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Very long-term efficacy and safety of paclitaxel-eluting balloon after a bare-metal stent for the treatment of ST-elevation myocardial infarction: 8-year results of a randomized clinical trial (PEBSI study). Cardiovasc Diagn Ther 2023; 13:792-804. [PMID: 37941845 PMCID: PMC10628420 DOI: 10.21037/cdt-22-623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/08/2023] [Indexed: 11/10/2023]
Abstract
Background Drug-eluting stents (DES) are considered the therapy of choice in ST-segment elevation myocardial infarction (STEMI); however, a low persistent rate of revascularizations and stent thrombosis exist over the time. We have previously shown that a paclitaxel (PTX)-drug-coated balloon (DCB) after a bare-metal stent (BMS) implantation (DCB-combined strategy) yields superior angiographic and clinical results compared to BMS in the short term. However, the long-term safety and efficacy of this approach remain uncertain. Methods An 8-year clinical follow-up was conducted on patients enrolled in the randomized PEBSI-1 trial (NCT01839890). The original trial included patients who suffered a STEMI, patients were randomly assigned to receive a DCB-combined strategy or BMS only and the primary endpoint was in-stent late luminal loss (LLL) at 9-month follow-up. After the completion of this study, death, myocardial re-infarction, ischemia-driven repeated revascularizations included target lesion revascularization (TLR) and target vessel revascularization (TVR), and stent thrombosis, were assessed by yearly contact by a clinical visit, telephone or by electronic records. These outcomes were adhered to ARC-2 criteria. Results The rate of incomplete follow-up was very low, with only 3 out of 111 patients (2.7%) in the DCB-combined strategy group and 1 out of 112 patients (0.9%) in the BMS group. At 8 years there were a lower rate of TVR [3.7% vs. 14.3%; hazard ratio (HR): 0.243; 95% confidence interval (CI): 0.081-0.727; P=0.006], and a trend towards lower TLR (2.8% vs. 8.9%; HR: 0.300; 95% CI: 0.083-1.090; P=0.052) in the DCB-combined strategy group. No statistical difference between the DCB-combined strategy and BMS groups were found for all causes of death, deaths from cardiovascular disease, reinfarctions or stent thrombosis. Notably in the DCB-combined strategy group, no episode of stent thrombosis occurred after the first year. Similarly, there were no cardiovascular deaths, TVR and TLR in the DCB-combined strategy group after 5 years. In contrast, during the period from year 5 to 8, the BMS group experienced an additional cardiovascular death, as well as one case of TVR, one case of TLR, and one case of stent thrombosis. Conclusions In STEMI patients, the DCB-combined strategy maintains its safety and clinical efficacy over time. Our rates of TVR, TLR, and very late stent thrombosis (VLST) at very long-term are the lowest ever found in a STEMI trial. Further studies are warranted to assess the potential superiority of this novel strategy as compared with new-generation DES to prevent very late events in these patients. Trial Registration ClinicalTrials.gov; identifier: NCT01839890.
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Diferencias regionales en la atenci�n al IAMCEST en Espa�a. Datos del Registro de C�digo Infarto ACI-SEC. REC: INTERVENTIONAL CARDIOLOGY 2023. [DOI: 10.24875/recic.m22000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Short-term mortality differs between men and women according to the presence of previous cardiovascular disease: Insights from a nationwide STEMI cohort. Int J Cardiol 2022; 367:90-98. [PMID: 36030132 DOI: 10.1016/j.ijcard.2022.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sex and prior cardiovascular disease (CVD) are known independent prognostic factors following an ST-elevation myocardial infarction (STEMI). We aimed to examine whether the association between sex and 30-day mortality differ according to the presence of previous CVD in STEMI patients. METHODS Prospective, observational, multicentre registry of consecutive patients managed in 17 STEMI networks in Spain (83 centres), between April and June 2019. Unadjusted and adjusted logistic regression models assessed the association of 30-day mortality with sex and prior CVD status, as well as their interaction. RESULTS Among 4366 patients (mean age 63.7 ± 13.0 years; 78% male), there were 337 (8.1%) deaths within the first 30 days. There was an association between crude 30-day mortality and sex (women 10.4% vs. men 7.4%, p = 0.003), and prior CVD (CVD 13.7% vs non-CVD 6.8%, p < 0.001). After adjustment for potential confounding, neither sex nor prior CVD were apparently associated with mortality. Nevertheless, we found a significant sex-CVD interaction (p-interaction = 0.006), since women were at lower risk than men in the subset of patients with prior CVD (OR = 0.30, 95%CI = 0.12-0.80) but not in those without CVD (OR = 1.17, 95%CI = 0.79-1.74). CONCLUSIONS Women as well as patients with prior CVD have an increased crude risk of 30-day mortality. However, sex-related differences in short term mortality are modulated by the interaction with CVD in STEMI patients. Compared to men, women had a similar prognosis in the subset of patients without CVD, whereas they were associated with a lower risk of mortality among those with prior CVD after adjusting for other prognostic factors.
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Analysis of the management of ST-segment elevation myocardial infarction in Spain. Results from the ACI-SEC Infarction Code Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:669-680. [PMID: 35067471 DOI: 10.1016/j.rec.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES ST-segment elevation myocardial infarction (STEMI) networks should guarantee STEMI care with good clinical results and within the recommended time parameters. There is no contemporary information on the performance of these networks in Spain. The objective of this study was to analyze the clinical characteristics of patients, times to reperfusion, characteristics of the intervention performed, and 30-day mortality. METHODS Prospective, observational, multicenter registry of consecutive patients treated in 17 STEMI networks in Spain (83 centers with the Infarction Code), between April 1 and June 30, 2019. RESULTS A total of 5401 patients were attended (mean age, 64±13 years; 76.9% male), of which 4366 (80.8%) had confirmed STEMI. Of these, 87.5% were treated with primary angioplasty, 4.4% with fibrinolysis, and 8.1% did not receive reperfusion. In patients treated with primary angioplasty, the time between symptom onset and reperfusion was 193 [135-315] minutes and the time between first medical contact and reperfusion was 107 [80-146] minutes. Overall 30-day mortality due to STEMI was 7.9%, while mortality in patients treated with primary angioplasty was 6.8%. CONCLUSIONS Most patients with STEMI were treated with primary angioplasty. In more than half of the patients, the time from first medical contact to reperfusion was <120 minutes. Mortality at 30 days was relatively low.
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Registro prospectivo del stent liberador de sirolimus con pol�mero estable de fluoroacrilato Angiolite: estudio EPIC02 � RANGO. REC: INTERVENTIONAL CARDIOLOGY 2022. [DOI: 10.24875/recic.m21000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Análisis de la atención al infarto con elevación del segmento ST en España. Resultados del Registro de Código Infarto de la ACI-SEC. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Requisitos y sostenibilidad de los programas de ICP primaria en Espa�a en el IAMCEST. Documento de consenso de SEC, AEEC y SEMES. REC: INTERVENTIONAL CARDIOLOGY 2021. [DOI: 10.24875/recic.m19000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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[camara] Encuesta sobre las necesidades de los programas de angioplastia primaria en Espa�a. REC: INTERVENTIONAL CARDIOLOGY 2021. [DOI: 10.24875/recic.m19000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiología intervencionista en España. REC: INTERVENTIONAL CARDIOLOGY 2021. [DOI: 10.24875/recic.m20000120] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience. ACTA ACUST UNITED AC 2020; 73:994-1002. [PMID: 32917566 PMCID: PMC7834732 DOI: 10.1016/j.rec.2020.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022]
Abstract
Introduction and objectives The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. Methods Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. Results Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. Conclusions The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
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Evidencia científica y opinión de expertos. ¿Por qué el TAVI es diferente? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Scientific evidence and expert opinion. Why is TAVI different? ACTA ACUST UNITED AC 2020; 73:431-432. [PMID: 32192876 DOI: 10.1016/j.rec.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022]
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Coronary Artery Tenting After Bypass Grafting: A Key Issue During Percutaneous Coronary Intervention of a Chronic Total Occlusion. THE JOURNAL OF INVASIVE CARDIOLOGY 2019; 31:E2-E3. [PMID: 30611126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This image series shows how bypass grafts may tent the vessel to which they are anastomosed, potentially changing the expected course of the native coronary vessel. This fact must be taken into account during CTO-PCI, and this case emphasizes the importance of careful analysis of coronary anatomy with several angiographic projections.
