Kaplan-Meier Type Survival Curves for COVID-19: A Health Data Based Decision-Making Tool.

Countries are recording health information on the global spread of COVID-19 using different methods, sometimes changing the rules after a few days. All of them are publishing the number of new individuals infected, recovered and dead individuals, along with some supplementary material. These data are often recorded in a non-uniform manner and do not conform the standard definitions of these variables. In this paper we show that, using data from the first wave of the epidemic (February-June), Kaplan-Meier curves calculated with them could provide useful information on the dynamics of the disease in different countries. We developed our scheme based on the cumulative total number of infected, recovered and dead individuals provided by the countries. We present a robust and simple model to show certain characteristics of the evolution of the dynamic process, showing that the differences in evolution between countries are reflected in the corresponding Kaplan-Meier-type curves. We compare the curves obtained for the most affected countries at that time, with the corresponding interpretation of the properties that distinguish them. The model is revealed as a practical tool for countries in the management of the Healthcare System.

[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)

Self-rated health and mortality: a follow-up study of a Spanish population.

OBJECTIVES: Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population. STUDY DESIGN: Longitudinal study. METHODS: A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations. RESULTS: Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability. CONCLUSIONS: SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

PM01183, a new DNA minor groove covalent binder with potent in vitro and in vivo anti-tumour activity.

BACKGROUND AND PURPOSE: PM01183 is a new synthetic tetrahydroisoquinoline alkaloid that is currently in phase I clinical development for the treatment of solid tumours. In this study we have characterized the interactions of PM01183 with selected DNA molecules of defined sequence and its in vitro and in vivo cytotoxicity. EXPERIMENTAL APPROACH: DNA binding characteristics of PM01183 were studied using electrophoretic mobility shift assays, fluorescence-based melting kinetic experiments and computational modelling methods. Its mechanism of action was investigated using flow cytometry, Western blot analysis and fluorescent microscopy. In vitro anti-tumour activity was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and the in vivo activity utilized several human cancer models. KEY RESULTS: Electrophoretic mobility shift assays demonstrated that PM01183 bound to DNA. Fluorescence-based thermal denaturation experiments showed that the most favourable DNA triplets providing a central guanine for covalent adduct formation are AGC, CGG, AGG and TGG. These binding preferences could be rationalized using molecular modelling. PM01183-DNA adducts in living cells give rise to double-strand breaks, triggering S-phase accumulation and apoptosis. The potent cytotoxic activity of PM01183 was ascertained in a 23-cell line panel with a mean GI(50) value of 2.7 nM. In four murine xenograft models of human cancer, PM01183 inhibited tumour growth significantly with no weight loss of treated animals. CONCLUSIONS AND IMPLICATIONS: PM01183 is shown to bind to selected DNA sequences and promoted apoptosis by inducing double-strand breaks at nanomolar concentrations. The potent anti-tumour activity of PM01183 in several murine models of human cancer supports its development as a novel anti-neoplastic agent.

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.

Basal fat oxidation and after a peak oxygen consumption test in obese women with a beta2 adrenoceptor gene polymorphism.

The Glu27Glu genotype in the beta2-adrenergic receptor (ADRB2) has been linked to a higher fat deposition and obesity in females. Also, in our population, it has been described that physically active women carrying the Glu allele had a higher BMI as compared to non-carriers performing the same level of activity. Since exercise may counterbalance a gene predisposition to obesity, we tested the hypothesis of a potential different metabolic response among ADRB2 Gln27Gln versus Glu27Glu obese women when submitted to a peak oxygen consumption test on a treadmill. In our study, 10 obese women with the Gln27Gln genotype were compared to 9 matched obese women bearing the Glu27Glu genotype. The ADRB2 polymorphism was identified by PCR-RFLP, fat oxidation was determined by indirect calorimetry and blood measurements were carried out following conventional procedures. The ADRB2 Glu27Glu subjects had lower plasma glycerol levels (P = 0.026), while plasma triglycerides (P <0.001) and the insulin:glucose ratio were higher (P = 0.046) as compared to the Gln27Gln group along the peak oxygen consumption trial intervention. There was a significantly lower fat oxidation (P = 0.024) in the Glu27Glu obese women during the recovery compared to Gln27Gln obese individuals. These data suggest that exercise would not benefit equally the two ADRB2 polymorphism homozygous groups, since both lipolysis and fat oxidation promoted by a peak oxygen consumption test appear to be blunted in the polymorphic Glu27Glu obese group.

