Impacto de la angiografía coronaria rotacional en la cantidad total de contraste administrado y la exposición a las radiaciones ionizantes en pacientes en los que se realizan procedimientos coronarios invasivos: revisión sistemática y metaanálisis / Impact of rotational coronary angiography in the amount of iodinated contrast and the exposure to ionising radiations in patients undergoing invasive coronary procedures: A systematic review and meta-analysis

Resumen Antecedentes: Los procedimientos coronarios invasivos conllevan la administración de contraste y la exposición a radiaciones ionizantes, comportando un incremento de la morbimortalidad. La angiografía coronaria rotacional (ACR) permite adquirir múltiples proyecciones con una inyección de contraste. Hasta la fecha, no hay metaanálisis específicos comparando la ACR y la angiografía coronaria convencional (ACC) en pacientes en los que se realizan procedimientos coronarios invasivos, tanto diagnósticos como diagnósticos y terapéuticos. El objetivo de este metaanálisis es evaluar el impacto de la ACR en la cantidad de contraste, y la radiación ionizante en procedimientos coronarios invasivos. Métodos: Se realizó una búsqueda en las bases de datos PubMed y Ovid para identificar estudios tanto diagnósticos como diagnósticos y terapéuticos que comparasen ACR y ACC. Los estudios fueron evaluados sobre la calidad y los sesgos, y fueron incluidos si contemplaban alguna de las siguientes variables de valoración: volumen de contraste, radiación ionizante medida como producto dosis-área, Kerma-aire o tiempo de fluoroscopia. Resultados: Dieciséis estudios, totalizando 2,327 pacientes, fueron incluidos en el análisis final (1,146 pacientes recibieron ACR y 1,181, ACC), objetivándose diferencias significativas en volumen de contraste (diferencia estándar de medias (intervalo de confianza al 95%) −1.887 (−2.472 a −1.302); p < 0.001), producto dosis-área (−0.726 (−1.034 a −0.418); p < 0.001), Kerma-aire (−0.842 (−1.104 a −0.581); p < 0.001) y tiempo de fluoroscopia (0.263 (−0.496 a −0.030); p = 0.027). Conclusiones: La ACR permite reducir el volumen de contraste y la radiación, evaluada como producto dosis-área, Kerma-aire y tiempo de fluoroscopia en pacientes a los que se les realizan procedimientos coronarios invasivos.

Abstract Background: Invasive coronary procedures involve the administration of iodinated contrast and the exposure to ionising radiations, increasing morbidity and mortality. The rotational coronary angiography (RCA) allows acquiring multiple projections with a unique injection of iodinated contrast. To date, there are no meta-analyses specifically comparing RCA and conventional coronary angiography (CCA) in patients undergoing invasive coronary procedures, whether diagnostic or diagnostic and therapeutic. The aim of this meta-analysis is to assess the impact of RCA on the amount of iodinated contrast and the exposure to ionising radiations during invasive coronary procedures. Methods: A search in PubMed and Ovid databases was conducted to identify studies, including diagnostic and diagnostic and therapeutic studies, comparing RCA and CCA. The manuscripts were evaluated on quality and biases, and were included if they analysed any of the following endpoints: volume of contrast and exposure to ionising radiations measured as dose-area product, and Kerma-air or fluoroscopy time. Results: Sixteen studies, with a total of 2,327 patients, were included in the final analysis (1,146 patients underwent RCA and 1,181 patients underwent CCA), with significant differences being detected in volume of contrast (standard difference in means (95% confidence interval) −1.887 (−2.472 to −1.302); P < .001), dose-area product (−0.726 (−1.034 to −0.418); P < .001), Kerma-air (−0.842 (−1.104 to −0.581); P < .001), and fluoroscopy time (0.263 (−0.496 to −0.030); P = .027). Conclusions: RCA reduces the volume of contrast and the exposure to radiation, evaluated as dose-area product, Kerma-air, and fluoroscopy time, in patients undergoing invasive coronary procedures.

[Impact of rotational coronary angiography in the amount of iodinated contrast and the exposure to ionising radiations in patients undergoing invasive coronary procedures: A systematic review and meta-analysis]. / Impacto de la angiografía coronaria rotacional en la cantidad total de contraste administrado y la exposición a las radiaciones ionizantes en pacientes en los que se realizan procedimientos coronarios invasivos: revisión sistemática y metaanálisis.

BACKGROUND: Invasive coronary procedures involve the administration of iodinated contrast and the exposure to ionising radiations, increasing morbidity and mortality. The rotational coronary angiography (RCA) allows acquiring multiple projections with a unique injection of iodinated contrast. To date, there are no meta-analyses specifically comparing RCA and conventional coronary angiography (CCA) in patients undergoing invasive coronary procedures, whether diagnostic or diagnostic and therapeutic. The aim of this meta-analysis is to assess the impact of RCA on the amount of iodinated contrast and the exposure to ionising radiations during invasive coronary procedures. METHODS: A search in PubMed and Ovid databases was conducted to identify studies, including diagnostic and diagnostic and therapeutic studies, comparing RCA and CCA. The manuscripts were evaluated on quality and biases, and were included if they analysed any of the following endpoints: volume of contrast and exposure to ionising radiations measured as dose-area product, and Kerma-air or fluoroscopy time. RESULTS: Sixteen studies, with a total of 2,327 patients, were included in the final analysis (1,146 patients underwent RCA and 1,181 patients underwent CCA), with significant differences being detected in volume of contrast (standard difference in means [95% confidence interval] -1.887 [-2.472 to -1.302]; P<.001), dose-area product (-0.726 [-1.034 to -0.418]; P<.001), Kerma-air (-0.842 [-1.104 to -0.581]; P<.001), and fluoroscopy time (0.263 [-0.496 to -0.030]; P=.027). CONCLUSIONS: RCA reduces the volume of contrast and the exposure to radiation, evaluated as dose-area product, Kerma-air, and fluoroscopy time, in patients undergoing invasive coronary procedures.

Pericarditis purulenta por Estafilococo Panton-Valentine secundaria a implantes de cabello / Purulent pericarditis by Staphylococcus Panton-Valentine secondary to hair implants

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Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome.

OBJECTIVES: To determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis. METHODS: Follow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable. RESULTS: The incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1-10.5), but these patients accounted for 56.6% (95% CI = 47.4-65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9-36.0) for in-hospital death, and 51.4% (95% CI = 44.8-58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3-53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8-31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9-8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2-18.1) for in-hospital death at the highest severity level. CONCLUSIONS: The effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge.