RESUMEN
BACKGROUND: In the past years, the percentage of percutaneous coronary angiography and coronary interventions using radial access had significantly increased due to its higher safety, lower risk of major bleeding, and hence lower cardiovascular mortality. Subclavian artery stenosis is one of the challenges that may be met during transradial coronary interventions, which may necessitate femoral access crossover or conversion. AIMS: To evaluate the feasibility and safety of performing subclavian angioplasty via radial access during complex coronary interventions using the forearm approach. METHODS: A series of patients with complex radial approach due to subclavian stenosis received subclavian angioplasty during the procedure. We included 48 patients out of 22 500 procedures performed from February 2009 to February 2020. All patients did not have alternative vascular access due to extensive peripheral arterial disease (previous history of iliac stenting or distal aortic occlusion, which makes femoral access crossover difficult; also the contralateral radial/ulnar artery was very faint or not detectable at all). RESULTS: Mean age was 72 (10) years and 67% of patients were males. Subclavian angioplasty was successfully done in all patients via ipsilateral radial access; 44 patients (91.7%) required subclavian stenting, and 4 patients were treated by subclavian angioplasty without stenting. Coronary angiography or intervention was perfectly achieved through the revascularized subclavian artery; coronary stenting was successfully done in 36 patients as indicated. CONCLUSIONS: It can be concluded that percutaneous subclavian artery angioplasty can be done safely and effectively to facilitate complex transradial coronary procedures with an acceptable immediate technical success, especially in patients without alternative vascular access. Also, we may conclude that subclavian angioplasty may be successfully performed in patients with symptomatic upper limb ischemia, via the radial approach.
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Angioplastia Coronaria con Balón , Arteriopatías Oclusivas , Masculino , Humanos , Anciano , Femenino , Angioplastia Coronaria con Balón/métodos , Arteria Radial/cirugía , Arteria Cubital , Angiografía Coronaria/métodos , Arteria Subclavia/cirugía , Resultado del TratamientoRESUMEN
The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20-50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23-2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40-3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10-2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25-3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome.
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OBJECTIVES: The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR). BACKGROUND: Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown. METHODS: A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success. RESULTS: Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03). CONCLUSIONS: TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.
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Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Cateterismo Cardíaco , Humanos , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Choque Cardiogénico , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: Thyroid hormone affects the metabolism of all tissues in the body. The aim of this study was to analyze the prevalence and implications of thyroid disorders in a cohort of consecutive patients with spontaneous coronary artery dissection (SCAD). METHODS: A total of 73 patients with SCAD were analyzed. Baseline characteristics and clinical outcomes were compared between euthyroid and hypothyroid patients. Subsequently, the prevalence of thyroid function abnormalities and the clinical characteristics of SCAD patients were compared with those in 73 patients with acute coronary syndrome but without SCAD, matched by age, sex, and presentation. RESULTS: Mean age was 55 ± 12 years and 26% had hypothyroidism. Compared with patients with normal thyroid function, patients with SCAD and hypothyroidism were all women (100% vs 69%, P = .01), more frequently had dissection in distal (74% vs 41%, P = .03) and tortuous coronary segments (68% vs 41%, p = .03), and more frequently received conservative medical management (79% vs 41%, P = .007). During a mean clinical follow-up of 4.1 ± 3.8 years, 23% of the patients had adverse cardiac events irrespective of thyroid function status. The prevalence of hypothyroidism was higher in patients with SCAD than in matched patients with acute coronary syndrome without SCAD (26% vs 8%, P = .004). CONCLUSIONS: There is a high prevalence of hypothyroidism in patients with SCAD. Patients with SCAD and hypothyroidism are more frequently women, more frequently have distal dissections in tortuous vessels, and are more frequently managed with a conservative medical strategy.
