term mortality. The data was used for survival analysis. RESULTS We registered 584 patients; 194 were treated with primary angioplasty and 390 with fibrinolysis. The mean time between first physician contact and balloon insertion was 160 minutes. The mean time between first physician contact and needle insertion for fibrinolysis was 30 minutes. The 2-year mortality rate was higher in patients treated with angioplasty (12.2%) than with those who underwent fibrinolysis (7.0%) ) (P=.04). Survival analysis showed that risk for death was higher in the primary angioplasty group (hazard ratio, 1.97 (95% CI, 0.64-0.95; P=.001). CONCLUSION When STEMI occurs more than 50 km from a catheterization laboratory, reperfusion by means of balloon angioplasty delays care considerably and is associated with a higher mortality rate than reperfusion by fibrinolysis.
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Affiliation(s)
- Jaime Aboal
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - María Núñez
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Daniel Bosch
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Coloma Tirón
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Ramón Brugada
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
| | - Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitari Josep Trueta, Girona, España
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Bernal E, Bayés-Genís A, Ariza-Solé A, Formiga F, Vidán MT, Escobar-Robledo LA, Aboal J, Alcoberro L, Guerrero C, Ariza-Segovia I, de Benito AH, Vilardell P, Sánchez-Salado JC, Lorente V, de Luna AB, Martinez-Sellés M. Corrigendum to “Interatrial block, frailty and prognosis in elderly patients with myocardial infarction” [J Electrocardiol 51(2018) 1–7]. J Electrocardiol 2018; 51:747. [DOI: 10.1016/j.jelectrocard.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Iglesies J, Loma-Osorio P, Aboal J, Núñez M, Brugada R. Mechanical Chest Compressions and Traumatic Complications in Out-of-hospital Cardiac Arrest. Is There a Price to Pay? ACTA ACUST UNITED AC 2018; 72:259-261. [PMID: 29655766 DOI: 10.1016/j.rec.2018.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Josep Iglesies
- Departamento de Cardiología, Hospital Dr. Josep Trueta, Girona, Spain.
| | - Pablo Loma-Osorio
- Departamento de Cardiología, Hospital Dr. Josep Trueta, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain.
| | - Jaime Aboal
- Departamento de Cardiología, Hospital Dr. Josep Trueta, Girona, Spain
| | - María Núñez
- Departamento de Cardiología, Hospital Dr. Josep Trueta, Girona, Spain
| | - Ramon Brugada
- Departamento de Cardiología, Hospital Dr. Josep Trueta, Girona, Spain; Departamento de Genética, Centro de Genética Cardiovascular, Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Martín-Asenjo R, Aboal J, Masip J, López de Sá E, Sionis A. Selection of the Best of 2017 in Ischemic Heart Disease. Rev Esp Cardiol (Engl Ed) 2018; 71:124-125. [PMID: 29221699 DOI: 10.1016/j.rec.2017.10.033] [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: 09/13/2017] [Accepted: 10/09/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - Josep Masip
- Servicio de Cardiología, Hospital Sanitas CIMA, Barcelona; Servei de Medicina Intensiva, Consorci Sanitari Integral, Universitat de Barcelona, Barcelona, Spain
| | - Esteban López de Sá
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Alessandro Sionis
- Unidad de Cuidados Agudos Cardiológicos, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, CIBER-CV, Universidad Autónoma de Barcelona, Barcelona, Spain
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Ariza-Solé A, Guerrero C, Formiga F, Aboal J, Abu-Assi E, Marín F, Bueno H, Alegre O, López-Palop R, Vidán MT, Martínez-Sellés M, Díez-Villanueva P, Vilardell P, Sionis A, Vives-Borrás M, Sanchís J, Bañeras J, Rafecas A, Llibre C, López J, González-Salvado V, Cequier À. Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry. Thromb Haemost 2018. [PMID: 29536466 DOI: 10.1055/s-0038-1623532] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. METHODS The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). RESULTS Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). CONCLUSION Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Guerrero
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Formiga
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaime Aboal
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Emad Abu-Assi
- Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Francisco Marín
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | - Héctor Bueno
- Cardiology Department, Hospital Doce de Octubre, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Oriol Alegre
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón López-Palop
- Cardiology Department, Hosptal Universitario San Juan, Alicante, Spain
| | - María T Vidán
- Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | - Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain
| | | | - Pau Vilardell
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miquel Vives-Borrás
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sanchís
- Cardiology Department, Hospital Clínico de Valencia, INCLIVA, Universidad de Valencia, CIBER CV, Valencia, Spain
| | - Jordi Bañeras
- Cardiology Department, Hospital de la Vall d'Hebron, CIBER CV, Barcelona, Spain
| | - Agnès Rafecas
- Cardiology Department, Hospital de la Vall d'Hebron, CIBER CV, Barcelona, Spain
| | - Cinta Llibre
- Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Javier López
- Cardiology Department, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Violeta González-Salvado
- Cardiology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Àngel Cequier
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Alfonso F, Sionis A, Bueno H, Ibáñez B, Sabaté M, Cequier Á, Barrabés J, Sanchis J, Abu-Assi E, Aboal J, López de Sá E, Martín Asenjo R, Pan M, Ojeda S, Pérez de Prado A, Jiménez Quevedo P, Serrador A, Roldán I, Ferreiro JL, Ruiz Nodar JM, López Sendón JL, San Román A, Alfonso F, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Rodríguez Padial L, Sánchez Fernández PL, Sionis A, Vázquez García R. Comentarios a la guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.10.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bernal E, Bayés-Genís A, Ariza-Solé A, Formiga F, Vidán MT, Escobar-Robledo LA, Aboal J, Alcoberro L, Guerrero C, Ariza-Segovia I, Hernández de Benito A, Vilardell P, Sánchez-Salado JC, Lorente V, Bayés de Luna A, Martinez-Sellés M. Interatrial block, frailty and prognosis in elderly patients with myocardial infarction. J Electrocardiol 2017; 51:1-7. [PMID: 28969847 DOI: 10.1016/j.jelectrocard.2017.08.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Eva Bernal
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria T Vidán
- Geriatric Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jaime Aboal
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | - Lídia Alcoberro
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carme Guerrero
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Iván Ariza-Segovia
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Hernández de Benito
- Geriatric Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pau Vilardell
- Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain
| | | | - Victoria Lorente
- Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Bayés de Luna
- Instituto Catalán de Ciencias Cardiovasculares, Hospital de Sant Pau, Barcelona, Spain
| | - Manuel Martinez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
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Conejos J, Aboal J, Loma-Osorio P, Nunez M, Bosch D, Iglesies J, Pascual J, Fluvia P, Brugada R. P4695Transient ST-elevation ECG pattern in acute coronary syndrome: friend or foe? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4695] [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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Iglesies Grau J, Loma Osorio P, Nunez Torras M, Aboal J, Conejos J, Olivet J, Fontquerni A, Ruiz De Morales E, Fluvia P, Muntaner L, Pascual J, Kassem H, Vilardell P, Brugada R. P2765Public-access defibrillation programme in a geographically disperse region: a 5-year analysis of the first experience in spain. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2765] [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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Fluvia P, Loma Osorio P, Pascual J, Aboal J, Nunez M, Conejos J, Iglesias J, Bosch D, Brugada R. P3667Evaluation of the diagnostic precision of a single determination of high sensitivity troponin in the screening of acute coronary syndrome in the emergency room. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3667] [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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Loma-Osorio P, Nuñez M, Aboal J, Bosch D, Batlle P, Ruiz de Morales E, Ramos R, Brugada J, Onaga H, Morales A, Olivet J, Brugada R. The Girona Territori Cardioprotegit Project: Performance Evaluation of Public Defibrillators. ACTA ACUST UNITED AC 2017; 71:79-85. [PMID: 28522305 DOI: 10.1016/j.rec.2017.