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Alfonso F, Fernández-Pérez C, del Prado N, García-Guimaraes M, Bernal JL, Bastante T, del Val D, García-Márquez M, Elola J. Characteristics and outcomes of percutaneous coronary interventions in patients with spontaneous coronary artery dissection. A study from the administrative minimum data set of the Spanish National Health System. Front Cardiovasc Med 2022; 9:1054413. [PMID: 36531730 PMCID: PMC9754633 DOI: 10.3389/fcvm.2022.1054413] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/07/2022] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Coronary revascularization in patients with spontaneous coronary artery dissection (SCAD) is challenging. Indications and results of percutaneous coronary interventions (PCI) in SCAD patients are not well established. AIM To assess indications and results of PCI in SCAD. METHODS The minimum basic data set of the Spanish National Health System (years 2016-2019) was used to identify 804 episodes of acute myocardial infarction (AMI) and SCAD, with a crude in-hospital mortality rate of 3%. Of these, 368 (46.8%) patients were revascularized with PCI during admission whereas 436 (54.2%) were managed conservatively. RESULTS Revascularization and in-hospital mortality rates both declined over the study period (p for trend both < 0.05). SCAD patients treated with PCI were older, more frequently male, and had higher frequency of diabetes, ST-segment elevation AMI and cardiogenic shock, compared to patients managed conservatively. The crude in-hospital mortality rate was higher in patients treated with PCI (4.9% vs. 1.4%; p = 0.004). However, after adjusting by propensity score (223 pairs) the in-hospital mortality rate was similar in the two groups (Adj OR: 1.21; 95%CI: 0.30-1.57; p = 0.76). Readmissions at 30-days were higher in patients managed conservatively (7.1 vs. 1.6%, p < 0.001) and this difference was maintained after propensity score adjustment (Adj average treatment effect: 2% vs. 12.2%; OR: 0.15; 95%CI: 0.04-0.45; p < 0.001). CONCLUSION Revascularization is frequently used in unselected patients with AMI and SCAD but its use is declining. Patients with SCAD treated with PCI have a higher in-hospital mortality but this appears to be explained by their adverse baseline clinical characteristics.
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Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Cristina Fernández-Pérez
- Department of Preventive Medicine, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigación de Santiago, Santiago de Compostela, Spain
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Náyade del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Marcos García-Guimaraes
- Department of Cardiology, Hospital del Mar – Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
- Department of Information and Management Control, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - David del Val
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
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Fernández Ortiz A, Viana Tejedor A, García-Márquez M, Noriega Sanz F, Ferrera Durán C, Elola J. Primary angioplasty in Spain. Does volume influence in-hospital mortality? Rev Esp Cardiol (Engl Ed) 2022; 75:1081-1083. [PMID: 35697334 DOI: 10.1016/j.rec.2022.04.014] [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: 03/09/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Antonio Fernández Ortiz
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Viana Tejedor
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - María García-Márquez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Francisco Noriega Sanz
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Ferrera Durán
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain.
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Alfonso F, Fernández-Pérez C, García-Márquez M, García-Guimaraes M, Bernal JL, Bastante T, Del Val D, Del Prado N, Elola J. Spontaneous coronary artery dissection in Spain: a study using the minimum data set of the Spanish National Health System. Rev Esp Cardiol (Engl Ed) 2022; 75:903-910. [PMID: 35716909 DOI: 10.1016/j.rec.2022.04.017] [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: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (AMI). We sought to compare the results on in-hospital mortality and 30-day readmission rates among patients with AMI-SCAD vs AMI due to other causes (AMI-non-SCAD). METHODS Risk-standardized in-hospital mortality (rIMR) and risk-standardized 30-day readmission ratios (rRAR) were calculated using the minimum dataset of the Spanish National Health System (2016-2019). RESULTS A total of 806 episodes of AMI-SCAD were compared with 119 425 episodes of AMI-non-SCAD. Patients with AMI-SCAD were younger and more frequently female than those with AMI-non-SCAD. Crude in-hospital mortality was lower (3% vs 7.6%; P<.001) and rIMR higher (7.6±1.7% vs 7.4±1.7%; P=.019) in AMI-SCAD. However, after propensity score adjustment (806 pairs), the mortality rate was similar in the 2 groups (AdjOR, 1.15; 95%CI, 0.61-2,2; P=.653). Crude 30-day readmission rates were also similar in the 2 groups (4.6% vs 5%, P=.67) whereas rRAR were lower (4.7±1% vs 4.8%±1%; P=.015) in patients with AMI-SCAD. Again, after propensity score adjustment (715 pairs) readmission rates were similar in the 2 groups (AdjOR, 1.14; 95%CI, 0.67-1.98; P=.603). CONCLUSIONS In-hospital mortality and readmission rates are similar in patients with AMI-SCAD and AMI-non-SCAD when adjusted for the differences in baseline characteristics. These findings underscore the need to optimize the management, treatment, and clinical follow-up of patients with SCAD.
