Supervivencia a medio plazo de los pacientes operados en cirugía cardiaca mayor / Mid-term survival of patients undergoing major cardiac surgery

Introducción y objetivos. La supervivencia en cirugía cardiaca es un parámetro de calidad de la cirugía realizada. Este estudio analiza la supervivencia y los factores de riesgo asociados con la mortalidad a medio plazo en la cirugía cardiaca del Hospital Universitario Son Dureta. Métodos. Desde noviembre de 2002 hasta diciembre de 2007, se intervino a 1.938 pacientes, que fueron estratificados en cuatro grupos de edad. De los 1.900 dados de alta vivos, se pudo realizar el seguimiento de 1.844 (fecha de corte, 31 de diciembre de 2008). La supervivencia se estimó mediante curvas de Kaplan-Meier y las variables asociadas con la mortalidad a medio plazo, mediante un análisis de regresión de Cox. Resultados. La mortalidad hospitalaria de los 1.938 pacientes fue del 1,96% (intervalo de confianza [IC] del 95%, 1,36-2,6%). La supervivencia acumulada a 1, 3 y 5 años fue del 98, el 94 y el 90%, respectivamente. La media del tiempo de seguimiento fue de 3,2 (0,01-6,06) años. La supervivencia de los pacientes de 70 años o más fue menor que la de los menores de dicha edad (log rank test, < 0,0001). La mortalidad observada al final del seguimiento fue del 6,5% (IC del 95%, 5,4-7,7%) y se asoció de forma independiente con la edad ≥ 70 años, el antecedente de función ventricular muy deprimida (fracción de eyección < 30%), hipertensión pulmonar severa, diabetes mellitus, anemia preoperatoria, accidente cerebrovascular postoperatorio y estancia hospitalaria. Conclusiones. Los pacientes dados de alta vivos presentaron una supervivencia excelente a medio plazo. La tasa de mortalidad varió en función de la edad y de otros factores presentes antes y después de la cirugía cardiaca (AU)

Introduction and Objectives. Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain). Methods. From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality. Results. In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged ≥70years showed a lower survival rate than those aged <70 log="" rank="" test="" i=""> P<.0001). At the end of follow-up, mortality was 6.5% (CI 95%, 5.4%-7.7%). Age ≥70years, a history of severe ventricular dysfunction (ejection fraction<30 severe="" pulmonary="" hypertension="" diabetes="" mellitus="" preoperative="" anemia="" postoperative="" stroke="" and="" hospital="" stay="" were="" independently="" associated="" with="" mid-term="" mortality="">. Conclusions. Mid-term survival after discharge was highly satisfactory. Mid-term mortality varied with age and other pre- and postoperative factors (AU)

[Mid-term survival of patients undergoing major cardiac surgery]. / Supervivencia a medio plazo de los pacientes operados en cirugía cardiaca mayor.

INTRODUCTION AND OBJECTIVES: Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain). METHODS: From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality. RESULTS: In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5 years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged ≥ 70 years showed a lower survival rate than those aged <70 (log rank test, P <.0001). At the end of follow-up, mortality was 6.5% (CI 95%, 5.4%-7.7%). Age ≥ 70 years, a history of severe ventricular dysfunction (ejection fraction < 30%), severe pulmonary hypertension, diabetes mellitus, preoperative anemia, postoperative stroke, and hospital stay were independently associated with mid-term mortality. CONCLUSIONS: Mid-term survival after discharge was highly satisfactory. Mid-term mortality varied with age and other pre- and postoperative factors.

Índice de masa corporal como factor pronóstico en pacientes tras un primer infarto de miocardio / Body mass index in the prognosis of first myocardial infarction

Fundamento y objetivos: El valor del índice de masa corporal en el pronóstico de pacientes con cardiopatía isquémica no está bien definido. El objetivo de nuestro estudio fue determinar la asociación del índice de masa corporal con otros factores de riesgo cardiovascular tanto clásicos como emergentes, con la mortalidad intrahospitalaria y a los 6 meses en pacientes con un primer infarto de miocardio. Pacientes y métodos: Estudio prospectivo, multicéntrico, con seguimiento a los 6 meses. Se incluyeron 1.063 pacientes entre 25 y 75 años con un primer infarto de miocardio que ingresaron de forma consecutiva dentro de las primeras 24h del inicio de los síntomas entre los años 2001 y 2003. Se determinaron las características demográficas, antropométricas, de factores de riesgo clásicos y emergentes, clínicas y tratamiento recibido. Resultados: El porcentaje de pacientes con sobrepeso u obesidad fue del 73,6 % y presentaban mayor prevalencia de factores de riesgo clásicos -salvo tabaquismo- y emergentes. Tanto en el análisis univariado como en el multivariado el índice de masa corporal no se asoció al pronóstico a 6 meses. Conclusiones: En nuestra población el índice de masa corporal no parece predecir el pronóstico de los pacientes tras un primer infarto de miocardio (AU)

