Evaluation of Success and Complications Scores for Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the Latin American Registry.

Chronic total occlusion (CTO) percutaneous coronary intervention is a complex procedure and is associated with considerable risk of complications. Several success and complication scores have been developed; however, data regarding their external validation in other populations such as Latin America are scarce. This study aimed to evaluate the accuracy of the main predictors of success and complications in a broad cohort of procedures in the Latin American (LATAM) CTO registry. From April 2008 to December 2023, 3,706 consecutive procedures listed in the LATAM CTO registry were screened. Of these, 2,835 procedures had sufficient information to analyze the Multicenter CTO Registry in Japan (J-CTO); Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS); Ostial location, Rentrop grade, and Age (ORA); Clinical and Lesion-related Score (CL-score); and EuroCTO Score (CASTLE) success scores. The complication scores were PROGRESS (MACE, mortality, and pericardiocentesis) and Outcomes, Patient health status, and Efficiency iN Chronic Total Occlusion hybrid procedures (OPEN-CTO),OPEN-CLEAN. The J-CTO and CASTLE scores demonstrated the highest areas under the curve (AUC) of 0.718 and 0.703, respectively. The AUC value for the CL-score was 0.685, whereas the PROGRESS score had an AUC of 0.598 and the ORA AUC was 0.545. The level of agreement between scores was low; only 4% of the procedures were classified as difficult or very difficult by all scores and <1% were classified as easy by all 5 scores. Of the complication scores, PROGRESS mortality (AUC 0.651) and PROGRESS MACE (AUC 0.588) showed the best performance, identifying groups with >10% event rate. These results may improve the selection of revascularization techniques, especially for patient demographics that are historically underrepresented in CTO research.

State of the art: pressure wire and coronary functional assessment.

The pressure wire has revolutionised cardiology by moving the focus of revascularisation from anatomy to physiology. This review provides a comprehensive viewpoint on the foundations of the field of intracoronary physiology, with emphasis on the development and clinical evidence of fractional flow reserve (FFR). Additionally, we critically appraise clinical decision making based on the evolving area of resting coronary physiology. The emerging role of coronary flow reserve and its complementariness with FFR is also discussed, and the importance of the invasive assessment of the coronary microcirculation in outlining prognosis is put into perspective. Overall, this review summarises the capacity of invasive coronary physiology indices to guide revascularisation and to discriminate patients at high risk of an adverse cardiovascular outcome.

Extremely rare single right coronary artery: multidetector computed tomography findings.

Coronary anomalies are rare, with a reported prevalence of 1.3% among patients who undergo coronary angiography. The great majority of coronary artery anomalies are incidental findings and are not clinically significant, but in some cases, may be responsible for angina, syncope, arrhythmias or even sudden death. In the following case, we describe coronary CT angiography findings of one of the rarest coronary anomalies. Lipton R-I type single right coronary artery has only been previously reported in very few occasions and has been seen in only 0.0007% of the population.

Extremely rare single right coronary artery: multidetector computed tomography findings / Arteria coronaria derecha única muy infrecuente: hallazgos por tomografía computada multidetector

Coronary anomalies are rare, with a reported prevalence of 1.3% among patients who undergo coronary angiography. The great majority of coronary artery anomalies are incidental findings and are not clinically significant, but in some cases, may be responsible for angina, syncope, arrhythmias or even sudden death. In the following case, we describe coronary CT angiography findings of one of the rarest coronary anomalies. Lipton R-I type single right coronary artery has only been previously reported in very few occasions and has been seen in only 0.0007% of the population.

Las anomalías congénitas de las arterias coronarias son raras, con una prevalencia estimada de 1.3% en pacientes sometidos a angiografía coronaria. La gran mayoría de estas anomalías no son clínicamente significativas, aunque en algunos casos, pueden producir angina, síncope, arritmias e incluso muerte súbita. En el siguiente caso, describimos mediante tomografía computarizada multicorte, una de las anomalías congénitas de las arterias coronarias más raras. La arteria coronaria derecha única tipo R-I de Lipton, de la que sólo se han reportado muy pocos casos y su prevalencia se estima en 0.0007%.

[Hemorrhagic complications of acute coronary syndromes treatment]. / Complicaciones hemorrágicas del tratamiento de los síndromes coronarios agudos.

