Prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) assays have been assessed in selected populations in different studies and in registries of members of the general population with ...low cardiovascular risk. The aim of this study was to determine the prognostic value of hs-cTnT in an asymptomatic very-high cardiovascular risk Spanish population.
From a previous prospective cohort of the TUSARC (troponina T UltraSensible en pacientes Asintomáticos de alto Riesgo Cardiovascular) registry, follow-up was conducted in 602 patients (93.18%). The association of high hs-cTnT (≥99th percentile value) and incidence of primary event was studied. A primary event was defined as a combined major cardiovascular event (incidence of cardiovascular death, decompensated heart failure, non-fatal cerebrovascular event, non-fatal myocardial infarction, or coronary revascularization). The association between high hs-cTnT and incidence of secondary events was studied as well.
In patients with high hs-cTnT, the incidence of primary event during follow-up was significantly higher (18.30% vs 3.67% P < .001): heart failure (6.25% vs 0.73% P < .001), cardiovascular death (7.29% vs 0.00% P < .001), and death from any cause (7.81% vs 0.98% P < .001).
In an asymptomatic very-high cardiovascular risk Spanish population, elevated hs-cTnT was significantly associated with incident major cardiovascular combined end point and incidence of heart failure, cardiovascular death, and death from any cause.
Abstract Introduction and objectives: To describe the efficacy of the BIOSS LIM C dedicated sirolimus-eluting stent to treat coronary bifurcation lesions, and impact on the bifurcation angle and ...carina through quantitative coronary angiography. Methods: Observational prospective study including 124 patients with bifurcation lesions treated with a BIOSS LIM C dedicated sirolimus-eluting stent excluding restenotic lesions and those without main vessel involvement. Results: The stent was successfully deployed in 121 patients (97.6%) while in 18 (14.5%) double stenting was used. The quantitative coronary analysis has shown proper stent expansion with a mean residual stenosis of 18% in the proximal segment, nearly 0% in the distal segment, and 21% in the side branch. The angiographic results of double stenting showed higher mean diameters (2.12 ± 0.30 vs 1.60 ± 0.42; P < .001), and lower residual stenosis (18.36 ± 9.94 vs 28.49 ± 14.19%, P < .01). Distortion imposed on the bifurcation angulation was minimal with an absolute reduction of 5 degrees (52.8 ± 18.4 vs 47.5 ± 17.2; P = .001). Conclusions: The dedicated BIOSS LIM C stent has had a very high success rate to treat coronary bifurcation lesions. Angiographic results are good with a remarkably low impact on the native bifurcation angulation, and excellent results from double stenting. We think this can be a very useful device to treat coronary bifurcation lesions with the advantage of easing out the bailout deployment of a second stent into the side branch.
Introduction and objectives: Coronary artery aneurysms are a complex situation. Our main objective is to describe the frequency of use of covered stents (grafts) for their management, as well as to ...characterize their long-term results compared to drug-eluting stents.
Methods: Ambispective observational study with data from the International Coronary Artery Aneurysm Registry (CAAR) (NCT-02563626). Only patients who received a stent-graft or a drug-eluting stent where the aneurysm occurred were selected.
Results: A total of 17 patients received, at least, 1 stent-graft while 196 received 1 drug-eluting in the aneurysmal vessel. Male predominance, a higher rate of dyslipidemia, a past medical history of coronary artery disease, previously revascularized coronary artery disease, and giant aneurysms were reported in the stent-graft cohort. The independent predictive variables of the composite endpoint of all-cause mortality, heart failure, unstable angina, reinfarction, stroke, systemic embolism, bleeding or any aneurysmal complications at the median follow-up of 38 months were suggestive of the existence of connective tissue diseases (HR, 5.94; 95%CI, 1.82-19.37), left ventricular dysfunction ≤ 55% (HR, 1.84; 95%CI, 1.09-3.1), and an acute indication for heart catheterization (HR, 2.98; 95%CI, 1.39-6.3). The use of stent-grafts was not associated with the occurrence of more composite endpoints (23.5% vs 29.6%; P = .598).
Conclusions: The use of stent-grafts to treat coronary aneurysms is feasible and safe in the long-term. Randomized clinical trials are needed to decide what the best treatment is for these complex lesions.
