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Verardi FM, Bujak K, Tolomeo P, Gómez-Lara J, Jiménez-Díaz V, Jiménez M, Jiménez-Quevedo P, Diletti R, Bordes P, Campo G, Silvestro A, Maristany J, Flores X, de Miguel-Castro A, Íñiguez A, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Tebaldi M, Biscaglia S, Vidal-Cales P, Ortega-Paz L, Romaguera R, Gómez-Hospital JA, Serruys PW, Sabaté M, Brugaletta S. Ten-year prognostic impact of target versus non-target vessel failure after STEMI. Insight from the EXAMINATION-EXTEND trial. Rev Esp Cardiol (Engl Ed) 2024; 77:215-225. [PMID: 37506972 DOI: 10.1016/j.rec.2023.07.001] [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: 03/21/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION AND OBJECTIVES After ST-segment myocardial infarction (STEMI), the impact of different adverse events on prognosis remains unknown. We aimed to assess very long-term predictors of patient-oriented composite endpoints (POCE) and investigate whether the occurrence of target vessel failure (TVF) vs a non-TVF event as the first event could potentially influence subsequent outcomes. METHODS The EXAMINATION-EXTEND trial randomized STEMI patients to receive either an everolimus-eluting stent or a bare-metal stent. The follow-up period was 10 years. Predictors of POCE (a composite of all-cause death, any myocardial infarction, or any revascularization) were evaluated in the overall study population. The patients were stratified based on the type of first event (TVF-first vs non-TVF-first) and were compared in terms of subsequent POCE. TVF was defined as a composite of cardiac death, TV myocardial infarction, or TV revascularization. RESULTS Out of the 1498 enrolled patients, 529 (35.3%) experienced a POCE during the 10-year follow-up. Independent predictors of POCE were age, diabetes mellitus, previous myocardial infarction, peripheral arterial disease, and multivessel coronary disease. The first event was a TVF in 296 patients and was a non-TVF in 233 patients. No significant differences were observed between TVF-first and non-TVF-first patients in terms of subsequent POCE (21.7% vs 39.3%, time ratio 1.79; 95%CI, 0.87-3.67;P=.12) or its individual components. CONCLUSIONS At the 10-year follow-up, approximately one-third of STEMI patients had experienced at least 1 POCE. Independent predictors of these events were age, diabetes, and more extensive atherosclerotic disease. The occurrence of a TVF or a non-TVF as the first event did not seem to influence subsequent outcomes. TRIAL REGISTRATION NUMBER NCT04462315.
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Affiliation(s)
- Filippo Maria Verardi
- Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain; Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Kamil Bujak
- Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain; 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Paolo Tolomeo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Josep Gómez-Lara
- Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Jiménez-Díaz
- Departamento de Cardiología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain; Investigación Cardiovascular, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Servizo Galego de Saúde-Universidade de Vigo (SERGAS-UVIGO), Vigo, Pontevedra, Spain
| | - Marcelo Jiménez
- Departamento de Cardiología, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | | | - Pascual Bordes
- Departamento de Cardiología, Hospital General de Alicante, Alicante, Spain
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Antonio Silvestro
- Cardiology Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Jaume Maristany
- Departamento de Cardiología, Hospital Son Dureta, Palma de Mallorca, Spain
| | - Xacobe Flores
- Departamento de Cardiología, Hospital Universitario de A Coruña, A Coruña, Spain
| | | | - Andrés Íñiguez
- Departamento de Cardiología, Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Alfonso Ielasi
- Cardiology Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Maurizio Tespili
- Cardiology Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Pablo Vidal-Cales
- Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain
| | - Luis Ortega-Paz
- Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, United States
| | - Rafael Romaguera
- Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Antoni Gómez-Hospital
- Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Manel Sabaté
- Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain
| | - Salvatore Brugaletta
- Institut Clínic Cardiovascular, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Hospital Clínic, Barcelona, Spain.
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Paredes-Vázquez JG, Tirado-Conte G, Jiménez-Quevedo P, Mon-Noboa M, Pozo E, Núñez-Gil I, Gonzalo N, Fernández-Ortiz A, Escaned J, Nombela-Franco L. Computed Tomography Analysis of Coronary Chimney Stenting Following Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2023:S1936-8798(23)01431-0. [PMID: 38180418 DOI: 10.1016/j.jcin.2023.10.036] [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] [Received: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 01/06/2024]
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Gutierrez-Ortiz E, Olmos C, Carrión-Sanchez I, Jiménez-Quevedo P, Nombela-Franco L, Párraga R, Gil-Abizanda S, Mahía P, Luaces M, de Agustín JA, Islas F. Redefining cardiac damage staging in aortic stenosis: the value of GLS and RVAc. Eur Heart J Cardiovasc Imaging 2023; 24:1608-1617. [PMID: 37315235 DOI: 10.1093/ehjci/jead140] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
AIMS Cardiac damage staging has been postulated as a prognostic tool in patients undergoing transcatheter aortic valve replacement (TAVR). The aims of our study are (i) to validate cardiac damage staging systems previously described to stratify patients with aortic stenosis (AS), (ii) to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR, and (iii) to develop a novel staging model and compare its predictive performance to that of the above mentioned. METHODS AND RESULTS Patients undergoing TAVR from 2017 to 2021 were included in a single-centre prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic and Cox's regression analysis were used to identify predictors of 1-year all-cause mortality. In addition, patients were classified based on previously published cardiac damage staging systems, and the predictive performance of the different scores was measured.Four hundred and ninety-six patients (mean age 82.1 ± 5.9 years, 53% female) were included. Mitral regurgitation (MR), left ventricle global longitudinal strain (LV-GLS) and right ventricular-arterial coupling (RVAc) were independent predictors of all-cause 1-year mortality. A new classification system with four different stages was developed using LV-GLS, MR, and RVAc. The area under the receiver operating characteristic curve was 0.66 (95% confidence interval 0.63-0.76), and its predictive performance was superior compared with the previously published systems (P < 0.001). CONCLUSION Cardiac damage staging might have an important role in patients' selection and better timing for TAVR. A model that includes LV-GLS, MR, and RVAc may help to improve prognostic stratification and contribute to better selection of patients undergoing TAVR.
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Affiliation(s)
- Eva Gutierrez-Ortiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Irene Carrión-Sanchez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Rocío Párraga
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Sandra Gil-Abizanda
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Patricia Mahía
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - María Luaces
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - José Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
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Asmarats L, Gutiérrez-Alonso L, Nombela-Franco L, Regueiro A, Millán X, Tirado-Conte G, Cepas P, Li CHP, Fernández-Peregrina E, Jiménez-Quevedo P, Freixa X, Arzamendi D. Cusp-overlap technique during TAVI using the self-expanding Portico FlexNav system. Rev Esp Cardiol (Engl Ed) 2023; 76:767-773. [PMID: 36804557 DOI: 10.1016/j.rec.2023.02.003] [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: 12/28/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES The cusp overlap technique (COT) has been proposed to reduce conduction disturbances (CD) after transcatheter aortic valve implantation (TAVI) with self-expanding supra-annular devices, but there are scarce data on COT with intra-annular valves. The aim of this study was to determine whether the use of the COT during Portico implantation results in higher valve implantation and lower rates of CD. METHODS We included 85 patients undergoing TAVI with the Portico FlexNav system: 43 retrospective patients using the standard 3-cusp view and 42 prospective patients with the COT. Primary endpoints were implantation depth and new-onset CD (composite outcome of new-onset left bundle branch block and new permanent pacemaker implantation). RESULTS COT resulted in a higher implantation depth (noncoronary cusp: 4.9±3.9 vs 7.4±3.0; P=.005) and lower new-onset CD (31.0% vs 58.1%; P=.012), with a tendency toward a lower need for permanent pacemaker implantation (14.3% vs 30.2%, P=.078; 7.7% vs 31.0%; P=.011 in patients without pre-existing right bundle branch block). Transvalvular aortic gradients were slightly lower with COT (8.7±3.7 vs 11.0±6.1; P=.044). There were no differences in technical success or major procedure-related complications. On multivariate analysis, COT use was associated with a lower risk of new-onset CD. CONCLUSIONS Use of the COT during Portico implantation is feasible and facilitates a higher valve implant, which in turn may help to reduce rates of new-onset CD.
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Affiliation(s)
- Lluis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Lola Gutiérrez-Alonso
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Gabriela Tirado-Conte
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Cepas
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Chi Hion Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Estefanía Fernández-Peregrina
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Ojeda S, González-Manzanares R, Jiménez-Quevedo P, Piñón P, Asmarats L, Amat-Santos I, Fernández-Nofrerias E, Valle RD, Muñoz-García E, Ferrer-Gracia MC, María de la Torre J, Ruiz-Quevedo V, Regueiro A, Sanmiguel D, García-Blas S, Elízaga J, Baz JA, Romaguera R, Cruz-González I, Moreu J, Gheorghe LL, Salido L, Moreno R, Urbano C, Serra V, Pan M. Coronary Obstruction After Transcatheter Aortic Valve Replacement: Insights From the Spanish TAVI Registry. JACC Cardiovasc Interv 2023; 16:1208-1217. [PMID: 37225292 DOI: 10.1016/j.jcin.2023.03.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Coronary obstruction (CO) following transcatheter aortic valve replacement (TAVR) is a life-threatening complication, scarcely studied. OBJECTIVES The authors analyzed the incidence of CO after TAVR, presentation, management, and in-hospital and 1-year clinical outcomes in a large series of patients undergoing TAVR. METHODS Patients from the Spanish TAVI (Transcatheter Aortic Valve Implantation) registry who presented with CO in the procedure, during hospitalization or at follow-up were included. Computed tomography (CT) risk factors were assessed. In-hospital, 30-day, and 1-year all-cause mortality rates were analyzed and compared with patients without CO using logistic regression models in the overall cohort and in a propensity score-matched cohort. RESULTS Of 13,675 patients undergoing TAVR, 115 (0.80%) presented with a CO, mainly during the procedure (83.5%). The incidence of CO was stable throughout the study period (2009-2021), with a median annual rate of 0.8% (range 0.3%-1.3%). Preimplantation CT scans were available in 105 patients (91.3%). A combination of at least 2 CT-based risk factors was less frequent in native than in valve-in-valve patients (31.7% vs 78.3%; P < 0.01). Percutaneous coronary intervention was the treatment of choice in 100 patients (86.9%), with a technical success of 78.0%. In-hospital, 30-day, and 1-year mortality rates were higher in CO patients than in those without CO (37.4% vs 4.1%, 38.3% vs 4.3%, and 39.1% vs 9.1%, respectively; P < 0.001). CONCLUSIONS In this large, nationwide TAVR registry, CO was a rare, but often fatal, complication that did not decrease over time. The lack of identifiable predisposing factors in a subset of patients and the frequently challenging treatment when established may partly explain these findings.
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Affiliation(s)
- Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain.
| | - Rafael González-Manzanares
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Pablo Piñón
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lluis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ignacio Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Raquel Del Valle
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Erika Muñoz-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Jose María de la Torre
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | | | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Dario Sanmiguel
- Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
| | - Sergio García-Blas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Jaime Elízaga
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Jose Antonio Baz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro,Vigo, Pontevedra, Spain
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital de Bellvitge, Barcelona, Spain; Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - José Moreu
- Servicio de Cardiología, Hospital Universitario de Toledo, Toledo, Spain
| | - Livia L Gheorghe
- Servicio de Cardiología, Hospital Universitario Puerta del Mar Hospital, Cádiz, Spain
| | - Luisa Salido
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
| | - Cristóbal Urbano
- Servicio de Cardiología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Vicenc Serra
- Servicio de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
| | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain
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Jiménez-Quevedo P, Alonso-Martin C, Campuzano Ruiz R, Guzmán-Martinez G, Pedreira Perez M, Sambola A. Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies? Kardiol Pol 2023; 81:338-349. [PMID: 36871309 DOI: 10.33963/kp.a2023.0051] [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: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide affecting both genders equally. However, in comparison to men, in women it often is underrecognized and undertreated in both the primary and secondary prevention settings. It is clear, that in the healthy population, there are profound differences both anatomically and biochemically between woman and men and this may impact how both groups present when they become ill. Therefore, there are some diseases that affect more frequently in women than in men such us myocardial ischemia or infarction without obstructive coronary disease, Tako-subo syndrome, some atrial arrhythmias or the appearance of heart failure with preserved ejection fraction. Therefore, the diagnostic and therapeutic strategies that have been established based largely on clinical studies with a predominant male population must be adapted before being applied to women. There is a paucity of data regarding cardiovascular disease in women. It is inadequate to only perform a subgroup analysis evaluating a specific treatment or invasive technique, when women constitute fifty percent of the population. In this regard, this may affect the time of clinical diagnosis and severity assessments of some valvulopathies. In this review, we will focus on the differences in the diagnosis, management, and outcomes of woman with the most frequent cardiovascular pathologies including coronary artery disease, arrythmias, heart failure and valvopathies. In addition, we will describe diseases that exclusively affect to women related with the pregnancy some of them are life treating. Although the lack of research in women plays a role in the poorer outcomes in women specially in ischemic heart disease the results of some techniques such as transcathether aortic valve implantation and transcatheter edge to edge therapy seem to have better outcome in women.