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Bioresorbable Vascular Scaffolds for Patients With In-Stent Restenosis. JACC Cardiovasc Interv 2017; 10:1841-1851. [DOI: 10.1016/j.jcin.2017.06.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
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PRotective Effect on the coronary microcirculation of patients with DIabetes by Clopidogrel or Ticagrelor (PREDICT): study rationale and design. A randomized multicenter clinical trial using intracoronary multimodal physiology. Cardiovasc Diabetol 2017; 16:68. [PMID: 28526024 PMCID: PMC5438565 DOI: 10.1186/s12933-017-0543-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/28/2017] [Indexed: 12/25/2022] Open
Abstract
Background In diabetic patients a predisposed coronary microcirculation along with a higher risk of distal particulate embolization during primary percutaneous intervention (PCI) increases the risk of peri-procedural microcirculatory damage. However, new antiplatelet agents, in particular Ticagrelor, may protect the microcirculation through its adenosine-mediated vasodilatory effects. Methods PREDICT is an original, prospective, randomized, multicenter controlled study designed to investigate the protective effect of Ticagrelor on the microcirculation during PCI in patient with diabetes mellitus type 2 or pre-diabetic status. The primary endpoints of this study aim to test (i) the decrease in microcirculatory resistance with antiplatelet therapy (Ticagrelor > Clopidogrel; mechanistic effect) and (ii) the relative microcirculatory protection of Ticagrelor compared to Clopidogrel during PCI (Ticagrelor < Clopidogrel; protective effect). Conclusions PREDICT will be the first multicentre clinical trial to test the adenosine-mediated vasodilatory effect of Ticagrelor on the microcirculation during PCI in diabetic patients. The results will provide important insights into the prospective beneficial effect of this drug in preventing microvascular impairment related to PCI (http://www.clinicaltrials.gov No. NCT02698618). Electronic supplementary material The online version of this article (doi:10.1186/s12933-017-0543-5) contains supplementary material, which is available to authorized users.
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Second-Generation Drug-Eluting Balloon for Ostial Side Branch Lesions (001-Bifurcations): Mid-Term Clinical and Angiographic Results. J Interv Cardiol 2017; 29:285-92. [PMID: 27245124 DOI: 10.1111/joic.12292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In the drug-eluting stent era, the best strategy to treat Medina 001 lesion remains unestablished. This is the first prospective registry assessing the efficacy and safety of the second-generation drug-coated balloon in patients with side-branch ostial lesion. METHODS Forty-nine patients with de novo Medina 001 lesion and associated myocardial ischemia were treated with second-generation drug-coated balloon-Dior balloon catheter (Eurocor GmbH, Bonn Germany), and prospectively included in this study. After mandatory pre-dilatation, a paclitaxel-eluting balloon was inflated for a minimum of 45 seconds. Left main bifurcation, severely calcified lesions and cardiogenic shock, were the only exclusion criteria. RESULTS The inclusion period was 2.7 years. Mean age was 62 ± 12 years old, 41% diabetic, 65% presented with acute coronary syndrome. The most common vessel treated was the first diagonal (50%). Pre-dilatation with a cutting balloon was used in 59%. Angiographic success was 86% (in 14% a bare metal stent was implanted because of acute recoil [n = 5] or coronary dissection more than type B [n = 2]). At a mean of 12.2 ± 2.2 months, major cardiac adverse events rate was 14.3% (1 myocardial infarction, 0 cardiac deaths, 7 target lesion revascularization). There was no thrombosis or occlusion. At a mean of 7.2 ± 1.1 months, binary restenosis was 22.5% (n = 7) with a late loss of 0.32 ± 0.73 mm. CONCLUSION Medina 001 lesion is an infrequent type of coronary lesion. Drug-coated balloon-Dior is a safe and technically easy therapeutic option, associated with acceptable mid-term clinical outcomes. (J Interven Cardiol 2016;29:285-292).
