Spanish cardiac catheterization and coronary intervention registry. 32nd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2022).

INTRODUCTION AND OBJECTIVES: This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. METHODS: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. RESULTS: A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. CONCLUSIONS: The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.

Algo más que un simple SCASEST: patrón de De Winter / Something more than simple non-STsegment elevation acute coronary syndrome: the De Winter pattern

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Determinación del índice tobillo-brazo mediante doppler portátil y tensiómetro automático en pacientes diabéticos / Determination of ankle-brachial index using a portable doppler and a blood pressure measuring device in diabetic patients

La enfermedad arterial periférica (EAP) es una de las manifestaciones sistémicas de aterotrombosis. Los sujetos con arteriosclerosis en un determinado lecho vascular tienen un riesgo elevado de presentar complicaciones cardiovasculares y cerebrovasculares. Los métodos diagnósticos con los que contamos actualmente en Atención Primaria (AP) para el diagnóstico de la EAP son la palpación de pulsos pedios, la oscilometría y el doppler. Se diseñó un estudio descriptivo transversal con el fin de determinar la prevalencia de EAP en pacientes diabéticos a los que se calculó el Índice tobillo-brazo (ITB) mediante doppler portátil HADECO SMARTDOP 30EX y tensiómetro automático OMRON por 2 exploradores previamente adiestrados, un profesional médico y otro de enfermería. Así mismo, se pretendía comparar los resultados obtenidos con ambos métodos diagnósticos y conocer el valor predictor de un evento vascular con un ITB alterado. Las prevalencias de EAP medido con doppler portátil y esfigmomanómetro automático fueron 29,3 IC (23,3-35,8) y 15,3 IC (10,2-20,5) respectivamente. El coeficiente de correlación intraclase (CCI) demostró una concordancia aceptable del ITB obtenido con tensiómetro automático comparado con técnica doppler. Hemos encontrado en nuestro estudio que las variables antecedentes de EAP, edad, duración de la diabetes y sexo presentan significación estadística con EAP. Los índices de correlación de ambos ITB con la existencia de un evento cardiovascular demostró que son significativos para los pacientes con cifras inferiores 0,9 con chi-cuadrado p<0,05. La detección temprana de la EAP en la consulta permite establecer estrategias preventivas e intensificar el tratamiento en estos casos (AU)

Abstract Peripheral arterial disease (PAD) is one of the systemic manifestations of atherothrombosis. The subjects with atherosclerosis in a particular vascular bed are at increased risk of cardiovascular and cerebrovascular complications. The diagnostic methods currently available in Primary Care (PC) for the diagnosis of PAD are pedal pulse palpation, oscillometry and Doppler. We designed a descriptive study to determine the prevalence of PAD in diabetic patients by calculating their ankle-brachial index (ABI) using portable Doppler HADECO SMARTDOP 30EX and OMRON automatic blood pressure by two previously trained investigators-examiners, a doctor and a nurse. It was also intended to compare the results obtained with both diagnostic methods and learn the predictive value of a vascular event with an abnormal ABI. The prevalences of PAD measured with portable Doppler and automatic sphygmomanometer were 29.3 (95% CI; 23.3 to35.8) and 15.3 (95% CI; 10.2 to 20.5), respectively. The intraclass correlation coefficient (ICC)showed an acceptable match of results obtained with the ABI automatic blood pressure compared to Doppler technique. We found in our study that the history variables of PAD, age, duration of diabetes, and sex showed statistical significance with PAD. The correlation coefficients of both ABI measurement with the existence of a cardiovascular event proved to be significant for patients with levels below 0.9 with a chi-squared P<.05. Early detection of PAD in the clinicenables preventive strategies to be established and to intensify the treatment in these cases (AU)

[Determination of ankle-brachial index using a portable doppler and a blood pressure measuring device in diabetic patients]. / Determinación del índice tobillo-brazo mediante doppler portátil y tensiómetro automático en pacientes diabéticos.