Background and objectives: The value of body mass index in the prognosis of patients with ischemic heart disease is not well defined. The objective of our study was to determine the association of body mass index with classic and emergent cardiovascular risk factors and with intra-hospital and 6-months mortality. Patients and methods: We conducted a prospective, multicenter study with a 6-months follow-up. We included 1063 patients between the ages of 25–75 years old who were consecutively admitted to the hospital within the first 24 hours of the onset of symptoms between years 2001 and 2003. We determined demographic and anthropometric variables, as well as classic and emergent factors of risk, clinical variables and the treatment administered. We carried out a univariate and multivariate analysis.Results: The percentage of patients with overweight or obesity in this population was 73.56%. Overweight and obesity were associated with classical risk factors, except for smoking, and emergent risk factors. Body mass index was not associated with short-or mid-term prognosis. Conclusions: Body mass index is not a useful anthropometric measure to determine the prognosis of patients after a first myocardial infarction (AU)

[Body mass index in the prognosis of first myocardial infarction]. / Índice de masa corporal como factor pronóstico en pacientes tras un primer infarto de miocardio.

BACKGROUND AND OBJECTIVES: The value of body mass index in the prognosis of patients with ischemic heart disease is not well defined. The objective of our study was to determine the association of body mass index with classic and emergent cardiovascular risk factors and with intra-hospital and 6-months mortality. PATIENTS AND METHODS: We conducted a prospective, multicenter study with a 6-months follow-up. We included 1063 patients between the ages of 25-75 years old who were consecutively admitted to the hospital within the first 24 hours of the onset of symptoms between years 2001 and 2003. We determined demographic and anthropometric variables, as well as classic and emergent factors of risk, clinical variables and the treatment administered. We carried out a univariate and multivariate analysis. RESULTS: The percentage of patients with overweight or obesity in this population was 73.56%. Overweight and obesity were associated with classical risk factors, except for smoking, and emergent risk factors. Body mass index was not associated with short-or mid-term prognosis. CONCLUSIONS: Body mass index is not a useful anthropometric measure to determine the prognosis of patients after a first myocardial infarction.

Oxidized LDL, lipoprotein (a) and other emergent risk factors in acute myocardial infarction (FORTIAM study).

INTRODUCTION AND OBJECTIVES: To determine the prevalence of acute myocardial infarction (AMI) without classical risk factors, and to ascertain whether affected patients exhibit a higher prevalence of emergent risk factors and whether the presence of specific emergent risk factors influence prognosis at 6 months. METHODS: The FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) study is a multicenter cohort study that includes 1371 AMI patients who were admitted within 24 hours of symptom onset. Strict definitions were used for classical risk factors and the concentrations of the following markers were determined: lipoprotein (a) [Lp(a)], oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein, fibrinogen, homocysteine and antibody to Chlamydia. The end-points observed during the 6-month follow-up were death, angina and re-infarction. RESULTS: The prevalence of AMI without classical risk factors was 8.0%. The absence of classical risk factors did not affect the 6-month prognosis. The only emergent risk factors independently associated with a poorer prognosis were the Lp(a) and oxLDL concentrations. Cut-points were determined using smoothing splines: 60 mg/ dL for Lp(a) and 74 U/L for oxLDL. The associated hazard ratios, adjusted for age, sex and classical risk factors, were 1.40 (95% confidence interval, 1.06-1.84 ) and 1.48 (95% confidence interval, 1.06-2.06), respectively. CONCLUSIONS: The proportion of AMI patients without classical risk factors was low and their prognosis was similar to that in other AMI patients. Both oxLDL and Lp(a) concentrations were independently associated with a poorer 6-month prognosis, irrespective of the presence of classical risk factors.

LDL oxidada, lipoproteína(a) y otros factores de riesgo emergentes en el infarto agudo de miocardio (estudio FORTIAM) / Oxidized LDL, lipoprotein (a) and other emergent risk factors in acute myocardial infarction (FORTIAM study)

Introducción y objetivos. Determinar la prevalencia de pacientes que sufren un infarto agudo de miocardio (IAM) sin factores de riesgo (FR) clásicos, si presentan una mayor prevalencia de FR emergentes y si algún FR emergente modifica el pronóstico a 6 meses. Métodos. FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) es un estudio multicéntrico de cohortes de 1.371 pacientes que sufrieron un IAM e ingresaron en las primeras 24 h. Se utilizaron definiciones estrictas para los FR clásicos y se determinaron: lipoproteína (a) [Lp(a)], lipoproteína de baja densidad oxidada (LDLox), proteína C reactiva ultrasensible, fibrinógeno, homocisteína y anticuerpos anticlamidia. Los acontecimientos de interés a 6 meses fueron: muerte, angina o reIAM. Resultados. La prevalencia de pacientes con IAM sin FR clásicos fue del 8%. La ausencia de FR clásicos no afectó al pronóstico a 6 meses. Lp(a) y LDLox fueron los únicos FR emergentes que de forma independiente se asociaron a un peor pronóstico. Puntos de corte (suavización con splines): 60 mg/dl para Lp(a) y 74 U/l para LDLox. La hazard ratio ajustada por edad, sexo y FR clásicos, 1,40 (intervalo de confianza [IC] del 95%, 1,06-1,84) y 1,48 (IC del 95%, 1,06-2,06) respectivamente. Conclusiones. La proporción de pacientes con un IAM sin FR clásicos es baja y su pronóstico es similar al resto de pacientes con IAM. LDLox y de Lp(a) se asociaron a un peor pronóstico a 6 meses de forma independientemente de los FR clásicos (AU)

Introduction and objectives. To determine the prevalence of acute myocardial infarction (AMI) without classical risk factors, and to ascertain whether affected patients exhibit a higher prevalence of emergent risk factors and whether the presence of specific emergent risk factors influence prognosis at 6 months. Methods. The FORTIAM (Factores Ocultos de Riesgo Tras un Infarto Agudo de Miocardio) study is a multicenter cohort study that includes 1371 AMI patients who were admitted within 24 hours of symptom onset. Strict definitions were used for classical risk factors and the concentrations of the following markers were determined: lipoprotein (a) [Lp(a)], oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein, fibrinogen, homocysteine, and antibody to Chlamydia. The endpoints observed during the 6-month follow-up were death, angina, and re-infarction. Results. The prevalence of AMI without classical risk factors was 8.0%. The absence of classical risk factors did not affect the 6-month prognosis. The only emergent risk factors independently associated with a poorer prognosis were the Lp(a) and oxLDL concentrations. Cut- points were determined using smoothing splines: 60 mg/dL for Lp(a) and 74 U/L for oxLDL. The associated hazard ratios, adjusted for age, sex, and classical risk factors, were 1.40 (95% confidence interval, 1.06-1.84 ) and 1.48 (95% confidence interval, 1.06-2.06), respectively. Conclusions. The proportion of AMI patients without classical risk factors was low and their prognosis was similar to that in other AMI patients. Both oxLDL and Lp(a) concentrations were independently associated with a poorer 6-month prognosis, irrespective of the presence of classical risk factors. factors was 8.0%. The absence of classical risk factors did not affect the 6-month prognosis. The only emergent risk factors independently associated with a poorer prognosis were the Lp(a) and oxLDL concentrations. Cut-points were determined using smoothing splines: 60 mg/ dL for Lp(a) and 74 U/L for oxLDL. The associated hazard ratios, adjusted for age, sex and classical risk factors, were 1.40 (95% confidence interval, 1.06-1.84 ) and 1.48 (95% confidence interval, 1.06-2.06), respectively. Conclusions. The proportion of AMI patients without classical risk factors was low and their prognosis was similar to that in other AMI patients. Both oxLDL and Lp(a) concentrations were independently associated with a poorer 6-month prognosis, irrespective of the presence of classical risk factors (AU)

Diagnóstico electrocardiográfico de la obstrucción del tronco común izquierdo / No disponible

No disponible

Pathogenic study of anti-CD20 infusion-related severe refractory shock in diffuse large B-cell lymphoma.

Although rituximab is an effective and safe therapy for B-cell lymphoid malignancies, a few cases of severe infusion-related reactions have been reported. Severe refractory distributive shock is an infrequent side-effect of treatment with rituximab and, to our knowledge, there are no reports describing its pathogenesis in a case of fatal outcome in detail. We present for the first time a case of fatal rituximab infusion-related refractory distributive shock in a patient with CD5+ diffuse large B-cell lymphoma (DLBCL) and analyse the pathogenic mechanisms involved. We have compared measurements obtained from the patient that experienced lethal refractory shock with the four subsequent DLBCL patients treated with rituximab, either at diagnosis or upon relapse, at our center. Serum cytokines [interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70] and complement components C3 and C4 were analysed, both pretreatment, and 3 h and 9 h after the onset of infusion. When compared with the control subjects, the potential risk factors for rituximab toxicity displayed by the patient that suffered refractory shock included C4 hypercomplementemia, IFN-gamma and IL-10 hypercytokinemia, as well as a high tumor burden. The refractory shock was distributive with most cytokines (IFN-gamma, TNF-alpha, IL-2, IL-4, IL-6 and IL-8) peaking 3 h after infusion and coinciding with the onset of the shock. Furthermore, the concentrations of IL-10 were persistently elevated. In conclusion, the cytokine pattern was similar to that observed in patients with rapid onset septic shock and serum cytokines reached levels markedly higher than previously described in other cases of severe rituximab infusion-related toxicity.