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Treatment of Small Vessel Disease With the Paclitaxel Drug-Eluting Balloon: 6-Month Angiographic and 1-Year Clinical Outcomes of the Spanish Multicenter Registry. J Interv Cardiol 2015; 28:430-8. [DOI: 10.1111/joic.12227] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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CRT-144 Percutaneous Intervention in Chronic Total Coronary Occlusions Due To In-stent Restenosis: A Multicenter Registry. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Long-term clinical performance of paclitaxel-eluting stents coated with a bioactive polymer (P-5) containing a triflusal derivative: results of the REWAC registry. THE JOURNAL OF INVASIVE CARDIOLOGY 2013; 25:391-396. [PMID: 23913603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS Although drug-eluting stents have dramatically reduced angiographic restenosis and clinical need for repeat revascularization procedures, some adverse effects, such as late stent thrombosis, have been described. We evaluated clinical performance of paclitaxel-eluting stents coated with a new bioactive polymer system (P-5) based on a copolymer of an acrylic derivative of triflusal in patients with coronary artery disease. METHODS AND RESULTS This was a multicenter, observational, prospective study to assess the incidence of target lesion revascularization (TLR) at 6 months and clinical major adverse cardiac events (MACEs) at 1 and 6 months and 1 and 2 years post-stent implantation in 537 patients. After stent implantation, only 1 case of thrombus and acute occlusion was reported in 1 lesion (0.14%). The incidence of new TLR was 0.89% at 6 months, 1.08% at 1 year, and 1.49% at 2 years, with a cumulative incidence of 3.54%. MACEs included cardiac death (0.93%), myocardial infarction (0.37%), and cardiac surgery (0.19%). No cases of late or very late stent thrombosis were recorded. CONCLUSION Under routine clinical practice, the implantation of paclitaxel-eluting stents coated with P-5 is associated with favorable clinical outcomes in both the short and long term (2 years) in patients with coronary artery disease.
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Double antiplatelet therapy after drug-eluting stent implantation: risk associated with discontinuation within the first year. J Am Coll Cardiol 2012; 60:1333-9. [PMID: 22999716 DOI: 10.1016/j.jacc.2012.04.057] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 04/23/2012] [Accepted: 04/30/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goal of this study was to assess the risk associated with double antiplatelet therapy (DAT) discontinuation, and specifically, temporary discontinuation, during the first year after drug-eluting stent (DES) implantation. BACKGROUND Doubts remain about the risk of temporary DAT discontinuation within 1 year after DES implantation. METHODS A total of 1,622 consecutive patients undergoing DES implantation at 29 hospitals were followed up at 3, 6, 9, and 12 months to record the 1-year antiplatelet therapy discontinuation (ATD) rate, the number of days without DAT, and the rate of 1-year major cardiac events. Cox regression was used to analyze the association between ATD considered as a time-dependent covariate and 1-year cardiac events. RESULTS One hundred seventy-two (10.6%) patients interrupted at least 1 antiplatelet drug during the first year after DES implantation, although only 1 during the first month. Most (n=111, 64.5%) interrupted DAT temporarily (median: 7 days; range: 5 to 8.5): 79 clopidogrel (31 temporarily), 38 aspirin (27 temporarily), and 55 both drugs (53 temporarily). Discontinuation was followed by acute coronary syndrome in 7 (4.1%; 95% confidence interval [CI]: 1.7 to 8.2), a similar rate of major cardiac events to that in patients without ATD (n=80; 5.5%; 95% CI: 4.4 to 6.8; p=0.23). ATD was not independently associated with 1-year major cardiac events (hazard ratio: 1.32 [95% CI: 0.56 to 3.12]). CONCLUSIONS ATD within the first year and beyond the first month after DES is not exceptional, is usually temporary, and does not appear to have a large impact on risk.
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AS-053 Improving the Safety of Drug Eluting Stent Focusing on the Platform Design and Bio-Polymer Properties. Initial and Mid-Term Outcome of the REWAC Registry. Am J Cardiol 2011. [DOI: 10.1016/j.amjcard.2011.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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A randomised comparison between everolimus-eluting stent and sirolimus-eluting stent in chronic coronary total occlusions. Rationale and design of the CIBELES (non-acute Coronary occlusion treated by EveroLimus-Eluting Stent) trial. EUROINTERVENTION 2010; 6:112-116. [PMID: 20542806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Chronic total coronary occlusions constitute a sub-group of lesions at very high risk of restenosis after successful percutaneous coronary intervention. The sirolimus-eluting coronary stent is the only drugeluting stent that has demonstrated to reduce angiographic restenosis and the need for new revascularisation procedures in comparison with bare-metal stents in randomised clinical trials focusing on these lesions. Everolimus-eluting stents have shown to offer optimal angiographic and clinical outcomes in comparison with bare-metal stents and paclitaxel-eluting stents, but no randomised trials have tested the device in chronic total occlusions. The CIBELES (non-acute Coronary occlusIon treated By EveroLimus- Eluting Stent) will randomise 208 patients with chronic total coronary occlusions in 13 centres from Portugal and Spain to receive everolimus- or sirolimus-eluting coronary stents. The primary endpoint will be angiographic in-stent late loss.
