Duration and clinical outcomes of dual antiplatelet therapy following percutaneous coronary intervention for acute coronary syndrome: A multicentre "real-world practice" registry-based study.

Background: The optimal duration of dual antiplatelet therapy (DAPT) ought to be determined taking into account individual ischaemic or bleeding events risks. To date, studies have provided inconclusive evidence on the effects of prolonged DAPT. We sought to evaluate the long-term outcomes of this strategy following percutaneous revascularization in the context of acute coronary syndrome (ACS). Methods: Retrospectively from four centers in Madrid, we identified 750 consecutive ACS patients, divided in two groups of DAPT duration: <13 months and >13 months, with a mean follow-up of 48 months. Results: Patients with DAPT > 13 months had a higher non-adjusted incidence of Major Adverse Cardiovascular Events (11.6% vs. 17.3%) and new revascularization (3.7% vs. 8.7%). Differences in all-cause death, cardiac death, myocardial infarction, stent thrombosis and stroke were non-significant. There was no difference in the incidence of major bleeding (7.4% vs. 6.3%). Multivariable Cox regression analysis showed that the independent risk predictors of MACE were age (HR: 1.04, 95% CI: 1.02-1.06, p < 0.001) and multivessel disease (HR: 2.29, 95% CI: 1.32-3.95, p = 0.003), whereas the independent protective predictor was normal hemoglobin (HR: 0.88, 95% CI: 0.78-0.98, p = 0.022). Conclusions: In this real-world registry cohort of ACS patients treated with PCI and 1 year of DAPT in Spain, we report a trend of increased rate of MACE and new revascularization not associated with TVR in patients with longer DAPT. Our findings support the need for future randomized controlled trials to confirm or refute these results.

The effect of weekends and public holidays on the care of acute coronary syndrome in the Spanish National Health System.

INTRODUCTION AND OBJECTIVES: To analyze whether admission on weekends or public holidays (WHA) influences the management (performance of angioplasty, percutaneous coronary intervention [PCI]) and outcomes (in-hospital mortality) of patients hospitalized for acute coronary syndrome in the Spanish National Health System compared with admission on weekdays. METHODS: Retrospective observational study of patients admitted for ST-segment elevation myocardial infarction (STEMI) or for non-ST-segment elevation acute coronary syndrome (NSTEACS) in hospitals of the Spanish National Health system from 2003 to 2018. RESULTS: A total of 438 987 episodes of STEMI and 486 565 of NSTEACS were selected, of which 28.8% and 26.1% were WHA, respectively. Risk-adjusted models showed that WHA was a risk factor for in-hospital mortality in STEMI (OR, 1.05; 95%CI,1.03-1.08; P < .001) and in NSTEACS (OR, 1.08; 95%CI, 1.05-1.12; P < .001). The rate of PCI performance in STEMI was more than 2 percentage points higher in patients admitted on weekdays from 2003 to 2011 and was similar or even lower from 2012 to 2018, with no significant changes in NSTEACS. WHA was a statistically significant risk factor for both STEMI and NSTEACS. CONCLUSIONS: WHA can increase the risk of in-hospital death by 5% (STEMI) and 8% (NSTEACS). The persistence of the risk of higher in-hospital mortality, after adjustment for the performance of PCI and other explanatory variables, probably indicates deficiencies in management during the weekend compared with weekdays.

Influence of Baseline Physical Activity as a Modifying Factor on COVID-19 Mortality: A Single-Center, Retrospective Study.

INTRODUCTION: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes a severe respiratory disease with a 3% global mortality. In the absence of effective treatment, controlling of risk factors that predispose to severe disease is essential to reduce coronavirus disease 2019 (COVID-19) mortality. Large observational studies suggest that exercise can reduce the risk of all-cause and disease-specific mortality. The aim of this study was to analyze the influence of the baseline physical activity level on COVID-19 mortality METHODS: This is a retrospective cohort study that included patients between 18 and 70 years old, diagnosed with COVID-19 and hospitalized in our center between February 15 and April 15, 2020. After discharge all the patients included in the study were contacted by telephone. Baseline physical activity level was estimated using the Rapid Assessment of Physical Activity Scale questionnaire and patients were divided into two groups for comparison: sedentary patients (group 1) and active patients (group 2). RESULTS: During the study period 552 patients were admitted to our hospital and met the inclusion criteria. Global mortality in group 1 was significantly higher than in group 2 (13.8% vs 1.8%; p < 0.001). Patients with a sedentary lifestyle had increased COVID-19 mortality independently of other risk factors previously described (hazard ratio 5.91 (1.80-19.41); p = 0.003). CONCLUSION: A baseline sedentary lifestyle increases the mortality of hospitalized patients with COVID-19. This finding may be of great utility in the prevention of severe COVID-19 disease.

