Comparison of One-Year Outcomes Between the ihtDEStiny BD Stent and the Durable-Polymer Everolimus- and Zotarolimus-Eluting Stents: A Propensity-Score-Matched Analysis.

OBJECTIVES: We sought to evaluate clinical outcomes in patients treated with the drug-eluting stent ihtDEStiny BD. BACKGROUND: The ihtDEStiny BD stent is a metallic sirolimus eluting stent with a biodegradable polymer with both drug and polymer coating the abluminal surface of the stent and balloon. METHODS: In this study, the clinical outcomes of a multicenter prospective registry of patients treated with this stent (DEStiny group) were analyzed and compared with those of a control group of patients treated with durable polymer everolimus or zotarolimus eluting stents (CONTROL group) paired by propensity score matching. Primary outcome was the target vessel failure (TVF) at 12 months defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI) and target vessel revascularization (TVR). RESULTS: A total of 350 patients were included in the DESTtiny group. The control group consisted initially of 1368 patients, but after matching (1:1) 350 patients were selected as CONTROL group. The baseline clinical, angiographic and procedural characteristics were quite comparable in both groups. At 12 months follow up the TVF was 6.6% in DEStiny group and 6.3% in CONTROL group (p = 0.8). No differences were observed for any of the individual components of the primary endpoint: cardiac death 1.1% vs. 1.4%, TV-MI 3.4% vs. 3.7% and TVR 2.6% vs. 2.3% respectively. CONCLUSIONS: The use of ihtDEStiny stent in real practice is associated with a clinical performance at 12 months follow up that appears to be non-inferior to the most widely used and largely evidence supported durable polymer drug eluting stents. A longer follow up is warranted.

Mild kidney disease as a risk factor for major bleeding in patients with atrial fibrillation undergoing percutaneous coronary stenting.

Bleeding risk is increased in patients with atrial fibrillation (AF) and moderate to severe kidney disease (KD); however, the implication of mild KD on bleeding remains unclear. The aim of this study was to determine whether the presence of mild KD increases risk for major bleeding (MB) in patients with AF undergoing percutaneous coronary intervention with stent implantation (PCI-S). Two hundred eighty-five patients were included. Patients were classified into three kidney function groups: moderate to severe KD (n=91; <60 ml/min/1.73 m²), mild KD (n=139; 60-89 ml/min/1.73 m²) and non-KD (n=55; ≥90 ml/min/1.73 m²). Estimated glomerular filtration rate was calculated using the simplified Modification of Diet in Renal Disease equation. Patients were followed for one year, and the occurrence of MB was obtained in all. A total of 28 patients (9.8%) presented MB. MB complications examined as a function of KD groups revealed that there was a graded increase in MB with worsening renal function (non KD=1.8%, mild KD=7.9%, moderate to severe KD=17.6%; p <0.001). Multivariable Cox regression analysis showed that mild KD was associated with nearly a 2.5-fold (2.43 95% confidence interval 1.11-5.34, p=0.039) increase in the risk of MB as compared with non-KD patients. Other independent predictors of MB were moderate-severe KD, anaemia and triple antithrombotic therapy after PCI-S (C-index=0.76). In this population, mild KD confers a significantly increase in the risk for MB complications. Future studies should assess the potential role of incorporating mild KD into the bleeding risk scales to improve the stratification of these patients.

Identificación del nervio frénico con tomografía computarizada cardiaca multidetector / Phrenic nerve identification with cardiac multidetector computed tomography

La crioablación con balón de las venas pulmonares es una técnica novedosa que se ha demostrado útil para prevenir las recurrencias de la fibrilación auricular paroxística y persistente. Una de las complicaciones más relevantes del procedimiento es la parálisis del nervio frénico derecho. Se ha descrito recientemente la utilidad de la tomografía computarizada multidetector para localizar el recorrido de la arteria y el nervio frénico y predecir el riesgo de parálisis frénica durante la crioablación, según la distancia del paquete vasculonervioso frénico derecho al ostium de la vena pulmonar superior derecha. A 55 pacientes consecutivos con fibrilación auricular paroxística (media de edad 52±12 años) sometidos a crioablación con balón, se les realizó estudio previo con tomografía computarizada multidetector para medir el tamaño de las venas pulmonares. Se pudo identificar algún fragmento de la arteria pericardiofrénica derecha en 10 pacientes (20%), con una longitud media de 25 (7-68) mm (AU)

