Impacto del COVID-19 en pacientes con estenosis aórtica severa: análisis basado en inteligencia artificial / The impact of COVID-19 in patients with severe aortic stenosis: Artificial intelligence research

Introducción: La estenosis aórtica severa es una enfermedad mortal en caso de no ser intervenida. Este estudio pretende conocer el impacto de la pandemia por COVID-19 en la mortalidad de pacientes con estenosis severa durante la primera ola y compararlo con el mismo período del año anterior. Métodos: Se analizaron mediante software basado en inteligencia artificial todos los pacientes que acudieron al hospital en una región española durante la primera ola y en el año anterior, evaluándose la mortalidad comparada entre pacientes con estenosis aórtica severa con y sin COVID-19 durante la pandemia y la era pre-COVID. Se comparó la mortalidad en tres grupos diferentes. En cuanto al número de cirugías cardiacas, se observó una tendencia a la baja en los pacientes sin COVID-19 con respecto al mismo período del año anterior (p = 0,07), y un descenso significativo entre pacientes COVID-19 positivo y COVID-19 negativo. Resultados: Durante la primera ola, acudieron un 13,82% menos de pacientes. Un total de 1.112 tenían estenosis aórtica, de los cuales un 5,48% fueron COVID-19 positivo. La mortalidad fue mayor (p=0,01) en COVID-19 negativo durante la pandemia (4,37%) frente a los de la era pre-COVID-19 (2,57%); también lo fue en el grupo COVID-19 positivo (11,47%) frente a los COVID-19 negativo (4,37%) durante la primera ola (p=0,01). Se observó una tendencia a la disminución de cirugías (p=0,07) en los pacientes COVID-19 negativo durante la pandemia y disminuyeron significativamente en pacientes COVID-19 positivo, frente a los COVID-19 negativo (p=0,04). Conclusiones: El estudio reveló una disminución de los pacientes que acudieron al hospital y un exceso de mortalidad en pacientes con estenosis aórtica severa sin la infección durante la primera ola, frente al mismo período del año anterior; y también, en los pacientes COVID-19 positivo, frente a los COVID-19 negativo. (AU)

Introduction: Untreated, severe, symptomatic aortic stenosis is associated with an ominous diagnosis without intervention. This study aims to determine the impact of the COVID-19 pandemic on the mortality of patients with severe stenosis during the first wave and compare it with the same period last year. Methods: All patients who went to the hospitals in an Spanish region during the first wave, and in the same period of previous year, were analyzed using artificial intelligence-based software, evaluating the mortality of patients with severe aortic stenosis with and without COVID-19 during the pandemic and the pre-COVID era. Mortality of the 3 groups was compared. Regarding cardiac surgeries was a tendency to decrease (P=.07) in patients without COVID-19 between the pandemic and the previous period was observed. A significant decrease of surgeries between patients with COVID-19 and without COVID-19 was shown. Results: Data showed 13.82% less admitted patients during the first wave. A total of 1,112 of them had aortic stenosis and 5.48% were COVID-19 positive. Mortality was higher (P=.01), in COVID-19 negative during the pandemic (4.37%) versus those in the pre-COVID-19 era (2.57%); it was also in the COVID-19 positive group (11.47%), versus COVID-19 negative (4.37%) during the first wave (P=.01). Conclusions: The study revealed a decrease in patients who went to the hospital and an excess of mortality in patients with severe aortic stenosis without infection during the first wave, compared to the same period last year; and also, in COVID-19 positive patients versus COVID-19 negative. (AU)

The impact of COVID-19 in patients with severe aortic stenosis: Artificial intelligence research.