Usefulness of the updated logistic clinical SYNTAX score after percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the GLOBAL LEADERS trial.

OBJECTIVES: We aimed to investigate the prognostic utility of the anatomical CABG SYNTAX and logistic clinical SYNTAX scores for mortality after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafts (CABG). BACKGROUND: The anatomical SYNTAX score evaluated the anatomical complexity of coronary artery disease and helped predict the prognosis of patients undergoing PCI. The anatomical CABG SYNTAX score was derived from the anatomical SYNTAX score in patients with prior CABG, whilst the logistic clinical SYNTAX score was developed by incorporating clinical factors into the anatomical SYNTAX score. METHODS: We calculated the anatomical CABG SYNTAX score and logistic clinical SYNTAX score in 205 patients in the GLOBAL LEADERS trial. The predictive abilities of these scores for 2-year all-cause mortality were evaluated. RESULTS: Using the median scores as categorical thresholds between low and high score groups, the logistic clinical SYNTAX score was able to discriminate the risk of 2-year mortality, unlike the anatomical CABG SYNTAX score. The logistic clinical SYNTAX was significantly better at predicting 2-year mortality, compared to the anatomical CABG SYNTAX score, as evidenced by AUC values in receiver-operating characteristic curve analysis (0.806 vs. 0.582, p < .001) and integrated discrimination improvement (0.121, p < .001). CONCLUSIONS: The logistic clinical SYNTAX score was superior to the anatomical CABG SYNTAX score in predicting 2-year mortality.

Cardiologists and the Cardiology of the Future. Vision and proposals of the Spanish Society of Cardiology for the Cardiology of the 21st Century.

The Cardiology of the Future is a project of the Spanish Society of Cardiology (SEC) whose objectives are as follows: to define the action policies of the SEC; to analyze the trends and changes in the environment that will influence the practice of cardiology in Spain; to define the profile of the cardiologists needed in the future; to propose policies to achieve the objectives resulting from the identified needs; and to identify the role of the SEC in the development and implementation of these policies. This article describes the methodology and the most relevant findings of the final report of this project and the strategic lines to be developed by the SEC in the immediate future, resulting from the analysis performed.

In-hospital Mortality and Readmissions for Heart Failure in Spain. A Study of Index Episodes and 30-Day and 1-year Cardiac Readmissions.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is a major health care problem in Spain. Epidemiological data from hospitalized patients are scarce and the association between hospital characteristics and patient outcomes is largely unknown. The aim of this study was to identify the factors associated with in-hospital mortality and readmissions and to analyze the relationship between hospital characteristics and outcomes. METHODS: A retrospective analysis of discharges with HF as the principal diagnosis at hospitals of the Spanish National Health System in 2012 was performed using the Minimum Basic Data Set. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) and in-hospital mortality at 30 days and 1 year after discharge by using a multivariate mixed model. RESULTS: We included 77 652 HF patients. Mean age was 79.2±9.9 years and 55.3% were women. In-hospital mortality during the index episode was 9.2%, rising to 14.5% throughout the year of follow-up. The 1-year cardiovascular readmissions rate was 32.6%. RSMR were lower among patients discharged from high-volume hospitals (> 340 HF discharges) (in-hospital RSMR, 10.3±5.6%; 8.6±2.2%); P <.001). High-volume hospitals had higher 1-year RSRR (32.3±3.7%; 33.7±4.5%; P=.006). The availability of a cardiology department at the hospital was associated with better outcomes (in-hospital RSMR, 9.9±3.8%; 9.2±2.4%; P <.001). CONCLUSIONS: High-volume hospitals and the availability of a cardiology department were associated with lower in-hospital mortality.