Acute coronary syndromes represent a problem of public health. The main goal of the treatment includes early reperfusion and avoidance of recurrent ischemic events. For this, thrombolytic, anticoagulant and antiplatelet drugs are used and, although they clearly improve the ischemic prognosis, are also associated with bleeding. It is now clear that bleeding has a negative impact in the patient's evolution and that its treatment can be also detrimental. It is important to recognize patients at high bleeding risk and to choose the therapy with the best risk-benefit profile. If the patient develops bleeding, it should be identified and treated properly to minimize its negative impact in the patient´s prognosis.

Complicaciones hemorrágicas del tratamiento de los síndromes coronarios agudos / Hemorrhagic complications of acute coronary syndromes treatment

Los síndromes coronarios agudos representan un problema de salud pública. La meta principal del tratamiento incluye la reperfusión temprana cuando está indicada y evitar la recurrencia de eventos isquémicos. Para ello, se utilizan fármacos trombolíticos, anticoagulantes y antiplaquetarios cada vez más potentes que, aunque claramente mejoran el pronóstico isquémico, se acompañan de diversas complicaciones entre las que destacan las hemorrágicas. Cada vez se reconoce con mayor claridad la importancia de estas complicaciones y su impacto negativo en el pronóstico del paciente. Es indispensable reconocer al paciente que tiene un riesgo elevado de desarrollar hemorragia y escoger la terapéutica con el mejor perfil riesgo-beneficio. En caso de que el paciente presente un evento hemorrágico, debe de ser identificado y tratado prontamente de forma adecuada para minimizar su impacto negativo en el pronóstico.

Acute coronary syndromes represent a problem of public health. The main goal of the treatment includes early reperfusion and avoidance of recurrent ischemic events. For this, thrombolytic, anticoagulant and antiplatelet drugs are used and, although they clearly improve the ischemic prognosis, are also associated with bleeding. It is now clear that bleeding has a negative impact in the patient's evolution and that its treatment can be also detrimental. It is important to recognize patients at high bleeding risk and to choose the therapy with the best risk-benefit profle. If the patient develops bleeding, it should be identified and treated properly to minimize its negative impact in the patient's prognosis.

Food allergy mediated by IgG antibodies associated with migraine in adults.

BACKGROUND: Migraine occurs with a high prevalence of 18 per cent. Management requires a tailored regimen of pharmacological and other measures based on individual clinical history. In some patients, allergen-specific IgG has been suspected to be involved in their mechanism, however, serological methods to investigate such possibility, are seldomly used. OBJECTIVE: The aim of this study was to investigate allergen-specific IgG in serum of patients with migraine refractory to traditional treatment. MATERIAL AND METHODS: Serum antibodies to specific 108 food allergens were measured by enzyme immunoassay from 56 patients with migraine and a control group without migraine. RESULTS: In addition to statistical significant differences in the number of positives for IgG food allergens between patients with migraine and a controlled group, elimination diets successfully control the migraine without the need of medications. CONCLUSION: According to the results obtained, serum IgG antibodies to common food should be investigated in patients with migraine.

[Metabolic syndrome in adults from 20 to 40 years old in a rural Mexican community]. / Síndrome metabólico en adultos de 20 a 40 años en una comunidad rural mexicana.

INTRODUCTION: Metabolic syndrome is the main health problem in Mexico. Its two principal complications (ischemic cardiopathy and type-2 diabetes) are the two main causes of death in Mexico since 2000. OBJECTIVE: To describe the prevalence of the metabolic syndrome in adults from 20 to 40 years old in a Mexican rural community (Senegal de Palomas, San Juan del Río, Querétaro) using the National Cholesterol Education Program (NCEP III) definition. MATERIAL AND METHODS: A descriptive study with a random sample was carried out. We present a univariate analysis with a 95% confidence interval. RESULTS: 73 cases were studied. The prevalence of the metabolic syndrome was 45.2% slightly higher in men (48.4%) than in women (42.8%). The prevalence of hypertension was 27.3%. The prevalence of obesity was 26.1% using the definition of the WHO and this prevalence rises up to 49.4% using the definition of the Mexican Official Norm. 90.5% of women and 93.5% of men had low HDLc. CONCLUSIONS: The prevalence of metabolic syndrome in adults from 20 to 40 years old in this Mexican rural community is much higher than the national mean for the same age cohort. The results show the necessity to increase the research of our rural communities in order to identify the possible causes to this problem and to create therapeutic programs for patients with metabolic syndrome.