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Coronary stent immobilization during angioplasty by transcoronary ventricular pacing via a guidewire. Rev Esp Cardiol 2009; 62:288-92. [PMID: 19268073 DOI: 10.1016/s1885-5857(09)71558-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES In some patients, cardiac contractions cause the coronary artery segment adjacent to a stent to move in such a way that accurate stent positioning is difficult. A number of techniques have been described for immobilizing the stent at the target site by inducing periods of either asystole or tachycardia. This study shows how pulsatile motion can be controlled by means of rapid ventricular pacing via an angioplasty guidewire. METHODS The study involved 27 consecutive patients in whom excessive stent movement during angioplasty complicated accurate stent implantation. In these selected patients, myocardial tachycardia was induced by transcoronary ventricular pacing via an angioplasty guidewire with the aim of reducing the pulsatile motion of the stent. RESULTS At baseline, the median displacement was 4.08 mm (interquartile range 2.75 mm). During pacing at 100 and 150 beats per minute, the median displacement was 1.39 mm and 0.54 mm, respectively (interquartile range 1.66 mm and 0.54 mm, respectively). Transcoronary myocardial pacing was effective in 96% of cases. No complications associated with pacing were reported. CONCLUSIONS Transcoronary ventricular pacing via an angioplasty guidewire was an effective and safe method for achieving stent immobilization in cases where there was excessive pulsatile motion.
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Inmovilización del stent coronario durante la angioplastia mediante estimulación ventricular transcoronaria con guía terapéutica. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70372-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
AIMS To evaluate the cardiac mortality in patients suffering from a first episode of sustained monomorphic ventricular tachycardia (SMVT). METHODS 100 patients less than 75 years old were evaluated during a 50-month follow-up period. Patients were classified into four groups: myocardial infarction, dilated cardiomyopathy, normal heart and miscellany. Seventeen patients underwent a cardioverter-defibrillator implantation, two heart transplant, three aneurysmectomy and 10 other types of cardiac surgical proceedings. RESULTS Patients with a left ventricle ejection fraction (EF)> or =50% presented a cardiac mortality of 5% compared with 38% of those with EF<50%. Etiology of underlying cardiomyopathy with an EF> or =50% was associated with a cardiac mortality of 5% (normal heart), 5% (myocardial infarction) and 9% (miscellany) compared to those with EF<50%: 33% (dilated cardiomyopathy) and 40% (myocardial infarction). Patients who experienced syncope during the first episode of SMVT showed a cardiac mortality of 31% compared to those 14% (P < 0.05) who did not experience. Patients with syncope, myocardial infarction and EF<50% showed a cardiac mortality of 68%. CONCLUSION The present study shows that survival after the first episode of SMVT is closely related to EF and the existence of syncope. Patients with myocardial infarction and EF<50% had a worse prognosis when the site was the inferior wall.
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[Exercise-induced atrioventricular block. Significance of the ischemic component. Report of 4 new cases]. Rev Esp Cardiol 1997; 50:278-82. [PMID: 9235612 DOI: 10.1016/s0300-8932(97)73218-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report four new cases of exercise-induced atrio-ventricular block (appearing during treadmill exercise testing). The mechanism was ischemia in two patients and the conduction disturbance disappeared after coronary artery bypass grafting. The literature on this matter is reviewed. Also the etiology, the natural history and management are discussed in these cases.
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[Syncope associated with glossopharyngeal neuralgia and parapharyngeal tumor]. Rev Esp Cardiol 1996; 49:704-6. [PMID: 9036496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The reflex-induced cardiovascular syncope is rarely associated with facial neuralgia and neck neoplasms. We report the case of a male with vasopressor and cardioinhibitor syncopes, despite the implantation of a pacemaker. Because of a glossopharyngeal neuralgia, a neoplasm of the left parapharyngeal fossae is diagnosed. The pathophysiology and the therapeutic approach is discussed.
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[Congenital stenosis of pulmonary veins in the adult]. Rev Esp Cardiol 1996; 49:697-700. [PMID: 9036494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a case of congenital bilateral pulmonary vein stenosis associated with a double-chambered right ventricle, ventricular septal defect and persistence of the ductus arteriosus in a 29 year-old female. The angiographic, echocardiographic and surgical findings are discussed. A precise diagnosis, the utility of the echocardiography and the surgical correction of this type of ostial stenosis is also reported.