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Affiliation(s)
| | - Concepción Alonso-Martin
- Arrhythmia Unit, Department of Cardiology. Hospital de la Santa Creu i Sant Pau, CIBERCV, Instituto de Recerca HSCSP-IIb Sant Pau, Universidad autónoma de Barcelona, Barcelona, Spain
| | - Raquel Campuzano Ruiz
- Cardiac Rehabilitation Unit, Department of Cardiology, Universitary Hospital Fundación Alcorcón, Madrid, Spain
| | - Gabriela Guzmán-Martinez
- Department of Cardiology, La Paz University Hospital, IdiPaz, Madrid, Spain.,Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain.,Atrys Health, Madrid, Spain
| | - Milagros Pedreira Perez
- Cardio-oncology and Cardiovascular Disease in Women Unit, Department of Cardiology, Universitary Hospital Santiago de Compostela, Spain
| | - Antonia Sambola
- Cardio-oncology and Cardiovascular Disease in Women Unit, Department of Cardiology, Universitary Hospital Santiago de Compostela, Spain.,Department of Cardiology and Research Institute, University Hospital Vall d'Hebron, Universitat Autònoma, CIBER Cardiovascular Diseases (CIBER-CV), Barcelona, Spain
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Arévalos V, Spione F, Gabani R, Ortega-Paz L, Gómez-Lara J, Jiménez-Díaz V, Jiménez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Fernández-Ortiz A, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gómez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Impact of Age at the Time of the First ST-Elevation Myocardial Infarction on 10-Year Outcomes (from the EXAMINATION-EXTEND Trial). Am J Cardiol 2023; 190:32-40. [PMID: 36549068 DOI: 10.1016/j.amjcard.2022.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/04/2022] [Revised: 10/21/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
The aim of this substudy of the EXAMINATION-EXTEND was to analyze 10-year outcomes according to the patient's age at the time of the first ST-elevation myocardial infarction (STEMI). Of 1,498 patients with STEMI included in the EXAMINATION-EXTEND study, those with a previous history of coronary ischemic even or ischemic stroke were excluded from this analysis. The remaining 1,375 patients were divided into 4 age groups: <55, 55 to 65, 65 to 75, and >75 years. The primary end point was 10-year patient-oriented composite end point (POCE) of all-cause death, any MI, or any revascularization. At 10-year follow-up, patients aged <55 years (adjusted hazard ratio [HR] 0.24, 95% confidence interval [CI] 0.18 to 0.31, p = 0.001), 55 to 65 years (adjusted HR 0.26, 95% CI 0.20 to 0.34, p = 0.001), and 65 to 75 years (adjusted HR 0.38, 95% CI 0.30 to 0.50, p = 0.001) showed lower risk of POCE than those aged >75 years, led by a lower incidence of all-cause death (<55 : 6% vs 55 to 65: 11.9% vs 65 to 75: 25.7% vs >75 years: 61.6%, p = 0.001). Cardiac death was more prevalent in the older group (<55: 3.7% vs 55 to 65: 5.8% vs 65 to 75: 10.9% vs >75 years: 35.5%, p = 0.001). In the landmark analyses, between 5- and 10-year follow-up, young patients exhibited a higher incidence of any revascularization (<55: 7.4% vs 55 to 65: 4.9% vs 65 to 75: 1.8% vs >65 years: 1.6%, p = 0.001). In conclusion, in patients with a first STEMI, advanced age was associated with high rates of POCE at 10-year follow-up due to all-cause and cardiac death. Conversely, younger patients exhibited a high risk of revascularization at long-term follow-up.
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Affiliation(s)
- Victor Arévalos
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Advanced Biomedical Sciences - University of Naples, Federico II, Italy
| | - Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Josep Gómez-Lara
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Víctor Jiménez-Díaz
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO
| | - Marcelo Jiménez
- Deparment of Cardiology, University Hospital of Sant Pau, Barcelona, Spain
| | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Antonio Silvestro
- Deparment of Cardiology, University Hospital Bolognini Seriate, Bergamo; Italy
| | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO
| | - Antonio Serra
- Deparment of Cardiology, University Hospital of Sant Pau, Barcelona, Spain
| | - Javier Escaned
- Department of Cardiology, University Hospital San Carlos, Madrid, Spain
| | - Alfonso Ielasi
- Deparment of Cardiology, University Hospital Bolognini Seriate, Bergamo; Italy
| | - Maurizio Tespili
- Deparment of Cardiology, University Hospital Bolognini Seriate, Bergamo; Italy
| | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gómez-Hospital
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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8
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Mori R, Macaya F, Giacobbe F, Moreno V, Quadri G, Chipayo D, Bianco M, Salinas P, Rolfo C, Mejía-Rentería H, Boi A, Tirado-Conte G, Cavallino C, Nombela-Franco L, Cinconze S, Jiménez-Quevedo P, Pavani M, Fernández-Ortiz A, Chinaglia A, Fuentes-Ferrer ME, Núñez-Gil IJ, Gonzalo N, Cerrato E, Varbella F, Escaned J. Association between hormone therapy and short-term cardiovascular events in women with spontaneous coronary artery dissection. Rev Esp Cardiol (Engl Ed) 2023; 76:165-172. [PMID: 35850485 DOI: 10.1016/j.rec.2022.07.004] [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] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Changes in sex hormone levels are a known triggering factor for spontaneous coronary artery dissection (SCAD) in women. However, it is unknown whether exposure to exogenous hormone therapy (HT) at the time of SCAD presentation modifies the clinical course of this condition. We investigated the association between HT in female patients presenting with SCAD and short-term clinical outcomes. METHODS We enrolled consecutive patients presenting with SCAD from the DISCO-IT/SPA (dissezioni spontanee coronariche Italian-Spanish) registry. Women on HT (estrogens, progestagens, or gonadotropins) at the time of presentation were identified, and their clinical characteristics and short-term outcomes were compared with those not receiving active HT. The outcome measure was nonfatal myocardial infarction and/or unplanned percutaneous coronary intervention during the first 28 days after the index catheterization. RESULTS Of 224 women presenting with SCAD (mean age 52.0±10.0 years), 39 (17.4%) were currently using HT while 185 (82.6%) were not. No significant differences were noted in the baseline demographics, clinical presentation, angiographic features, or initial treatment received between the 2 groups. All patients on systemic HT (n=36, 92%) discontinued it at the time of diagnosis. The composite outcome occurred in 7 (17.9%) patients with prior HT compared with 14 (7.6%) without (P=.039). After multivariable adjustment, HT remained associated with the composite outcome recorded in the first 28 days of follow-up (HR, 3.53; 95%CI, 1.30-9.61; P=.013). CONCLUSIONS In women with SCAD, exposure to HT at the time of clinical presentation was associated with short-term recurrent cardiovascular events such as nonfatal myocardial infarction and/or unplanned percutaneous revascularization.
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Affiliation(s)
- Ricardo Mori
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Macaya
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.
| | - Federico Giacobbe
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Víctor Moreno
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Giorgio Quadri
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - David Chipayo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Matteo Bianco
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Pablo Salinas
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Rolfo
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Hernán Mejía-Rentería
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Boi
- Dipartimento di Cardiologia, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Gabriela Tirado-Conte
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Chiara Cavallino
- Dipartimento di Cardiologia, Sant'Andrea Hospital, Vercelli, Italy
| | - Luis Nombela-Franco
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Sebastian Cinconze
- Dipartimento di Cardiologia, Azienda Ospedaliera S Croce e Carle, Cuneo, Italy
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Marco Pavani
- Dipartimento di Cardiologia, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Antonio Fernández-Ortiz
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alessandra Chinaglia
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Manuel Enrique Fuentes-Ferrer
- Departamento de Medicina Preventiva, Unidad de soporte metodológico a la investigación, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Iván J Núñez-Gil
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Enrico Cerrato
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Ferdinando Varbella
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Javier Escaned
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
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9
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Ramos-López N, Ferrera C, Luque T, Enríquez-Vázquez D, Mahía-Casado P, Galván-Herráez L, Pedrajas JM, Salinas P, Fraile PZ, Islas F, Real C, Mejía-Rentería H, Jiménez-Quevedo P, Gonzalo N, Nuñez-Gil I, Nombela-Franco L, Tirado G, Macaya F, Escaned J, Hernández AMM, Bustamante J, Serrano MP, García EB, Pozzi MAO, Higueras J, Agustín AD, Viana-Tejedor A, Fernández-Ortiz A. Impact of a pulmonary embolism response team initiative on hospital mortality of patients with bilateral pulmonary embolism. Med Clin (Barc) 2023:S0025-7753(23)00017-9. [PMID: 36801109 DOI: 10.1016/j.medcli.2022.12.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) response teams (PERT) for the management of high-risk PE (HR-PE) and intermediate-high risk PE (IHR-PE) are encouraged in PE guidelines. We aimed to assess the impact of a PERT initiative on mortality in these groups of patients, compared with standard care. METHODS We conducted a prospective, single-center registry, including consecutive patients with HR-PE and IHR-PE with PERT activation from February-2018 to December-2020 (PERT group, n=78 patients) and compared it with an historic cohort of patients admitted to our hospital in a previous 2-year period (2014-2016), managed with standard of care (SC-group, n=108 patients). RESULTS Patients in the PERT group were younger and less comorbid. The risk profile at admission and the percentage of HR-PE was similar in both cohorts (13% in SC-group and 14% in PERT-group, p=0.82). Reperfusion therapy was more frequently indicated in PERT-group (24.4% vs 10.2%, p=0.01), with no differences in fibrinolysis treatment, while catheter-directed therapy (CDT) was more frequent in PERT group (16.7% vs 1.9%, p<0.001). Reperfusion and CDT were associated with lower in-hospital mortality (2.9% vs 15.1%, p=0.001 for reperfusion and 1.5% vs 16.5%, p=0.001 for CDT). The primary outcome, 12-month mortality, was lower in the PERT-group (9% vs 22.2%, p=0.02), There were no differences in 30-day readmissions. In multivariate analysis PERT activation was associated with lower mortality at 12 months (HR 0.25, 95% confidence interval 0.09-0.7, p=0.008). CONCLUSION A PERT initiative in patients with HR-PE and IHR-PE was associated with a significant reduction in 12-month mortality compared with standard of care, and also with an increase in the use of reperfusion, especially catheter-directed therapies.
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Affiliation(s)
- Noemi Ramos-López
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Ferrera
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Tania Luque
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | - José María Pedrajas
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain.
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10
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McInerney A, García Márquez M, Tirado-Conte G, Bernal JL, Fernández-Pérez C, Jiménez-Quevedo P, Gonzalo N, Núñez-Gil I, Del Prado N, Escaned J, Fernández-Ortiz A, Elola J, Nombela-Franco L. In-hospital outcomes following percutaneous versus surgical intervention in the treatment of aortic stenosis and concomitant coronary artery disease. Rev Esp Cardiol (Engl Ed) 2023:S1885-5857(23)00025-7. [PMID: 36669732 DOI: 10.1016/j.rec.2022.12.011] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND OBJECTIVES Concomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD. METHODS Using discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission. RESULTS Matching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P <.001) as was periprocedural stroke (0.9% vs 2.2%; P=.004), acute kidney injury (4.3% vs 16.0%, P <.001), blood transfusion (9.6% vs 21.1%, P <.001), and hospital-acquired pneumonia (0.1% vs 1.7%, P=.001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P <.001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P <.001) and SAVR/CABG (8.3 vs 6.8%, P <.001). Thirty-day cardiovascular readmission did not differ between groups. CONCLUSIONS In this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation.
