According to the data presented, the two groups of included patients were quite balanced for all risk factors except hypertension, which was much higher in the conditioning group, and properly ...acknowledged by Bøtker and colleagues. ... our results do not support a confounding effect by β-blocker treatment, but our patient numbers are too small to establish a firm conclusion.
The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI ...management during the COVID-19 outbreak.
Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.
Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 150-375 vs 200 140-332 minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.
The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
El impacto del brote de COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) no está claro. El objetivo de este estudio es evaluar los cambios en el tratamiento del IAMCEST durante el brote de COVID-19.
Se utilizó un registro multicéntrico, nacional, retrospectivo y observacional de pacientes consecutivos atendidos en 75 centros, se compararon las características de los pacientes y de los procedimientos y los resultados hospitalarios en 2 cohortes según se los hubiera tratado antes o durante la COVID-19.
Los casos con sospecha de IAMCEST disminuyeron el 27,6% y los pacientes con IAMCEST confirmado se redujeron de 1.305 a 1.009 (22,7%). No hubo diferencias en la estrategia de reperfusión (más del 94% tratados con angioplastia primaria). El tiempo de isquemia fue más largo durante la COVID-19 (233 150-375 frente a 200 140-332 min; p <0,001), sin diferencias en el tiempo primer contacto médico-reperfusión. La mortalidad hospitalaria fue mayor durante la COVID-19 (el 7,5 frente al 5,1%; OR bruta=1,50; IC95%, 1,07-2,11; p <0,001); esta asociación se mantuvo tras ajustar por factores de confusión (OR ajustada=1,88; IC95%, 1,12-3,14; p=0,017). La incidencia de infección confirmada por SARS-CoV-2 fue del 6,3%.
El brote de COVID-19ha implicado una disminución en el número de pacientes con IAMCEST, un aumento del tiempo entre el inicio de los síntomas y la reperfusión y un aumento en la mortalidad hospitalaria. No se han detectado cambios en la estrategia de reperfusión. La combinación de infección por SARS-CoV-2 e IAMCEST fue relativamente infrecuente.
In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the ...RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up.
A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012.
A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P=.014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed.
In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.
En 2014 se publicó el Documento de Consenso desarrollado por SEIP-SERPE-SEOP para el diagnóstico y el tratamiento de las infecciones osteoarticulares (IOA). En 2015 se constituyó RIOPed como red nacional multidisciplinar para la investigación en IOA. El objetivo del estudio ha sido valorar el grado de adecuación a las recomendaciones establecidas en el consenso durante un año de seguimiento.
Estudio prospectivo multicéntrico nacional realizado entre septiembre de 2015 y septiembre de 2016 en 37 hospitales con inclusión de pacientes menores de 16 años diagnosticados de IOA, confirmada mediante aislamiento microbiológico, o probable: artritis séptica (AS) con >40.000 leucocitos en líquido sinovial u osteomielitis (OM)/osteoartritis (OA)/espondilodiscitis (ED) con prueba de imagen compatible. Los resultados se compararon con los obtenidos en el estudio retrospectivo realizado entre 2008 y 2012.
Se incluyeron 255 casos: 131 OM, 79 AS, 30 OA y 15 ED. Respecto a las pruebas complementarias que el consenso consideró de obligada realización, la radiografía se llevó a cabo en el 87,8% de los casos, el hemocultivo en el 91,6% y el cultivo de líquido sinovial en el 99% de AS. Se realizó RM en el 71% de las OM. La elección del tratamiento antibiótico intravenoso empírico se adecuó a las recomendaciones en el 65,1% de los casos, y en el 62,3% para el tratamiento oral. Se llevó a cabo cirugía en el 36,8% de las AS (85,7% artrotomía), con un descenso significativo respecto al estudio retrospectivo (P=,014). Solo el 58,5% de casos se ajustaron a las recomendaciones de duración del tratamiento; sin embargo, se comprobó una menor duración del tratamiento intravenoso.
En general, el grado de adecuación a las recomendaciones que marcaron el grupo de expertos es bueno para las pruebas complementarias y aceptable respecto a la elección del tratamiento antibiótico, aun detectándose casi un 40% de inadecuación. Se ha conseguido un descenso de la estancia hospitalaria.