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[Thrombocytosis and coronary disease. Report of a case]. Rev Esp Cardiol 1996; 49:542-4. [PMID: 8754451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the case of a young male with an inferior myocardial infarction who was treated with fibrinolytic agents and displayed a good evolution. The only cardiovascular risk factor that this patient had was an idiopathic thrombocytosis with abnormal platelet hyperreactivity tests. The angiogram showed an eccentric lesion of 60% in the left main coronary artery. A week later, after treatment based on anticoagulants and antithrombotic agents the angiogram was normal, and the lesion had disappeared. The association between these conditions is discussed the therapeutic approach is also discussed. A review of the literature is conducted.
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[Surgical treatment of partial anomalous pulmonary venous drainage]. Rev Esp Cardiol 1996; 49:130-5. [PMID: 8948723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We studied all patients operated for partial anomalous pulmonary venous drainage and half-time follow-up. MATERIALS AND METHODS Twenty-eight patients with a mean age of 5 +/- 5 years (5 patients were less than 1 year old). There were sixteen male and twelve female patients. Thirteen patients were symptomatic (47%). The drainage was to the superior vena cava in thirteen cases, to the inferior vena cava in eight cases, to the right atrium in five cases, mixed (to the superior vena cava and to the inferior vena cava) in one case and to the innominate vein in one patient. The diagnosis was made through echocardiography and catheterization in 25 patients, whereas nuclear magnetic resonance was performed in the last five patients. All cases were corrected through medium thoracotomy, except for the single case in which the drainage was to the innominate vein). In 27 patients, the pulmonary veins were guided to the left atrium through an enlarged present atrial septal defect or through a created atrial septal defect. In one case a direct connection was performed from the veins to the left atrium. After the surgical correction, all patients underwent a color-coded Doppler echocardiography study and a nuclear magnetic resonance study was performed in five patients. RESULTS Twenty-seven patients survived after surgical correction. The patient with a mixed drainage developed an obstruction of the superior vena cava, the pressure gradient was 9 mmHg. He required a second surgical procedure followed with angioplasty on two occasions during a six month period. Two patients showed an ectopic atrial rhythm at some late time. The patient who died was one month old and had an associated pulmonary parenchymal sequestration. CONCLUSION Partial anomalous venous connection is a congenital heart disease which has an easy surgical correction. Complications may arise after the surgical correction, among them obstruction of the superior vena cava and arrythmias are most frequently found. Obstruction is present when 50% of the caval area is occupied by the patch. The arrythmias occur following all surgical techniques. In order to decrease the arrythmias it is necessary to perform a good hemosthasis at the site of the patch, to leave the sinus node free of compression and to perform the atrial incision at the posterior wall. The diagnosis and the follow-up can be performed with non-invasive procedures.
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Intermittent aortic regurgitation following aortic valve replacement. THE JOURNAL OF CARDIOVASCULAR SURGERY 1995; 36:443-5. [PMID: 8522559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Intermittent aortic regurgitation is an unusual complication following a mechanical prosthesis replacement in the early postoperative period. Arterial pressure recording and echocardiographic assessment were enough to diagnose the prosthetic dysfunction. Reexploration of the valve confirmed the dysfunction, which was caused by a pannus of previous aortic valve replacement with the pulmonary valve. The pannus impeded normal closure of the leaflet in an intermittent way during diastole. Reorientation of the valve corrected the aortic insufficiency. Doppler ultrasound was a very useful noninvasive technique in order to evaluate the suspected prosthetic valve dysfunction in the immediate postoperative period.