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Affiliation(s)
- Angela McInerney
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Gabriela Tirado-Conte
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Información y 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, Área Sanitaria de Santiago de Compostela y Barbanza, Instituto de Investigaciones Sanitarias de Santiago (idis), Santiago de Compostela, A Coruña, Spain
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nieves Gonzalo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Iván Núñez-Gil
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Náyade Del Prado
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Javier Escaned
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Antonio Fernández-Ortiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Javier Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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11
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Spione F, Arevalos V, Gabani R, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Impact of Diabetes on 10-Year Outcomes Following ST-Segment-Elevation Myocardial Infarction: Insights From the EXAMINATION-EXTEND Trial. J Am Heart Assoc 2022; 11:e025885. [PMID: 36444863 PMCID: PMC9851431 DOI: 10.1161/jaha.122.025885] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Long-term outcomes of ST-segment-elevation myocardial infarction in patients with diabetes have been barely investigated. The objective of this analysis from the EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION trial) trial was to compare 10-year outcomes of patients with ST-segment-elevation myocardial infarction with and without diabetes. Methods and Results Of the study population, 258 patients had diabetes and 1240 did not. The primary end point was patient-oriented composite end point of all-cause death, any myocardial infarction, or any revascularization. Secondary end points were the individual components of the primary combined end point, cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis. All end points were adjusted for potential confounders. At 10 years, patients with diabetes showed a higher incidence of patient-oriented composite end point compared with those without (46.5% versus 33.0%; adjusted hazard ratio [HR], 1.31 [95% CI, 1.05-1.61]; P=0.016) mainly driven by a higher incidence of any revascularization (24.4% versus 16.6%; adjusted HR, 1.61 [95% CI, 1.19-2.17]; P=0.002). Specifically, patients with diabetes had a higher incidence of any revascularization during the first 5 years of follow-up (20.2% versus 12.8%; adjusted HR, 1.57 [95% CI, 1.13-2.19]; P=0.007) compared with those without diabetes. No statistically significant differences were found with respect to the other end points. Conclusions Patients with ST-segment-elevation myocardial infarction who had diabetes had worse clinical outcome at 10 years compared with those without diabetes, mainly driven by a higher incidence of any revascularizations in the first 5 years. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04462315.
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Affiliation(s)
- Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Division of Cardiology University of Florida College of Medicine Jacksonville FL
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Victor Jimenez-Diaz
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | | | | | | | | | - Gianluca Campo
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | - Simone Biscaglia
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Patrick W Serruys
- International Center of Circulatory Health Imperial College London London United Kingdom.,Department of Cardiology National University of Ireland Galway Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
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Barrero A, Carrasco-Chinchilla F, Benito-González T, Pascual I, Arzamendi D, Estévez-Loureiro R, Nombela-Franco L, Pan M, Freixa X, Trillo-Nouche R, Sánchez-Recalde Á, Andraka L, Cruz-González I, López-Mínguez JR, Diez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchis J, Bosa F, Ruiz V, Del Trigo M, Molina E, Serrador AM, Alonso-Briales JH, Garrote C, Avanzas P, Li CH, Baz JA, Jiménez-Quevedo P, Mesa D, Regueiro A, Cid B, Carrasco-Moraleja M, Rodríguez-Gabella T, Hernández-García JM, Fernández-Vázquez F, Amat-Santos IJ. Temporal trend and potential impact of angiotensin receptor neprilysin inhibitors on transcatheter edge-to-edge mitral valve repair. Rev Esp Cardiol (Engl Ed) 2022; 75:1001-1010. [PMID: 35272968 DOI: 10.1016/j.rec.2022.02.001] [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: 11/13/2021] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter edge-to-edge repair (TEER) should be considered in patients with heart failure and secondary mitral regurgitation (MR). Angiotensin receptor-neprilysin inhibitors (ARNIs) have been demonstrated to improve prognosis in heart failure. We aimed to evaluate the impact ARNIs on patient selection and outcomes. METHODS The population of the Spanish TEER prospective registry (March 2012 to January 2021) was divided into 2 groups: a) TEER before the ARNI era (n=450) and b) TEER after the recommendation of ARNIs by European Guidelines (n=639), with further analysis according to intake (n=52) or not (n=587) of ARNIs. RESULTS A total of 1089 consecutive patients underwent TEER for secondary MR. In the ARNI era, there was a reduction in left ventricle dilation (82mL vs 100mL, P=.025), and better function (35% vs 38%, P=.011). At 2 years of follow-up, mortality (10.6% vs 17.3%, P <.001) and heart failure readmissions (16.6% vs 27.8%, P <.001) were lower in the ARNI era, but not recurrent MR. In the ARNI era, 1- and 2-year mortality were similar irrespective of ARNI intake but patients on ARNIs had a lower risk of readmission+mortality at 2 years (OR, 0.369; 95%CI, 0.137-0.992; P=.048), better NYHA class, and lower recurrence of MR III-IV (1.9% vs 14.3%, P=.011). CONCLUSIONS Better patient selection for TEER has been achieved in the last few years with a parallel improvement in outcomes. The use of ARNIs was associated with a significant reduction in overall events, better NYHA class, and lower MR recurrence.
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Affiliation(s)
- Alejandro Barrero
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Fernando Carrasco-Chinchilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Tomás Benito-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Isaac Pascual
- Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Dabit Arzamendi
- Departamento de Cardiología, Hospital Sant Pau, Barcelona, Spain
| | | | | | - Manuel Pan
- Departamento de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Xavier Freixa
- Departamento de Cardiología, Hospital Clinic, Barcelona, Spain
| | - Ramiro Trillo-Nouche
- Departamento de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Leire Andraka
- Departamento de Cardiología, Hospital Civil de Basurto, Bilbao, Vizcaya, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | - José Luis Diez Gil
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
| | - Francisco Bosa
- Departamento de Cardiología, Hospital Universitario, Canarias, Spain
| | - Valeriano Ruiz
- Departamento de Cardiología, Complejo Hospitalario, Navarra, Spain
| | - María Del Trigo
- Departamento de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Eduardo Molina
- Departamento de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Ana M Serrador
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Juan H Alonso-Briales
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Carmen Garrote
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Pablo Avanzas
- Departamento de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Chi Hion Li
- Departamento de Cardiología, Hospital Sant Pau, Barcelona, Spain
| | - José Antonio Baz
- Departamento de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Dolores Mesa
- Departamento de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - Ander Regueiro
- Departamento de Cardiología, Hospital Clinic, Barcelona, Spain
| | - Belén Cid
- Departamento de Cardiología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuel Carrasco-Moraleja
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Tania Rodríguez-Gabella
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José M Hernández-García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Felipe Fernández-Vázquez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario, León, Spain
| | - Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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13
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Mori R, Macaya F, Giacobbe F, Moreno V, Quadri G, Chipayo D, Bianco M, Salinas P, Rolfo C, Mejía-Rentería H, Boi A, Tirado-Conte G, Cavallino C, Nombela-Franco L, Cinconze S, Jiménez-Quevedo P, Pavani M, Fernández-Ortiz A, Chinaglia A, Fuentes-Ferrer ME, Núñez-Gil IJ, Gonzalo N, Cerrato E, Varbella F, Escaned J. Asociación entre el tratamiento hormonal y los eventos clínicos tempranos en mujeres con disección coronaria espontánea. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.06.012] [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: 10/14/2022]
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14
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Gabani R, Spione F, Arevalos V, Grima Sopesens N, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Gender Differences in 10-Year Outcomes Following STEMI: A Subanalysis From the EXAMINATION-EXTEND Trial. JACC Cardiovasc Interv 2022; 15:1965-1973. [PMID: 36008267 DOI: 10.1016/j.jcin.2022.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/19/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Short-term outcomes following ST-segment elevation myocardial infarction (STEMI) in women are worse than in men, with a higher mortality rate. It is unknown whether gender plays a role in very long term outcomes. OBJECTIVES The aim of this study was to assess whether very long term outcomes following STEMI treatment are influenced by gender. METHODS EXAMINATION-EXTEND (10-Year Follow-Up of the EXAMINATION Trial) was an investigator-driven 10-year follow-up of the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial, which randomly 1:1 assigned 1,498 patients with STEMI to receive either everolimus-eluting stents or bare-metal stents. The present study was a subanalysis according to gender. The primary endpoint was the composite patient-oriented endpoint (all-cause death, any myocardial infarction, or any revascularization) at 10 years. Secondary endpoints were individual components of the primary endpoint. All endpoints were adjusted for age. RESULTS Among 1,498 patients with STEMI, 254 (17%) were women. Overall, women were older, with more arterial hypertension and less smoking history than men. At 10 years, no difference was observed between women and men for the patient-oriented composite endpoint (40.6% vs 34.2%; adjusted HR: 1.14; 95% CI: 0.91-1.42; P = 0.259). There was a trend toward higher all-cause death in women vs men (27.6% vs 19.4%; adjusted HR: 1.30; 95% CI: 0.99-1.71; P = 0.063), with no difference in cardiac death or other endpoints. CONCLUSIONS At very long term follow-up, there were no differences in the combined patient-oriented endpoint between women and men, with a trend toward higher all-cause death in women not driven by cardiac death. The present findings underline the need for focused personalized medicine in women after percutaneous revascularization aimed at both cardiovascular and gender-specific risk factor control and targeted treatment. (10-Years Follow-Up of the EXAMINATION Trial [EXAMINAT10N]; NCT04462315).
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Affiliation(s)
- Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Victor Jimenez-Diaz
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d'Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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15
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Jerónimo A, Travieso A, McInerney A, Hennessey B, Marroquín L, Pérez-Vyzcaino MJ, Nombela L, Jiménez-Quevedo P, Mejía-Rentería H, Tirado-Conte G, Núñez-Gil I, Salinas P, Macaya-Ten F, Fernández-Ortiz A, Escaned y J, Gonzalo N. Predictores cl�nicos y caracter�sticas angiogr�ficas del infarto agudo de miocardio por embolia sist�mica. RECIC 2022. [DOI: 10.24875/recic.m22000286] [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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16
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Barrero A, Carrasco-Chinchilla F, Benito-González T, Pascual I, Arzamendi D, Estévez-Loureiro R, Nombela-Franco L, Pan M, Freixa X, Trillo-Nouche R, Sánchez-Recalde Á, Andraka L, Cruz-González I, López-Mínguez JR, Diez Gil JL, Urbano-Carrillo C, Sanmiguel Cervera D, Sanchis J, Bosa F, Ruiz V, del Trigo M, Molina E, Serrador AM, Alonso-Briales JH, Garrote C, Avanzas P, Li CH, Baz JA, Jiménez-Quevedo P, Mesa D, Regueiro A, Cid B, Carrasco-Moraleja M, Rodríguez-Gabella T, Hernández-García JM, Fernández-Vázquez F, Amat-Santos IJ. Cambios en la selección e impacto potencial de los inhibidores de neprilisina y del receptor de la angiotensina en los pacientes sometidos a reparación mitral percutánea borde a borde. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.02.001] [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: 11/16/2022]
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17
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Fernández-Peregrina E, Pascual I, Freixa X, Tirado-Conte G, Estévez-Loureiro R, Carrasco-Chinchilla F, Benito-González T, Asmarats L, Sanchís L, Jiménez-Quevedo P, Avanzas P, Caneiro-Queija B, Molina-Ramos AI, Fernández-Vázquez F, Li CH, Flores-Umanzor E, Sans-Roselló J, Nombela-Franco L, Arzamendi D. Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification. EUROINTERVENTION 2022; 17:1300-1309. [PMID: 34483091 PMCID: PMC9743252 DOI: 10.4244/eij-d-21-00205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/23/2022]
Abstract
BACKGROUND MAC is commonly found in patients affected with MR, and it is associated with high morbidity, mortality and worse cardiac surgical outcomes. Transcatheter edge-to-edge repair could be an alternative treatment, although there is little evidence in this population. AIMS The aim of this study was to analyse the safety, efficacy and durability of MitraClip implantation in patients affected with mitral regurgitation (MR) and mitral annulus calcification (MAC). METHODS We analysed the outcomes of 61 suitable patients affected with severe MR and moderate or severe MAC (the "MAC" group) and 791 patients with no or mild MAC (the "NoMAC" group) treated with the MitraClip device. RESULTS Procedural success was similar (91.8% vs 95.1%, p=0.268, in MAC and NoMAC, respectively), with a very low rate of complications. At one-year follow-up, 90.6% of MAC and 79.5% of NoMAC patients had MR grade ≤2 (p=0.129), 80% in both groups remained in NYHA Functional Class ≤II, and a significant reduction in cardiac readmissions was observed (65% vs 78% in MAC vs NoMAC, p=0.145). One-year mortality tended to be higher in MAC patients (19.7% vs 11.3%, p=0.050), with no difference in cardiovascular mortality (15.3% vs 9.2%, p=0.129). CONCLUSIONS MitraClip use in selected patients with moderate or severe MAC is safe, feasible and achieves good clinical and echocardiographic results at one-year follow-up.
