How to optimize the percutaneous treatment of bifurcated lesions: dedicated stents vs. provisional stenting.

Although provisional T-stenting with stenting of the main branch and optional side branch stenting is nowadays the default strategy generally preferred for simple bifurcation lesions, percutaneous coronary intervention (PCI) of complex true bifurcation lesions remains a difficult task to achieve also with modern second generation drug eluting stents. Treatment of complex bifurcational lesions is not only more time consuming but can lead to significantly higher rate of periprocedural myocardial infarction and late estenosis, stent thrombosis and target lesion revascularization. These clinical complications may be at least in part be due to the fact that current bifurcation techniques often fail to ensure continuous stent coverage of the SB ostium and the bifurcation branches and often leave a significant number of malapposed struts. Struts left unapposed in the lumen are not efficient for drug delivery to the vessel wall, disturb blood flow and may increase the risk of restenosis and stent thrombosis. This article summarises the various techniques of bifurcation stenting, highlighting their relative merits and disadvantages. In addition, the role of newer dedicated bifurcation stent devices, as well as the role of imaging in guiding optimal stent deployment will be discussed.

[Prevalence of metabolic syndrome and association with ischemic heart disease in cardiological outpatients]. / Prevalencia de síndrome metabólico y asociación con la cardiopatía isquémica en pacientes cardiológicos ambulatorios.

INTRODUCTION: The metabolic syndrome (MS) is a cluster of cardiovascular risk factors with a common pathological link: insulin resistance. We analyzed its prevalence and its impact for the presence of ischemic heart disease (IHD). METHODS: We recorded data from 1,000 consecutive patients that attended the outpatient clinic of the Department of Cardiology from a tertiary hospital for the first time. The assessment of the metabolic syndrome was made according to the ATP-III. RESULTS: The global prevalence of the MS was 27.3% (95% CI: 25.6-28.9), and increased parallel to age. The highest prevalence of MS was found in patients with diabetes or impaired fasting glucose (70.1%) followed by patients with obesity (58.6%) or hypertension (4.3%). MS conferred higher risk for IHD (OR: 5.5) as compared to diabetes (OR: 3.8). Half of the patients with IHD had MS as well as 90% of the diabetics with ischemic heart disease. MS conferred the highest risk for IHD in patients with obesity (OR: 8.6), hypertriglyceridemia (OR: 6.5), family history of IHD (OR: 5.6), overweight (OR: 5.5) or hypertension (OR: 4.6). CONCLUSIONS: MS is highly prevalent in the patients from a Cardiological outpatient clinic and is an important risk factor for IHD, especially in subjects with obesity.

Prevalencia de síndrome metabólico y asociación con la cardiopatía isquémica en pacientes cardiológicos ambulatorios / Prevalence of metabolic syndrome and association with ischemic heart disease in cardiological outpatients

Introducción. El síndrome metabólico (SM) es una asociación de factores de riesgo cardiovascular con un nexo fisiopatológico común: la resistencia insulínica. Analizamos su prevalencia y su impacto para la presencia de cardiopatía isquémica (CI). Métodos. Se registraron los datos de 1.000 pacientes consecutivos que acudieron por primera vez a la consulta externa de un Servicio de Cardiología de un hospital terciario. El diagnóstico del SM se realizó según los criterios del Adult Treatment Pannel (ATP-III). Resultados. La prevalencia global de SM fue del 27,3% (IC al 95%: 25,6-29,0) y aumentó de forma paralela a la edad. La mayor prevalencia se encontró entre los pacientes con diabetes mellitus o intolerancia hidrocarbonada (70,1%) seguidos de los que tienen obesidad (58,6%) o hipertensión (48,3%). El SM confirió mayor riesgo de CI (odds ratio [OR]: 5,5) que la diabetes (OR: 3,8). La mitad de los pacientes con CI presentaron síndrome metabólico y el 90% de los diabéticos con CI. El SM confiere el mayor riesgo de tener CI en los pacientes con obesidad (OR: 8,6), hipertrigliceridemia (OR: 6,5), antecedentes familiares de CI (OR: 5,6), sobrepeso (OR: 5,5) o hipertensión arterial (OR: 4,6). Conclusiones. El SM es altamente prevalente en los pacientes atendidos en una consulta de Cardiología y es un importante factor de riesgo para la CI, especialmente en los pacientes que tienen obesidad

Introduction. The metabolic syndrome (MS) is a cluster of cardiovascular risk factors with a common pathological link: insulin resistance. We analyzed its prevalence and its impact for the presence of ischemic heart disease (IHD). Methods. We recorded data from 1,000 consecutive patients that attended the outpatient clinic of the Department of Cardiology from a tertiary hospital for the first time. The assessment of the metabolic syndrome was made according to the ATP-III. Results. The global prevalence of the MS was 27.3% (95% CI: 25.6-28.9), and increased parallel to age. The highest prevalence of MS was found in patients with diabetes or impaired fasting glucose (70.1%) followed by patients with obesity (58.6%) or hypertension (4.3%). MS conferred higher risk for IHD (OR: 5.5) as compared to diabetes (OR: 3.8). Half of the patients with IHD had MS as well as 90% of the diabetics with ischemic heart disease. MS conferred the highest risk for IHD in patients with obesity (OR: 8.6), hypertriglyceridemia (OR: 6.5), family history of IHD (OR: 5.6), overweight (OR: 5.5) or hypertension (OR: 4.6). Conclusions. MS is highly prevalent in the patients from a Cardiological outpatient clinic and is an important risk factor for IHD, especially in subjects with obesity

Nuevas estrategias en prevención cardiovascular / New strategies in cardiovascular prevention

Las enfermedades cardiovasculares son la principal causa de mortalidaden España y en los países occidentales, especialmente la cardiopatíaisquémica. La prevención de las complicaciones se basa enla estratificación del riesgo cardiovascular, que se basa en la presenciade los factores de riesgo clásicos. Existen diferentes escalas quepermiten estratificar el riesgo cardiovascular de un sujeto como bajo,intermedio o alto. Pese a que el impacto y tratamiento de los factoresde riesgo es bien conocido, el control de los mismos es bastantepobre. Además, la obesidad, la diabetes y la hipertensión parecenestar aumentando debido a los cambios en los estilos de vida yalimentación que están experimentando nuestras comunidades.En las últimas décadas se han identificado nuevos factores de riesgocardiovascular, o emergentes, que pueden mejorar la estratificacióndel riesgo cardiovascular y son principalmente la proteína C-reactiva,la homocisteína y la lipoproteína a. El síndrome metabólico es unaasociación de factores de riesgo cardiovascular que tienden a aparecerde forma conjunta por tener un nexo fisiopatológico común: laresistencia insulínica. Su presencia se asocia con la mayoría de losfactores de riesgo cardiovascular, tanto clásicos o emergentes, especialmentela obesidad, hipertensión arterial y la proteína C-reactiva.Por otra parte, la detección de formas subclínicas o incipientes deaterosclerosis, especialmente mediante la medición del grosor de laíntima-media carotídea, aporta información indirecta pero estrechamenterelacionada con la aterosclerosis coronaria que mejora laestratificación en sujetos de riesgo intermedio

Cardiovascular diseases, especially coronary heart disease, are theleading cause of mortality in Spain and western countries. The preventionof complications is based on a cardiovascular risk stratificationthat is based on the presence of classical cardiovascular riskfactors. There are many scales for cardiovascular risk stratificationthat classify subjects into low, intermediate or high risk. Despite thefact that the impact and treatment of risk factors are well known, theircontrol remains poor. Obesity, diabetes, and hypertension seems alsoseem to be increasing trends due to the changes in lifestyles andnutritional habits of our communities.In recent decades some new, or emerging, cardiovascular risk factorshave been identified that can improve the stratification of cardiovascularrisk: C-reactive protein, homocysteine, and lipoprotein a. Themetabolic syndrome is an association of cardiovascular risk factorsthat cluster in the same subject because they share a physiopathologiclink: insulin resistance. Its presence is related to most cardiovascularrisk factors, classical or emerging, especially obesity, hypertension,and C-reactive protein. On the other hand, detection of subclinicalor incipient atherosclerosis, especially with the measurementof intima-media thickness, offers indirect information closely relatedto coronary atherosclerosis that improves the stratification of subjectsat intermediate risk

[New strategies in cardiovascular prevention]. / Nuevas estrategias en prevención cardiovascular.

Cardiovascular diseases, especially coronary heart disease, are the leading cause of mortality in Spain and western countries. The prevention of complications is based on a cardiovascular risk stratification that is based on the presence of classical cardiovascular risk factors. There are many scales for cardiovascular risk stratification that classify subjects into low, intermediate or high risk. Despite the fact that the impact and treatment of risk factors are well known, their control remains poor. Obesity, diabetes, and hypertension seems also seem to be increasing trends due to the changes in lifestyles and nutritional habits of our communities. In recent decades some new, or emerging, cardiovascular risk factors have been identified that can improve the stratification of cardiovascular risk: C-reactive protein, homocysteine, and lipoprotein a. The metabolic syndrome is an association of cardiovascular risk factors that cluster in the same subject because they share a physiopathologic link: insulin resistance. Its presence is related to most cardiovascular risk factors, classical or emerging, especially obesity, hypertension, and C-reactive protein. On the other hand, detection of subclinical or incipient atherosclerosis, especially with the measurement of intima-media thickness, offers indirect information closely related to coronary atherosclerosis that improves the stratification of subjects at intermediate risk.