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López-Sendón J, Álvarez-Ortega C, Zamora Auñon P, Buño Soto A, Lyon AR, Farmakis D, Cardinale D, Canales Albendea M, Feliu Batlle J, Rodríguez Rodríguez I, Rodríguez Fraga O, Albaladejo A, Mediavilla G, González-Juanatey JR, Martínez Monzonis A, Gómez Prieto P, González-Costello J, Serrano Antolín JM, Cadenas Chamorro R, López Fernández T. Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: the CARDIOTOX registry. Eur Heart J 2021; 41:1720-1729. [PMID: 32016393 DOI: 10.1093/eurheartj/ehaa006] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/18/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
AIM Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. METHODS AND RESULTS We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40-49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22-40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5-19.2) (P < 0.001). CONCLUSIONS The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices.
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Affiliation(s)
- José López-Sendón
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Carlos Álvarez-Ortega
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Pilar Zamora Auñon
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Antonio Buño Soto
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Alexander R Lyon
- Royal Brompton Hospital and Imperial College, Cardiology, London, United Kingdom of Great Britain and Northern Ireland
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus.,Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, I.R.C.C.S, Milan, Italy
| | - Miguel Canales Albendea
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Jaime Feliu Batlle
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Isabel Rodríguez Rodríguez
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Olaia Rodríguez Fraga
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Ainara Albaladejo
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Guiomar Mediavilla
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | | | - Amparo Martínez Monzonis
- University Hospital of Santiago de Compostela, Cardiology, CiberCV, Santiago De Compostela, Spain
| | - Pilar Gómez Prieto
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | | | | | | | - Teresa López Fernández
- University Hospital La Paz, UAM, IdiPaz, CiberCV, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
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Martín García A, Mitroi C, Mazón Ramos P, García Sanz R, Virizuela JA, Arenas M, Egocheaga Cabello I, Albert D, Anguita Sánchez M, Arrarte Esteban VI, Ayala de la Peña F, Bonanand Lozano C, Castro A, Castro Fernández A, Córdoba R, Cosín-Sales J, Chaparro-Muñoz M, Dalmau R, Drak Hernández Y, Deiros Bronte L, Díez-Villanueva P, Escobar Cervantes C, Fernández Redondo C, García Rodríguez E, Lozano T, Marco Vera P, Martínez Monzonis A, Mesa D, Oristrell G, Palma Gámiz JL, Pedreira M, Reinoso-Barbero L, Rodríguez I, Serrano Antolín JM, Toral B, Torres Royo L, Velasco Del Castillo S, Vicente-Herrero T, Zatarain-Nicolás E, Tamargo J, López Fernández T. Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC. ACTA ACUST UNITED AC 2021; 74:438-448. [PMID: 33712348 DOI: 10.1016/j.rec.2020.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).
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Affiliation(s)
- Ana Martín García
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, USAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain.
| | - Cristina Mitroi
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pilar Mazón Ramos
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Ramón García Sanz
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC-ISCIII), Spain
| | | | - Meritxell Arenas
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | - Dimpna Albert
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Raúl Córdoba
- Servicio de Hematología, Fundación Jiménez Díaz, Madrid, Spain
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Regina Dalmau
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Lucía Deiros Bronte
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Escobar Cervantes
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | | | - Teresa Lozano
- Servicio de Cardiología, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Pascual Marco Vera
- Servicio de Hematología y Hemoterapia, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Amparo Martínez Monzonis
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Gerard Oristrell
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Milagros Pedreira
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Isabel Rodríguez
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Belén Toral
- Servicio de Cardiología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Torres Royo
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | | | - Eduardo Zatarain-Nicolás
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Juan Tamargo
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Teresa López Fernández
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
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Caro-Codón J, López-Fernández T, Álvarez-Ortega C, Zamora Auñón P, Rodríguez IR, Gómez Prieto P, Buño Soto A, Canales Albendea M, Albaladejo A, Mediavilla G, Feliu Batlle J, Rodríguez Fraga O, Martínez Monzonis A, González-Costello J, Serrano Antolín JM, Cadenas Chamorro R, González-Juanatey JR, López-Sendón J. Cardiovascular risk factors during cancer treatment. Prevalence and prognostic relevance: insights from the CARDIOTOX registry. Eur J Prev Cardiol 2020; 29:859-868. [DOI: 10.1093/eurjpc/zwaa034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/03/2020] [Revised: 04/29/2020] [Accepted: 07/30/2020] [Indexed: 12/21/2022]
Abstract
Abstract
Aims
The actual usefulness of cardiovascular (CV) risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Prospective multicentre study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk.
Methods and results
A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples, and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years, and 2 years after initiation of cancer therapy. At baseline, 893 patients (67.4%) presented at least one risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity (CTox) and all-cause mortality [hazard ratio (HR) 1.79 (95% confidence interval, CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)].
Conclusions
This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline CV risk assessment using SCORE predicted severe CTox and all-cause mortality. Therefore, its use should be considered in the evaluation of cancer patients.