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Affiliation(s)
- Estefanía Fernández-Peregrina
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Xavier Freixa
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | | | | | | | - Lluis Asmarats
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Sanchís
- Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, Barcelona, Spain
| | | | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Chi-Hion Li
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jordi Sans-Roselló
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
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Tirado-Conte G, Salazar CH, McInerney A, Cruz-Utrilla A, Jiménez-Quevedo P, Cobiella J, Gonzalo N, Carnero M, Núñez-Gil I, Mejía-Rentería H, Salinas P, Macaya F, Maroto LC, Vilacosta I, Fernández-Ortiz A, Escaned J, Macaya C, Nombela-Franco L. Incidence, clinical impact and predictors of thrombocytopenia after transcatheter aortic valve replacement. Int J Cardiol 2022; 352:21-26. [DOI: 10.1016/j.ijcard.2022.01.072] [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] [Received: 12/06/2020] [Revised: 11/20/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
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19
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Castro-Mejía AF, Travieso-González A, Pérez-Vizcayno MJ, Mejía-Rentería H, Núñez-Gil IJ, Salinas P, Nombela-Franco L, Jiménez-Quevedo P, Fernández-Ortiz A, Macaya C, Escaned y J, Gonzalo N. Diabetes mellitus y seguridad a largo plazo del diferimiento de la revascularizaci�n coronaria basado en FFR e iFR. RECIC 2022. [DOI: 10.24875/recic.m21000233] [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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20
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Vera-Urquiza R, López-Jamar JME, Nombela-Franco L, Vázquez Romero M, Espejo y C, Jiménez-Quevedo P. F�stula esofagopleural tratada con un dispositivo de cierre percut�neo de comunicaci�n interventricular muscular. RECIC 2022. [DOI: 10.24875/recic.m20000171] [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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21
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Vera Vera S, Nombela-Franco L, Santos-Martínez S, Moreno R, Jiménez-Díaz VA, Rodríguez-Gabella T, Catalá P, Castro-Mejía AF, Galeote G, Baz JA, Gutiérrez H, Serrador A, García-Gómez M, Redondo A, Baladrón C, Arnold R, Jiménez-Quevedo P, Carrasco-Moraleja M, Gómez Salvador I, San Román JA, Amat-Santos IJ. Self-expandable transcatheter heart valves for aortic stenosis. Short-term outcome and matched hemodynamic performance. Rev Esp Cardiol (Engl Ed) 2021; 74:1032-1041. [PMID: 33158760 DOI: 10.1016/j.rec.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/07/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Aortic self-expandable (SE) transcatheter aortic valve implantation (TAVI) devices are particularly useful for patients with aortic stenosis and small/tortuous vessels, small aortic annuli, or low coronary ostia. However, it is unclear whether the growing range of SE devices shows comparable hemodynamic and clinical outcomes. We aimed to determine the differential hemodynamic (residual valve area and regurgitation) and clinical outcomes of these devices in comparable scenarios. METHODS All patients were enrolled from 4 institutions and were managed with 4 different SE TAVI devices. Baseline and follow-up clinical data were collected and echocardiographic tests blindly and centrally analyzed. Patients were compared according to valve type and a 1:1 matched comparison was performed according to degree of calcification, aortic annulus dimensions, left ventricular ejection fraction, and body surface area. RESULTS In total, 514 patients were included (Evolut R/PRO, 217; ACURATE neo, 107; ALLEGRA, 102; Portico, 88). Surgical risk scores were comparable in the unmatched population. No differences were observed in the post-TAVI regurgitation rate and in in-hospital mortality (2.7%). The rate of pacemaker implantation at discharge was significantly different among devices (P=.049), with Portico showing the highest rate (23%) and ACURATE neo the lowest (9.5%); Evolut R/PRO and ALLEGRA had rates of 15.9% and 21.2%, respectively. The adjusted comparison showed worse residual TAVI gradients and aortic valve area with ACURATE neo vs ALLEGRA (P=.001) but the latter had higher risk of valve embolization and a tendency for more cerebrovascular events. CONCLUSIONS A matched comparison of 4 SE TAVI devices showed no differences regarding residual aortic regurgitation and in-hospital mortality.
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Affiliation(s)
- Silvio Vera Vera
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Sandra Santos-Martínez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Victor A Jiménez-Díaz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Tania Rodríguez-Gabella
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pablo Catalá
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Guillermo Galeote
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - José Antonio Baz
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Hipólito Gutiérrez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana Serrador
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Mario García-Gómez
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alfredo Redondo
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carlos Baladrón
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Roman Arnold
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Manuel Carrasco-Moraleja
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Itziar Gómez Salvador
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - J Alberto San Román
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio J Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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22
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Vera Vera S, Nombela-Franco L, Santos-Martínez S, Moreno R, Jiménez-Díaz VA, Rodríguez-Gabella T, Catalá P, Castro-Mejía AF, Galeote G, Baz JA, Gutiérrez H, Serrador A, García-Gómez M, Redondo A, Baladrón C, Arnold R, Jiménez-Quevedo P, Carrasco-Moraleja M, Gómez Salvador I, San Román JA, Amat-Santos IJ. Prótesis percutáneas autoexpandibles para la estenosis aórtica: resultados a corto plazo y comparación hemodinámica tras emparejamiento. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.09.023] [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: 10/22/2022]
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23
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Jiménez-Quevedo P, Nombela-Franco L, Muñoz-García E, Del Valle-Fernández R, Trillo R, de la Torre Hernández JM, Salido L, Elizaga J, Ojeda S, Sánchez Gila J, García Del Blanco B, Berenguer A, Lasa-Larraya G, Urbano Carrillo C, Albarrán A, Ruiz-Salmerón R, Moreu J, Gheorghe L, Arzamendi D, Yanes-Bowden G, Díaz J, Pérez-Moreiras I, Artaiz M, Vaquerizo B, Cruz-González I, Ruiz-Quevedo V, Blanco-Mata R, Baz JA, Villa M, Ortiz de Salazar Á, Tascón-Quevedo V, Casellas S, Moreno R. Early clinical outcomes after transaxillary versus transfemoral TAVI. Data from the Spanish TAVI registry. ACTA ACUST UNITED AC 2021; 75:479-487. [PMID: 34711513 DOI: 10.1016/j.rec.2021.07.019] [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: 03/25/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transaxillary access (TXA) has become the most widely used alternative to transfemoral access (TFA) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to compare total in-hospital and 30-day mortality in patients included in the Spanish TAVI registry who were treated by TXA or TFA access. METHODS We analyzed data from patients treated with TXA or TFA and who were included in the TAVI Spanish registry. In-hospital and 30-day events were defined according to the recommendations of the Valve Academic Research Consortium. The impact of the access route was evaluated by propensity score matching according to clinical and echocardiogram characteristics. RESULTS A total of 6603 patients were included; 191 (2.9%) were treated via TXA and 6412 via TFA access. After adjustment (n=113 TXA group and n=3035 TFA group) device success was similar between the 2 groups (94%, TXA vs 95%, TFA; P=.95). However, compared with the TFA group, the TXA group showed a higher rate of acute myocardial infarction (OR, 5.3; 95%CI, 2.0-13.8); P=.001), renal complications (OR, 2.3; 95%CI, 1.3-4.1; P=.003), and pacemaker implantation (OR, 1.6; 95%CI, 1.01-2.6; P=.03). The TXA group also had higher in-hospital and 30-day mortality rates (OR, 2.2; 95%CI, 1.04-4.6; P=.039 and OR, 2.3; 95%CI, 1.2-4.5; P=.01, respectively). CONCLUSIONS Compared with ATF, TXA is associated with higher total mortality, both in-hospital and at 30 days. Given these results, we believe that TXA should be considered only in those patients who are not suitable candidates for TFA.
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Affiliation(s)
- Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Erika Muñoz-García
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Ramiro Trillo
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - José M de la Torre Hernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Luisa Salido
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jaime Elizaga
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Joaquín Sánchez Gila
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Alberto Berenguer
- Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Agustín Albarrán
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - José Moreu
- Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Livia Gheorghe
- Servicio de Cardiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Geoffrey Yanes-Bowden
- Servicio de Cardiología, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - José Díaz
- Servicio de Cardiología, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain
| | | | - Miguel Artaiz
- Servicio de Cardiología, Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Instituto de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Ignacio Cruz-González
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | | | - José Antonio Baz
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Manuel Villa
- Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Valentín Tascón-Quevedo
- Servicio de Cirugía Cardiaca, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Sandra Casellas
- Servicio de Cirugía Cardiaca, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Raúl Moreno
- Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
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24
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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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25
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Jiménez-Quevedo P, Nombela-Franco L, Muñoz-García E, del Valle-Fernández R, Trillo R, de la Torre Hernández JM, Salido L, Elizaga J, Ojeda S, Sánchez Gila J, García del Blanco B, Berenguer A, Lasa-Larraya G, Urbano Carrillo C, Albarrán A, Ruiz-Salmerón R, Moreu J, Gheorghe L, Arzamendi D, Yanes-Bowden G, Díaz J, Pérez-Moreiras I, Artaiz M, Vaquerizo B, Cruz-González I, Ruiz-Quevedo V, Blanco-Mata R, Baz JA, Villa M, Ortiz de Salazar Á, Tascón-Quevedo V, Casellas S, Moreno R. Resultados clínicos tempranos tras el implante percutáneo de válvula aórtica por acceso transaxilar comparado con el acceso transfemoral. Datos del registro español de TAVI. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.07.013] [Citation(s) in RCA: 2] [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: 12/30/2022]
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26
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Moreno R, Ojeda S, Romaguera R, Jiménez-Quevedo P, Cruz-González I. Implante percutáneo de válvula aórtica durante la pandemia de COVID-19. Recomendaciones de la ACI-SEC. RECIC 2021. [DOI: 10.24875/recic.m20000132] [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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27
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Jiménez-Quevedo P, Muñoz-García A, Trillo-Nouche R, del Valle R, Torre Hernández JMDL, Salido L, Gutiérrez E, Pan M, Sánchez-Gila J, del Blanco BG, Moreno R, Blanco Mata R, Francisco Oteo J, Amat-Santos I, Regueiro A, Ten F, Manuel Nogales J, Fernández-Nofrerias E, Andraka L, Cruz Ferrer M, Pinar E, Romaguera R, Cuellas Ramón C, Alfonso F, García-Blas S, Piñero A, Ignasi J, Díaz Méndez R, Bordes P, Meseguer J, Nombela-Franco L, de TAVI RE. <i class="fa fa-video-camera" aria-hidden="true"></i> Evolución temporal en el tratamiento transcatéter de la estenosis aórtica: análisis del registro español de TAVI. RECIC 2021. [DOI: 10.24875/recic.m19000087] [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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28
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Junquera L, Urena M, Muñoz-Garcia A, Nombela-Franco L, Faurie B, Veiga-Fernandez G, Alperi A, Serra V, Fischer Q, Himbert D, Muñoz-García E, Vera-Urquiza R, Jiménez-Quevedo P, de la Torre Hernandez JM, Pascual I, Garcia Del Blanco B, Mohammadi S, Faroux L, Couture T, Côté M, Rodés-Cabau J. Secondary Femoral Access Hemostasis During Transcatheter Aortic Valve Replacement: Impact of Vascular Closure Devices. J Invasive Cardiol 2021; 33:E604-E613. [PMID: 34338651] [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: 06/13/2023]
Abstract
BACKGROUND Vascular and bleeding complications related to secondary femoral access site are frequent in patients undergoing transcatheter aortic valve replacement (TAVR), and their occurrence is associated to poorer outcomes. We aimed to evaluate the clinical impact of vascular closure devices (VCDs) for secondary femoral access hemostasis in TAVR procedures. METHODS This was a multicenter study including 4031 patients who underwent TAVR (mean age, 81 ± 8 years; mean Society of Thoracic Surgeons [STS] score, 4.9 [interquartile range, 3.3-7.6]), and had a secondary femoral access. The 30-day clinical outcomes were analyzed according to femoral access-site hemostasis (manual compression vs VCD), and according to the type of VCD (Perclose [Abbott Cardiovascular] vs Angio-Seal [Terumo Interventional Systems]) using a propensity-matched, multivariable, logistic regression model. RESULTS Manual compression was used in 941 patients (23.3%) and VCDs were used in 3090 patients (76.7%; Perclose in 1549 patients [38.4%] and Angio-Seal in 1541 patients [38.2%]) for secondary femoral access hemostasis. Vascular complications related to secondary access site occurred in 162 patients (4%), and were more frequent in patients who underwent manual compression (7.2%) compared with VCD hemostasis (3%; adjusted P<.001). In the VCD group, the use of Angio-Seal (vs Perclose) was associated with a higher rate of vascular complications (3.7% vs 2.4%, respectively; adjusted P=.02), femoral artery pseudoaneurysm (1.3% vs 0.4%, respectively; adjusted P<.01), invasive treatment requirement for treating vascular complications (surgery: 0.8% vs 0.3%, respectively [adjusted P=.03]; and thrombin injection: 0.9% vs 0%, respectively [adjusted P<.001]). CONCLUSION VCDs represented a safer and more effective alternative compared with manual compression for secondary femoral access-site hemostasis in patients undergoing TAVR procedures, and the Perclose VCD was associated with the lowest risk of vascular complications. Future randomized studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada.
