[Patients with vulnerable coronary plaques have higher serum metalloproteinase-1 levels]. / Los pacientes con placas coronarias vulnerables presentan mayores niveles séricos de metaloproteinasa-1.

BACKGROUND: Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography. Metalloproteinase-1 is an enzyme involved in extracellular matrix metabolism which has been correlated with the rupture of atherosclerotic plaques. Its serum levels in patients with vulnerable plaques remain unknown. METHODS: Patients with suspected stable coronary artery disease undergoing coronary angiography in our hospital were in-cluded. The coronary arteries were studied with optical coherence tomography to detect vulnerable plaques. Blood samples were taken from a peripheral vein and from the coronary sinus, to assess metalloproteinase-1 levels. RESULTS: Fifty-one patients were included, 13 of whom had at least one vulnerable plaque. There were not significant dif-ferences in clinical characteristics, lipid profile or C reactive protein levels, between patients with or without vulnerable plaques. Patients with vulnerable plaques had significant higher metalloproteinase-1 levels both in peripheral (7330±5541 vs 2894±1783 pg/ml, p=0.025) and coronary sinus serum (6012±3854 vs 2707±1252 pg/ml, p=0.047). CONCLUSIONS: Patients with vulnerable plaques had significantly higher metalloproteinase-1 serum levels. Further studies with clinical follow up are needed to assess the prognostic value of serum metalloproteinase-1.

Los pacientes con placas coronarias vulnerables presentan mayores niveles séricos de metaloproteinada-I / Patients with vulnerable coronary plaques have higher serum metalloproteinase-1 levels

Fundamento: Las placas ateroscleróticas que producen la mayoría de los síndromes coronarios agudos al romperse son los fibroateromas de cápsula fina, denominados placas vulnerables. Éstas pueden ser detectadas únicamente con técnicas invasivas de imagen intracoronaria. Es preciso encontrar un biomarcador no invasivo que permita identificar a los pacientes con estas placas sin necesidad de cateterismo cardiaco. La metaloproteinasa-1 es una enzima involucrada en el metabolismo de la matriz extracelular que ha sido relacionada con la ruptura de las placas ateroscleróticas. Se desconocen sus niveles séricos en pacientes con placas vulnerables. Material y métodos: Se incluyeron pacientes sometidos a cateterismo cardiaco por enfermedad coronaria estable. Se estudiaron las arterias coronarias con tomografía de coherencia óptica para detectar placas vulnerables. Se extrajeron muestras de sangre periférica y del seno coronario para analizar la concentración de metaloproteinasa-1. Resultados: Se incluyeron 51 pacientes. Trece tenían al menos un fibroateroma de cápsula fina. No se encontraron diferencias significativas en las características clínicas, perfil lipídico ni proteína C reactiva entre los pacientes con y sin placas vulnerables. Los pacientes con placas vulnerables presentaron concentraciones significativamente mayores de metaloproteinasa-1, tanto en sangre periférica (7330±5541 vs 2894±1783 pg/ml, p=0,025) como en seno coronario (6012±3854 vs 2707±1252 pg/ml, p=0,047). Conclusiones: Los pacientes con placas vulnerables presentaron niveles séricos significativamente mayores de metaloproteinasa-1. Se requieren estudios con seguimiento clínico para evaluar el valor pronóstico de la metaloproteinasa-1 sérica (AU)

Background: Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography. Metalloproteinase-1 is an enzyme involved in extracellular matrix metabolism which has been correlated with the rupture of atherosclerotic plaques. Its serum levels in patients with vulnerable plaques remain unknown. Methods: Patients with suspected stable coronary artery disease undergoing coronary angiography in our hospital were included. The coronary arteries were studied with optical coherence tomography to detect vulnerable plaques. Blood samples were taken from a peripheral vein and from the coronary sinus, to assess metalloproteinase-1 levels. Results: Fifty-one patients were included, 13 of whom had at least one vulnerable plaque. There were not significant differences in clinical characteristics, lipid profile or C reactive protein levels, between patients with or without vulnerable plaques. Patients with vulnerable plaques had significant higher metalloproteinase-1 levels both in peripheral (7330±5541 vs 2894±1783 pg/ml, p=0.025) and coronary sinus serum (6012±3854 vs 2707±1252 pg/ml, p=0.047). Conclusions: Patients with vulnerable plaques had significantly higher metalloproteinase-1 serum levels. Further studies with clinical follow up are needed to assess the prognostic value of serum metalloproteinase-1 (AU)

[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.

Tiempo de demora prehospitalaria, la cara oculta de la isquemia coronaria / Prehospital delay: the hidden face of coronary ischaemia

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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)

Avances en intervencionismo coronario / Technological improvements in interventional cardiology

En los últimos años, la evolución del intervencionismo coronario, hasido muy importante. La tasa de éxito primario al comienzo de ladécada de los noventa era del 86-88% con una incidencia derestenosis del 30-40%. En la actualidad estas cifras de éxito primariohan aumentado a amas del 95% y la tasa de restenosis se hareducido a menos del 10% incluidos muchos tipos de lesionesclínicamente consideradas complejas. La principal limitación delintervencionismo coronario actual son lesiones en las que resultaimposible acceder debido a una oclusión antigua tortuosidad ocalcifacion extrema de los segmentos proximales. Los avances tanrápidos de estos años han permitido ampliar las indicaciones de estamodalidad de revascularizacion. Se describen los últimos avancestécnicos

In the last few years, the evolution of coronary interventionism has been very important. The primary success rates in the early 1990s were 86-88% with a re-stenosis rate of 30%-40%. Current primary success rates have risen to over 95% with a re-stenosis rate of under 10% even for many types of lesions classically considered complex. Currently the main limitations in interventional cardiology remain coronary segments that cannot be accessed due to chronic total occlusion, or severe proximal tortuosity or calcification. Rapid improvements have led to broader clinical indications for percutaneous revascularization procedures. We describe the latest improvements in techniques (AU)

[Technological improvements in interventional cardiology]. / Avances en intervencionismo coronario.

In the last few years, the evolution of coronary interventionism has been very important. The primary success rates in the early 1990s were 86-88% with a re-stenosis rate of 30%-40%. Current primary success rates have risen to over 95% with a re-stenosis rate of under 10% even for many types of lesions classically considered complex. Currently the main limitations in interventional cardiology remain coronary segments that cannot be accessed due to chronic total occlusion, or severe proximal tortuosity or calcification. Rapid improvements have led to broader clinical indications for percutaneous revascularization procedures. We describe the latest improvements in techniques.