Peripheral arterial disease (PAD) is one of the systemic manifestations of atherothrombosis. The subjects with atherosclerosis in a particular vascular bed are at increased risk of cardiovascular and cerebrovascular complications. The diagnostic methods currently available in Primary Care (PC) for the diagnosis of PAD are pedal pulse palpation, oscillometry and Doppler. We designed a descriptive study to determine the prevalence of PAD in diabetic patients by calculating their ankle-brachial index (ABI) using portable Doppler HADECO SMARTDOP 30EX and OMRON automatic blood pressure by two previously trained investigators-examiners, a doctor and a nurse. It was also intended to compare the results obtained with both diagnostic methods and learn the predictive value of a vascular event with an abnormal ABI. The prevalences of PAD measured with portable Doppler and automatic sphygmomanometer were 29.3 (95% CI; 23.3 to 35.8) and 15.3 (95% CI; 10.2 to 20.5), respectively. The intraclass correlation coefficient (ICC) showed an acceptable match of results obtained with the ABI automatic blood pressure compared to Doppler technique. We found in our study that the history variables of PAD, age, duration of diabetes, and sex showed statistical significance with PAD. The correlation coefficients of both ABI measurement with the existence of a cardiovascular event proved to be significant for patients with levels below 0.9 with a chi-squared P<.05. Early detection of PAD in the clinic enables preventive strategies to be established and to intensify the treatment in these cases.

[Analysis of differences in flow-mediated dilation in relation to the treatment of coronary patients]. / Anális de las diferencias encontradas en la dilatación mediada por flugo según la terapia seguida en pacientes con enfermedad coronaria.

INTRODUCTION: Flow-mediated dilation (FMD) is thought to be related to the development of coronary disease. We were interested in knowing the degree of FMD in a large sample of coronary patients in relation to the therapy they were given in clinical practice. PATIENTS AND METHOD: We studied 1,081 coronary patients (age 68 +/- 12 years, 73% male) in which FMD was evaluated in the brachial artery. The patients were classified into 5 treatment groups (416 who receive 2 or more treatments were excluded): group A: 81 controls treated with aspirin, group B: 198 treated with ACE inhibitors, group C: 106 with calcium antagonists, group D: 145 with beta-blockers, and group E: 135 with lipid lowering medication (93% statins). RESULTS: ANOVA was used to analyze the differences between groups. With regard to the number of risk factors present in each group, the patients treated with ACE inhibitors (2.44 +/- 0.79 vs 2.14 +/- 0.89; p < 0.05) and statins (3.45 +/- 0.70 vs 2.14 +/- 0.89; p < 0.05) had more risk factors than GrA and higher levels of LDL-cholesterol (ACE inhibitors 145.0 +/- 33.5 vs 128.5 +/- 32.2 and statins 157.8 +/- 45.3 vs 128.5 +/- 32.2; p < 0.05). GrB had a higher glycemia than controls (123.4 +/- 32.2 vs 114.7 +/- 33.7; p < 0.05). The control group was younger than the therapeutic groups (p < 0.05). Compared with the control group, FMD was significantly higher only in the group treated with ACE inhibitors (3.42 +/- 6.01 vs 0.82 +/- 6.04; p < 0.05). Multivariate logistical regression showed that treatment with ACE inhibitors and statins (p < 0.05) were independent predictors of FMD > 4%. CONCLUSION: Treatment with ACE inhibitors or statins was predictive of the normalization of FMD in coronary patients in clinical practice.

Análisis de las diferencias encontradas en la dilatación mediada por flujo según la terapia seguida en pacientes con enfermedad coronaria / Analysis of differences in flow-mediated dilation in relation to the treatment of coronary patients

Introducción. La dilatación mediada por flujo (DMF) ha sido propuesta como un marcador de enfermedad coronaria. Nuestro objetivo ha sido conocer el grado de DMF en una muestra amplia de enfermos coronarios según la terapia seguida en la práctica clínica. Pacientes y método. Estudiamos a 1.081 pacientes coronarios (edad 68 ñ 12; 73 por ciento varones) en los que se evaluó la DMF braquial. Según el tratamiento, los pacientes fueron clasificados en 5 grupos (fueron excluidos 416 pacientes con 2 terapias): grupo A, 81 controles tratados con aspirina; grupo B, 198 con IECA; grupo C, 106 con antagonistas del calcio; grupo D, 145 con bloqueadores beta, y grupo E, 135 tratados con fármacos hipolipemiantes (93 por ciento estatinas).Resultados. Mediante ANOVA se analizaron las diferencias entre grupos. Respecto al número de factores de riesgo, los pacientes en tratamiento con IECA (2,44 ñ 0,79 frente a 2,14 ñ 0,89; p 4 por ciento. Conclusión. El tratamiento con IECA o estatinas es predictor de una mejor dilatación mediada por flujo en pacientes coronarios en la práctica clínica (AU)