INTRODUCTION: Untreated, severe, symptomatic aortic stenosis is associated with an ominous diagnosis without intervention. This study aims to determine the impact of the COVID-19 pandemic on the mortality of patients with severe stenosis during the first wave and compare it with the same period last year. METHODS: All patients who went to the hospitals in a spanish region during the first wave, and in the same period of previous year, were analysed using Artificial Intelligence-based software, evaluating the mortality of patients with severe aortic stenosis with and without COVID-19 during the pandemic and the pre-COVID era. Mortality of the three groups were compared. Regarding cardiac surgeries was a tendency to decrease (p = .07) in patients without COVID-19 between the pandemic and the previous period was observed. A significant decrease of surgeries between patients with COVID-19 and without COVID-19 was shown. RESULTS: Data showed 13.82% less admitted patients during the first wave. 1112 of them, had aortic stenosis and 5.48% were COVID-19 positive. Mortality was higher (p = .01), in COVID-19 negative during the pandemic (4.37%) versus those in the pre-COVID19 era (2.57%); it was also in the COVID-19 positive group (11.47%), versus covid-19 negative (4.37%) during the first wave (p = .01). CONCLUSIONS: The study revealed a decrease in patients who went to the hospital and an excess of mortality in patients with severe AD without infection during the first wave, compared to the same period last year; and also, in COVID-19 positive patients versus COVID-19 negative.

[The impact of COVID-19 in patients with severe aortic stenosis: Artificial intelligence research]. / Impacto del COVID-19 en pacientes con estenosis aórtica severa: análisis basado en inteligencia artificial.

Introduction: Untreated, severe, symptomatic aortic stenosis is associated with an ominous diagnosis without intervention. This study aims to determine the impact of the COVID-19 pandemic on the mortality of patients with severe stenosis during the first wave and compare it with the same period last year. Methods: All patients who went to the hospitals in an Spanish region during the first wave, and in the same period of previous year, were analyzed using artificial intelligence-based software, evaluating the mortality of patients with severe aortic stenosis with and without COVID-19 during the pandemic and the pre-COVID era. Mortality of the 3 groups was compared. Regarding cardiac surgeries was a tendency to decrease (P = .07) in patients without COVID-19 between the pandemic and the previous period was observed. A significant decrease of surgeries between patients with COVID-19 and without COVID-19 was shown. Results: Data showed 13.82% less admitted patients during the first wave. A total of 1,112 of them had aortic stenosis and 5.48% were COVID-19 positive. Mortality was higher (P = .01), in COVID-19 negative during the pandemic (4.37%) versus those in the pre-COVID-19 era (2.57%); it was also in the COVID-19 positive group (11.47%), versus COVID-19 negative (4.37%) during the first wave (P = .01). Conclusions: The study revealed a decrease in patients who went to the hospital and an excess of mortality in patients with severe aortic stenosis without infection during the first wave, compared to the same period last year; and also, in COVID-19 positive patients versus COVID-19 negative.

Estudio aleatorizado para comparar el stentbioactivo de titanio con el stent de everolimus en pacientes diabéticos (TITANIC XV), resultados a 1 año / A Randomized Study to Compare Bioactive Titanium Stents and Everolimus-eluting Stents in Diabetic Patients (TITANIC XV): 1-year Results

Introducción y objetivos Hasta un 25% de los pacientes sometidos a intervencionismo coronario percutáneo presentan alguna limitación para la utilización de los stents farmacoactivos. Nuestro objetivo es evaluar si el stent bioactivo de titanio y óxido nítrico podía ser una buena alternativa al stent de everolimus para pacientes diabéticos.MétodosSe aleatorizó a 173 pacientes diabéticos con lesiones de riesgo de reestenosis intermedio (criterios de exclusión: diámetro < 2,5 mm o longitud > 28 mm en vasos < 3 mm, oclusión crónica): 83 pacientes en el grupo con titanio y 90 en el grupo con everolimus.ResultadosLas variables basales estaban bien equilibradas, el 28,3% eran insulinodependientes. Al año, las incidencias de eventos adversos cardiacos mayores (muerte, infarto de miocardio no fatal, ictus o nueva revascularización del vaso tratado) eran significativamente más frecuente en el grupo con titanio que en el grupo con everolimus (total, el 14,5 frente al 4,4%; p = 0,02; subgrupo no insulinodependiente, el 9,7 frente al 3,2%; p = 0,14; insulinodependiente, el 28,6 frente al 7,1%; p = 0,04) y de muerte, infarto de miocardio no fatal, ictus o cualquier revascularización, del 16,9% en el grupo con titanio y el 7,8% en el grupo con everolimus (p = 0,06). La revascularización de la lesión diana se produjo en el 8,4 frente al 3,3% (p = 0,15), y la del vaso tratado, el 13,3 frente al 3,3% (p = 0,01). El seguimiento angiográfico a 9 meses mostró una pérdida luminal tardía significativamente menor en el grupo con everolimus (en el segmento, 0,52 ± 0,58 frente a -0,05 ± 0,32 mm; en el stent, 0,76 ± 0,54 frente a 0,13 ± 0,31 mm; p < 0,0001). ConclusionesEl stent de everolimus fue superior al titanio en pacientes diabéticos incluso con lesiones de riesgo de eventos clínicos y angiográficos intermedio (AU)