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29
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Ojeda S, Jiménez-Quevedo P, Romaguera R, Cruz-González I, Moreno R. Impacto de la pandemia de COVID-19 en el implante de prótesis valvular aórtica percutánea en España. RECIC 2021. [DOI: 10.24875/recic.m20000161] [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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30
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McInerney A, Travieso Gonzalez A, Castro Mejía A, Tirado-Conte G, Mejía-Rentería H, Cerrato E, Nombela-Franco L, Jiménez-Quevedo P, Salinas P, Macaya Ten F, Núñez Gil I, Fernandez Ortiz A, Macaya C, Escaned J, Gonzalo N. Long-term outcomes after deferral of revascularization of in-stent restenosis using fractional flow reserve. Catheter Cardiovasc Interv 2021; 99:723-729. [PMID: 34156742 DOI: 10.1002/ccd.29823] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/16/2021] [Accepted: 06/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the outcomes of deferred coronary revascularization in patients with non-significant in-stent restenosis (ISR) by physiological assessment. BACKGROUND The pathophysiology and natural history of ISR is markedly different from de-novo stenoses. There is a paucity of data on the safety of deferral of revascularization of ISR using physiological assessment. METHODS In this single centre study, using a propensity-score matched analysis, we compared the long-term clinical outcomes of patients with ISR and de-novo disease deferred based on intracoronary physiology. Matching was on a 1:2 basis of ISR to de-novo stenosis. The primary end point was major adverse cardiovascular events (MACE) a composite of all-cause mortality, target lesion revascularization or target vessel myocardial infarction at 36 months. RESULTS Matched cohorts of 56 ISR and 112 de-novo stenoses were analyzed. The median percentage stenosis was 50% in both groups (p = 0.403). Deferral was based on fractional flow reserve (FFR). The mean FFR was 0.86 across both groups (p = 0.942). At 36-months, freedom from MACE was similar between groups; 86.2% versus 92.8% log rank p=0.180 for ISR and de-novo lesions, respectively. Neither were there differences in the individual components of MACE. CONCLUSIONS Deferral of coronary revascularization in patients with ISR based on its functional impact is associated to similar long-term safety as in de-novo coronary stenosis.
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Affiliation(s)
- Angela McInerney
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | | | - Alex Castro Mejía
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Enrico Cerrato
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain.,San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (Turin), Italy
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | | | - Pablo Salinas
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Fernando Macaya Ten
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Ivan Núñez Gil
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | | | - Carlos Macaya
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
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31
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Núñez-Gil IJ, Vera R, Jiménez-Quevedo P, Nombela-Franco L, Fernández-Ortiz A. TAVI y tronco común comprometido. Resolución ping-pong guiada con IVUS. RECIC 2021. [DOI: 10.24875/recic.m20000118] [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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32
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Giacoppo D, Alfonso F, Xu B, Claessen BEPM, Adriaenssens T, Jensen C, Pérez-Vizcayno MJ, Kang DY, Degenhardt R, Pleva L, Baan J, Cuesta J, Park DW, Schunkert H, Colleran R, Kukla P, Jiménez-Quevedo P, Unverdorben M, Gao R, Naber CK, Park SJ, Henriques JPS, Kastrati A, Byrne RA. Paclitaxel-coated balloon angioplasty vs. drug-eluting stenting for the treatment of coronary in-stent restenosis: a comprehensive, collaborative, individual patient data meta-analysis of 10 randomized clinical trials (DAEDALUS study). Eur Heart J 2021; 41:3715-3728. [PMID: 31511862 PMCID: PMC7706792 DOI: 10.1093/eurheartj/ehz594] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/26/2019] [Accepted: 08/08/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Aims
Consensus is lacking regarding the best treatment for coronary in-stent restenosis (ISR). The two most effective treatments are angioplasty with paclitaxel-coated balloon (PCB) and repeat stenting with drug-eluting stent (DES) but individual trials were not statistically powered for clinical endpoints, results were heterogeneous, and evidence about comparative efficacy and safety in relevant subsets was limited.
Methods and results
The Difference in Anti-restenotic Effectiveness of Drug-eluting stent and drug-coated balloon AngiopLasty for the occUrrence of coronary in-Stent restenosis (DAEDALUS) study was a comprehensive, investigator-initiated, collaborative, individual patient data meta-analysis comparing angioplasty with PCB alone vs. repeat stenting with DES alone for the treatment of coronary ISR. The protocol was registered with PROSPERO (CRD42017075007). All 10 available randomized clinical trials were included with 1976 patients enrolled, 1033 assigned to PCB and 943 to DES. At 3-year follow-up, PCB was associated with a significant increase in the risk of target lesion revascularization (TLR) compared with DES [hazard ratio (HR) 1.32, 95% CI 1.02–1.70, P = 0.035; number-needed-to-harm 28.5]. There was a significant interaction between treatment effect and type of restenosed stent (P = 0.029) with a more marked difference in patients with DES-ISR and comparable effects in patients with bare-metal stent-ISR. At 3-year follow-up, the primary safety endpoint of all-cause death, myocardial infarction, or target lesion thrombosis was comparable between treatments (HR 0.80, 95% CI 0.58–1.09, P = 0.152). A pre-specified subgroup analysis indicated a significant interaction between treatment effect and type of DES used to treat ISR (P = 0.033), with a lower incidence of events associated with PCB compared with first-generation DES and similar effect between PCB and second-generation DES (HR 1.06, 95% CI 0.71–1.60, P = 0.764). Long-term all-cause mortality was similar between PCB and DES (HR 0.81, 95% CI 0.53–1.22, P = 0.310); results were consistent comparing PCB and non-paclitaxel-based DES (HR 1.42, 95% CI 0.80–2.54, P = 0.235). Myocardial infarction and target lesion thrombosis were comparable between treatments.
Conclusions
In patients with coronary ISR, repeat stenting with DES is moderately more effective than angioplasty with PCB at reducing the need for TLR at 3 years. The incidence of a composite of all-cause death, myocardial infarction, or target lesion thrombosis was similar between groups. The rates of individual endpoints, including all-cause mortality, were not significantly different between groups.
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Affiliation(s)
- Daniele Giacoppo
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid 28006, Spain
| | - Bo Xu
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng, 100037 Beijing, China
| | - Bimmer E P M Claessen
- Mount Sinai Heart, the Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, 10029 New York, NY, USA
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christoph Jensen
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - María J Pérez-Vizcayno
- Department of Cardiology, Hospital Clinico San Carlos, Calle Profesor Martin Lagos, 28040 Madrid, Spain
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - Ralf Degenhardt
- Department of Cardiology, Herz-Kreislauf-Zentrum, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany
| | - Leos Pleva
- Department of Cardiology, University Hospital Ostrava, tr. 17 listopadu 1790, 70852 Ostrava, Czech Republic
| | - Jan Baan
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de León 62, Madrid 28006, Spain
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - Heribert Schunkert
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Roisin Colleran
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - Pavel Kukla
- Department of Cardiology, University Hospital Ostrava, tr. 17 listopadu 1790, 70852 Ostrava, Czech Republic
| | - Pilar Jiménez-Quevedo
- Department of Cardiology, Hospital Clinico San Carlos, Calle Profesor Martin Lagos, 28040 Madrid, Spain
| | - Martin Unverdorben
- Department of Cardiology, Herz-Kreislauf-Zentrum, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.,Daiichi Sankyo, 211 Mt. Airy Road, 07920 Basking Ridge, NJ, USA
| | - Runlin Gao
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng, 100037 Beijing, China
| | - Christoph K Naber
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth Krankenhaus, Klara-Kopp-Weg 1, 45138 Essen, Germany
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan, 388-1 Poongnapdong, Seoul 138-736, South Korea
| | - José P S Henriques
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Adnan Kastrati
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Robert A Byrne
- Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
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Gonzalo N, Salazar CH, Pérez-Vizcayno MJ, Gómez-Polo JC, Jiménez-Quevedo P, Jiménez-Valero S, Masotti M, Romaguera R, Fernández-Ortiz A, Escaned J, Alfonso F, Macaya C. Influencia de la neoateroesclerosis en el pronóstico y la respuesta al tratamiento de los pacientes con reestenosis en el stent. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.03.004] [Citation(s) in RCA: 2] [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: 12/18/2022]
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Junquera L, Urena M, Latib A, Muñoz-Garcia A, Nombela-Franco L, Faurie B, Alperi A, Serra V, Regueiro A, Fisher Q, Himbert D, Mangieri A, Colombo A, Muñoz García E, Vera Urquiza R, Jiménez-Quevedo P, Pascual I, Garcia Del Blanco B, Sabaté M, Mohammadi S, Freitas-Ferraz AB, Muntané-Carol G, Couture T, Paradis JM, Côté M, Rodés-Cabau J. Clinical Impact of Crossover Techniques for Primary Access Hemostasis in Transfemoral Transcatheter Aortic Valve Replacement Procedures. J Invasive Cardiol 2021; 33:E302-E311. [PMID: 33600353] [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 determine the occurrence of vascular complications (VCs) following transfemoral transcatheter aortic valve replacement (TAVR) with new-generation devices according to the use of a crossover technique (COT). BACKGROUND The use of a COT (with/without balloon) has been associated with a reduction of VCs in TAVR patients. However, scarce data support its use with second-generation devices. Also, its potential benefit in obese patients (at high-risk of VCs) has not been elucidated. METHODS A multicenter study including 2214 patients who underwent full percutaneous transfemoral TAVR (COT, 1522 patients; no COT, 692 patients). Thirty-day events were evaluated according to the use of a COT using a multivariate logistic regression model. A subanalysis was performed in obese patients. RESULTS Primary access major VCs (3.5% COT vs 3.9% no COT; P=.19), major/life-threatening bleeding (3.4% COT vs 2.0% no COT; P=.33), and mortality rates (2.4% COT vs 2.6% no COT; P=.23) were similar between groups. However, minor VCs (11.7% COT vs 5.9% no COT; P<.001) and postprocedural acute renal failure (8.9% COT vs 3.9% no COT; P<.001) were higher in patients undergoing the COT. In the overall cohort, percutaneous closure device failure was more frequent in obese patients (4.0% in the obese group vs 1.9% in the non-obese group; P<.01), but these differences were no longer significant in those undergoing a COT (3.4% in the obese group vs 2.0% in the non-obese group; P=.12). Indeed, in the subset of obese patients, the COT tended to be associated with fewer VCs (3.4% COT vs 5.9% no COT; P=.09). CONCLUSIONS The use of a COT was not associated with a reduction of major VCs or improved outcomes. However, some patient subsets, such as those with higher body mass index, may benefit from the use of a COT. These findings would suggest the application of a tailored strategy, following a risk-benefit assessment in each TAVR candidate.