[Atrioventricular conduction disturbances after CoreValve(®) aortic prosthesis implantation. Predictive role of transesophageal echocardiography]. / Trastornos de conducción auriculoventricular tras implantación de prótesis aórtica CoreValve(®). Papel predictivo de la ecocardiografía transesofágica.

Atrioventricular conduction disorders can appear after the implantation of percutaneous aortic CoreValve(®) prostheses in patients requiring permanent pacemakers (40%-45% of these patients). The aim of our study was to detect if 2- or 3-dimensional echocardiographic variables could predict the appearance of atrioventricular conduction disorders. For this purpose, the relationship of the prosthesis with the interventricular septum was studied in 26 consecutive patients. Twelve patients (46.1%) developed atrioventricular conduction disorders. A prosthetic penetration >12 mm in the left ventricular outflow tract and a contact surface >90% between the interventricular septum and the stent of the prosthesis in diastole were strongly associated with the appearance of conduction disturbances (87.5%; P=.034). The percentage of the prosthetic stent in contact with the interventricular septum in end diastole was the only independent predictor of atrioventricular conduction disorders (odds ratio=1.12; 95% confidence interval, 1.01-1.25; P=.03). The results suggest that a higher implantation of the prosthesis and a reduced stent length might decrease the incidence of this complication.

[Evolution and scientific impact of research grants from the spanish society of cardiology and spanish heart foundation (2000-2006)]. / Evolución y repercusión científica de las becas de investigación de la Sociedad Española de Cardiología y la Fundación Española del Corazón (2000-2006).

INTRODUCTION AND OBJECTIVES: The Sociedad Española de Cardiología (Spanish Society of Cardiology) every year awards grants to finance research in the field of cardiovascular diseases. The aim of this study is to identify the impact of these investments during the period 2000-2006 from the subsequently published articles in scientific journals. METHODS: Using the identifying data of each project as search terms, all articles that resulted from these grants were located in the Spanish Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud databases, and in Science Citation Index-Expanded and Scopus. Descriptive statistical analysis of these articles included type of grant, number and amount awarded per year, and the recipient's sex and institutional affiliation. RESULTS: The Sociedad Española de Cardiología awarded €3,270,877 to 207 recipients, an average annual total of €467,268. We identified 231 publications that resulted from 123 (59.42%) of these grants. The average number of articles per grant awarded was 1.12, and 1.9 when taking into account only the awards that led to publication. CONCLUSIONS: During the period 2000 to 2006, the Sociedad Española de Cardiología/ Fundación Española del Corazón (Spanish Heart Foundation) provided about €500,000 per year to fund research grants, thereby contributing to the fight against cardiovascular diseases. Almost 60% of grants have led to publications, 73% of which were published in international journals, and 91.34% in national or international journals with an impact factor in the Journal Citation Reports.

Cardiovascular scientific production in Spain and in the European and global context (2003-2007).

INTRODUCTION AND OBJECTIVES: The publication of research articles has increased considerably in recent years in all biomedical fields. The present study examines the position of Spanish quality research in cardiology in the European and world context, and its evolution during the 5-year period 2003-2007. METHODS: Using the Science Citation Index Expanded of Thomson Reuters as data source, we compared Spanish cardiovascular scientific production with that of the rest of countries in the European Union and of the most important countries worldwide, along with relative productivity as per number of inhabitants and Gross Domestic Product, and the number of citations in the journals of the <> area of the Journal Citation Reports (CCS-JCR). RESULTS: Spain ranks sixth in the European Union and ninth worldwide in scientific production (tenth worldwide if only the journals of the first quartile of the CCS-JCR area are considered). As regards the number of citations received, Spain ranks seventh in the European Union and eleventh worldwide. In terms of relative productivity as per number of inhabitants and Gross Domestic Product, the Spanish ranking is less favorable (positions 15 and 18, respectively). CONCLUSIONS: The ranking of Spanish cardiovascular research is similar to that of other biomedical fields, though its position is less favorable in relation to certain demographic and economical indicators. In order to maintain adequate investigational levels, it is necessary for the European governments and scientific societies to regard the promotion of high-quality cardiological research as a priority concern.

Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse. Is transesophageal echocardiography still mandatory?

BACKGROUND: Segmental analysis in mitral prolapse is important to decide the chances of valvular repair. Multiplane transesophageal echocardiography (TEE) is the only echocardiographic tool validated for this aim hitherto. The aim of the study was to assess if segmental analysis can be performed with transthoracic real-time 3-dimensional (3D) echocardiography as accurately as with TEE, hence representing a valid alternative to TEE. METHODS: Forty-one consecutive patients diagnosed with mitral prolapse underwent TEE and a complete 3D echocardiography study, including parasternal and apical real-time; apical full-volume; and 3D color full-volume. Investigators performing TEE were blinded to the 3D results. RESULTS: Three-dimensional echocardiogram was feasible in 40 to 41 patients (97.7%). Ages ranged from 15 to 92 years, and all possible anatomical patterns of prolapse were represented. Thirty-seven patients (90.2%) had mitral regurgitation of any degree. The level of agreement was k = 0.93 (P < or = .0001), sensitivity of 96.7%, specificity of 96.7%, likelihood ratio for a positive result of 29.0%, and likelihood ratio for a negative result of 0.03%. Four false positives were found, corresponding to scallops A2 (1), A3 (2), and P3 (1). Four false negatives were found, corresponding to scallops A1 (2) and P1 (2). Sensitivity and specificity in the scallop P2 were 100%. CONCLUSION: Segmental analysis in mitral prolapse can be performed with transthoracic real-time 3D echocardiography as accurately as with TEE. False negatives tend to appear around the anterolateral commissure, whereas false positives tend to appear around the posteromedial commissure. Highest accuracy was reached in central scallops.

[Transient left midventricular dyskinesia: clinical features of a new variant]. / Discinesia medioventricular izquierda transitoria: aspectos clínicos de una nueva variante.

We report five consecutive patients with transient midventricular dyskinesia, a recently described variant of transient apical dyskinesia. It is a syndrome that shares a broad clinical, prognostic and, probably, pathogenetic resemblance to the latter. The patients, the majority of whom were experiencing an episode of emotional or physical stress, were all admitted to an emergency department with a clinical presentation compatible with acute myocardial infarction. Evidence of dyskinesia or akinesia in midventricular segments was seen on ventriculography. These ventricular abnormalities resolved completely over a short period of time. No coronary artery abnormality was evident in any patient. The existence of this variant shows that segments other than apical ventricular segments, which are affected in takotsubo syndrome, can also undergo reversible change. The occurrence of new variants raises further questions about the relationship between the nervous system, catecholamines and reversible myocardial lesions.

[Myocardial infarction with ST segment elevation and angiographically normal coronary arteries: epidemiology and mid-term follow-up]. / Infarto de miocardio con elevación del segmento ST y arterias coronarias angiográficamente normales: epidemiología y evolución a medio plazo.

BACKGROUND AND OBJECTIVE: The myocardial infarction (MI) with ST elevation and angiographically normal coronary arteries isn't frequent. The aim of this study is to describe clinical characteristic and mid-term follow-up of those patients. PATIENTS AND METHOD: Between January 1997 and December 2004 we identified 75 patients with MI and normal coronary arteries in a coronary angiography performed within one month of the AMI. All had criteria of MI and their coronary arteries were smooth and without obstructive lesions. RESULTS: The incidence was 3%, and mean age (standard deviation): 49 (11) years; 63% of patients were males and 47% were smokers, 33% had hypertension, 24% dislipemia and 9% diabetes. No patient had previous angina. MI location was anterior in 43%, inferior in 40% and lateral in 17%. The peak of creatine phosphokinase was 700 U/dl (range: 431-1,115) and the ejection fraction was 65% (14%). After a medium follow up of 30 months (range: 12-84) the events were: one death and 2 new MI. CONCLUSIONS: MI with normal coronary arteries is rare, is associated with a relative low rate of coronary risk factors, and with a good initial outcome, low rate of recurrent events and preservation of left ventricular function.