[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.

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

Fundamento: El intervencionismo coronario percutáneo (PCI) es una opción terapéutica fundamental en pacientes con enfermedad coronaria. Para realizarla los especialistas deben formarse y acreditarse. Se sabe que el número de procedimientos realizados al año influye en los resultados. Pretendemos mostrar que con un bajo volumen de PCI algunos centros obtienen buenos resultados. Método: Análisis prospectivo de las características clínicas y resultados inmediatos obtenidos en nuestro centro con el PCI entre 2006 y 2012 y análisis retrospectivo de la supervivencia global, supervivencia libre de eventos y reestenosis de los PCI realizados entre 2006 y 2009. Se compararon las características clínicas, los eventos agudos y a largo plazo (complicaciones, supervivencia y mortalidad) entre nuestros pacientes y los de algunos trabajos publicados. Resultados: Nuestra probabilidad de tener cualquier complicación en un PCI fue del 9% con una mortalidad global del 2%. La mortalidad del PCI en situación estable fue del 0,43% y en el síndrome coronario agudo del 6,25%. Las complicaciones en el lugar del acceso vascular fueron del 1,44% y la incidencia de reestenosis a los nueve meses, en pacientes sometidos por primera vez a PCI, fue del 5,2%. Conclusiones: Aunque el alto volumen intervencionista ha demostrado ser importante para tener una baja tasa de complicaciones y una buena evolución a largo plazo, hay centros con bajo volumen intervencionista que por sus características pueden obtener resultados equiparables a los de alto volumen (AU)

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 in a 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, in patients 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 (AU)

[Study of myocardial viability using single-photon emission computed tomography with 201-thallium and re-injection in 4 series (early and late images]. / Estudio de la viabilidad miocárdica mediante tomografía de emisión de fotón único con talio-201 y reinyección en 4 series (imágenes precoces y tardías).

OBJECTIVE: The present study was designed to determine whether 24-hour imaging after thallium reinjection or imaging obtained shortly after reinjection provides better results regarding reversibility of fixed perfusion defects observed in conventional stress-redistribution imaging. PATIENTS AND METHODS: We studied 24 patients undergoing stress-redistribution thallium tomography with fixed defects (15 exercise, 6 adenosine, 3 dobutamine). All patients had coronary angiography and 17 a history of myocardial infarction. After obtaining the redistribution images, 1 mCi thallium was injected at rest, and images were acquired at 30 minutes and 24 hours after reinjection. The tomograms obtained were divided into 12 segments and analyzed quantitatively. RESULTS: Of the 190 abnormal segments on the stress images, 53 (28%) demonstrated improved thallium uptake on redistribution images and 137 had persistent defects. Shortly after reinjection, 33 (24%) segments had improved thallium uptake and 104 had persistent defects, 29 (28%) of which showed further improvement in the 24-hour study. In patients with myocardial infarction, of the 36 fixed severe defects, 9 (25%) had improved thallium uptake shortly after reinjection, increasing activity from 36 +/- 10% to 53 +/- 8%, and 22 (61%) defects improved at 24 hours, increasing activity from 37 +/- 8% to 56 +/- 6%. Therefore, 13 irreversible segments in the short-term study after reinjection were reversible on 24-hour images. CONCLUSION: These data indicate that 24-hour imaging after thallium reinjection provides better results regarding reversibility of fixed perfusion defects observed in conventional stress-redistribution imaging than imaging obtained shortly after reinjection.

[Rehabilitation in the heart transplant patient]. / Rehabilitación en el paciente trasplantado de corazón.

Cardiac transplantation should not only enlarge life time but additionally should provide the patient with good quality of life and a satisfactory rehabilitation level. An integrated rehabilitation program can help to the process of recovery. In spite of the multiple factors which modify the physiological response during exercise, an appropriate training can be reached by many patients. Nevertheless the physiological rehabilitation is one of the components of the patients global restitution in order to reach satisfactory life style after transplantation.