A maximal effort trial in obese women carrying the beta2-adrenoceptor Gln27Glu polymorphism.

The aim of this study was to observe the relationship of the beta2-adrenoceptor (ADRB2) gene polymorphism Gln27Glu in a group of obese female subjects submitted to an acute physical activity test. Six Glu27/Glu27 obese women were compared with six Gln27/Gln27 obese women (coupled by age, BMI, waist circumference, percentage of fat mass and absence of smoking). These groups were selected after having genotyped 91 obese subjects (BMI>30 kg/m2, age 20-60). Polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) were used to genotype the obese population. The physical activity challenge consisted of a Maximal effort trial (VO2 max) following the Bruce protocol on a walking treadmill. The frequency for the Glu allele was 0.42, which is similar to other Caucasian populations. In basal conditions, subjects with the Glu27/Glu27 genotype showed a higher value of plasma insulin, while circulating glucose levels were similar in both groups. Also, diastolic arterial pressure was higher in the Glu27/Glu27 obese women. After the VO2 max trial, the Glu27 group had a significantly higher respiratory exchange ratio than the Gln27 group suggesting a lower post- exercise fat oxidation. These results provide evidence about a possible impact of the Gln27Glu polymorphism in the ADRB2 gene concerning a better response to exercise in obese Gln27 female subjects, in which basal insulinemia may play a role.

Utilidad de los marcadores tumorales en el diagnóstico de neoplasia asociada a trombosis venosa profunda idiopática / Usefulness of the tumor markers in the diagnose of idiopathic deep venous thrombosis associated cancer

Objetivo: Valorar la utilidad para el diagnóstico de neoplasia de la determinación de un perfil amplio de marcadores tumorales (MT) junto a la evaluación inicial de los pacientes con trombosis venosa profunda (TVP) idiopática. Material y métodos: Estudio prospectivo de 48 pacientes con diagnóstico de TVP idiopática. Se determinó en suero a todos los pacientes: antígeno carcinoembronario, alfa-fetoprotetína, CA 19.9, CA 125, beta2-microglobulina, antígeno de células escamosas, enolasa neuronal específica, antígeno prostático específico en los varones y CA15.3 en las mujeres. Los pacientes fueron evaluados para neoplasia durante el ingreso y seguidos a los 6 y 12 meses. Resultados: La edad media fue de 65 años. En 23 pacientes (48 por ciento) se detectó al menos un marcador elevado. Se diagnosticaron 8 neoplasias (16 por ciento), 4 en el grupo con marcadores elevados y 4 en el grupo con marcadores normales. No apreciamos diferencias significativas en las incidencias de neoplasia entre ambos grupos. Sin embargo, de los 4 casos de neoplasias diagnosticadas en el grupo con marcadores elevados, solo 1 se consideró verdadero positivo puesto que en las otras el marcador elevado no resultó congruente con la neoplasia. Seis neoplasias se diagnosticaron durante el ingreso hospitalario y dos durante el seguimiento. Se obtuvo una sensibilidad del 12 por ciento, una especificidad del 52 por ciento, un valor predictivo positivo del 5 por ciento y un valor predictivo negativo del 75 por ciento. Conclusiones: La incidencia de neoplasia fue similar a la comunicada por otros autores. Encontramos poca sensibilidad y especificidad, y escaso valor predictivo positivo con numerosos falsos positivos. Sin embargo, el valor predictivo del resultado negativo fue del 75 por ciento, con lo que la mayoría de los pacientes con un perfil completo normal de MT y asintomáticos no tuvieron neoplasia al diagnóstico ni durante el tiempo de seguimiento (AU)

[Usefulness of the tumor markers in the diagnosis of idiopathic deep venous thrombosis associated cancer]. / Utilidad de los marcadores tumorales en el diagnóstico de neoplasia asociada a trombosis venosa profunda idiopática.