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Anomalías de los Vasos Coronarios/etiología , Vasos Coronarios/diagnóstico por imagen , Hipotiroidismo/complicaciones , Enfermedades Vasculares/congénito , Biomarcadores/sangre , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Tirotropina/sangre , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/epidemiología , Enfermedades Vasculares/etiologíaRESUMEN
The OPTIS integrated system (St. Jude Medical) is a new technology allowing the online co-registration of optical coherence tomography (OCT) images with the angiogram in the catheterization laboratory. Additionally, 3D navigation can be performed. This integration of OCT information on an angiographic roadmap could find broad application in the characterization of substrates causing acute coronary syndromes with normal or near-normal coronary arteries. The utility of OCT with co-registration for the guidance of percutaneous coronary intervention could be considerable in the management of patients with acute coronary syndromes.
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Síndrome Coronario Agudo/diagnóstico , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Imagenología Tridimensional/estadística & datos numéricos , Tomografía de Coherencia Óptica/estadística & datos numéricos , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Coherencia Óptica/métodosRESUMEN
Six-month PCI follow-up results of left anterior descending (LAD) and circumflex (CX) drug-eluting stent implantation are presented. Angiography showed patent LAD and CX stents. However, OCT revealed almost all abluminal cavities were completely filled, which the authors surmise was due to a neointimal healing process.
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Trombosis Coronaria/cirugía , Vasos Coronarios/diagnóstico por imagen , Intervención Coronaria Percutánea/métodos , Infarto del Miocardio con Elevación del ST/cirugía , Tomografía de Coherencia Óptica/métodos , Angiografía Coronaria , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico , Vasos Coronarios/cirugía , Stents Liberadores de Fármacos , Humanos , Inmunosupresores/farmacología , Masculino , Persona de Mediana Edad , Neointima/patología , Diseño de Prótesis , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/etiología , Sirolimus/farmacologíaRESUMEN
Spontaneous coronary artery dissection is a rare condition, and diagnosis and treatment are challenging among patients who present with acute coronary syndrome. Typically, the condition affects young females who have no underlying atherosclerotic disease. To date, few cases of bioresorbable scaffold implantation for the treatment of spontaneous coronary artery dissection have been reported. Therefore, we describe the cases of 4 patients whom we treated with scaffolds. We evaluated the long-term results by using intravascular ultrasound and optical coherence tomographic scanning.
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Implantes Absorbibles , Anomalías de los Vasos Coronarios/cirugía , Vasos Coronarios/cirugía , Intervención Coronaria Percutánea/métodos , Andamios del Tejido , Enfermedades Vasculares/congénito , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Diseño de Prótesis , Factores de Tiempo , Tomografía de Coherencia Óptica , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/cirugíaRESUMEN
We present 2 illustrative cases of acute coronary syndrome and spontaneous coronary artery spasm evaluated by optical coherence tomography. Different spasm patterns were showed by optical coherence tomography (OCT), according to whether there were underlying atherosclerotic plaques or not.
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Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/cirugía , Enfermedad de la Arteria Coronaria/cirugía , Placa Aterosclerótica/cirugía , Espasmo/diagnóstico por imagen , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Placa Aterosclerótica/diagnóstico , Tomografía de Coherencia Óptica/métodosRESUMEN
BACKGROUND: Angioplasty on the radial artery have been performed with good success rates in patients with critical hand ischemia. We sought to assess the feasibility and safety of radial angioplasty on complex radial access in patients undergoing coronary angiography. METHODS/MATERIAL: A prospective series of procedures with complex radial/ulnar access to which radial-ulnar angioplasty (RU-A) was performed. We set goals of efficacy and safety that included the success rate of the procedure (need for ¨Crossover femoral¨) and the existence of radial pulse at one month. RESULTS: 18 cases of RU-A out of 11,500 procedures from March 2010 to July 2016 (0.15%) were included. The majority of the patients were men with a variety of cardiovascular risk factors (age 71±9; 94% Hypertensive, 56% Diabetic, 18% chronic kidney disease). The most common indication for radial/ulnar angioplasty was severe arteriosclerotic stenosis. Angioplasty was performed with different types of over the wire peripheral balloons (Mean diameter 4,3±1 and mean length 42±15mm), in one case a stent implantation was needed. The success rate was 100% without vascular complications at 1-month clinical and vascular doppler follow-up. CONCLUSIONS: Radial/ulnar artery angioplasty is feasible and safe in selected patients undergoing elective angiography or percutaneous coronary intervention using complex forearm approach.