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[Univentricular heart with left morphology with permeable atrio-ventricular valves. Study of the bulbo-ventricular foramen with color echo-Doppler. Importance for the surgical repair]. Rev Esp Cardiol 1995; 48:318-25. [PMID: 7792426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES Bidimensional and color-coded Doppler echocardiography were used to study 19 patients with univentricular heart, permeable atrioventricular valves, muscular bulbo-ventricular foramen and an anterior rudimentary chamber. We evaluated the influence of the foramen upon the size of the great vessels, and in consequence the most appropriated surgical techniques. MATERIAL AND METHODS The foramen was measured in two projections at the end of the systolic period, and its area was calculated, according to the body surface, with the formula S = pi (D1/2 x D2/2). Indexes lower than 2 cm2/m2 were considered as restrictive. We studied 19 patients that presented a mean age of 11 +/- 12 years (range 1 day-39 years). The patients were classified in two groups. Group A: patients who had transposition of the great vessels (13 cases). Group B: patients who had normal connection of the great vessels (6 cases). Each group was classified in two subgroups: subgroup 1, patients who presented a restrictive foramen, and subgroup 2, patients who presented a normal foramen. In this study, we evaluated the associated cardiac anomalies. RESULTS Group A. Thirteen cases. The index value for the whole group was 2.47 +/- 1.18 cm2/m2. The first subgroup included 6 cases with a restrictive foramen, 2 patients presented pathology of the arch. Four patients had a pressure gradient between the ventricle and the rudimentary chamber beyond 20 mmHg. The index of this subgroup was 1.68 +/- 0.39 cm2/m2, the median was 1.7. Seven cases, with a normal foramen, were included in the second subgroup, six of them had pulmonary valve stenosis, and the other one had undergone a pulmonary artery bandage 2 months before. Only one patient had a gradient pressure at the foramen beyond 20 mmHg. The index for this second subgroup was 3.34 +/- 0.83 cm2/m2. GROUP B Six patients with normal connection of the great vessels were included. The index was 1.56 +/- 1.17 cm2/m2. The first subgroup included 3 cases with a restrictive foramen. The index was 0.72 +/- 0.29 cm2/m2 (range 0.41-1) and the median was 0.75. Pressure gradient between the ventricle and the rudimentary chamber was greater than 20 mmHg. Three patients with a normal foramen were in the second subgroup and here, the index was under normal limits 2.4 +/- 0.52 cm2/m2 (range 2.1-3), the median was 2.1. One patient underwent a pulmonary artery bandage two months before. CONCLUSIONS Bulbo-ventricular foramen size/body surface index may exert an influence on the size of the vessel connected to the rudimentary chamber. The index vary in a negative way with the evolution time, or in those cases with transposition of the great vessels after a pulmonary artery bandage. Whenever the foramen is restrictive, the pulmonary artery or the aorta have a smaller diameter and the pressure gradient between the ventricle and the rudimentary chamber rises.
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Abstract
UNLABELLED Between May 1974 and December 1993, 37 patients (0.75%) with a double-chambered right ventricle underwent surgical repair. The patients ranged in age from 11 months to 12 years (mean 4 +/- 1.1 years). Cardiac catheterization was performed in 36 patients. The proximal right chamber pressure was 118 +/- 10 mmHg and the mean ventricular gradient pressure was 75 +/- 10 mmHg. A ventricular septal defect was present in 36 cases and fixed subaortic stenosis in eight. Longitudinal right ventriculotomy, group I, was performed in 19 patients (51.3%): 11 had a perimembranous ventricular septal defect and eight an infundibular ventricular septal defect. Combined pulmonary arteriotomy and right atriotomy, group II, was performed in 18 patients (48.7%): 17 patients had a perimembranous ventricular septal defect. The ventricular septal defect was closed using a double velour patch in 26 patients, continuous suture in four and a Gore-Tex patch in six. In the ventriculotomy group one patient died shortly after the operation (following pulmonary complication), and ten patients required inotropic support. Two patients developed patch dehiscence and underwent reoperation. There were no complications in group II patients who underwent right atriotomy. Associated cardiac anomalies were corrected in all patients. Follow-up of 6.5 +/- 3.1 years after operation showed that 36 patients were alive and asymptomatic. CONCLUSION the transatrial approach with pulmonary arteriotomy is an appropriate and effective double-chambered right ventricle correction even if it is associated with a perimembranous ventricular septal defect.
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[Acute right ventricular insufficiency reversible following anthracycline treatment]. Rev Esp Cardiol 1995; 48:205-7. [PMID: 7701103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Anthracyclines are very effective antineoplastic agents for the treatment of acute leukemia. Early and late dose-related cardiotoxicity can occur. We present a 33 year old women who developed a reversible right heart failure fifteen days after receiving a treatment with doxorubicine. Severe regional wall motion abnormalities were appreciated through two-dimensional and Doppler-flow echocardiography, there was no evidence of impaired systolic or diastolic left ventricle function. Two weeks later, remission of acute right ventricle failure was obtained, echocardiographic assessment was normal at this time. Incidence of right ventricle abnormalities after treatment is discussed.