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Affiliation(s)
- Lucía Junquera
- Quebec Heart & Lung Institute, Laval University, 2725, Chemin Sainte-Foy, Québec, Canada G1V 4G5.
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Salinas P, Travieso A, Vergara-Uzcategui C, Tirado-Conte G, Macaya F, Mejía-Rentería H, Nombela-Franco L, Núñez-Gil IJ, Gonzalo N, Jiménez-Quevedo P, Pérez-Vizcayno MJ, Escaned J, Fernández-Ortiz A. Clinical Profile and 30-Day Mortality of Invasively Managed Patients with Suspected Acute Coronary Syndrome During the COVID-19 Outbreak. Int Heart J 2021; 62:274-281. [PMID: 33731529 DOI: 10.1536/ihj.20-574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/18/2022]
Abstract
The COVID-19 pandemic severely disrupted cardiovascular care during the spring of 2020 in Europe. Our study analyzed the clinical profile, COVID-19 impact, and 30-day prognosis of invasively managed patients with acute coronary syndrome (ACS) compared to a historical cohort.All invasively managed ACS patients from March 1st to April 30th, 2020 were compared to a cohort from the same timeframe of 2019 (n = 316). COVID-19 confirmed cases were defined by a positive SARS-CoV-2 polymerase chain reaction (PCR) test (CoV+). The primary outcome was all-cause 30-day mortality and multivariable predictors of this outcome.A 40.4% reduction in ACS patients was noted (198 cases in 2019 to 118 in 2020), and 11% of 2020 ACS patients were CoV+. Baseline characteristics were similar between groups. There were significantly more in-hospital patients with ACS (15.3% versus 6.1%, P = 0.007), and fewer patients were found to have a culprit lesion (58.5% versus 74.2%, P = 0.004) in 2020 compared to 2019. Thirty-day mortality in 2020 (7%) was not different from that in 2019 (4.2%), P = 0.294, but it was significantly higher in CoV+ patients (23.1%) compared to that in negative SARS-CoV-2 PCR test (CoV-) patients (5%), P = 0.047, in the 2020 group. In the multivariate analysis, CoV+ was an independent mortality predictor (OR = 9.8, 95% CI = 1.48-64.78), along with the left ventricular ejection fraction (LVEF) (OR = 0.91, 95% CI = 0.86-0.97), P = 0.0006.This study found increased 30-day mortality of invasively managed CoV+ ACS patients compared to that of CoV- patients during the 2020 COVID-19 spring outbreak. In the multivariable analysis, a SARS-CoV-2 positive test was independently associated with 30-day mortality. Further investigations of the underlying physiopathological relations between COVID-19 and ACS are warranted.
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Affiliation(s)
- Pablo Salinas
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Alejandro Travieso
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Carlos Vergara-Uzcategui
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Gabriela Tirado-Conte
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Hernán Mejía-Rentería
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Luis Nombela-Franco
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Nieves Gonzalo
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Pilar Jiménez-Quevedo
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - María-José Pérez-Vizcayno
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
| | - Antonio Fernández-Ortiz
- Department of Cardiology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)
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Brugaletta S, Gomez-Lara J, Ortega-Paz L, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Mainar V, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, De Miguel-Castro A, Iñiguez A, Serra A, Nombela-Franco L, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Rodriguez-Arias JJ, Al-Shaibani S, Arevalos V, Romaguera R, Gomez-Hospital JA, Serruys PW, Sabaté M. 10-Year Follow-Up of Patients With Everolimus-Eluting Versus Bare-Metal Stents After ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2021; 77:1165-1178. [PMID: 33663733 DOI: 10.1016/j.jacc.2020.12.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/22/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Outcomes data for a durable-polymer everolimus-eluting stent (EES) at extended long-term follow-up in patients with ST-segment elevation myocardial infarction (STEMI) are unknown. OBJECTIVES The aim of this study was to assess the 10-year outcomes of patients enrolled in the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial. METHODS The EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION Trial) study is an investigator-driven 10-year follow-up of the EXAMINATION trial, which randomly assigned 1,498 patients with STEMI in a 1:1 ratio to receive either EES (n = 751) or bare-metal stents (n = 747). The primary endpoint was a patient-oriented composite endpoint of all-cause death, any myocardial infarction, or any revascularization. Secondary endpoints included a device-oriented composite endpoint of cardiac death, target vessel myocardial infarction, or target lesion revascularization; the individual components of the combined endpoints; and stent thrombosis. RESULTS Complete 10-year clinical follow-up was obtained in 94.5% of the EES group and 95.9% of the bare-metal stent group. Rates of the patient-oriented composite endpoint and device-oriented composite endpoint were significantly reduced in the EES group (32.4% vs. 38.0% [hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.96; p = 0.013] and 13.6% vs. 18.4% [hazard ratio: 0.72; 95% confidence interval: 0.55 to 0.93; p = 0.012], respectively), driven mainly by target lesion revascularization (5.7% vs. 8.8%; p = 0.018). The rate of definite stent thrombosis was similar in both groups (2.2% vs. 2.5%; p = 0.590). No differences were found between the groups in terms of target lesion revascularization (1.4% vs. 1.3%; p = 0.963) and definite or probable stent thrombosis (0.6% vs. 0.4%; p = 0.703) between 5 and 10 years. CONCLUSIONS At 10-year follow-up, EES demonstrated confirmed superiority in combined patient- and device-oriented composite endpoints compared with bare-metal stents in patients with STEMI requiring primary percutaneous coronary intervention. Between 5- and 10-year follow-up, a low incidence of adverse cardiovascular events related to device failure was found in both groups. (10-Years Follow-Up of the EXAMINATION Trial; NCT04462315).
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Affiliation(s)
- Salvatore Brugaletta
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Luis Ortega-Paz
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Juan Jose Rodriguez-Arias
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | - Victor Arevalos
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Rafael Romaguera
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Patrick W Serruys
- International Center of Circulatory Health, Imperial College London, London, United Kingdom; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Manel Sabaté
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Spain
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Mejía-Rentería H, Lee JM, van der Hoeven NW, Gonzalo N, Jiménez-Quevedo P, Nombela-Franco L, Núñez-Gil IJ, Salinas P, Del Trigo M, Cerrato E, van Royen N, Knaapen P, Koo BK, Macaya C, Fernández-Ortiz A, Escaned J. Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization. J Am Heart Assoc 2020; 8:e011534. [PMID: 31014181 PMCID: PMC6512122 DOI: 10.1161/jaha.118.011534] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Concerns exist about reliability of pressure‐wire‐guided coronary revascularization of non‐infarct‐related arteries (non‐IRA). We investigated whether physiological assessment of non‐IRA during the subacute phase of myocardial infarction might be flawed by microcirculatory dysfunction. Methods and Results We analyzed non‐IRA that underwent fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance assessment. Microcirculation and hyperemic response were evaluated in 49 acute myocardial infarction patients (59 non‐IRA) and compared with a matched control group of 46 stable angina (SA) patients (59 vessels). Time between acute myocardial infarction to physiological interrogation was 5.9±2.4 days. Fractional flow reserve was similar in both groups (0.79±0.11 in non‐IRA versus 0.80±0.13 in SA vessels, P=0.527). Lower coronary flow reserve values were found in non‐IRA compared with SA vessels (1.77 [1.25–2.76] versus 2.44 [1.63–4.00], P=0.018), primarily driven by an increased baseline flow in non‐IRA (rest mean transit time 0.58 [0.32–0.83] versus 0.65 s [0.39–1.20], P=0.045), whereas the hyperemic flow was similar (hyperemic mean transit time 0.26 [0.20–0.42] versus 0.26 s [0.18–0.35], P=0.873). No differences were found regarding index of microcirculatory resistance (15.6 [10.4–21.8] in non‐IRA versus 16.7 [11.6–23.6] U in SA vessels, P=0.559). During adenosine infusion, the hyperemic response was similar in both groups (non‐IRA versus SA vessels) in terms of the resistive reserve ratio (3.1±2.1 versus 3.7±2.2, P=0.118). Conclusions In the subacute phase of myocardial infarction, non‐IRA show an increased baseline flow that may cause abnormal coronary flow reserve despite preserved hyperemic flow. In non‐IRA, microcirculatory resistance and adenosine‐induced hyperemic response are similar to those found in SA patients. From a physiological perspective, these findings support the use of fractional flow reserve to interrogate non‐IRA during the subacute phase of myocardial infarction. See Editorial Koh and Samady
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Affiliation(s)
- Hernán Mejía-Rentería
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - Joo Myung Lee
- 2 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | | | - Nieves Gonzalo
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - Pilar Jiménez-Quevedo
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - Luis Nombela-Franco
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - Iván J Núñez-Gil
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - Pablo Salinas
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - María Del Trigo
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | - Enrico Cerrato
- 4 Interventional Cardiology San Luigi Gonzaga University Hospital Orbassano and Rivoli Infermi Hospital Turin Italy
| | - Niels van Royen
- 3 Department of Cardiology VU University Medical Center Amsterdam The Netherlands
| | - Paul Knaapen
- 3 Department of Cardiology VU University Medical Center Amsterdam The Netherlands
| | - Bon-Kwon Koo
- 5 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,6 Institute on Aging Seoul National University Seoul Korea
| | - Carlos Macaya
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
| | | | - Javier Escaned
- 1 Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain
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Junquera L, Vilalta V, Trillo R, Sabaté M, Latib A, Nombela-Franco L, Moris C, Garcia Del Blanco B, Larman M, Hernandez JM, Iñiguez A, Amat-Santos I, Fernandez-Nofrerias E, Regueiro A, Colombo A, Tzanis G, Jiménez-Quevedo P, Pérez-Serranos I, Duran-Priu M, Duocastella L, Paradis JM, Rodés Cabau J. Transradial Crossover Balloon Occlusion Technique for Primary Access Hemostasis During Transcatheter Aortic Valve Replacement: Initial Experience With the Oceanus 140 cm and 200 cm Balloon Catheters. J Invasive Cardiol 2020; 32:283-288. [PMID: 32737263] [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: 06/11/2023]
Abstract
OBJECTIVES The crossover balloon occlusion technique (CBOT) facilitates primary access hemostasis in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). The CBOT is usually performed through the contralateral femoral artery. The aim of this study was to evaluate, in patients undergoing TAVR, the safety and feasibility of transradial CBOT using the new Oceanus balloon dilatation catheter (iVascular). METHODS This multicenter study included 104 patients (mean age, 81 ± 7 years; 43% women) undergoing transfemoral TAVR. A modified CBOT through the radial artery was performed in all patients with the Oceanus balloon catheter. Data regarding transradial CBOT, balloon performance, vascular complications, and 30-day clinical events were recorded. RESULTS Up to 21% of patients had a height >170 cm and 17% presented with severe aortic/iliofemoral tortuosity. The transradial CBOT (left radial 74%, right radial 26%) was performed using either the 140 cm Oceanus (37.5%) or the 200 cm Oceanus (62.5%) balloon catheter. The balloon reached the femoral artery in all patients, and balloon inflation achieved an appropriate vessel closure in 98%. There were no complications related to the balloon catheter, and only 1 patient (1.0%) suffered a minor vascular complication related to the secondary radial access. The 30-day rates of primary access major vascular complications and death were 3.8% and 1.9%, respectively. CONCLUSION In patients undergoing transfemoral TAVR, transradial CBOT with the Oceanus balloon dilatation catheter was feasible and safe. A balloon length up to 200 cm allowed the use of this technique (from right or left radial access) in all patients regardless of patient height or the presence of a challenging vascular anatomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Josep Rodés Cabau
- Quebec Heart & Lung Institute, Laval University 2725 Chemin Ste-Foy, G1V 4GS Quebec City, Quebec, Canada.