Cryoballoon ablation of the pulmonary veins is a new technique that has proven useful in preventing paroxysmal and persistent atrial fibrillation recurrence. One of the most serious complications of this method is right phrenic nerve palsy. The usefulness of multidetector computed tomography to locate the right phrenic nerve and artery and predict the risk of phrenic nerve palsy during cryoablation according to the distance between the right phrenic neurovascular bundle and the right superior pulmonary vein ostium has recently been described. Fifty-five consecutive patients with paroxysmal atrial fibrillation (52±12 years) underwent balloon cryoablation, following multidetector computed tomography to measure the pulmonary veins. We were able to identify segments of the right pericardiacophrenic artery (mean length 25mm [range 7-68mm]) in only 10 patients (20%) (AU)

[Phrenic nerve identification with cardiac multidetector computed tomography]. / Identificación del nervio frénico con tomografía computarizada cardiaca multidetector.

Cryoballoon ablation of the pulmonary veins is a new technique that has proven useful in preventing paroxysmal and persistent atrial fibrillation recurrence. One of the most serious complications of this method is right phrenic nerve palsy. The usefulness of multidetector computed tomography to locate the right phrenic nerve and artery and predict the risk of phrenic nerve palsy during cryoablation according to the distance between the right phrenic neurovascular bundle and the right superior pulmonary vein ostium has recently been described. Fifty-five consecutive patients with paroxysmal atrial fibrillation (52 ± 12 years) underwent balloon cryoablation, following multidetector computed tomography to measure the pulmonary veins. We were able to identify segments of the right pericardiacophrenic artery (mean length 25 mm [range 7-68 mm]) in only 10 patients (20%).

[Influence of gender on the clinical characteristics and prognosis of patients hospitalized for heart failure]. / Influencia del sexo en el perfil clínico y pronóstico de la insuficiencia cardiaca tras el alta hospitalaria.

BACKGROUND AND OBJECTIVES: The natural history of heart failure (HF) may be different in women due to their clinical characteristics, treatment and prognosis being distinct. Our aim was to describe the differential characteristics of women hospitalized with HF. METHODS: We prospectively studied consecutive patients who were discharged with a diagnosis of HF (n=412). Clinical, laboratory, echocardiographic, and therapeutic variables were recorded at discharge. During follow-up (16 [9] months), all-cause mortality and the need for rehospitalization were recorded. RESULTS: Compared with men, women (n=157, 38%) were older (75 [12] years vs. 71 [18] years, P< .001), had a higher prevalence of arterial hypertension (71% vs. 51%, P< .001), had more frequently been previously hospitalized for HF (36% vs. 25%, P=.02), had a higher prevalence of HF with a preserved left ventricular ejection fraction (LVEF) (44% vs. 21%, P<001), had less coronary disease (34% vs. 49%, P=.007), had more hypertensive cardiomyopathy (17% vs. 8%, P=.006), had worse renal function (52 [25] vs. 58 [25] mL/min per 1.73m2, P=.002), and had lower hemoglobin levels (12.1 [1.7] vs. 12.9 [1.9] g/dL, P< .001). This clinical profile resulted in less use of coronary angiography (22% vs. 37%, P=.001), antiplatelet drugs (45% vs. 62%, P=.001), and beta-blockers (39% vs. 50%, P=.03). In addition, women received statin treatment less often (31% vs. 45%, P=.003). Nevertheless, mortality (23% vs. 18%, P=.26) and the rehospitalization rate (44% vs. 46%, P=.81) were similar. In women, age (hazard ratio [HR] = 1.05, 95% confidence interval [CI] 1.01-1.09; P=.036) and anemia (HR = 2.43, 95% CI 1.16-5.12; P=.015) were independent predictors of death. CONCLUSIONS: Women hospitalized for HF had a distinct clinical profile: their LVEF was greater and they more frequently had comorbid conditions. This led to different treatment, though prognosis was similar to that in men.