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Angioplastia de Balón/métodos , Cateterismo Periférico/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Antebrazo/irrigación sanguínea , Intervención Coronaria Percutánea/métodos , Enfermedad Arterial Periférica/terapia , Arteria Radial , Arteria Cubital , Anciano , Anciano de 80 o más Años , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Cateterismo Periférico/efectos adversos , Constricción Patológica , Angiografía Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/fisiopatología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Punciones , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiopatología , Estudios Retrospectivos , Stents , Arteria Cubital/diagnóstico por imagen , Arteria Cubital/fisiopatología , Grado de Desobstrucción VascularRESUMEN
A patient presented with an inferior non-ST segment elevation myocardial infarction and a tight lesion on the distal right coronary artery. After stent implantation, a large scaffold malapposition was observed by optical coherence tomography. This case emphasizes the importance of not expanding a bioresorbable vascular scaffold more than 0.5 mm over its nominal size.
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Implantes Absorbibles/efectos adversos , Angioplastia Coronaria con Balón/instrumentación , Reestenosis Coronaria , Infarto del Miocardio sin Elevación del ST , Implantación de Prótesis/efectos adversos , Reoperación , Andamios del Tejido/efectos adversos , Angioplastia Coronaria con Balón/métodos , Angiografía Coronaria/métodos , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/etiología , Reestenosis Coronaria/cirugía , Vasos Coronarios/diagnóstico por imagen , Stents Liberadores de Fármacos , Humanos , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/cirugía , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/cirugía , Falla de Prótesis/etiología , Implantación de Prótesis/métodos , Reoperación/instrumentación , Reoperación/métodos , Tomografía de Coherencia Óptica/métodos , Resultado del TratamientoAsunto(s)
Estenosis de la Válvula Aórtica/cirugía , Arteria Axilar , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Axila , Femenino , Humanos , Masculino , Ilustración Médica , Fotograbar , Diseño de Prótesis , Estudios Retrospectivos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversosRESUMEN
We report a case of spontaneous dissection of the left main coronary artery in a 32-year-old healthy woman that was unrelated with childbirth or other known risk factors. The clinical presentation was an extensive acute anterior myocardial infarction. She was treated by thrombolysis, but did not meet reperfusion criteria. Coronary angiography revealed dissection of the left main coronary artery that extended into the anterior descending and circumflex coronary arteries. Rescue angioplasty with stenting was performed. The clinical, diagnostic, and therapeutic features of this rare entity are discussed.
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Disección Aórtica/complicaciones , Aneurisma Coronario/complicaciones , Infarto del Miocardio/etiología , Infarto del Miocardio/terapia , Stents , Terapia Trombolítica , Adulto , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Angioplastia Coronaria con Balón , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/terapia , Angiografía Coronaria , Vasos Coronarios/patología , Vasos Coronarios/cirugía , Electrocardiografía , Femenino , Humanos , Infarto del Miocardio/diagnóstico por imagen , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: The ACC/AHA/ESC 2001 guidelines for the management of atrial fibrillation (AF) establish 4 categories: first episode, paroxysmal, persistent and permanent. The aim of this study was to analyze the frequency of the different clinical patterns of presentation of AF in hospitalized patients. PATIENTS AND METHOD: We analyzed the pattern of AF in 300 hospitalized patients, 200 of whom were admitted to the cardiology and 100 to the internal medicine department. We determined the clinical profile and evaluated the factors influencing therapeutic management. RESULTS: The permanent form was present in 30% of the patients admitted to the cardiology department and in 51% if those admitted to the internal medicine department. The first episode pattern was the most frequent in cardiology department patients (41%). In patients hospitalized the in cardiology the percentage use of anticoagulants (57.9% vs. 41%; p < 0.01) and beta blockers was greater than in internal medicine patients, and digitalis use was lower. In the multivariate analysis, admission to the cardiology department was an independent predictor of treatment with beta blockers (OR = 3.8; 95% CI, 1.3-11.1; p < 0.05), and discharge from the hospital with AF was a predictor of anticoagulant prescription (OR = 4.8; 95% CI, 2.5-9.2; p < 0.001). CONCLUSIONS: a) Atrial fibrillation is an arrhythmia with a heterogeneous clinical pattern that varies depending on the type of care provided; b) on admission to cardiology, only 30% of the patients present with permanent arrhythmia, and the most frequent clinical pattern is first episode; and c) discharge from the hospital with AF was the principal determinant of therapeutic management.
