[Patients with vulnerable coronary plaques have higher serum metalloproteinase-1 levels]. / Los pacientes con placas coronarias vulnerables presentan mayores niveles séricos de metaloproteinasa-1.

BACKGROUND: Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography. Metalloproteinase-1 is an enzyme involved in extracellular matrix metabolism which has been correlated with the rupture of atherosclerotic plaques. Its serum levels in patients with vulnerable plaques remain unknown. METHODS: Patients with suspected stable coronary artery disease undergoing coronary angiography in our hospital were in-cluded. The coronary arteries were studied with optical coherence tomography to detect vulnerable plaques. Blood samples were taken from a peripheral vein and from the coronary sinus, to assess metalloproteinase-1 levels. RESULTS: Fifty-one patients were included, 13 of whom had at least one vulnerable plaque. There were not significant dif-ferences in clinical characteristics, lipid profile or C reactive protein levels, between patients with or without vulnerable plaques. Patients with vulnerable plaques had significant higher metalloproteinase-1 levels both in peripheral (7330±5541 vs 2894±1783 pg/ml, p=0.025) and coronary sinus serum (6012±3854 vs 2707±1252 pg/ml, p=0.047). CONCLUSIONS: Patients with vulnerable plaques had significantly higher metalloproteinase-1 serum levels. Further studies with clinical follow up are needed to assess the prognostic value of serum metalloproteinase-1.

[Percutaneous coronary intervention in Navarre. Outcomes of a low volume centre]. / Intervencionismo coronario percutáneo en Navarra. Resultados de un centro de bajo volumen intervencionista.

BACKGROUND: Percutaneous coronary intervention (PCI)is currently a basic therapeutic option in patients with coronary artery disease. To carry this out specialists must be trained and accredited. It is known that the number of procedures performed each year influences results. We suggest that some low volume centres may also get good results. METHODS: Prospective analysis of clinical features and immediate results obtained in our centre following PCI performed between 2006 and 2012 and retrospective analysis of overall survival, outcome-free survival and restenosis in patients treated between 2006 and 2009.The clinical features, acute and long-term events (complications,survival and mortality) of our group were compared with other published studies. RESULTS: In our centre the likelihood of complications ina PCI was 9% with an overall mortality of 2%. PCI mortality in stable coronary disease was 0.43% and in acute coronary syndrome 6.25%. Complications at the vascular access site was 1.44% and restenosis at nine months, inpatients undergoing PCI for the first time, was 5.2%. CONCLUSIONS: Although a high interventionist volume has been shown to reduce the rate of complications and improve long-term evolution, some low volume interventional centres can obtain similar results to those of high volume interventional centres.

[Technological improvements in interventional cardiology]. / Avances en intervencionismo coronario.

In the last few years, the evolution of coronary interventionism has been very important. The primary success rates in the early 1990s were 86-88% with a re-stenosis rate of 30%-40%. Current primary success rates have risen to over 95% with a re-stenosis rate of under 10% even for many types of lesions classically considered complex. Currently the main limitations in interventional cardiology remain coronary segments that cannot be accessed due to chronic total occlusion, or severe proximal tortuosity or calcification. Rapid improvements have led to broader clinical indications for percutaneous revascularization procedures. We describe the latest improvements in techniques.