Influencia del sexo en el perfil clínico y pronóstico de la insuficiencia cardiaca tras el alta hospitalaria / Influence of gender on the clinical characteristics and prognosis of patients hospitalized for heart failure

Introducción y objetivos. La historia natural de la insuficiencia cardiaca puede ser distinta en mujeres, debido a su diferente perfil clínico, terapéutico y pronóstico. Nuestro objetivo fue definir las características diferenciales de mujeres hospitalizadas por insuficiencia cardiaca. Métodos. Estudiamos prospectivamente a los pacientes consecutivos dados de alta con el diagnóstico de insuficiencia cardiaca (n = 412). Al alta, se registraron las variables clínicas, analíticas, ecocardiográficas y terapéuticas. Durante el seguimiento (16 ± 9 meses) se registraron mortalidad y reingreso hospitalario. Resultados. Respecto a los varones, las mujeres (n = 157; 38%) presentaron: mayor edad (75 ± 12 y 71 ± 18 años; p < 0,001), hipertensión arterial (el 71 y el 51%; p < 0,001) e ingresos previos por insuficiencia cardiaca (el 36 y el 25%; p = 0,02); mayor prevalencia de fracción de eyección del ventrículo izquierdo (FEVI) preservada (el 44 y el 21%; p < 0,001); menor prevalencia de cardiopatía isquémica (el 34 y el 49%; p = 0,007) y mayor de hipertensiva (el 17 y el 8%; p = 0,006); peor función renal (52 ± 25 y 58 ± 25 ml/min/1,73 m2; p = 0,002) y menos hemoglobina (12,1 ± 1,7 y 12,9 ± 1,9; p < 0,001). Este perfil clínico conllevó menos coronariografías (el 22 y el 37%; p = 0,001), antiplaquetarios (el 45 y el 62%; p = 0,001) y bloqueadores beta (el 39 y el 50%; p = 0,03); el sexo femenino tiene relación con menos uso de estatinas (el 31 y el 45%; p = 0,003). Sin embargo, su mortalidad (el 23 contra el 18%; p = 0,26) y sus reingresos hospitalarios (el 44 y el 46%; p = 0,81) fueron similares. En mujeres, los predictores independientes de muerte fueron edad (p = 0,036; hazard ratio [HR] = 1,05 [1,01-1,09]) y anemia (p = 0,015; HR = 2,43 [1,16-5,12]). Conclusiones. Las mujeres hospitalizadas por insuficiencia cardiaca presentan un perfil clínico diferente, con FEVI más preservada y mayores comorbilidades, que conlleva un manejo terapéutico distinto. Su pronóstico es similar al de los varones (AU)