OBJECTIVE: To evaluate a wide detection of tumor markers practiced during admission for the diagnosis of cancer in patients with idiopathic deep venous thrombosis. MATERIAL AND METHODS: Prospective study including 48 patients with documented DVT who lacked a predisposing cause to DVT. It was determined in serum: carcinoembryonic antigen, alphafetoprotein, CA 19-9, CA 125, beta-2-microglobulin, SCC (squamous cell antigen), NSE (neuron-specific enolase), PSA (prostate-specific antigen) in the males and CA15-3 in the women. The patients were evaluated for cancer during admission and followed up at 6 and 12 months. RESULTS: The age was 65 years. A positive tumor marker at least was detected in 23 patients (48%). A cancer was diagnosed in 8 patients (16%), 4 in the group with elevated tumor markers and 4 in the group with normal tumor markers. We don't find significant differences in cancer incidence between both groups. However, of the 4 cases of cancer diagnosed in the group with elevated markers only 1 was considered true positive since in the others three cases the elevate tumor marker was not appropriated with the cancer diagnosed. Six tumors were diagnosed during admission and two during follow-up period. According to these results was obtained a sensitivity of 12%, a specificity of 52%, a positive predictive value of 5% and a negative predictive value of 75%. CONCLUSIONS: The cancer incidence is similar to previous series. We have found a poor sensitivity, specificity and positive predictive value. However, the negative predictive value was of 75% and the patients who were normals for results of all tumor markers and was asymptomatic during admission hadn't a subsequent cancer diagnosis.

Influencia del grado de la severidad de la estenosis, del diámetro del vaso y del modelo de stent en el fenómeno del retroceso elástico en angioplastia coronaria. Evaluación angiográfica / No disponible

Objetivos: El fenómeno de retroceso elástico, tras la implantación del stent, sigue siendo de gran importancia en el éxito del procedimiento angiográfico. El objetivo de este estudio es valorar la influencia que el tamaño del vaso, el modelo de stent y el modelo angiográfico de lesión, puedan tener en el retroceso elástico. Material y métodos: Se incluyeron en el estudio 61 pacientes, en los que se implantaron con éxito 81 stents de diferentes modelos. Se valoró mediante angiografía coronaria cuantitativa los diámetros durante la implantación y tras la retirada del balón. Los resultados fueron analizados en función del modelo de stent, de las características del vaso y de las características angiográficas de la lesión. Resultados: No se hallaron diferencias significativas en el fenómeno del retroceso elástico en relación a la longitud, simetría y severidad de la lesión. Tampoco en relación al modelo de stent empleado. Sí hubo diferencias si se tenía en cuenta el tamaño del vaso, siendo significativamente menor en los vasos pequeños (<2,75 mm). Discusión: El hallazgo de que el retroceso elástico sea menor en los vasos pequeños supone una paradoja. Tradicionalmente se ha considerado el pequeño tamaño del vaso como un factor de riesgo independiente para el desarrollo de reestenosis tras la implantación del stent. Este hallazgo mantiene la polémica sobre el empleo del stent en vasos pequeños (AU)

Purpose: Stent recoil following stent deployment is still a very important outcome predictor after angiographic intervention. The aim of this study is to assess the influence of device model, angiographic characteristics of the lesion and vessel size on stent recoil. Methods: 61 consecutive patients were included in the study. 81 stents were successfully deployed. Maximal balloon diameter at peak pressure and maximal lumen diameter after stenting were measured by QCA (quantitative coronary angiography) Results: There were no significant differences regarding either the model of device or length, symmetry or severity of the lesion. There were significant differences regarding the vessel size. Stent recoil was greater in small vessels (<2,75 mm). Discussion: This finding is a paradox. The small size of the vessel has been always identified as an independent risk factor for the development of stenosis. The use of stents in small vessels remains controversial (AU)

[Cholesterol crystals embolization. A case report]. / Embolismo por cristales de colesterol. A propósito de un caso.