Introducción y objetivos: Los aneurismas coronarios son una situación compleja. Planteamos como objetivo principal describir la frecuencia de utilización de stents recubiertos (grafts) para su tratamiento y caracterizar sus resultados a largo plazo en comparación con stents farmacoactivos.
Métodos: Estudio observacional ambispectivo, con información procedente del Registro Internacional de Aneurismas Coronarios (CAAR) (NCT-02563626). Se seleccionaron los pacientes que recibieron un stent-graft o un stent farmacoactivo en la zona del aneurisma.
Resultados: Un total de 17 pacientes recibieron al menos un stent-graft y 196 un stent farmacoactivo en la zona aneurismática. Se observa un predominio del sexo masculino y una mayor frecuencia de dislipemia, antecedentes de coronariopatía, enfermedad coronaria revascularizada previamente y aneurismas gigantes en la cohorte de stent-graft. Como variables independientes predictoras del desarrollo del evento combinado (muerte por cualquier causa, insuficiencia cardiaca, angina inestable, reinfarto, ictus, embolia sistémica, sangrado o cualquier complicación en el aneurisma), tras una mediana de seguimiento de 38 meses, destacaron la existencia de conectivopatías (hazard ratio HR = 5,94; intervalo de confianza del 95% IC95%, 1,82-19,37), la disfunción del ventrículo izquierdo ≤ 55% (HR = 1,84; IC95%, 1,09-3,1) y la indicación aguda del cateterismo índice (HR = 2,98; IC95%, 1,39-6,3). El uso de stent-grafts comparado con el de stents farmacoactivos no se asoció al desarrollo de más eventos combinados (23,5 frente a 29,6%; p = 0,598).
Conclusiones: El uso de stents recubiertos en aneurismas coronarios es factible y seguro a largo plazo. Se necesitan estudios clínicos aleatorizados para decidir el mejor tratamiento de este tipo de lesiones complejas.
En los últimos años, el perfil de riesgo de los pacientes remitidos para angiografía coronaria ha empeorado, y de igual manera lo han hecho los hallazgos angiográficos. Así pues, el envejecimiento ...progresivo de la población y el desarrollo de mejores técnicas para abordar la complejidad de los escenarios angiográficos condicionan la situación actual de la intervención coronaria percutánea. El equilibrio entre la demanda y la oferta en este campo está en continua expansión. La gestión de situaciones tan delicadas, a menudo patrimonio de la cirugía cardiaca, requiere un conocimiento profundo de técnicas dedicadas y un juicio clínico preciso1-3. A menudo se rechaza a esta población para cirugía de derivación coronaria, y a veces se le niega el tratamiento percutáneo debido al riesgo clínico elevado o al perfil angiográfico desfavorable.
ABSTRACT Introduction and objectives: Coronary artery aneurysms are a complex situation. Our main objective is to describe the frequency of use of covered stents (grafts) for their management, as ...well as to characterize their long-term results compared to drug-eluting stents. Methods: Ambispective observational study with data from the International Coronary Artery Aneurysm Registry (CAAR) (NCT-02563626). Only patients who received a stent-graft or a drug-eluting stent where the aneurysm occurred were selected. Results: A total of 17 patients received, at least, 1 stent-graft while 196 received 1 drug-eluting in the aneurysmal vessel. Male predominance, a higher rate of dyslipidemia, a past medical history of coronary artery disease, previously revascularized coronary artery disease, and giant aneurysms were reported in the stent-graft cohort. The independent predictive variables of the composite endpoint of all-cause mortality, heart failure, unstable angina, reinfarction, stroke, systemic embolism, bleeding or any aneurysmal complications at the median follow-up of 38 months were suggestive of the existence of connective tissue diseases (HR, 5.94; 95%CI, 1.82-19.37), left ventricular dysfunction ≤ 55% (HR, 1.84; 95%CI, 1.09-3.1), and an acute indication for heart catheterization (HR, 2.98; 95%CI, 1.39-6.3). The use of stent-grafts was not associated with the occurrence of more composite endpoints (23.5% vs 29.6%; P = .598). Conclusions: The use of stent-grafts to treat coronary aneurysms is feasible and safe in the long-term. Randomized clinical trials are needed to decide what the best treatment is for these complex lesions. Keywords: Coronary aneurysm. Registry. Stent. Stent graft. Angioplasty.
Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an ...elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8–14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI.
To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality.
Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center.
60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI).
AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.
Se realizó cirugía a un varón de 73 años con estenosis aórtica grave y enfermedad coronaria grave de la arteria descendente anterior (DA) y la arteria coronaria derecha (CD), que incluyó el implante ...de una bioprótesis aórtica St. Jude Trifecta del número 21 (Saint Jude Inc, Estados Unidos) y revascularización quirúrgica de la arteria mamaria interna a la DA (AMI-DA) y de la vena safena a la CD (VS-CD). Un mes después de la cirugía se presentó en la consulta externa refiriendo angina de esfuerzo progresiva. El ecocardiograma transtorácico mostró una bioprótesis valvular aórtica normofuncionante. En la angiografía coronaria se vio la enfermedad coronaria nativa ya conocida y que el injerto AMI-DA estaba permeable, pero el injerto de VS no estaba conectado a la CD distal, sino que rellenaba el seno venoso coronario (figura 1 y vídeo 1 del material adicional). La tomografía computarizada cardiaca verificó la conexión entre el injerto de VS y la vena cardiaca media, que finalmente drena en el seno coronario (figura 2). Se revascularizó percutáneamente la CD con el implante de 1 stent farmacoactivo y se decidió en sesión médico-quirúrgica cerrar el injerto de VS con el implante de un AVP4 de 6 × 12 mm...
Coronary artery calcification is probably the main determinant of the poor outcome of percutaneous coronary interventions and is associated with higher rates of adverse events. There are currently ...different balloon or specific device-based plaque modification techniques available. Knowing their characteristics and proper use is key for the optimal treatment of calcified lesions. This position paper—promoted by the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC)—describes existing plaque modification techniques currently available and proposes an algorithm for the management of calcified lesions.
La calcificación coronaria es probablemente el mayor determinante de un mal resultado de la angioplastia y se asocia a mayores tasas de eventos adversos. En la actualidad existen distintas técnicas de modificación de la placa basadas en balones o en dispositivos específicos. El conocimiento de sus características y su uso adecuado son aspectos clave para el tratamiento óptimo de las lesiones calcificadas. Este artículo de posicionamiento, promovido desde la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC), describe las técnicas de modificación de la placa existentes en la actualidad y propone un algoritmo para el tratamiento de la lesión calcificada.
Resumen Introducción y objetivos La troponina T ultrasensible (TnT-us) se ha cuantificado en poblaciones de ensayos clínicos y en registros poblacionales de bajo riesgo cardiovascular (RCV). El ...objetivo del estudio es determinar en qué proporción de la población española asintomática de muy alto RCV se puede cuantificar la TnT-us, qué proporción presenta TnT-us elevada y qué variables se asocian con la presencia de TnT-us elevada. Métodos Se incluyó a 690 pacientes. Se analizó la detección de la TnT-us y de la TnT-us elevada (≥ percentil 99 de referencia) y su asociación con las diferentes variables recogidas. Resultados Se analizó la TnT-us en 646 pacientes y se detectó en 645. Presentaron TnT-us elevada 212 pacientes (32,9%). En el análisis multivariable, la TnT-us elevada se asoció al sexo masculino (OR = 2,81; IC95%, 1,67-4,73; p < 0,001), mayor edad (OR = 1,06; IC95%, 1,04-1,09; p < 0,001) mayor índice de masa corporal (OR = 1,07; IC95%, 1,02-1,12; p < 0,002), tratamiento con insulina (OR = 1,99; IC95%, 1,15-3,46; p = 0,01), insuficiencia cardiaca previa (OR = 3,92; IC95%, 1,24-12,39; p = 0,02) y filtrado glomerular estimado calculado por la fórmula CKD-EPI (OR = 0,96; IC95%, 0,95-0,97; p < 0,001). Conclusiones En una población española asintomática de muy alto RCV, la TnT-us se detectó prácticamente en todos los pacientes, y estaba elevada en un tercio de ellos. La TnT-us elevada se asoció a mayor edad, el sexo masculino, el índice de masa corporal, la insuficiencia cardiaca previa, el tratamiento con insulina y un menor filtrado glomerular.
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