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Fibrilación Atrial/diagnóstico , Hospitalización , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Servicio de Cardiología en Hospital , Cateterismo Periférico , Arteria Femoral , Departamentos de Hospitales , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/mortalidad , Femenino , Humanos , Masculino , Seguridad del Paciente , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Punciones , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , España , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del TratamientoRESUMEN
Introducción y objetivos: La hormona tiroidea afecta al metabolismo de todos los tejidos del organismo. El objetivo es analizar la prevalencia y las implicaciones de las alteraciones tiroideas en una cohorte de pacientes consecutivos con disección coronaria espontánea (DCE). Métodos: Se evaluó a 73 pacientes diagnosticados de DCE y se compararon las características y la evolución clínica de los pacientes eutiroideos frente a los hipotiroideos. Se comparó posteriormente la prevalencia de alteraciones tiroideas y las características clínicas de estos pacientes con las de 73 pacientes con síndrome coronario agudo pero sin DCE emparejados por edad, sexo y presentación clínica. Resultados: La media de edad fue 55 +/- 12 años y el 26% tenía hipotiroidismo. Los pacientes con DCE e hipotiroidismo eran todas mujeres (el 100 frente al 69%; p = 0,01), tenían disecciones más distales (el 74 frente al 41%; p = 0,03), en arterias en tirabuzón (el 68 frente al 41%; p = 0,03) y recibieron tratamiento más conservador (el 79 frente al 41%; p = 0,007). Durante un seguimiento medio de 4,1 +/- 3,8 años, la tasa de eventos adversos fue del 23%, sin diferencias según el estado de la función tiroidea. La prevalencia de hipotiroidismo fue significativamente mayor en los pacientes con DCE que en el grupo con síndrome coronario agudo sin DCE (el 26 frente al 8%; p = 0,004). Conclusiones: Hay una elevada prevalencia de hipotiroidismo en los pacientes con DCE. Los pacientes hipotiroideos con DCE son más frecuentemente mujeres, tienen disecciones más distales y en arterias en tirabuzón y reciben tratamiento más conservador
Introduction and objectives: Thyroid hormone affects the metabolism of all tissues in the body. The aim of this study was to analyze the prevalence and implications of thyroid disorders in a cohort of consecutive patients with spontaneous coronary artery dissection (SCAD). Methods: A total of 73 patients with SCAD were analyzed. Baseline characteristics and clinical outcomes were compared between euthyroid and hypothyroid patients. Subsequently, the prevalence of thyroid function abnormalities and the clinical characteristics of SCAD patients were compared with those in 73 patients with acute coronary syndrome but without SCAD, matched by age, sex, and presentation. Results: Mean age was 55 +/- 12 years and 26% had hypothyroidism. Compared with patients with normal thyroid function, patients with SCAD and hypothyroidism were all women (100% vs 69%, P = .01), more frequently had dissection in distal (74% vs 41%, P = .03) and tortuous coronary segments (68% vs 41%, p = .03), and more frequently received conservative medical management (79% vs 41%, P = .007). During a mean clinical follow-up of 4.1 +/- 3.8 years, 23% of the patients had adverse cardiac events irrespective of thyroid function status. The prevalence of hypothyroidism was higher in patients with SCAD than in matched patients with acute coronary syndrome without SCAD (26% vs 8%, P = .004). Conclusions: There is a high prevalence of hypothyroidism in patients with SCAD. Patients with SCAD and hypothyroidism are more frequently women, more frequently have distal dissections in tortuous vessels, and are more frequently managed with a conservative medical strategy