Cholesterol Crystals Embolization is not a very frequent entity that happens in people with atheromatous disease of spontaneous for or after the realization of vascular manipulation (angiographic, angioplasty procedures, cardiovascular surgery) or more rarely with the treatment with oral anticoagulants and after thrombolytic therapy. The clinical presentation is according to the arterial affected territory and so from diagnosed cases in autopsy reports to florid clinic forms exist. The more frequent are the cutaneous manifestations with apparition of livedo reticularis and purple toes that could go accompanied of necrosis of lower limbs, consecutive from the renal manifestations and the gastrointestinal tract one. The diagnosis is based on the biopsy of organ affected lesions to level of arterioles, that revealed characteristic cholesterol clefts, above all the cutaneous biopsy, muscular and in any case renal. As for the treatment is symptomatic with analgesics, antiplatelet agents, anti-inflammatory, etc ... but it doesn't after the presage and the evolution of the illness. A clear contraindication exists to the use of oral anticoagulants and heparin.

[Initial results and 6 month clinical follow-up after implantation of a silicon carbide coated coronary stent]. / Resultados iniciales y seguimiento clínico a 6 meses tras el implante de un stent coronario recubierto de carburo de silicio.

INTRODUCTION AND OBJECTIVES: To present the initial Spanish experience with the Tenax coronary stent, a laser sculpted from high-precision 316L stainless steel coated with hydrogen rich amorphous silicon carbide that reduces thrombogenecity and improves biocompatibility. PATIENTS AND METHODS: From July 1998 to July 1999, 206 patients (62 +/- 5 years) underwent implantation of 231 Tenax stents in 9 centers as the only revascularization procedure. The most frequent clinical indication was unstable angina (66%), and most of the lesions were complex (class B2 and C). The target vessels were the left anterior descending (51%) and right coronary arteries (36%). The ejection fraction was < 0.5 in 19% cases. RESULTS: Revascularization was complete in 70%, elective in 80%, and the implantation was direct in 25% of the cases. The procedure was successful in all the lesions, reducing stenosis from 62 +/- 16 to 16 +/- 10% and increasing the minimal luminal diameter from 0.81 +/- 0.40 to 2.61 +/- 0.59 mm. The TIMI flow was reduced in 30%, but normalized after the stent in all but one case. The incidence of cardiac events was minimal: 1 acute thrombosis (0.5%) resolved by a new angioplasty and 1 non-Q myocardial infarction (0.5%). At the 6-month clinical follow-up 10% of the patients presented complaints of angina greater than class II, and a new angioplasty was carried out in 1.9% of these cases. CONCLUSION: Clinical and angiographic data suggest that the hydrogenated silicon carbide coating of the Tenax coronary stent may indeed play a beneficial role in patient outcome, and should therefore be evaluated by prospective clinical trials.

Upper extremity deep vein thrombosis in a young patient double heterozygous for factor V Leiden and prothrombin G20210A mutation.

We report on a 19-year-old girl with upper extremity deep vein thrombosis after catheter indwelling whose thrombophilic study disclosed the coexistence of factor V Leiden and the prothrombin G20210A mutation. The family study identified five other members who were also heterozygous for both mutations. This is the first case of upper extremity deep vein thrombosis with the co-inheritance of both genetic defects. It provides further evidence that thrombophilic defects mostly require additional triggering factors to induce a thrombotic event and suggests that in young patients with this venous thrombotic location, a thrombophilic search should be performed even when there are other acquired thrombotic risk factors.

