Análisis de la atención al infarto con elevación del segmento ST en España. Resultados del Registro de Código Infarto de la ACI-SEC / Analysis of the management of ST-segment elevation myocardial infarction in Spain. Results from the ACI-SEC Infarction Code Registry

Introducción y objetivos Las redes de Código Infarto deben garantizar una atención al infarto agudo de miocardio con elevación del segmento ST con buenos resultados clínicos y dentro de los parámetros de tiempo recomendados. No hay información contemporánea sobre el funcionamiento de estas redes en España. El objetivo es analizar las características clínicas de los pacientes atendidos, el tiempo hasta la reperfusión, las características de la intervención realizada y la mortalidad a 30 días. Métodos Registro prospectivo, observacional y multicéntrico de pacientes los consecutivos atendidos en 17 redes de Código Infarto en España (83 centros con Código Infarto) entre el 1 de abril y el 30 de junio de 2019. Resultados Se atendió a 5.401 pacientes (media de edad, 64±13 años; el 76,9% varones), de los que 4.366 (80,8%) sufrieron un infarto con elevación del ST. De estos, se trató al 87,5% con angioplastia primaria, al 4,4% con fibrinolisis y al 8,1% sin reperfusión. En los casos tratados con angioplastia primaria, el tiempo entre el inicio de los síntomas y la reperfusión fue 193 [135-315] min y el tiempo entre el primer contacto médico y la reperfusión, 107 [80-146] min. La mortalidad total a 30 días por infarto agudo de miocardio con elevación del ST fue del 7,9%, mientras que entre los pacientes tratados con angioplastia primaria fue del 6,8%. Conclusiones Se trató con angioplastia primaria a la inmensa mayoría de los pacientes con infarto agudo de miocardio con elevación del ST, y en más de la mitad de los casos el tiempo desde el primer contacto médico hasta la reperfusión fue <120 min. La mortalidad a 30 días fue relativamente baja (AU)

Introduction and objectives ST-segment elevation myocardial infarction (STEMI) networks should guarantee STEMI care with good clinical results and within the recommended time parameters. There is no contemporary information on the performance of these networks in Spain. The objective of this study was to analyze the clinical characteristics of patients, times to reperfusion, characteristics of the intervention performed, and 30-day mortality. Methods Prospective, observational, multicenter registry of consecutive patients treated in 17 STEMI networks in Spain (83 centers with the Infarction Code), between April 1 and June 30, 2019. Results A total of 5401 patients were attended (mean age, 64±13 years; 76.9% male), of which 4366 (80.8%) had confirmed STEMI. Of these, 87.5% were treated with primary angioplasty, 4.4% with fibrinolysis, and 8.1% did not receive reperfusion. In patients treated with primary angioplasty, the time between symptom onset and reperfusion was 193 [135-315] minutes and the time between first medical contact and reperfusion was 107 [80-146] minutes. Overall 30-day mortality due to STEMI was 7.9%, while mortality in patients treated with primary angioplasty was 6.8%. Conclusions Most patients with STEMI were treated with primary angioplasty. In more than half of the patients, the time from first medical contact to reperfusion was <120 minutes. Mortality at 30 days was relatively low (AU)

Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON / Plaque modification in calcified chronic total occlusions: the PLACCTON study

Introducción y objetivos: La calcificación grave está presente en más del 50% de las oclusiones coronarias crónicas totales (OCT) tratadas mediante intervención percutánea. Nuestro objetivo fue describir el uso contemporáneo de los dispositivos de modificación de placa (DMP) en este contexto. Métodos: Los pacientes se incluyeron en el Registro Ibérico de OCT de forma prospectiva y consecutiva (32 centros de España y Portugal), de 2015 a 2020. Se compararon en función del uso o no de DMP. Resultados: Se incluyó a 2.235 pacientes, en 1.900 de los cuales se logró cruzar con éxito la lesión con guía. Se utilizó al menos un DMP en un 7% (134 pacientes) y más de uno en 24 pacientes (1%). Los DMP seleccionados fueron: aterectomía rotacional (35,1%), litotricia (5,2%), láser (11,2%), balones de corte (27,6%), balones OPN (2,9%) o combinaciones de más de uno (18%). Se utilizaron DMP en pacientes más ancianos, con mayor riesgo cardiovascular y puntuaciones Syntax y J-CTO más elevados. Esta mayor complejidad se asoció con procedimientos más prolongados, pero similar longitud total de stent (52 frente a 57mm; p=0,105). Cuando la guía cruzó con éxito la oclusión, la tasa de éxito final del procedimiento fue del 87,2%, pero se incrementó al 96,3% cuando se utilizaron DMP (p=0,001). Por el contrario, los DMP no se asociaron con mayor tasa de complicaciones en el procedimiento (3,7 frente a 3,2%; p=0,615). Pese al peor perfil de riesgo basal, a los 2 años de seguimiento no hubo diferencias en la tasa de supervivencia (94,3% DPM frente a no-DMP: 94,3% no-DPM, respectivamente, p=0,967). Conclusiones: Cuando la guía cruzó con éxito una OCT, la tasa de uso de los DMP fue del 7% y se asoció a una tasa de éxito final del procedimiento significativamente mayor. Los resultados a medio plazo fueron comparables cuando se precisaron DMP pese a su mayor riesgo basal, lo que sugiere que un mayor uso adecuado de estas técnicas en este contexto (AU)

Introduction and objectives: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. Methods: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. Results: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). Conclusions: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits (AU)

Macitentan in daily clinical practice: A single centre, 1-year experience.