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/02/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES In recent years, public access defibrillation programs have exponentially increased the availability of automatic external defibrillators (AED) in public spaces but there are no data on their performance in our setting. We conducted a descriptive analysis of the performance of AED since the launch of a public defibrillation program in our region. METHODS A retrospective analysis was conducted of electrocardiographic tracings and the performance of AED in a public defibrillation program from June 2011 to June 2015 in the province of Girona, Spain. RESULTS There were 231 AED activations. Full information was available on 188 activations, of which 82% corresponded to mobile devices and 18% to permanent devices. Asystole was the most prevalent rhythm (42%), while ventricular fibrillation accounted for 23%. The specificity of the device in identifying a shockable rhythm was 100%, but there were 8 false negatives (sensitivity 83%). There were 47 shockable rhythms, with a spontaneous circulation recovery rate of 49% (23 cases). There were no accidents related to the use of the device. CONCLUSIONS Nearly half of the recorded rhythms were asystole. The AED analyzed showed excellent safety and specificity, with moderate sensitivity. Half the patients with a shockable rhythm were successfully treated by the AED.
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Affiliation(s)
- Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain.
| | - Maria Nuñez
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Daniel Bosch
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Pau Batlle
- Departamento de Salud, Diputación de Girona (Dipsalut), Girona, Spain
| | | | - Rafael Ramos
- Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Instituto de Investigación en Atención Primaria (IDIAP Jordi Gol), Girona, Spain
| | - Josep Brugada
- Instituto del Tórax, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Hisao Onaga
- Servicio de Emergencias Médicas (SEM), Región Sanitaria de Girona, Girona, Spain
| | - Alex Morales
- Departamento de Salud, Diputación de Girona (Dipsalut), Girona, Spain
| | - Josep Olivet
- Grupo de Investigación, Salud y Atención Sanitaria, Universidad de Girona, Girona, Spain
| | - Ramon Brugada
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Centro de Genética Cardiovascular, Instituto de investigación biomédica de Girona (IDIBGI), Girona, Spain
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Ariza-Solé A, Díez-Villanueva P, Carol A, Bonanad C, Alegre O, Aboal J. Selection of the Best of 2016 on the Management of Acute Coronary Syndromes in Elderly Patients. ACTA ACUST UNITED AC 2016; 70:61-62. [PMID: 27913072 DOI: 10.1016/j.rec.2016.11.008] [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] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Albert Ariza-Solé
- Unidad Coronaria, ÿrea de Enfermedades del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, LHospitalet de Llobregat, Barcelona, Spain.
| | | | - Antoni Carol
- Servicio de Cardiología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Oriol Alegre
- Unidad Coronaria, ÿrea de Enfermedades del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, LHospitalet de Llobregat, Barcelona, Spain
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitario Josep Trueta, Girona, Spain
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Ariza-Solé A, Formiga F, Vidán MT, Bueno H, Curós A, Aboal J, Llibre C, Rueda F, Bernal E, Cequier A. Impact of frailty and functional status on outcomes in elderly patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: rationale and design of the IFFANIAM study. Clin Cardiol 2013; 36:565-9. [PMID: 24114768 DOI: 10.1002/clc.22182] [Citation(s) in RCA: 31] [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: 06/03/2013] [Revised: 07/01/2013] [Indexed: 11/12/2022] Open
Abstract
The IFFANIAM study (Impact of frailty and functional status in elderly patients with ST segment elevation myocardial infarction undergoing primary angioplasty) is an observational multicenter registry to assess the impact of frailty and functional status on outcomes of elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. STEMI patients age 75 years or older undergoing primary angioplasty will be extensively studied during admission in 4 tertiary care Hospitals in Spain, assessing their baseline functional status (Barthel index, Lawton-Brody index), frailty (Fried criteria, FRAIL scale [fatigue, resistance, ambulation, illnesses, and loss of weight]), comorbidities (Charlson index), nutritional status (Mini Nutritional Assessment-Short Form), and quality of life (Seattle Angina Questionnaire). Participants will be managed according current recommendations. The primary outcome will be the description of 1-year mortality, its causes, and associated factors. Secondary outcomes will be functional capacity and quality of life. Results will help to better understand the impact of frailty and functional ability on outcomes in elderly STEMI patients undergoing primary angioplasty, thus potentially contributing to improving their clinical management. Higher life expectancy has resulted in a large segment of elderly population and an increase in myocardial infarction in these patients. This calls attention to healthcare systems to focus on promoting methods to improve the clinical management of this population.
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Affiliation(s)
- Albert Ariza-Solé
- Cardiology Department, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Loma-Osorio P, Aboal J, Sanz M, Caballero Á, Vila M, Lorente V, Sánchez-Salado JC, Sionis A, Curós A, Lidón RM. Clinical characteristics and vital and functional prognosis of out-of-hospital cardiac arrest survivors admitted to five cardiac intensive care units. Rev Esp Cardiol (Engl Ed) 2013; 66:623-628. [PMID: 24776330 DOI: 10.1016/j.rec.2013.03.011] [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: 10/03/2012] [Accepted: 03/01/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Survivors of out-of-hospital cardiac arrest constitute an increasing patient population in cardiac intensive care units. Our aim was to characterize these patients and determine their vital and functional prognosis in accordance with the latest evidence. METHODS A multicenter, prospective register was constructed with information from patients admitted to 5 cardiac intensive care units from January 2010 through January 2012 with a diagnosis of resuscitated out-of-hospital cardiac arrest. The information included clinical status, cardiac arrest characteristics, in-hospital course, and vital and neurologic status at discharge and at 6 months. RESULTS A total of 204 patients were included. In 64% of cases, a first shockable rhythm was identified. The time to return of spontaneous circulation was 29 (18) min. An etiologic diagnosis was made in 86% of patients; 44% were discharged with no neurologic sequelae; 40% died in the hospital. At 6 months, 79% of survivors at discharge were still alive and neurologically intact with minimal sequelae. Short resuscitation time, first recorded rhythm, pH on admission >7.1, absence of shock, and use of hypothermia were the independent variables associated with a good neurologic prognosis. CONCLUSIONS Half the patients who recovered from out-of-hospital cardiac arrest had good neurologic prognosis at discharge, and 79% of survivors were alive and neurologically intact after 6 months of follow-up.
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Affiliation(s)
- Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitario Josep Trueta, Girona, Spain.
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitario Josep Trueta, Girona, Spain
| | - Maria Sanz
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Ángel Caballero
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Montserrat Vila
- Servicio de Cardiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Victoria Lorente
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Carlos Sánchez-Salado
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alessandro Sionis
- Servicio de Cardiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni Curós
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Rosa-Maria Lidón
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Gonzalez-Barcala FJ, Aboal J, Carreira JM, Rodriguez-Alvarez MX, Puga A, Sanjose E, Pintos M, Valdes L. Trends of asthma mortality in Galicia from 1993 to 2007. J Asthma 2012; 49:1016-20. [PMID: 23102239 DOI: 10.3109/02770903.2012.728272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In the past few years, deaths due to asthma appear to decrease at least in Western countries; but there are significant variations between populations. The aim of this study is to describe the trends in deaths due to asthma between 1993 and 2007 in our community and to analyze any factors associated with this. METHODS All cases, which had asthma as a cause of death, were included in the study. The mortality data were obtained from the official death certificate from the Deaths Register. Mortality relative risk, based on the calendar year, sociodemographic variables (age and gender), seasons, and days of the week, were estimated using a Poisson generalized linear model with a log-link. RESULTS In the 15 years of the study period, a total of 1180 people had died due to asthma, mainly in winter (34.5%), women (64.5%), and advanced age (65 years or above; 84.6%). A tendency of decreased mortality in all age groups was observed during the period of the study, which was significant in both the sexes in the 35- to 64-year-old age group, and in males above 65 years. CONCLUSION Death due to asthma is changing favorably in our community, with a tendency to decrease in the past few years. Advanced age, being female, and the winter period are associated with a higher mortality rate due to asthma.