Background and objectives. The natural history of heart failure (HF) may be different in women due to their clinical characteristics, treatment and prognosis being distinct. Our aim was to describe the differential characteristics of women hospitalized with HF. Methods. We prospectively studied consecutive patients who were discharged with a diagnosis of HF (n=412). Clinical, laboratory, echocardiographic, and therapeutic variables were recorded at discharge. During follow-up (16 [9] months), all-cause mortality and the need for rehospitalization were recorded. Results. Compared with men, women (n=157, 38%) were older (75 [12] years vs. 71 [18] years, P<.001), had a higher prevalence of arterial hypertension (71% vs. 51%, P<.001), had more frequently been previously hospitalized for HF (36% vs. 25%, P=.02), had a higher prevalence of HF with a preserved left ventricular ejection fraction (LVEF) (44% vs. 21%, P<001), had less coronary disease (34% vs. 49%, P=.007), had more hypertensive cardiomyopathy (17% vs. 8%, P=.006), had worse renal function (52 [25] vs. 58 [25] mL/min per 1.73m2, P=.002), and had lower hemoglobin levels (12.1 [1.7] vs. 12.9 [1.9] g/dL, P<.001). This clinical profile resulted in less use of coronary angiography (22% vs. 37%, P=.001), antiplatelet drugs (45% vs. 62%, P=.001), and beta-blockers (39% vs. 50%, P=.03). In addition, women received statin treatment less often (31% vs. 45%, P=.003). Nevertheless, mortality (23% vs. 18%, P=.26) and the rehospitalization rate (44% vs. 46%, P=.81) were similar. In women, age (hazard ratio [HR] = 1.05, 95% confidence interval [CI] 1.01­1.09; P=.036) and anemia (HR = 2.43, 95% CI 1.16­5.12; P=.015) were independent predictors of death. Conclusions. Women hospitalized for HF had a distinct clinical profile: their LVEF was greater and they more frequently had comorbid conditions. This led to different treatment, though prognosis was similar to that in men (AU)

Manejo conservador en la disección coronaria espontánea del tronco común izquierdo / Conservative management of spontaneous left main coronary artery dissection

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[Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure]. / Determinantes clínicos y valor pronóstico de la hemoglobina en pacientes hospitalizados con insuficiencia cardiaca sistólica.

INTRODUCTION AND OBJECTIVES: Anemia is a common finding in outpatients with heart failure (HF) and is associated with increased mortality. The aims of this study were to identify determinants of the hemoglobin level in a large group of hospitalized patients with systolic HF and to investigate the medium-term prognostic value of the hemoglobin level. METHODS: The study included 460 consecutive patients (age 68.3 [12.3] years, 74% male) who were hospitalized with a diagnosis of HF and left ventricular systolic dysfunction (i.e., a left ventricular ejection fraction <45%). At hospital discharge, biochemical and hematological parameters were measured and clinical and echocardiographic variables were recorded. Patients were followed up for 16.8[9.7] months. RESULTS: Anemia, as defined by World Health Organization criteria, was present in 189 (41.1%) patients. The following independent determinants of the hemoglobin level were identified: age (relative risk [RR]=1.035, 95% CI, 1.011-1.060; P=.004), female sex (RR=1.843, 95% CI, 1.083-3.135; P=.024), diabetes mellitus (RR=1.413, 95% CI, 1.087-1.838; P=.010), plasma urea level (RR=1.013, 95% CI, 1.005-1.022; P=.001), and loop diuretic use (RR=2.801, 95% CI, 1.463-5.364; P=.002). A decrease in hemoglobin level was associated with increased risks of death (RR per g/dL=1.232, 95% CI, 1.103-1.375; P<.001) and death or HF readmission (RR per g/dL=1.152, 95% CI, 1.058-1.255; P<.001), but not with readmission for non-fatal HF (RR per g/dL=1.081, 95% CI, 0.962-1.215; P=.265). Blood transfusion during hospitalization did not alter the increased risk of death (RR=2.19, 95% CI 1.40-3.41; P=.001). CONCLUSIONS: In hospitalized patients with systolic HF, the hemoglobin level at hospital discharge was an independent predictor of death in the medium term, but not of readmission for non-fatal HF. The main determinants of the hemoglobin level were age, sex, renal function, diabetes, and the need for diuretics.

