Infarto agudo de miocardio prematuro con elevación del segmento ST: análisis de una cohorte en la década 2012-2022 / Premature acute myocardial infarction with ST segment elevation: a cohort study in the 2012-2022 decade

Resumen Antecedentes y objetivo: El infarto prematuro tiene un alto impacto socioeconómico y carecemos de estudios contemporáneos que analicen las características asociadas al desarrollo de estos eventos y a su evolución Material y meéodos: En un estudio observacional sobre una cohorte retrospectiva que incluyó pacientes menores de 46 años con un infarto entre junio de 2012 y junio de 2022, se analizaron las características sociodemográficas, factores de riesgo cardiovasculares, tóxicos, características del infarto, datos sobre infección e inmunización por SARS-CoV-2, se realizó un seguimiento retrospectivo a un anÌo mediante la historia electrónica y se compararon los resultados con los reportados en la literatura. Resultados: El 12.1% de las angioplastias primarias corresponded a infartos prematuros (103). Entre los factores de riesgo clásicos destacaron la dislipidemia y el sobrepeso. La hipertensión y la diabetes fueron significativamente menores que las cifras reportadas en población mayor. El consumo de tabaco fue significativamente mayor, aí como el de otros tóxicos entre los que destacaron el cannabis y la ocaína. Los antecedentes familiares estuvieron presentes en 27 pacientes. El 27.2% (28) tuvieron complicaciones durante el ingreso y la mortalidad fue del 4.9% (5). No se identificaron diferencias significativas entre los pacientes que iniciaron con un evento antes o despuéde la pandemia, a excepción de una tendencia a la disminción del hábito tabáquico. Conclusiones: El infarto prematuro es una patología al alza con una morbimortalidad considerable. La concienciación sobre los hábitos tóxicos y prevención de los factores de riesgo clásicos son tareas prioritarias en nuestro medio.

Abstract Background and purpose: Premature infarction has a high socioeconomic impact and we lack contemporary studies that analyze the characteristics associated with its development and evolution. Material and methods: In an observational study on a retrospective cohort of patients younger than 46 years old, who had suffered from an infarction from June 2012 to June 2022, sociodemographic characteristics, cardiovascular and toxic risk factors, infarction characteristics, SARS-CoV-2 infection and immunization data were investigated. Indeed, a one-year retrospective follow-up was performed through their electronic health record and results were compared with the ones reported in literature. Results: 12.1% of primary angioplasties corresponded to premature infarctions (103). Among classical risk factors, dyslipidemia and overweight stood out, while hypertension and diabetes incidence was significantly lower than the one reported in older population. The consumption of tobacco and other drugs (especially cannabis and cocaine) was higher than that reported at older ages. Twenty-seven patients had a family history of ischemic cardiopathy or sudden cardiac death, 27.2% (28) had complications during admission and mortality was 4.9% (5). No significant differences were identified between the patients who debuted with an event before or after the pandemic, except for a tendency to smoking cessation. Conclusions: Premature infarction is a rising pathology with considerable morbidity and mortality. Raising awareness about toxic habits and prevention of the classical risk factors are priority tasks in this setting.

Premature acute myocardial infarction with ST segment elevation: a cohort study in the 2012-2022 decade.

BACKGROUND AND PURPOSE: Premature infarction has a high socioeconomic impact and we lack contemporary studies that analyze the characteristics associated with its development and evolution. MATERIAL AND METHODS: In an observational study on a retrospective cohort of patients younger than 46 years old, who had suffered from an infarction from June 2012 to June 2022, sociodemographic characteristics, cardiovascular and toxic risk factors, infarction characteristics, SARS-CoV-2 infection and immunization data were investigated. Indeed, a one-year retrospective follow-up was performed through their electronic health record and results were compared with the ones reported in literature. RESULTS: 12.1% of primary angioplasties corresponded to premature infarctions (103). Among classical risk factors, dyslipidemia and overweight stood out, while hypertension and diabetes incidence was significantly lower than the one reported in older population. The consumption of tobacco and other drugs (especially cannabis and cocaine) was higher than that reported at older ages. Twenty-seven patients had a family history of ischemic cardiopathy or sudden cardiac death, 27.2% (28) had complications during admission and mortality was 4.9% (5). No significant differences were identified between the patients who debuted with an event before or after the pandemic, except for a tendency to smoking cessation. CONCLUSIONS: Premature infarction is a rising pathology with considerable morbidity and mortality. Raising awareness about toxic habits and prevention of the classical risk factors are priority tasks in this setting.