Utilidad de la braquiterapia intravascular en la prevención de la reestenosis secundaria a angioplastia transluminal coronaria / Efficacy of the intravascular brachytherapy for the prevention of the secondary restenosis to the transluminal coronary angioplasty

La radioterapia intravascular coronaria ha demostrado de manera convincente en estudios clínicos y experimentales que produce una disminución favorable del proceso de reestenosis. Hay evidencia suficiente para definir a dicha técnica como la principal terapia actual en el manejo de la reestenosis intra stent. Existe experiencia acumulada de hasta 3 años en pacientes tratados con radiación gamma y múltiples estudios en varios centros demuestran beneficios similares con emisores beta. Como efectos adversos de la braquiterapia se han descrito el desarrollo de nuevas estenosis en los márgenes de la lesión tratada (el ‘efecto borde’) y la oclusión trombótica tardía. A pesar de esto, la mayoría de investigadores cree que estos problemas pueden ser evitados y que la radiación intravascular es la terapia de elección en pacientes con alto riesgo de reestenosis tras intervención percutánea de revascularización coronaria. Ahora que se ha pasado de la experimentación animal a la fase clínica, y mientras la investigación continua, la tecnología está siendo optimizada para encontrar nuevas fuentes y vías de administración de la radiación que puedan ser lanzadas al mercado. El presente artículo revisa una serie de sistemas de radioterapia y hace una puesta al día sobre el empleo de la braquiterapia intravascular en pacientes cardiológicos (AU)

Intravascular radiotherapy has convincingly shown in several experimental and clinical studies to result in a marked and favorable control of the restenotic process. The evidence that radiation therapy constitutes a major breakthrough therapy for patients with in-stent restenosis is convincing, and the safety and long-lasting benefit with gamma-radiation at 3 years has been demonstrated. It is known that this benefit comes at the price of an excess of new stenoses at the lesion edge (the edge effect) and late (>1 month) thrombotic occlusion compared with control groups. However, investigators believe these problems can be avoided and that radiation therapy is the first-line treatment in this group of patients. Intravascular radiotherapy has moved from animal experiments via the safety and feasibility testing into the phase of clinical trials of efficacy in large numbers of patients. While ongoing research continues to search for new sources and delivery techniques, currently available technology is being optimized in pursuit advanced intravascular radiotherapy systems and resumes the principal issues of intravascular brachytherapy in the cardiology field (AU)

Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START): a four-year follow-up.

OBJECTIVE: The purpose of this study was to test the hypothesis that stent implantation in de novo coronary artery lesions would result in lower restenosis rates and better long-term clinical outcomes than balloon angioplasty. BACKGROUND: Placement of an intracoronary stent, as compared with balloon angioplasty, has proven to reduce the rate of restenosis. However, the long-term clinical benefit of stenting over angioplasty has not been assessed in large randomized trials. METHODS: We randomly assigned 452 patients with either stable (129 patients) or unstable (323 patients) angina pectoris to elective stent implantation (229 patients) or standard balloon angioplasty (223 patients). Coronary angiography was performed at baseline, immediately after the procedure and six months later. End points were the rate of restenosis at six months and a composite of death, myocardial infarction (MI) and target vessel revascularization over four years of follow-up. RESULTS: Procedural success rate was achieved in 84% and 95% (balloon angioplasty vs. stent, respectively). The increase in the minimal luminal diameter was greater in the stent group both after the intervention (2.02 +/- 0.6 mm vs. 1.43 +/- 0.6 mm in the angioplasty group; p < 0.0001), and at six-month follow-up (1.98 +/- 0.7 mm vs. 1.63 +/- 0.7 mm; p < 0.001). The corresponding restenosis rates were 22% and 37%, respectively (p < 0.002). After four years, no differences in mortality (2.7% vs. 2.4%) and nonfatal MI (2.2% vs. 2.8%) were found between the stent and the angioplasty groups, respectively. However, the requirement for further revascularization procedures of the target lesions was significantly reduced in the stent group (12% vs. 25% in the angioplasty group; relative risk 0.49, 95% confidence interval 0.32 to 0.75, p = 0.0006); most of the repeat procedures (84%) were carried out within six months of entry into the study. CONCLUSIONS: Patients who received an intracoronary stent showed a lower rate of restenosis than those treated with conventional balloon angioplasty. The benefit of stenting was maintained four years after implantation, as manifested by a significant reduction in the need for repeat revascularization.