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Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, University Hospital La Paz, UAM, IdiPaz, CiberCV, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Teresa López-Fernández
- Cardiology Department, University Hospital La Paz, UAM, IdiPaz, CiberCV, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Carlos Álvarez-Ortega
- Cardiology Department, University Hospital La Paz, UAM, IdiPaz, CiberCV, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Pilar Zamora Auñón
- Oncology Department, University Hospital La Paz, UAM, IdiPaz, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Isabel Rodríguez Rodríguez
- Oncoradiotherapy Department University Hospital La Paz, UAM, IdiPaz, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Pilar Gómez Prieto
- Hematology Department University Hospital La Paz, UAM, IdiPaz, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Antonio Buño Soto
- Clinical Analytics Department University Hospital La Paz, UAM, IdiPaz, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Miguel Canales Albendea
- Hematology Department University Hospital La Paz, UAM, IdiPaz, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Ainara Albaladejo
- Cardiology Department, University Hospital La Paz, UAM, IdiPaz, CiberCV, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Guiomar Mediavilla
- Cardiology Department, University Hospital La Paz, UAM, IdiPaz, CiberCV, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Jaime Feliu Batlle
- Oncology Department, University Hospital La Paz, UAM, IdiPaz, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Olaia Rodríguez Fraga
- Clinical Analytics Department University Hospital La Paz, UAM, IdiPaz, CiberONC, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Amparo Martínez Monzonis
- Department of Cardiology, University Hospital of Santiago de Compostela, CiberCV, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - José González-Costello
- Department of Cardiology, University Hospital of Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - José María Serrano Antolín
- Department of Cardiology, University Hospital of Fuenlabrada, Camino del Molino, 2, 28942 Fuenlabrada, Madrid, Spain
| | - Rosalía Cadenas Chamorro
- Department of Cardiology, University Hospital Infanta Sofia, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - José R González-Juanatey
- Department of Cardiology, University Hospital of Santiago de Compostela, CiberCV, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - José López-Sendón
- Cardiology Department, University Hospital La Paz, UAM, IdiPaz, CiberCV, Paseo de la Castellana 261, Madrid 28046, Spain
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Mata Caballero R, Serrano Antolín JM, Jimenez Hernandez RM, Talavera Calle P, Curcio Ruigomez A, Del Castillo Arrojo S, Graupner Abad C, Cristóbal Varela C, Alonso Martín JJ. Incidence of long-term cardiotoxicity and evolution of the systolic function in patients with breast cancer treated with anthracyclines. Cardiol J 2020; 29:228-234. [PMID: 32329038 PMCID: PMC9007491 DOI: 10.5603/cj.a2020.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 12/05/2022] Open
Abstract
Background Anthracycline cardiotoxicity (AC) may manifest years after treatment (long-term cardiotoxicity). There is little data on the incidence and natural history of AC in the current context, with protocols including lower anthracycline doses. The present study prospectively evaluated the incidence, time of occurrence and clinical correlates of long-term cardiotoxicity and the evolution of systolic function in patients with breast cancer treated with anthracyclines. Methods This study prospectively included 85 consecutive patients undergoing chemotherapy (CHT) with anthracyclines without trastuzumab. All patients underwent evaluation at baseline, at the end of CHT, 3 months after the end of CHT and 1 and 4 years subsequent to the beginning of CHT. Clinical data and echocardiographic parameters were evaluated in all examinations. Results The mean dose of doxorubicin used was 243.53 mg/m2. Median follow-up of the current cohort was 4.5 years. At 1 year the incidence of AC was 1% and at the end of the follow-up 16.5% (14 of 85 patients). Therefore, the incidence of late cardiotoxicity (after the first year) was 15%. Of these 14 patients with AC, 12 had asymptomatic systolic dysfunction, 1 had heart failure and 1 suffered sudden death. Fifteen percent developed systolic dysfunction during follow-up. An early decline in strain was observed in patients who developed long-term AC. Conclusions The incidence of long-term cardiotoxicity in patients treated with low-cumulative dose of anthracyclines is high, 16.5% at 4.5 years. This was observed in almost all cases after the first year of follow-up. Therefore, long-term monitoring may be advisable.
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Affiliation(s)
| | | | | | - Pedro Talavera Calle
- Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942 Fuenlabrada (Madrid), Spain
| | | | | | - Catherine Graupner Abad
- Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942 Fuenlabrada (Madrid), Spain
| | - Carmen Cristóbal Varela
- Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942 Fuenlabrada (Madrid), Spain
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Alonso Martín JJ, Curcio Ruigómez A, Cristóbal Varela C, Tarín Vicente MN, Serrano Antolín JM, Talavera Calle P, Graupner Abad C. [Coronary revascularization: clinical features and indications]. Rev Esp Cardiol 2005; 58:198-216. [PMID: 15743566] [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: 05/02/2023]
Abstract
Coronary artery revascularization is an established therapeutic intervention and is therefore included in all treatment guidelines for patients with coronary artery disease. Although the procedure has been available for more than 40 years, constant technical progress in surgical and percutaneous revascularization continues to bring the benefits of revascularization therapy to new groups of patients. Therefore the indications and limitations of this approach need to be reviewed and updated periodically. The aim of revascularization therapy is to improve the prognosis or symptoms and quality of life in patients with ischemic heart disease. The revascularization process comprises two aspects: 1) indication and selection of the revascularization procedure, and 2) performance of the procedure. Involvement of the clinical cardiologist in the first step is fundamental. Basing their decisions on clinical, functional and anatomical features, these professionals detect and select patients who would benefit, and also help to select the revascularization technique. In this Update article on revascularization we review, for stable ischemic heart disease and non-ST segment elevation acute coronary syndromes, the following: 1) the most relevant aspects to consider when evaluating the need for and the type of revascularization (age, sex, diabetes, renal function, electrocardiographic changes, ventricular function and quantification of functional relevance of coronary artery disease and viability of the acinetic areas); 2) indications for surgical or percutaneous intervention, and the choice of therapeutic strategy according to the latest clinical evidence and guidelines of scientific societies, and 3) currently available data on the controversy regarding choice of the revascularization procedure in patients with multivessel disease.
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Alonso Martín JJ, Curcio Ruigómez A, Cristóbal Varela C, Tarín Vicente MN, Serrano Antolín JM, Talavera Calle P, Graupner Abad C. Indicaciones de revascularización: aspectos clínicos. Rev Esp Cardiol 2005. [DOI: 10.1157/13071894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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