Determinantes clínicos y valor pronóstico de la hemoglobina en pacientes hospitalizados con insuficiencia cardiaca sistólica / Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure

Introducción y objetivos. En pacientes ambulatorios con insuficiencia cardiaca, la anemia es frecuente y se asocia con un aumento de la mortalidad. Estudiamos los determinantes del valor de hemoglobina y su valor pronóstico a medio plazo en una población amplia de pacientes hospitalizados con IC sistólica. Métodos. Se incluyó a 460 pacientes consecutivos (68,3 ± 12,3 años, 74% varones) hospitalizados con el diagnóstico de insuficiencia cardiaca y disfunción sistólica (fracción de eyección del ventrículo izquierdo [FEVI] < 45%). En el momento del alta hospitalaria se realizaron las determinaciones bioquímicas y hematológicas y se recogieron las variables clínicas y ecocardiográficas. Los pacientes fueron seguidos durante 16,8 ± 9,7 meses. Resultados. Un total de 189 (41,1%) pacientes presentaban anemia (según la definición de la Organización Mundial de la Salud). Los determinantes independientes del valor de hemoglobina fueron la edad (riesgo relativo [RR] = 1,035; intervalo de confianza [IC] del 95%, 1,011-1,060; p = 0,004), el sexo femenino (RR = 1,843; IC del 95%, 1,083-3,135; p = 0,024), diabetes mellitus (RR = 1,413; IC del 95%, 1,087-1,838; p = 0,010), urea plasmática (RR = 1,013; IC del 95%, 1,005-1,022; p = 0,001) y diuréticos del asa (RR = 2,801; IC del 995%, 1,463-5,364; p = 0,002). Un menor valor de hemoglobina se asoció con un mayor riesgo de muerte evento (RR = 1,232; IC del 95%, 1,103-1,375; p < 0,001) y del evento combinado de muerte o reingreso por insuficiencia cardiaca (RR = 1,152; IC del 95%, 1,058-1,255; p < 0,001), pero no de reingreso por insuficiencia cardiaca no fatal (RR = 1,081; IC del 95%, 0,962-1,215; p = 0,265). La transfusión de hematíes durante el ingreso no modificó el incremento del riesgo de muerte (RR = 2,19; IC del 95%, 1,40-3,41, p = 0,001). Conclusiones. En pacientes hospitalizados con IC sistólica, el valor de hemoglobina en el momento del alta es un predictor independiente de mortalidad a medio plazo, pero no de reingresos por IC no fatal. Sus principales determinantes fueron la edad, el sexo, la función renal, la diabetes y la necesidad de diuréticos (AU)

Introduction and objectives. Anemia is a common finding in outpatients with heart failure (HF) and is associated with increased mortality. The aims of this study were to identify determinants of the hemoglobin level in a large group of hospitalized patients with systolic HF and to investigate the medium-term prognostic value of the hemoglobin level. Methods. The study included 460 consecutive patients (age 68.3 [12.3] years, 74% male) who were hospitalized with a diagnosis of HF and left ventricular systolic dysfunction (i.e., a left ventricular ejection fraction < 45%). At hospital discharge, biochemical and hematological parameters were measured and clinical and echocardiographic variables were recorded. Patients were followed up for 16.8[9.7] months. Results. Anemia, as defined by World Health Organization criteria, was present in 189 (41.1%) patients. The following independent determinants of the hemoglobin level were identified: age (relative risk [RR]=1.035, 95% CI, 1.011–1.060; P=.004), female sex (RR=1.843, 95% CI, 1.083–3.135; P=.024), diabetes mellitus (RR=1.413, 95% CI, 1.087–1.838; P=.010), plasma urea level (RR=1.013, 95% CI, 1.005–1.022; P=.001), and loop diuretic use (RR=2.801, 95% CI, 1.463–5.364; P=.002). A decrease in hemoglobin level was associated with increased risks of death (RR per g/dL=1.232, 95% CI, 1.103–1.375; P < 001) and death or HF readmission (RR per g/dL=1.152, 95% CI, 1.058–1.255; P < .001), but not with readmission for nonfatal HF (RR per g/dL=1.081, 95% CI, 0.962–1.215; P=.265). Blood transfusion during hospitalization did not alter the increased risk of death (RR=2.19, 95% CI 1.40–3.41; P=.001). Conclusions. In hospitalized patients with systolic HF, the hemoglobin level at hospital discharge was an independent predictor of death in the medium term, but not of readmission for non-fatal HF. The main determinants of the hemoglobin level were age, sex, renal function, diabetes, and the need for diuretics (AU)

Hyperuricaemia and long-term outcome after hospital discharge in acute heart failure patients.