Biomarkers are frequently used to estimate infarct size (IS) as an endpoint in experimental and clinical studies. Here, we prospectively studied the impact of left ventricular (LV) hypertrophy (LVH) ...on biomarker release in clinical and experimental myocardial infarction (MI).
ST-segment elevation myocardial infarction (STEMI) patients (n=140) were monitored for total creatine kinase (CK) and cardiac troponin I (cTnI) over 72 hours postinfarction and were examined by cardiac magnetic resonance (CMR) at 1 week and 6 months postinfarction. MI was generated in pigs with induced LVH (n=10) and in sham-operated pigs (n=8), and serial total CK and cTnI measurements were performed and CMR scans conducted at 7 days postinfarction. Regression analysis was used to study the influence of LVH on total CK and cTnI release and IS estimated by CMR (gold standard). Receiver operating characteristic (ROC) curve analysis was performed to study the discriminatory capacity of the area under the curve (AUC) of cTnI and total CK in predicting LV dysfunction. Cardiomyocyte cTnI expression was quantified in myocardial sections from LVH and sham-operated pigs. In both the clinical and experimental studies, LVH was associated with significantly higher peak and AUC of cTnI, but not with differences in total CK. ROC curves showed that the discriminatory capacity of AUC of cTnI to predict LV dysfunction was significantly worse for patients with LVH. LVH did not affect the capacity of total CK to estimate IS or LV dysfunction. Immunofluorescence analysis revealed significantly higher cTnI content in hypertrophic cardiomyocytes.
Peak and AUC of cTnI both significantly overestimate IS in the presence of LVH, owing to the higher troponin content per cardiomyocyte. In the setting of LVH, cTnI release during STEMI poorly predicts postinfarction LV dysfunction. LV mass should be taken into consideration when IS or LV function are estimated by troponin release.
Atherothrombosis, atherosclerosi,s and their thrombotic complications have become epidemic. Both an elevated low-density lipoprotein (LDL) cholesterol level and a decreased high-density lipoprotein ...(HDL) cholesterol level are associated with the increased incidence of atherothrombosis. Reducing LDL using statins has been shown to provide very effective therapy for both primary and secondary prevention. Nevertheless, despite statin treatment, a large percentage of patients continues to experience cardiovascular events. Therapies aimed at increasing HDL have been investigated for several decades, with promising results. However, because statin treatment was not standardized in earlier trials, it has been difficult to draw clear conclusions. Recent advances in both animal studies and clinical trials indicate that increasing the HDL level could result in additional benefits to those achieved by reducing LDL levels using statins. Intravenous infusion of various HDL preparations appears to lead to the accelerated regression and stabilization of atheromatous plaque, and could provide a novel approach to treatment in high-risk patients. This review describes the biological rationale underlying the use of treatments that increase HDL and discusses the potential benefits of such treatment.
La aterotrombosis —aterosclerosis y sus complicaciones trombóticas— es una afección de dimensiones epidémicas. Elevadas concentraciones de colesterol de las lipoproteínas de baja densidad (LDL) y bajas concentraciones de colesterol de las lipoproteínas de alta densidad (HDL) se asocian a una incidencia incrementada de aterotrombosis. La reducción de LDL con estatinas se ha mostrado como una terapia muy eficaz tanto en prevención primaria como en secundaria. Sin embargo, pese al tratamiento con estatinas, un gran porcentaje de pacientes siguen sufriendo eventos cardiovasculares. Las terapias dirigidas a aumentar las HDL se prueban desde hace varias décadas, con resultados prometedores. La falta de estandarización en el tratamiento con estatinas en estos ensayos hace difícil extraer conclusiones definitivas. Recientes avances, tanto en estudios animales como en ensayos clínicos, indican que el incremento de las HDL puede resultar en un beneficio adicional al de la reducción de las LDL con estatinas. Parece que la infusión intravenosa de diferentes formas de HDL reduce y estabiliza las placas de ateroma de una manera acelerada, y supone un nuevo enfoque para el tratamiento de los pacientes en muy alto riesgo. En esta revisión se describen las bases biológicas que sustentan el tratamiento con intervenciones que aumentan las HDL, así como los potenciales beneficios que conlleva.
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