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Affiliation(s)
- F J Gonzalez-Barcala
- Department of Respiratory Diseases, University Hospital of Santiago de Compostela, Spain.
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Sala C, Grau M, Masia R, Vila J, Subirana I, Ramos R, Aboal J, Sureda A, Brugada R, Marrugat J, Sala J, Elosua R. Trends in Q-wave acute myocardial infarction case fatality from 1978 to 2007 and analysis of the effectiveness of different treatments. Am Heart J 2011; 162:444-50. [PMID: 21884859 DOI: 10.1016/j.ahj.2011.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/21/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND We sought to analyze the trends in first Q-wave acute myocardial infarction (AMI) case fatality from 1978 to 2007 in a population-based hospital register, to determine the variables related to these changes, and to assess the effectiveness of current AMI management. METHODS Population-based hospital registry included patients with first Q-wave AMI aged 25 to 74 years admitted between 1978 and 2007. Sociodemographic and clinical characteristics, treatments, and procedures used during hospital stay, and 28-day case fatality were recorded. Logistic regression was used for multivariate analysis of six 5-year periods. RESULTS The 30-year study included 3,982 patients. Mean 28-day case fatality was 8.96%, with a decreasing trend from 16.6% in the first 5-year period to 4.7% in the sixth (P for trend < .001). Study period was independently associated with case fatality. Case-fatality reduction attributable to pharmacologic treatments was 51% overall; in 24-hour survivors, pharmacologic treatments and broad use of invasive procedures explained 39% and 38%, respectively, of the difference between the observed case fatality in 2003-2007 and 1978-1982. CONCLUSION A dramatic decrease in 28-day case fatality occurred during this 30-year period and was mainly related to the use of antiplatelet drugs, β-blockers, thrombolysis, and invasive procedures. These data support the current guidelines for the management of acute coronary syndrome.
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Moral S, Aboal J, Morales M. Multiple aorto-right cavitary fistula: a rare complication of prosthetic valvular endocarditis in intravenous drug users. Eur J Echocardiogr 2009; 10:374-5. [PMID: 19129269 DOI: 10.1093/ejechocard/jen328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aorto-cavitary fistula is an infrequent complication in infective endocarditis as well as multiple fistula, being the most rare among intracardiac fistulas. The prognosis of infective endocarditis worsens if there are fistulas associated, exceeding the mortality over 40% despite aggressive surgical treatment. Although transoesophageal echocardiography offers a better sensitivity and specificity, sometimes transthoracic echocardiography is enough to obtain these infrequent pictures that we present.
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Affiliation(s)
- Sergio Moral
- Hospital Universitario Doctor Josep Trueta, Avda Franca s/n, 17007 Girona, Spain.
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Moral S, Ortuño P, Aboal J. Multislice CT in congenital heart disease: Partial anomalous pulmonary venous connection. Pediatr Cardiol 2008; 29:1120-1. [PMID: 18587607 DOI: 10.1007/s00246-008-9252-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 01/17/2008] [Revised: 04/01/2008] [Accepted: 05/27/2008] [Indexed: 11/29/2022]
Abstract
Computed Tomography (CT) is increasingly becoming an imaging technique for congenital heart diseases, particularly for the diagnosis of partially anomalous pulmonary venous connections. When echocardiography cannot provide the diagnosis, multislice CT offers some advantages in comparison with RMN and angiography.
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Affiliation(s)
- Sergio Moral
- Department of Cardiology, Hospital Doctor Josep Trueta, Girona. Av. de Francia s/n., Girona, Spain.
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Marrugat J, Sala J, Aboal J. [Epidemiology of cardiovascular disease in women]. Rev Esp Cardiol 2006; 59:264-74. [PMID: 16712751] [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: 05/09/2023]
Abstract
Both mortality due to cerebrovascular disease in individuals aged under 85 years and mortality due to acute myocardial infarction (AMI) are lower in women than men. In contrast, the age-adjusted 28-day case fatality rate after a first AMI is 20% higher in women, particularly in countries where the incidence of AMI is low. In Spain, the case fatality rate is elevated in women hospitalized for a first AMI, but not in those with other forms of coronary heart disease. The pattern of mortality observed after symptom onset, which shows that death is delayed in women, suggests that the mechanism of death is different in the two sexes. The substantial variation that exists in the way results are adjusted and presented make it very difficult to compare the findings of different studies. Relative to men, women with AMI are 10 years older, reach hospital one hour later on average, more frequently have a comorbid condition (mainly diabetes and hypertension), progress to a more serious clinical state, and have a higher adjusted 28-day mortality risk. Moreover, the treatment given to women during the acute phase is less aggressive. A change in healthcare workers' attitudes is needed so that women with acute coronary syndromes can be identified earlier, thereby increasing the use of diagnostic and therapeutic procedures to a level that corresponds to the greater severity of AMI observed in women at presentation.
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Affiliation(s)
- Jaume Marrugat
- Unitat de Lípids i Epidemiologia Cardiovascular, Institut Municipal d'Investigació Mèdica, Barcelona, España
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Bosch X, López De Sá E, López Sendón J, Aboal J, Miranda-Guardiola F, Bethencourt A, Rubio R, Moreno R, Martín Jadraque L, Roldán I, Calviño R, Valle V, Malpartida F. [Clinical characteristics, prognosis, and variability in the management of non-ST-segment elevation acute coronary syndromes. Data from the PEPA registry]. Rev Esp Cardiol 2003; 56:346-53. [PMID: 12689568 DOI: 10.1016/s0300-8932(03)76877-8] [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: 11/19/2022]
Abstract
OBJECTIVES To assess the clinical characteristics and inter-hospital variability in the treatment and prognosis of patients with non-ST-segment elevation acute coronary syndromes. PATIENTS AND METHOD Data from the PEPA study, a prospective registry that enrolled 4,115 patients in 18 Spanish hospitals, were analyzed. RESULTS The mean age of the patients enrolled was 65 years, 33% were women, and 26% had diabetes. Large differences were observed in the clinical profile of patients admitted to different centers, especially relative the history of previous disease, prior coronary revascularization, and co-morbidity. Antiplatelet treatment was used in 93% of patients, heparin in 45%, beta-blockers in 42%, nitrates in 67%, and calcium antagonists in 46%. During hospitalization, exercise stress testing was performed in 37% of patients, coronary angiography in 32%, coronary angioplasty in 9%, and coronary surgery in 4%. Inter-hospital variability was minimal for the use of antiplatelet agents, wide for the use of heparin and beta-blockers, and huge for the use of revascularization procedures. Mortality and the incidence of death or myocardial infarction were 2.6% and 4.4% during hospitalization, and 4.6% and 8% at 3 months, with wide inter-hospital variability. These differences were not significant once adjusted for clinical characteristics and the treatment received at admission. CONCLUSIONS Patients with non-ST-segment elevation acute coronary syndromes represent an heterogeneous group with a high incidence of complications. Pharmacologic and, especially, invasive treatment varies widely in different hospitals. These results underline the importance of correct initial risk stratification and uniform treatment following the recommendations of clinical guidelines.
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Affiliation(s)
- Xavier Bosch
- Servicio de Cardiología. Institut de Malalties Cardiovasculars. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Barcelona. España.
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