Long-term prognostic value of quantitative-flow-ratio-concordant revascularization in stable coronary artery disease.

OBJECTIVES: Confirming the prognostic value of global QFR and evaluating the long-term prognosis of QFR-concordant therapy in stable coronary artery disease. BACKGROUND: Wire-based functional evaluation of coronary disease is linked to patient's prognosis. Quantitative Flow Ratio (QFR) is a newer index of computational physiology, linked to clinical outcomes and prognosis at 1 year follow-up. Long-term prognosis of QFR-concordant revascularization in stable coronary artery disease is however unknown hitherto. METHODS: Consecutive patients with stable coronary disease undergoing coronary angiography were included. Centralized and blinded QFR analysis of three coronary territories was performed. Three vessel QFR (3vQFR) was defined as the sum of the basal QFR of each coronary territory. QFR-concordant revascularization was met if all significant lesions (QFR ≤ 0.80) were revascularized and all non-significant lesions (QFR > 0.80) were not; otherwise, the case was defined as QFR-discordant revascularization. Patient-oriented composite end-point (POCE) of cardiac death, myocardial infarction and unscheduled revascularization was the primary endpoint. RESULTS: A total of 803 patients from six high-volume centers were included. Canadian Cardiovascular Society (CCS) class II angina was the most frequent (48.9%) clinical presentation. Median of follow-up was 68.8 months. 3vQFR was an independent predictor of POCE (HR 1.79 CI95% 1.01-3.18), with 2.75 as optimal cut-off value, irrespective of the therapy received. QFR-discordant revascularization (QFR+/Revascularization- or QFR-/Revascularization+) was an independent predictor of POCE in multivariate analysis (HR 1.65, CI 95% 1.03-2.64). CONCLUSION: Global burden of epicardial coronary atherosclerosis, as evaluated by 3vQFR, as well as QFR-discordant therapy are independent predictors of adverse clinical outcome at long-term follow-up in stable coronary artery disease.

Impact of Anemia on the Risk of Bleeding Following Percutaneous Coronary Interventions in Patients ≥75 Years of Age.

Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, p = 0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.

Disposición inadecuada de materiales altamente contaminantes y sus posibles implicaciones para la salud de la población humana en la República de Panamá / Inadequate dispos al of highly pollutant materials and its possible implications for the health of human population in the Republic of Panama

Ex is te un incremento exponencial en la fabricación, utilización y desecho de artículos tecnológicos electrónicos y no electrónicos a nivel mundial, que conlleva un incremento en la presencia de mate­riales contaminantes y peligrosos para el ser humano. Las consecuencias de inadeacuados siste­mas de disposición de sustancias peligrosas presentes en estos dispositivos, su uso cada vez más frecuente de forma doméstica e industrial, junto a una tasa de recambio cada vez más acelerada, se convertirá muy pronto en una amenaza importante para la salud de poblaciones humanas en países subdesarrollados o con gestiones ineficientes para sustancias peligrosas, con consecuen­cias perniciosas para diferentes grupos poblacionales. Se hace necesario un cuidadoso análisis de nuestra situación como sociedad con respecto a esto, junto con la implementación de políticas efi­cientes para disminuir las posibilidades de enfrentar severos problemas de salud pública en las si­guientes décadas o siglos.

There is an exponential increase in manufacture, use and discard of electronic and not electronic devices in the world, implying an increase in the availability of pollutants and hazardous materials for human beings. Consequences of inefficient systems for disposing hazardous materials in these devices , their more frequent use in domestic and industrial settings, as well as an increased repla­cement rate, will bring important health threats to human populations in underdeveloped countries or with inefficient systems for managing hazardous materials, with disastrous consequences for dif­ferent human populations. It is necessary a cautious analysis of our society in this respect, as well as executing efficient policies for decreasing the possibilities of facing severe public health problems in the upcoming decades or centuries.