[Changes in the diameter of the coronary arteries in heart transplant recipients with angiographically normal vessels during five years]. / Cambios de diámetro de las arterias coronarias en receptores de transplante cardíaco con vasos angiográficamente normales durante cinco años.

INTRODUCTION: Diffuse or focal coronary artery narrowing is a frequent complication of cardiac transplantation. Coronary enlargement has also been described although it is less known. To study the changes of the coronary arteries in transplant recipients, we have performed a quantitative study throughout 5 years. METHODS: Serial coronary angiography was performed annually in all survivors of heart transplant. Forty four patients with visually normal coronary arteries and at least 5 years of evolution were selected for this study. Quantitative measurements of the diameter of the coronary arteries were performed in each angiogram at different levels: proximal, medium and distal left anterior descending coronary artery; proximal and distal left circumflex; proximal, medium and distal right coronary artery. Changes in diameter were compared throughout the 5 years. RESULTS: In the entire group of patients there was a small increase in the diameter of each segment. Taking each patient separately, an enlargement of the diameter of the proximal descending coronary artery was seen in 17 cases; medium descending coronary artery in 13; distal descending coronary artery in 8; proximal left circumflex in 11; distal left circumflex in 14; proximal right coronary artery in 18; medium right coronary artery in 18 and distal right coronary artery in 15. In total, 114 of 352 coronary segments (32%) underwent dilatation. Only 6 patients failed to have dilatation of any segment. CONCLUSIONS: Enlargement of the coronary arterial diameter was seen in 32% of segments of the main coronary arteries in heart transplant recipients with angiographically normal coronary arteries during 5 years of evolution. This could be due to intimal thickening with overcompensation by an additional vessel enlargement with net lumen gain.

[The characteristics, management and prognosis of the acute myocardial infarct patient in the Valencian Community in 1995: the results of the PRIMVAC Registry (The Registry Project of Acute Myocardial Infarct in Valencia, Alicante and Castellón). As representatives of the PRIMVAC investigators]. / Características, manejo y pronóstico del paciente con infarto agudo de miocardio en la Comunidad Valenciana en 1995: resultados del registro PRIMVAC (Proyecto de Registro de Infarto Agudo de Miocardio de Valencia, Alicante y Castellón). En represntación de los investigadores del PRIMVAC.

BACKGROUND AND OBJECTIVES: Regional registers of patients with acute myocardial infarction are scarce in Spain. The PRIMVAC register (Proyecto de Registro de Infarto agudo de Miocardio de Valencia, Alicante y Castellón) was initiated to obtain updated information on the management of these patients in the Valencia Autonomous Community. Data of the first twelve months of the register are presented. METHODS: The 17 participating hospitals cover 2,833,938 inhabitants. Demographic, clinical, procedural and outcome data as well as predictive variables of mortality were analysed in the patients with acute myocardial infarction during their stay in the coronary care units from 1 December 1994 to 30 November 1995. RESULTS: During 12 months, 2,377 patients were included. Mean age was 65.3 years (SD 11.9) and 23.2% were female. Left ventricular failure was present in 39.8%. Thrombolytic therapy was applied in 42.1% with a median time delay of 195 min from chest pain onset. This time was longer in the women (250 min) and in the elderly (210 min). The in-coronary-care-unit-mortality rate was 13.9%. Age, female gender, diabetes, previous myocardial infarction, Q wave and right ventricular infarction independently predicted increased early mortality. CONCLUSION: Present data show the feasibility of an acute myocardial infarction register in the Valencia Autonomous Community. Although an acceptable level of thrombolysis has been reached, the mortality rate is still high. The long delay in initiating thrombolysis, particularly in female and elderly patients is remarkable.