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Giacoppo D, Alfonso F, Xu B, Claessen BE, Adriaenssens T, Jensen C, Pérez-Vizcayno MJ, Kang DY, Degenhardt R, Pleva L, Baan J, Cuesta J, Park DW, Kukla P, Jiménez-Quevedo P, Unverdorben M, Gao R, Naber CK, Park SJ, Henriques JP, Kastrati A, Byrne RA. Drug-Coated Balloon Angioplasty Versus Drug-Eluting Stent Implantation in Patients With Coronary Stent Restenosis. J Am Coll Cardiol 2020; 75:2664-2678. [DOI: 10.1016/j.jacc.2020.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/10/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022]
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Gonzalo N, Salazar CH, Pérez-Vizcayno MJ, Gómez-Polo JC, Jiménez-Quevedo P, Jiménez-Valero S, Masotti M, Romaguera R, Fernández-Ortiz A, Escaned J, Alfonso F, Macaya C. Influence of neoatherosclerosis on prognosis and treatment response in patients with in-stent restenosis. ACTA ACUST UNITED AC 2020; 74:427-435. [PMID: 32439297 DOI: 10.1016/j.rec.2020.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Neoatherosclerosis is one of the causes of in-stent restenosis (ISR). Our objective was to evaluate the influence of neoatherosclerosis on prognosis and treatment response in patients with ISR. METHODS This is a pooled analysis of the optical coherence tomography (OCT)-substudies of 2 multicenter, randomized clinical trials, RIBS IV and V, comparing treatment with paclitaxel-coated balloon vs everolimus-eluting stent in patients with ISR. OCT evaluation was performed at baseline and at 6 to 9 months. Neoatherosclerosis was defined in baseline OCT as neointima with calcified or lipid content. We evaluated the angiographic and OCT results at 6 to 9 months and the occurrence of major adverse cardiovascular events at 3 years of follow-up in patients with and without neoatherosclerosis treated with paclitaxel-coated balloon or everolimus-eluting stents. RESULTS Sixty-four patients underwent OCT at the time of the index procedure. Neoatherosclerosis was documented in 23 (36%) lesions. Angiographic follow-up at 6 to 9 months showed no differences in restenosis [5 (24%) vs 6 (15%) P=.49], minimum lumen diameter (1.79±0.7 vs 1.94±0.6mm; P=.41) or late loss (0.33±0.7 vs 0.15±0.5; P=.34) in patients with and without neoatherosclerosis, respectively. Follow-up OCT confirmed the absence of differences in quantitative parameters and the characteristics of tissue coverage between the 2 groups. At 3 years of follow-up, the major adverse cardiovascular events rate was 3 (13%) vs 5 (12%) in the neoatherosclerosis and nonneoatherosclerosis groups (HR, 0.94; 95%CI, 0.22-3.93; P=.93). CONCLUSIONS In this limited study population, OCT-defined neoatherosclerosis did not seem to influence acute and long-term outcomes in patients randomized to paclitaxel-coated balloon or everolimus-eluting stents for ISR.
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Affiliation(s)
- Nieves Gonzalo
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain.
| | - Carlos H Salazar
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - María José Pérez-Vizcayno
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Juan Carlos Gómez-Polo
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | - Monica Masotti
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínic, Barcelona, Spain
| | - Rafael Romaguera
- Departamento de Cardiología Intervencionista, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Fernández-Ortiz
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Javier Escaned
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Fernando Alfonso
- Departamento de Cardiología Intervencionista, Hospital Universitario de la Princesa, Madrid, Spain
| | - Carlos Macaya
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
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Junquera L, Urena M, Latib A, Muñoz-Garcia A, Nombela-Franco L, Faurie B, Veiga-Fernandez G, Alperi A, Serra V, Regueiro A, Fischer Q, Himbert D, Mangieri A, Colombo A, Muñoz-García E, Vera-Urquiza R, Jiménez-Quevedo P, de la Torre JM, Pascual I, Garcia Del Blanco B, Sabaté M, Mohammadi S, Freitas-Ferraz AB, Guimarães L, Couture T, Côté M, Rodés-Cabau J. Comparison of Transfemoral Versus Transradial Secondary Access in Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008609. [PMID: 32089002 DOI: 10.1161/circinterventions.119.008609] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transfemoral approach has been commonly used as secondary access in transcatheter aortic valve replacement (TAVR). Scarce data exist on the use and potential clinical benefits of the transradial approach as secondary access during TAVR procedures. The objective of the study is to determine the occurrence of vascular complications (VC) and clinical outcomes according to secondary access (transfemoral versus transradial) in patients undergoing TAVR. METHODS This was a multicenter study including 4949 patients who underwent TAVR (mean age, 81±8 years, mean Society of Thoracic Surgeons score, 4.9 [3.3-7.5]). Transfemoral and transradial approaches were used as secondary access in 4016 (81.1%) and 933 (18.9%) patients, respectively. The 30-day clinical events (vascular and bleeding complications, stroke, acute kidney injury, and mortality) were evaluated and defined according to Valve Academic Research Consortium-2 criteria. Clinical outcomes were analyzed according to the secondary access (transfemoral versus transradial) in the overall population and in a propensity score-matched population involving 2978 transfemoral and 928 transradial patients. RESULTS Related-access VC occurred in 834 (16.9%) patients (major VC, 5.7%) and were related to the secondary access in 172 (3.5%) patients (major VC, 1.3%). The rate of VC related to the secondary access was higher in the transfemoral group (VC, 4.1% versus 0.9%, P<0.001; major VC, 1.6% versus 0%, P<0.001). In the propensity score-matched population, VC related to the secondary access remained higher in the transfemoral group (4.7% versus 0.9%, P<0.001; major VC, 1.8% versus 0%, P<0.001), which also exhibited a higher rate of major/life-threatening bleeding events (1.0% versus 0%, P<0.001). Significant differences between secondary access groups were observed regarding the rates of 30-day stroke (transfemoral: 3.1%, transradial: 1.6%; P=0.043), acute kidney injury (transfemoral: 9.9%, transradial: 5.7%; P<0.001), and mortality (transfemoral: 4.0%, transradial: 2.4%, P=0.047). CONCLUSIONS The use of transradial approach as secondary access in TAVR procedures was associated with a significant reduction in vascular and bleeding complications and improved 30-day outcomes. Future randomized studies are warranted.
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Affiliation(s)
- Lucía Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (M.U., Q.F., D.H.)
| | - Azeem Latib
- San Raffaele Scientific Institute, Milan, Italy (A.L., A.M., A.C.).,Montefiore Medical Center, New York, NY (A.L.)
| | | | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F., R.V.U., P.J.-Q.)
| | - Benjamin Faurie
- Groupe Hospitalier Mutualiste de Grenoble, Institut Cardiovasculaire,Grenoble, France (B.F.)
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Spain (A.A., I.P.)
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain (V.S., B.G.d.B.)
| | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (M.U., Q.F., D.H.)
| | - Dominique Himbert
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France (M.U., Q.F., D.H.)
| | - Antonio Mangieri
- San Raffaele Scientific Institute, Milan, Italy (A.L., A.M., A.C.).,Maria Cecilia GVM Hospital, Cotignola, Italy (A.M., A.C.)
| | - Antonio Colombo
- San Raffaele Scientific Institute, Milan, Italy (A.L., A.M., A.C.).,Maria Cecilia GVM Hospital, Cotignola, Italy (A.M., A.C.)
| | - Erika Muñoz-García
- Hospital Universitario Virgen de la Victoria, Málaga, Spain (A.M.-G., E.M.-G.)
| | - Rafael Vera-Urquiza
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F., R.V.U., P.J.-Q.)
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F., R.V.U., P.J.-Q.)
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Spain (A.A., I.P.)
| | | | - Manel Sabaté
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (A.R., M.S.)
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Afonso B Freitas-Ferraz
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Leonardo Guimarães
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Melanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (L.J., S.M., A.B.F.-F., L.G., T.C., M.C., J.R.-C.)
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Castro-Mejía AF, Ortega-Armas ME, Mejía-Rentería H, Gonzalo N, Salinas P, Nombela-Franco L, Del Trigo M, Jiménez-Quevedo P, Escaned J, Fernández-Ortiz A, Macaya C, Nuñez-Gil IJ. Short-term clinical outcomes of percutaneous coronary intervention of unprotected left main coronary disease in cardiogenic shock. Catheter Cardiovasc Interv 2020; 95:515-521. [PMID: 31350804 DOI: 10.1002/ccd.28404] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of left main (LM) disease in patients with cardiogenic shock (CS) represents a clinical challenge. Evidence on clinical outcomes according to revascularization strategies in this scenario remains scarce. The objective was to investigate the short-term outcomes according to treatment strategies for this population. METHODS We retrospectively analyzed 78 consecutive patients who underwent PCI of LM in established CS at two experienced centers. Characteristics of PCI and short-term clinical outcomes were assessed. RESULTS LM stenosis was considered the culprit lesion in 49 patients (62.8%). In the remaining cases, LM stenosis was treated after successful PCI of the culprit vessel because of persistent CS. The majority of patients presented complex coronary anatomy (43.6% had Syntax score > 32). Complete revascularization was performed in 34.6%; a 2-stents technique in the LM bifurcation was used in 12.8% and intra-aortic balloon pump (IABP) in 73.1%. In-hospital mortality was 48.7%. At 90 days follow-up it was 50% without differences between 1 or 2 stent LM bifurcation-techniques (p = .319). Mortality was higher in patients with partial revascularization and residual Syntax score ≥ 15 (p < .05 by univariate analysis), and in those with TIMI flow<3 in the left coronary artery at the end of PCI (p < .05 by multivariate analysis). There were no significant differences in the use of IABP in relation to 90-day mortality (p = .92). CONCLUSIONS In patients presenting with cardiogenic shock and LM disease, neither 2-stents strategy in the LM nor use of IABP displayed a reduced short-term mortality. However, patients with final TIMI flow <3 presented higher short-term mortality in our series.
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Affiliation(s)
- Alex F Castro-Mejía
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - María E Ortega-Armas
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Hernán Mejía-Rentería
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Nieves Gonzalo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Nombela-Franco
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - María Del Trigo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Jiménez-Quevedo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Escaned
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Nuñez-Gil
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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43
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Broyd CJ, Hernández-Pérez F, Segovia J, Echavarría-Pinto M, Quirós-Carretero A, Salas C, Gonzalo N, Jiménez-Quevedo P, Nombela-Franco L, Salinas P, Núñez-Gil I, Del Trigo M, Goicolea J, Alonso-Pulpón L, Fernández-Ortiz A, Parker K, Hughes A, Mayet J, Davies J, Escaned J. Identification of capillary rarefaction using intracoronary wave intensity analysis with resultant prognostic implications for cardiac allograft patients. Eur Heart J 2019; 39:1807-1814. [PMID: 29253131 DOI: 10.1093/eurheartj/ehx732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 12/05/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Techniques for identifying specific microcirculatory structural changes are desirable. As such, capillary rarefaction constitutes one of the earliest changes of cardiac allograft vasculopathy (CAV) in cardiac allograft recipients, but its identification with coronary flow reserve (CFR) or intracoronary resistance measurements is hampered because of non-selective interrogation of the capillary bed. We therefore investigated the potential of wave intensity analysis (WIA) to assess capillary rarefaction and thereby predict CAV. Methods and results Fifty-two allograft patients with unobstructed coronary arteries and normal left ventricular (LV) function were assessed. Adequate aortic pressure and left anterior descending artery flow measurements at rest and with intracoronary adenosine were obtained in 46 of which 2 were lost to follow-up. In a subgroup of 15 patients, simultaneous RV biopsies were obtained and analysed for capillary density. Patients were followed up with 1-3 yearly screening angiography. A significant relationship with capillary density was noted with CFR (r = 0.52, P = 0.048) and the backward decompression wave (BDW) (r = -0.65, P < 0.01). Over a mean follow-up of 9.3 ± 5.2 years patients with a smaller BDW had an increased risk of developing angiographic CAV (hazard ratio 2.89, 95% CI 1.12-7.39; P = 0.03). Additionally, the index BDW was lower in those who went on to have a clinical CAV-events (P = 0.04) as well as more severe disease (P = 0.01). Conclusions Within cardiac transplant patients, WIA is able to quantify the earliest histological changes of CAV and can predict clinical and angiographic outcomes. This proof-of-concept for WIA also lends weight to its use in the assessment of other disease processes in which capillary rarefaction is involved.
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Affiliation(s)
- Christopher J Broyd
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain.,National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Francisco Hernández-Pérez
- Department of Cardiology, Hospital Puerto de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain
| | - Javier Segovia
- Department of Cardiology, Hospital Puerto de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain
| | - Mauro Echavarría-Pinto
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Alicia Quirós-Carretero
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Clara Salas
- Department of Cardiology, Hospital Puerto de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain
| | - Nieves Gonzalo
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Pilar Jiménez-Quevedo
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Luis Nombela-Franco
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Pablo Salinas
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Ivan Núñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Maria Del Trigo
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Javier Goicolea
- Department of Cardiology, Hospital Puerto de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain
| | - Luis Alonso-Pulpón
- Department of Cardiology, Hospital Puerto de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
| | - Kim Parker
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Alun Hughes
- Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, 62 Huntley St, Fitzrovia, London, WC1E 6DD, UK
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Justin Davies
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Prof Martin Lagos, 28040 Madrid, Spain
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44
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Pascual I, Arzamendi D, Carrasco-Chinchilla F, Fernández-Vázquez F, Freixa X, Nombela-Franco L, Avanzas P, Serrador Frutos AM, Pan M, Cid Álvarez AB, Hernández-Antolín RA, Andraka Ikazuriaga L, Cruz-González I, Díez Gil JL, Alcasena Juango MS, Berenguer Jofresa A, Alonso-Briales JH, Li CH, Benito González T, Regueiro A, Armijo G, León V, Amat-Santos IJ, Romero M, Trillo Nouche R, Fernández-Golfín C, Ruiz Gómez L, Campos-Arjona R, Millán X, Garrote Coloma C, Sanchis L, Jiménez-Quevedo P, Morís C, Hernández-García JM, Serra A, Pérez de Prado A, Estévez-Loureiro R. Transcatheter mitral repair according to the cause of mitral regurgitation: real-life data from the Spanish MitraClip registry. ACTA ACUST UNITED AC 2019; 73:643-651. [PMID: 31732437 DOI: 10.1016/j.rec.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/27/2019] [Accepted: 07/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter mitral valve repair (TMVR) with MitraClip is a therapeutic option for high surgical risk patients with severe mitral regurgitation (MR). The main objective of this study was to analyze differences in outcomes in patients with severe MR according to the cause of MR. METHODS Observational, multicenter, and prospective study with consecutive patient inclusion. The primary endpoint was the combination of all-cause mortality and new readmissions due to heart failure after 1 year. We compared clinical and procedural characteristics and the event rate for each MR group. We performed a multivariate analysis to identify predictive variables for the primary endpoint. RESULTS A total of 558 patients were included: 364 (65.2%) with functional etiology, 111 (19.9%) degenerative and 83 (14.9%) mixed. The mean age was 72.8±11.1 years and 70.3% of the sample were men. There were 95 (17%) events in the overall sample. No significant differences were found in the 3 groups in the number of primary outcome events: 11 (11.3%) in degenerative MR, 71 (21.3%) in functional MR, and 13 (18.1%) in mixed MR (P=.101). Independent predictors were functional class (P=.029), previous surgical revascularization (P=.031), EuroSCORE II (P=.003), diabetes mellitus (P=.037), and left ventricular ejection fraction (P=.015). CONCLUSIONS This study confirms the safety and efficacy of TMVR with MitraClip irrespective of MR etiology in real-life data and shows the main factors related to prognosis during the first year of follow up.
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Affiliation(s)
- Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Xavier Freixa
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Asturias, Spain.
| | | | - Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ana Belén Cid Álvarez
- Servicio de Cardiología, Complejo Hospitalario Universitario Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | | | | | | | - José Luis Díez Gil
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
| | | | | | - Juan H Alonso-Briales
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Chi Hion Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Ander Regueiro
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Germán Armijo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Víctor León
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Ignacio J Amat-Santos
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Miguel Romero
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ramiro Trillo Nouche
- Servicio de Cardiología, Complejo Hospitalario Universitario Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | | | - Lara Ruiz Gómez
- Servicio de Cardiología, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Rafael Campos-Arjona
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Laura Sanchis
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - César Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Asturias, Spain
| | | | - Antonio Serra
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Costa F, Brugaletta S, Pernigotti A, Flores-Ulmanzor E, Ortega-Paz L, Cequier A, Iniguez A, Serra A, Jiménez-Quevedo P, Mainar V, Campo G, Tespili M, den Heijer P, Bethencourt A, Vazquez N, van Es GA, Backx B, Valgimigli M, Serruys P, Sabaté M. Does Large Vessel Size Justify Use of Bare-Metal Stents in Primary Percutaneous Coronary Intervention? Circ Cardiovasc Interv 2019; 12:e007705. [DOI: 10.1161/circinterventions.118.007705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/16/2022]
Abstract
Background:
Drug-eluting stents (DES) showed improved efficacy and safety compared with bare-metal stents (BMS), and international guidelines recommend their use as first line treatment. Yet, BMS are still widely used in practice, especially in large coronary vessels. We aimed to compare efficacy and safety of second-generation DES over BMS in large coronary culprit ST-segment elevated myocardial infarction lesions.
Methods:
We evaluated impact of large coronary stents (maximum size ≥3.50 mm) or smaller stents (<3.50 mm), among 1498 patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention, randomly allocated to everolimus-eluting DES or to an equivalent BMS platform in the EXAMINATION trial (Clinical Evaluation of the Xience-V Stent in Acute Myocardial Infarction Trial). Clinical events up to 5 years of follow-up were evaluated.
Results:
Large coronary stents were used in 683 patients (45.9%). At 5-year follow-up, the crude rate of the primary end point, a composite of all-cause death, any myocardial infarction, or any revascularization, was similar among patients treated with large or smaller coronary stents. The impact of DES versus BMS implantation was consistent irrespective of the stent size both for the primary end point (
P
int
=0.82) and other secondary ischemic end points. Within patients treated with bigger stents, DES implantation was associated to a trend toward a reduction of target lesion (hazard ratio, 0.53; 95% CI, 0.27–1.02;
P
=0.05) and target vessel revascularization (hazard ratio, 0.60; 95% CI, 0.34–1.03;
P
=0.066).
Conclusions:
Our results do not support the preferential use of BMS for patients with large coronary vessels. DES may warrant improved efficacy irrespective of stent size among patients undergoing primary percutaneous coronary intervention.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00828087.
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Affiliation(s)
- Francesco Costa
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
- Department of Clinical and Experimental Medicine, University of Messina, Italy (F.C.)
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain (F.C.)
| | - Salvatore Brugaletta
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
| | | | - Eduardo Flores-Ulmanzor
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
| | - Luis Ortega-Paz
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
| | | | - Andres Iniguez
- Hospital Álvaro Cunqueiro – Vigo, Spain (A.I.)
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A.I.)
| | | | | | | | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy (G.C.)
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy (G.C.)
| | | | | | | | | | | | - Bianca Backx
- Cardialysis, Rotterdam, the Netherlands (G.A.v.E., B.B.)
| | | | | | - Manel Sabaté
- Instituto Clínico Cardiovascular (ICCV), Hospital Clínic i Provincial de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain (F.C., S.A.P., E.F.-U., L.O.-P., M.S.)
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Sambola A, Viana Tejedor A, Jiménez-Quevedo P, Alfonso F. Definición de infarto tipo 4a: ¿podemos definir mejor su diagnóstico y sistematizar la práctica clínica? Respuesta. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.02.014] [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: 10/27/2022]
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47
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Freixa X, Cruz-González I, Regueiro A, Nombela-Franco L, Estévez-Loureiro R, Ruiz-Salmerón R, Bethencourt A, Gutiérrez-García H, Fernández-Díaz JA, Moreno-Samos JC, Jiménez-Quevedo P, Martin-Yuste V, Arnold R, Millan X, Asmarats L, Ronquillo M, Agudelo-Montañez VH, López-Mínguez JR, Goicolea J, Pérez de Prado A, Arzamendi D. Left Atrial Appendage Occlusion as Adjunctive Therapy to Anticoagulation for Stroke Recurrence. J Invasive Cardiol 2019; 31:212-216. [PMID: 31088992] [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
BACKGROUND Stroke recurrence despite optimal oral anticoagulation (OAC) might represent a novel indication for left atrial appendage occlusion (LAAO). The heterogeneity of these patients is generally high, as the presence of valvular atrial fibrillation (VAF) is common. The aim of this study was to explore the role of LAAO as an adjunctive therapy to OAC in patients with recurrent stroke despite optimal OAC. METHODS The study screened consecutive patients who underwent percutaneous LAAO at nine centers between 2009 and 2017. Patients with recurrent stroke despite optimal OAC were selected and those with an absolute or relative contraindication to OAC were not included in the study. RESULTS Among 837 patients who underwent LAAO between the study period, a total of 22 (2.6%) met the inclusion criteria. There was a high percentage of VAF (38%) and 59% presented more than one cardioembolic event before LAAO. All patients underwent successful implantation of the device and no procedural major adverse events were reported. In all but 3 patients, anticoagulation was continued after LAAO. With a median clinical follow-up of 1.8 years (range, 0.7-2.8 years), only 1 stroke and 1 transient ischemic attack were reported, translating into a significant reduction of cerebrovascular events before and after LAAO (2.0 ± 1.0 events vs 0.1 ± 0.3 events; P<.01). Imaging follow-up revealed only 1 case of device thrombosis. CONCLUSIONS LAAO as an adjunctive therapy to OAC seems to be feasible and safe in patients with previous cardioembolic events despite optimal OAC. In our series, this strategy was associated with a low rate of cerebrovascular events after LAAO.
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Affiliation(s)
- Xavier Freixa
- Hospital Clinic de Barcelona, c/ Villarroel 170, Escala 3 Planta 6, 08015 Barcelona, Spain.
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48
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Sambola A, Viana Tejedor A, Jiménez-Quevedo P, Alfonso F. Definition of Myocardial Infarction Type 4a: Can We Define Its Diagnosis and Systematize Clinical Practice? Response. Rev Esp Cardiol (Engl Ed) 2019; 72:696. [PMID: 31122785 DOI: 10.1016/j.rec.2019.02.020] [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: 02/17/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Antonia Sambola
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain.
| | - Ana Viana Tejedor
- Departamento de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Fernando Alfonso
- Departamento de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
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Chamandi C, Barbanti M, Munoz-Garcia A, Latib A, Nombela-Franco L, Gutiérrez-Ibanez E, Veiga-Fernandez G, Cheema AN, Cruz-Gonzalez I, Serra V, Tamburino C, Mangieri A, Colombo A, Jiménez-Quevedo P, Elizaga J, Lee DH, Garcia del Blanco B, Puri R, Côté M, Philippon F, Rodés-Cabau J. Long-Term Outcomes in Patients With New-Onset Persistent Left Bundle Branch Block Following TAVR. JACC Cardiovasc Interv 2019; 12:1175-1184. [DOI: 10.1016/j.jcin.2019.03.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/25/2019] [Accepted: 03/19/2019] [Indexed: 11/25/2022]
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50
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Pan M, Jiménez-Quevedo P, Serrador A, Pérez de Prado A, Mesa D, Estévez Loureiro R. Selection of the Best of 2016 in MitraClip Therapy for the Treatment of Functional Mitral Regurgitation. ACTA ACUST UNITED AC 2018; 70:216-218. [PMID: 28254141 DOI: 10.1016/j.rec.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Manuel Pan
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain.
| | | | - Ana Serrador
- Servicio de Cardiología, Hospital Clínico, Valladolid, Spain
| | | | - Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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