Myocardial revascularization failure among patients requiring cardiac catheterization and secondary revascularization in contemporary clinical practice: Results of the REVASEC multicenter registry.

BACKGROUND: Myocardial revascularization failure (MRF) and Secondary revascularization (SR) are contemporary interventional cardiology challenges. AIM: To investigate the characteristics, management, and prognosis of patients with myocardial revascularization failure (MRF) and need for secondary revascularization (SR) in contemporary practice. METHODS: The REVASEC study is a prospective registry (NCT03349385), which recruited patients with prior revascularization referred for coronary angiography at 19 centers. The primary endpoint is a patient-oriented composite (POCE) at 1 year, including death, myocardial infarction, or repeat revascularization. RESULTS: A total of 869 patients previously revascularized by percutaneous intervention (83%) or surgery (17%) were recruited. MRF was found in 83.7% (41.1% stent/graft failure, 32.1% progression of coronary disease, and 10.5% residual disease). SR was performed in 70.1%, preferably by percutaneous intervention (95%). The POCE rate at 1 year was 14% in the overall cohort, with 6.4% all-cause death. In the multivariate analysis, lower POCE rates were found in the groups without MRF (9.4%) and with disease progression (11%) compared with graft/stent failure (17%) and residual disease (18%), hazard ratio 0.67 (95% confidence interval: 0.45-0.99), p = 0.043. At 1 year, the SR group had less chronic persistent angina (19% vs. 34%, p < 0.001), but a higher rate of repeat revascularization (9% vs. 2.9%, p < 0.001). CONCLUSION: MRF was found in 84% of patients with prior revascularization referred for coronary angiography. Stent/graft failure and residual coronary disease were associated with a worse prognosis. SR provided better symptom control at the expense of a higher rate of new revascularization.

Design and Rationale for a Real-World Prospective, Multicenter Registry of Myocardial Revascularization Failure and Secondary Revascularization: The REVASEC Study.

AIM: To investigate key aspects of the problem of myocardial revascularization failure (MRF) and repeat or secondary myocardial revascularization (SR) in contemporary practice. METHODS: The registry of secondary revascularization (REVASEC) is an investigator-initiated, multicenter, prospective registry enhanced with data monitoring and independent event adjudication (ClinicalTrials.govNCT03349385). It includes patients with prior revascularization referred to coronary angiography for suspected MRF with broad inclusion criteria. The main objectives are to describe the characteristics of patients with prior revascularization referred for repeat angiography, to describe and the rate and mechanisms of MRF (stent or graft failure, coronary artery disease progression or residual coronary artery disease); to evaluate the management including medical treatment and SR of these patients; and to assess the prognosis according to the outlined causative mechanisms. The registry has one year follow up for the primary endpoint (Patient-oriented composite endpoint including all-cause death, any myocardial infarction or any new unplanned revascularization according to subsets of MRF), but extended follow-up will be carried out up to 5 years. CONCLUSION: The REVASEC Registry will provide updated data on the characteristics, patterns of treatment, and 1-year outcomes of patients with MRF and SR in contemporary clinical practice.

Fibrilación auricular no valvular: el problema de una definición indefinida / Nonvalvular atrial fibrillation: the problem of an undefined definition

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[Endothelial dysfunction in cardiologists after 24 hours on call]. / Disfunción endotelial en cardiólogos tras una guardia médica.

The objective was to determine if the stress caused by 24 hours on call in a cardiology emergency room alters endothelial function assessed by high-resolution ultrasonography in the brachial artery. Fifteen young physicians were studied in a crossover design: a) after a normal night of sleep at home, and b) after 24 hours on call without sleeping in an emergency room. Both studies were made at rest, 5 minutes after forearm occlusion and 3 minutes after administration of sublingual nitroglycerin. High-resolution ultrasonography and a 7.5-MHz linear array transducer were used to measure the brachial artery lumen. After 24 hours on call, physicians had significantly higher resting systolic and diastolic blood pressure. They also had a non-significant increase in heart rate and a lower brachial artery diameter. Brachial artery dilatation caused by hyperemia was only 3.35%, while it increased to 11.34% after normal sleep (p < 0.001). Only 2 physicians showed more than 4.4% dilatation, which was considered a normal response, while 13 had more than 4.4% after a normal night of sleep at home (p < 0.01). The response to nitroglycerin was similar under control conditions and after 24 hours of duty oncall.In conclusion, stress caused by 24 hours on call in a cardiology emergency room depresses or abolishes endothelial function.

Disfunción endotelial en cardiólogos tras una guardia médica / Endothelial dysfunction in cardiologists after 24 hours on call

El objetivo fue explorar si el estrés causado por una guardia médica en el servicio de urgencias de cardiología altera la función endotelial determinada por ultrasonidos en la arteria humeral. Siguiendo un diseño cruzado se estudió a 15 médicos jóvenes en dos condiciones por la mañana: a) después de una jornada habitual de trabajo hospitalario, y b) tras una guardia médica de 24 h. Ambos estudios se hicieron en reposo, después de hiperemia postoclusiva de 5 min y tras administrar nitroglicerina sublingual. Para medir el lumen de la arteria humeral se empleó un equipo de ultrasonidos de alta resolución con un transductor de 7,5 MHz. Después de la guardia, en reposo, hubo una aumento de la presión arterial (p < 0,05), así como un incremento de la frecuencia cardíaca y una pequeña disminución del lumen arterial, ambas sin significación estadística. La dilatación por hiperemia, dependiente del endotelio, sólo fue 3,35 por ciento mayor que la basal, mientras que después de una jornada habitual, sin insomnio, aumentó hasta un 11,34 por ciento (p < 0,001). Después de la guardia sólo 2 médicos tuvieron más de un 4,4 por ciento de dilatación por hiperemia (p < 0,01), mientras que tras condiciones habituales de vida 13 presentaron más del 4,4 por ciento. La respuesta a la nitroglicerina (independiente del endotelio) fue semejante en ambos estudios. En conclusión, el estrés causado por una guardia médica disminuye o suprime transitoriamente la función del endotelio vascular (AU)