ANTECEDENTES Y OBJETIVO: El infarto prematuro tiene un alto impacto socioeconómico y carecemos de estudios contemporáneos que analicen las características asociadas al desarrollo de estos eventos y a su evolución. MATERIAL Y MEÉODOS: En un estudio observacional sobre una cohorte retrospectiva que incluyó pacientes menores de 46 años con un infarto entre junio de 2012 y junio de 2022, se analizaron las características sociodemográficas, factores de riesgo cardiovasculares, tóxicos, características del infarto, datos sobre infección e inmunización por SARS-CoV-2, se realizó un seguimiento retrospectivo a un anÌo mediante la historia electrónica y se compararon los resultados con los reportados en la literatura. RESULTADOS: El 12.1% de las angioplastias primarias corresponded a infartos prematuros (103). Entre los factores de riesgo clásicos destacaron la dislipidemia y el sobrepeso. La hipertensión y la diabetes fueron significativamente menores que las cifras reportadas en población mayor. El consumo de tabaco fue significativamente mayor, aí como el de otros tóxicos entre los que destacaron el cannabis y la ocaína. Los antecedentes familiares estuvieron presentes en 27 pacientes. El 27.2% (28) tuvieron complicaciones durante el ingreso y la mortalidad fue del 4.9% (5). No se identificaron diferencias significativas entre los pacientes que iniciaron con un evento antes o despuéde la pandemia, a excepción de una tendencia a la disminción del hábito tabáquico. CONCLUSIONES: El infarto prematuro es una patología al alza con una morbimortalidad considerable. La concienciación sobre los hábitos tóxicos y prevención de los factores de riesgo clásicos son tareas prioritarias en nuestro medio.

Changes in the Treatment Strategy Following Intracoronary Pressure Wire in a Contemporaneous Real-Life Cohort of Patients With Intermediate Coronary Stenosis. Results From a Nationwide Registry.

BACKGROUND: Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease. AIMS: To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis. METHODS: Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed. RESULTS: 1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0 %). The extent of coronary artery disease changed in 771 patients (54.5 %). There was a change in treatment strategy in 779 patients (55.1 %) (18.0 % if medical treatment; 68.8 % if PCI; 58.9 % if surgery (p < 0.001 for PCI vs medical treatment; p = 0.041 for PCI vs CABG; p < 0.001 for medical treatment vs CABG)). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6 % vs 8.2 %, p = 0.034). CONCLUSIONS: The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.

Supersymmetry in the time domain and its applications in optics.

Supersymmetry is a conjectured symmetry between bosons and fermions aiming at solving fundamental questions in string and quantum field theory. Its subsequent application to quantum mechanics led to a ground-breaking analysis and design machinery, later fruitfully extrapolated to photonics. In all cases, the algebraic transformations of quantum-mechanical supersymmetry were conceived in the space realm. Here, we demonstrate that Maxwell's equations, as well as the acoustic and elastic wave equations, also possess an underlying supersymmetry in the time domain. We explore the consequences of this property in the field of optics, obtaining a simple analytic relation between the scattering coefficients of numerous time-varying systems, and uncovering a wide class of reflectionless, three dimensional, all-dielectric, isotropic, omnidirectional, polarisation-independent, non-complex media. Temporal supersymmetry is also shown to arise in dispersive media supporting temporal bound states, which allows engineering their momentum spectra and dispersive properties. These unprecedented features may enable the creation of novel reconfigurable devices, including invisible materials, frequency shifters, isolators, and pulse-shape transformers.

Angiography and Optical Coherence Tomography Assessment of the Drug-Coated Balloon ESSENTIAL for the Treatment of In-Stent Restenosis.

OBJECTIVES: This study sought to assess the efficacy of the drug-coated balloon (DCB) ESSENTIAL for the treatment of in-stent restenosis (ISR). BACKGROUND: DCBs have proven a valid therapeutic option for the management of ISR in several clinical trials, yet no class effect can be claimed. Accordingly, every new DCB model has to be individually evaluated through clinical studies. METHODS: This is a prospective, multicenter study including consecutive patients undergoing percutaneous coronary intervention for ISR with the ESSENTIAL DCB. A 6-month quantitative coronary angiography (QCA)/optical coherence tomography (OCT) follow-up was scheduled. The primary endpoint was OCT-derived in-segment maximal area stenosis. Secondary endpoints included QCA-derived in-segment late lumen loss (LLL) and target lesion failure (TLF) rates at 6, 12, and 24 months. TLF was defined as the composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization. RESULTS: A total of 31 patients were successfully treated with DCB, with 67% of ISR corresponding to drug-eluting stents (DES). At 6 months, 26 patients underwent the scheduled angiographic follow-up. The mean value for in-segment maximal area stenosis was 51.4 ±â€¯13% and the median value was 53% (IQR 46.4-59.5). In the DES-ISR subgroup, these parameters were 52.6 ±â€¯10% and 55.2% (IQR 49.3-58.5), respectively. In-segment LLL was 0.25 ±â€¯0.43 mm with only 2 (7.7%) patients showing binary restenosis (>50%). The incidence of TLF was 10% at 6 months, 13.3% at 12 months, and 13.3% at 24 months. CONCLUSIONS: In this study, the ESSENTIAL DCB showed sustained efficacy in the prevention of recurrent restenosis after treatment of ISR. SUMMARY: We sought to assess the efficacy of the drug-coated balloon ESSENTIAL for the treatment of in-stent restenosis through a prospective, multicenter study including QCA and OCT assessment at 6-month follow-up. The primary endpoint was in-segment maximal area stenosis. Among the 31 patients successfully treated with the ESSENTIAL DCB, an angiographic follow-up was conducted in 26. Mean in-segment maximal area stenosis was 51.4 ±â€¯13% and the median value was 53% (IQR 46.4-59.5). In the DES-ISR subgroup, corresponding values were 52.6 ±â€¯10% and 55.2% (IQR 49.3-58.5), respectively. The observed in-segment LLL was 0.25 ±â€¯0.43 mm and binary restenosis rate was 7.7%. TLF was 10% at 6 months and 13.3% at 12 and 24 months.

Ultra-short pulse propagation model for multi-core fibers based on local modes.

Multi-core fibers (MCFs) have sparked a new paradigm in optical communications and open new possibilities and applications in experimental physics and other fields of science, such as biological and medical imaging. In many of these cases, ultra-short pulse propagation is revealed as a key factor that enables us to exploit the full potential of this technology. Unfortunately, the propagation of such pulses in real MCFs has not yet been modelled considering polarization effects or typical random medium perturbations, which usually give rise to both longitudinal and temporal birefringent effects. Using the concept of local modes, we develop here an accurate ultra-short pulse propagation model that rigorously accounts for these phenomena in single-mode MCFs. Based on this theory, we demonstrate analytically and numerically the intermodal dispersion between different LP01 polarized core modes induced by these random perturbations when propagating femtosecond pulses in the linear and nonlinear fiber regimes. The ever-decreasing core-to-core distance significantly enhances the intermodal dispersion induced by these birefringent effects, which can become the major physical impairment in the single-mode regime. To demonstrate the power of our model, we give explicit strategies to reduce the impact of this optical impairment by increasing the MCF perturbations.