BACKGROUND: Uric acid (UA) may be involved in chronic heart failure (HF) pathogenesis, entailing a worse outcome. The purpose of this study was to examine the role of hyperuricaemia as a prognostic marker after hospital discharge in acute HF patients. METHODS: We studied 212 patients consecutively discharged after an episode of acute HF with LVEF<40%. Blood samples for UA measurement were extracted in the morning prior to discharge. The evaluated endpoints were death and new HF hospitalization. RESULTS: Mean UA levels were 7.4+/-2.4 mg/dl (range 1.6 to 16 mg/dl), with 127 (60%) of patients being within the range of hyperuricaemia. Hyperuricaemia was associated with a higher risk of death (n=48) (HR 2.0, 95% CI 1.1-3.9, p=0.028), new HF readmission (n=67) (HR 1.8, 95% CI 1.1-3.1, p=0.023) and the combined event (n=100) (HR 1.9, 95% CI 1.2-2.9, p=0.004). At 24 months, cumulative event-free survival was lower in the two higher UA quartiles (36.9% and 40.7% vs. 63.5% and 59.5%, log rank=0.006). After adjustment for potential confounders, hyperuricaemia remains an independent risk factor for adverse outcomes (HR 1.6, 95% CI 1.1-2.6, p=0.02). CONCLUSIONS: In hospitalized patients with acute HF and LV systolic dysfunction, hyperuricaemia is a long-term prognostic marker for death and/or new HF readmission.

[Balloon rupture and alcohol leakage into the left anterior descending coronary artery during percutaneous septal ablation for hypertrophic obstructive cardiomyopathy]. / Rotura de balón y extravasación de alcohol hacia la arteria descendente anterior durante la ablación septal en paciente con miocardiopatía hipertrófica obstructiva.

We present a case of rupture of the balloon during percutaneous transluminal septal myocardial ablation with alcohol in a patient with hypertrophic obstructive cardiomyopathy. Rupture of the balloon caused reflux of alcohol into the left anterior descending artery. Angina, mild global hypokinesia of the left ventricle and advanced atrioventricular block were observed. Cardiac function recovered in a few minutes and peak creatine kinase was 526 U. Despite the restoration of sinus rhythm, there were episodes of complete atrioventricular block that made permanent pacemaker implantation necessary.

Rotura de balón y extravasación de alcohol hacia la arteria descendente anterior durante la ablación septal en paciente con miocardiopatía hipertrófica obstructiva / Balloon rupture and alcohol leakage into the left anterior descending coronary artery during percutaneous septal ablation for hypertrophic obstructive cardiomyopathy

Presentamos un caso de rotura del balón de oclusión septal durante el procedimiento de ablación con alcohol en un paciente con miocardiopatía hipertrófica obstructiva. La rotura causó reflujo de alcohol a la arteria descendente anterior y originó angina, leve hipocinesia global, transitoria de ventrículo izquierdo y bloqueo auriculoventricular avanzado. La función contráctil se recuperó en pocos minutos y el pico de creatincinasa fue de 526 U. A pesar de restaurarse el ritmo sinusal, hubo episodios de bloqueo auriculoventricular que obligaron al implante de marcapasos definitivo

We present a case of rupture of the balloon during percutaneous transluminal septal myocardial ablation with alcohol in a patient with hypertrophic obstructive cardiomyopathy. Rupture of the balloon caused reflux of alcohol into the left anterior descending artery. Angina, mild global hypokinesia of the left ventricle and advanced atrioventricular block were observed. Cardiac function recovered in a few minutes and peak creatine kinase was 526 U. Despite the restoration of sinus rhythm, there were episodes of complete atrioventricular block that made permanent pacemaker implantation necessary