The effectiveness and safety of macitentan, a dual endothelin-receptor antagonist (ERA) approved for the treatment of pulmonary arterial hypertension (PAH), were shown in an extensive clinical trial oriented towards morbidity and mortality events. Our aim was to describe a single centre's experience of the utilization of macitentan in patients with PAH in clinical practice settings. Thirteen patients with different aetiologies and previous PAH treatments were studied. After 12 months of macitentan treatment, 11 patients improved their functional class (FC), all patients improved their 6-minute walk distance (6MWD) test, and 10 patients lowered their NT-proBNP plasma levels. Additionally, cardiac imaging parameters were also improved. No cases resulted in hospitalization, septostomy, transplant or death.

Tratamiento percutáneo del tromboembolismo pulmonar masivo / Percutaneous management of massive pulmonary thromboembolism

No disponible

Transcatheter closure of paravalvular leaks: state of the art.

Paravalvular leak (PVL) is a serious complication after surgical valve replacement or after transcatheter aortic valve replacement. Approximately 1-5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or haemolytic anaemia. For years, surgical re-intervention has been considered the treatment of choice for symptomatic patients with PVLs. However, surgical re-intervention is associated with a high risk of morbidity and mortality. Transcatheter PVL (TPVL) closure is a less invasive alternative to surgical re-intervention. The safety and feasibility of TPVL closure has been confirmed in several registries and a meta-analysis.In this review, we discuss the clinical implications and diagnosis of PVLs, technical considerations for TPVL, execution of the procedure and assessment of the results.

[Assessment of the new Ballard score to estimate gestational age]. / Valoración del test de Ballard en la determinación de la edad gestacional.

BACKGROUND AND OBJECTIVES: The New Ballard Score (NBS) is commonly used to estimate gestational age (GA) in the newborn. The aims of this study were: a) to determine the reliability of the NBS; b) to estimate the agreement between two methods of GA assessment, NBS and ultrasonography (US) or last menstrual period (LMP); c) to estimate the agreement between NBS and US/LMP in distinct subgroups of neonates. PATIENTS AND METHODS: We performed a prospective, blind study. NBS was performed in neonates born in Hospital 12 Octubre, Madrid before the age of 48 hours. The level of agreement was estimated with two analytical parameters: the intraclass correlation coefficient (ICC) and the mean differences method (MD). RESULTS: Inter-observer agreement was very good (ICC > 0.8). Agreement between US/LMP and NBS was good (ICC = 0.6-0.8). In infants with lower weight or GA, and in those whose mothers had received prenatal corticosteroid therapy, NBS tended to overestimate GA compared with US/LMP (MD = 1.2-2.9). CONCLUSIONS: The agreement between two observers in NBS assessment was very good. The agreement between NBS and US/LMP was good, but differences of more than 2 weeks in GA were frequent. In very preterm newborns and in infants whose mothers had received prenatal corticosteroid therapy, NBS tends to overestimate GA.

Valoración del test de Ballard en la determinación de la edad gestacional / Assessment of the new Ballard score to estimate gestational age

Antecedentes y objetivos: El test de Ballard (NBS) es un método clínico utilizado frecuentemente para datar la edad gestacional (EG) del recién nacido. Los objetivos del estudio son: a) determinar la reproducibilidad del NBS; b) estimar el grado de acuerdo del NBS con la EG establecida por ecografía (ECO) y fecha de última regla (FUR), y c) determinar el grado de acuerdo del NBS con la EG estimada por ECO y FUR en distintos subgrupos de neonatos. Pacientes y métodos: Se trata de un estudio prospectivo y ciego, en el que se realiza el NBS a los neonatos con menos de 48 h de vida nacidos en el Hospital 12 de Octubre. La reproducibilidad y el grado de acuerdo se estimaron mediante el coeficiente de correlación intraclase (CCI) y el método de la media de las diferencias (MD). Resultados: El grado de acuerdo entre observadores estimado mediante el CCI fue muy bueno (> 0,8), y el obtenido entre ECO/FUR y NBS fue bueno (0,6-0,8). En los neonatos de menor peso y EG y en aquéllos cuyas madres habían recibido corticoides, se observó una tendencia a sobreestimar la EG mediante el NBS con respecto a la estimada por ECO/FUR (MD = 1,2-2,9). Conclusiones: Se halló un grado de acuerdo muy bueno entre los observadores. El grado de correlación del NBS con ECO/FUR es bueno, pero frecuentemente las diferencias en la asignación de la EG difieren en más de 2 semanas. En sujetos más inmaduros y en aquéllos cuyas madres recibieron corticoides existe tendencia a asignar mayor EG mediante NBS

Background and objectives: The New Ballard Score (NBS) is commonly used to estimate gestational age (GA) in the newborn. The aims of this study were: a) to determine the reliability of the NBS; b) to estimate the agreement between two methods of GA assessment, NBS and ultrasonography (US) or last menstrual period (LMP); c) to estimate the agreement between NBS and US/LMP in distinct subgroups of neonates. Patients and methods: We performed a prospective, blind study. NBS was performed in neonates born in Hospital 12 Octubre, Madrid before the age of 48 hours. The level of agreement was estimated with two analytical parameters: the intraclass correlation coefficient (ICC) and the mean differences method (MD). Results: Inter-observer agreement was very good (ICC > 0.8). Agreement between US/LMP and NBS was good (ICC = 0.6-0.8). In infants with lower weight or GA, and in those whose mothers had received prenatal corticosteroid therapy, NBS tended to overestimate GA compared with US/LMP (MD = 1.2-2.9). Conclusions: The agreement between two observers in NBS assessment was very good. The agreement between NBS and US/LMP was good, but differences of more than 2 weeks in GA were frequent. In very preterm newborns and in infants whose mothers had received prenatal corticosteroid therapy, NBS tends to overestimate GA