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Affiliation(s)
- Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Cristina Fernández-Pérez
- Servicio de Medicina Preventiva, Instituto de Investigación de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, Santiago de Compostela, A Coruña, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - María García-Márquez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Marcos García-Guimaraes
- Servicio de Cardiología, Hospital del Mar-Parc de Salut Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain; Servicio de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Bastante
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - David Del Val
- Servicio de Cardiología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria (IMAS), Madrid, Spain
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Fernández-Ortiz A, Bas Villalobos MC, García-Márquez M, Bernal Sobrino JL, Fernández-Pérez C, del Prado González N, Viana Tejedor A, Núñez-Gil I, Macaya Miguel C, Elola Somoza FJ. Identificación y cuantificación del efecto fin de semana y festivos en la atención del síndrome coronario agudo en el Sistema Nacional de Salud. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.018] [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: 12/01/2022]
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Fernández-Ortiz A, Bas Villalobos MC, García-Márquez M, Bernal Sobrino JL, Fernández-Pérez C, Del Prado González N, Viana Tejedor A, Núñez-Gil I, Macaya Miguel C, Elola Somoza FJ. The effect of weekends and public holidays on the care of acute coronary syndrome in the Spanish National Health System. Rev Esp Cardiol (Engl Ed) 2022; 75:756-762. [PMID: 35067469 DOI: 10.1016/j.rec.2021.10.022] [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: 08/04/2021] [Accepted: 10/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES To analyze whether admission on weekends or public holidays (WHA) influences the management (performance of angioplasty, percutaneous coronary intervention [PCI]) and outcomes (in-hospital mortality) of patients hospitalized for acute coronary syndrome in the Spanish National Health System compared with admission on weekdays. METHODS Retrospective observational study of patients admitted for ST-segment elevation myocardial infarction (STEMI) or for non-ST-segment elevation acute coronary syndrome (NSTEACS) in hospitals of the Spanish National Health system from 2003 to 2018. RESULTS A total of 438 987 episodes of STEMI and 486 565 of NSTEACS were selected, of which 28.8% and 26.1% were WHA, respectively. Risk-adjusted models showed that WHA was a risk factor for in-hospital mortality in STEMI (OR, 1.05; 95%CI,1.03-1.08; P < .001) and in NSTEACS (OR, 1.08; 95%CI, 1.05-1.12; P < .001). The rate of PCI performance in STEMI was more than 2 percentage points higher in patients admitted on weekdays from 2003 to 2011 and was similar or even lower from 2012 to 2018, with no significant changes in NSTEACS. WHA was a statistically significant risk factor for both STEMI and NSTEACS. CONCLUSIONS WHA can increase the risk of in-hospital death by 5% (STEMI) and 8% (NSTEACS). The persistence of the risk of higher in-hospital mortality, after adjustment for the performance of PCI and other explanatory variables, probably indicates deficiencies in management during the weekend compared with weekdays.
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Affiliation(s)
- Antonio Fernández-Ortiz
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Marian Cristina Bas Villalobos
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | | | - José Luis Bernal Sobrino
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Cristina Fernández-Pérez
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva y Salud Pública, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - Ana Viana Tejedor
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Iván Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
| | - Carlos Macaya Miguel
- Instituto Cardiovascular, Hospital Clínico Universitario San Carlos, Madrid, Spain; Fundación Interhospitalaria de Investigación Cardiovascular, Madrid, Spain
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Fernández Ortiz A, Viana Tejedor A, García-Márquez M, Noriega Sanz F, Ferrera Durán C, Elola J. Angioplastia primaria en España. ¿El volumen influye en la mortalidad hospitalaria? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.04.020] [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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Alfonso F, Fernández-Pérez C, García-Márquez M, García-Guimaraes M, Bernal JL, Bastante T, del Val D, del Prado N, Elola J. Disección coronaria espontánea en España: un estudio sobre bases administrativas realizado a partir del Conjunto Mínimo Básico de Datos español. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.04.009] [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: 10/31/2022]
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Núñez-Gil IJ, Elola J, García-Márquez M, L. Bernal J, Fernández-Pérez C, Íñiguez A, Nombela-Franco L, Jiménez-Quevedo P, Escaned J, Macaya C, Fernández-Ortiz A. <i class="fa fa-video-camera" aria-hidden="true"></i> Reemplazo valvular a�rtico percut�neo y quir�rgico. Influencia del volumen y del tipo de centro tratante en los resultados. RECIC 2021. [DOI: 10.24875/recic.m20000149] [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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Shimabukuro-Vornhagen A, García-Márquez M, Fischer RN, Iltgen-Breburda J, Fiedler A, Wennhold K, Rappl G, Abken H, Lehmann C, Herling M, Wolf D, Fätkenheuer G, Rubbert-Roth A, Hallek M, Theurich S, von Bergwelt-Baildon M. Antigen-presenting human B cells are expanded in inflammatory conditions. J Leukoc Biol 2016; 101:577-587. [DOI: 10.1189/jlb.5a0416-182r] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/16/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022] Open
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