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[Angioplasty of the stenotic Blalock-Taussig]. Rev Esp Cardiol 1994; 47:819-23. [PMID: 7855377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Balloon angioplasty is a useful therapeutic method in some congenital heart diseases. We show our experience of stenotic Blalock-Taussig angioplasty, which was effective in six cases. PATIENTS AND METHODS Six symptomatic patients with different congenital heart diseases, reduced pulmonary blood flow and a previous Blalock-Taussig shunt (it was classic in three patients and modified in another three) underwent the procedure. Conventional angioplasty was performed in four cases and coronary angioplasty technique, under monorail system, was applied in the other two. RESULTS After angioplasty, we observed an increase in the minimum luminal diameter from 1 +/- 0.7 to 4 +/- 0.5 mm (p < 0.01), a reduction in the percentage of the stenosis from 77 +/- 15 to 13 +/- 13 (p < 0.01) and an increase in oxygen saturation from 63 +/- 10% to 82 +/- 5% (p < 0.05). The effectiveness of the technique in an extreme case of a thrombosed Blalock-Taussig, hours later the surgery, is reported. In the follow-up, we observed a symptomatic improvement, stable oxygenation levels, and a tendency in the hematocrit reduction. CONCLUSION We consider that angioplasty of Blalock-Taussig shunt is indicated in those symptomatic patients, in whom a complete surgical correction is contraindicated. We demonstrate the effectiveness of the procedure, the coronary angioplasty, under monorail system is very useful for the stenotic modified Blalock-Taussig. It can be an effective technique when there is a postoperative thrombosis of the fistula.
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[The efficacy of verapamil in sustained monomorphic ventricular tachycardia]. Rev Esp Cardiol 1994; 47:633-5. [PMID: 7973032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We present a 36-year-old male without overt cardiac disease who suffered, since he was 15 years old, from sustained monomorphic ventricular tachycardia of left bundle branch block with a right axis, lasting for several hours; sometimes, syncope was a clinical form of manifestation. Electrophysiologic study, twenty-four hours Holter recording, cardiac catheterization and blood analysis were not useful in order to find its etiology. Efficacy of different drugs, like Mexiletil, Amiodarone, Atenolol and Verapamil (at a dose of 240 mg/day) were tested through multistaged graded-treadmill stress-testing using the Bruce protocol. Ventricular tachycardia was suppressed by administration of Lidocaine. Oral verapamil given at a dose of 360 mg/day prevented the induction of the arrhythmia, the efficacy was tested with maximal treadmill exercise and twenty-four hours Holter recording.
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[Ventricular hernia: a case report and review of the literature]. Rev Esp Cardiol 1994; 47:626-9. [PMID: 7973030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a case of one young patient with symptoms of palpitations and ventricular and supraventricular arrhythmias documented in the 24-hours Holter record. He had a deformity of silhouette and pericardial calcification in the chest roentgenogram. In the computed tomography and the magnetic resonance employed in the evaluation of structural anomalies, dates compatible with ventricular herniation, across one parcel of pathologically calcified pericardium, were present. The probable etiology, operatory findings and the management of those patients are discussed.
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[Propafenone efficacy in preventing supraventricular tachycardia in childhood]. Rev Esp Cardiol 1994; 47:86-91. [PMID: 8165353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES In order to study the efficiency of oral dose of propafenone in preventing childhood supraventricular tachycardias, we have treated 38 children without left ventricular dysfunction. METHODS The mean age has been 8 +/- 4.7 years old. All of them had suffered at least two episodes of supraventricular tachycardia, and eleven had undergone a previous antiarrhythmic treatment. The initial dose of propafenone has been 6.5 +/- 2.1 mg/kg/24 h (in 3 doses), which has been increased in case of inefficacy. RESULTS We have not advised neither side-effects, nor proarrhythmic effects, during a follow-up of 13 +/- 6 months. Propafenone has been efficient in preventing supraventricular tachycardias in all patients. The initial dose has been efficient in 17 patients, and we have increased the initial dose up to 11.1 +/- 3.7 mg/kg/24 h in 21 patients. The mean effective dose has been 8.9 +/- 3.6 mg/kg/24 h. We stopped treatment in 14 patients after been 6 months without supraventricular tachycardias. CONCLUSION From our study, we conclude that propafenone has been efficient in preventing supraventricular tachycardias in childhood with a dose of 8.9 mg/kg/24 h. We have not found side-effects.
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