Introduction and objectives Up to 25% of patients who undergo a percutaneous coronary intervention show some limitation in the use of drug-eluting stents. The aim of this study was to evaluate if titanium-nitride-oxide-coated stents could be a good alternative to everolimus-eluting stents in diabetic patients.MethodsA total of 173 diabetic patients with lesions at moderate risk of restenosis (exclusion criteria: diameter < 2.5 mm or length > 28 mm in vessels < 3 mm, chronic occlusion) were randomized to a titanium group (83 patients) or an everolimus group (90 patients).ResultsBaseline characteristics were well balanced; 28.3% of patients were insulin dependent. At 1 year, the incidence of major adverse cardiac events (death, nonfatal myocardial infarction, stroke, or repeat target vessel revascularization) was significantly higher in the titanium group than in the everolimus group (total, 14.5% vs 4.4%; P = .02; noninsulin-dependent subgroup, 9.7% vs 3.2%; P = .14; insulin-dependent subgroup, 28.6% vs 7.1%; P = .04). The incidence of death, nonfatal myocardial infarction, stroke, or any revascularization was 16.9% in the titanium group and 7.8% in the everolimus group (P = .06). Target lesion and vessel revascularizations occurred in 8.4% compared with 3.3% (P = .15) and in 13.3% compared with 3.3% (P = .01) in the titanium and everolimus groups, respectively. Angiographic follow-up at 9 months showed significantly less late lumen loss in the everolimus group (in-segment, 0.52 [standard deviation, 0.58) mm vs -0.05 [0.32] mm; in-stent, 0.76 [0.54] mm vs 0.13 [0.31] mm; P < .0001).ConclusionsThe everolimus-eluting stent is superior to the titanium stent for clinical and angiographic end points in diabetic patients with lesions at moderate risk of restenosis (AU)

A randomized study to compare bioactive titanium stents and everolimus-eluting stents in diabetic patients (TITANIC XV): 1-year results.

INTRODUCTION AND OBJECTIVES: Up to 25% of patients who undergo a percutaneous coronary intervention show some limitation in the use of drug-eluting stents. The aim of this study was to evaluate if titanium-nitride-oxide-coated stents could be a good alternative to everolimus-eluting stents in diabetic patients. METHODS: A total of 173 diabetic patients with lesions at moderate risk of restenosis (exclusion criteria: diameter < 2.5 mm or length > 28 mm in vessels < 3mm, chronic occlusion) were randomized to a titanium group (83 patients) or an everolimus group (90 patients). RESULTS: Baseline characteristics were well balanced; 28.3% of patients were insulin dependent. At 1 year, the incidence of major adverse cardiac events (death, nonfatal myocardial infarction, stroke, or repeat target vessel revascularization) was significantly higher in the titanium group than in the everolimus group (total, 14.5% vs 4.4%; P = .02; noninsulin-dependent subgroup, 9.7% vs 3.2%; P = .14; insulin-dependent subgroup, 28.6% vs 7.1%; P = .04). The incidence of death, nonfatal myocardial infarction, stroke, or any revascularization was 16.9% in the titanium group and 7.8% in the everolimus group (P = .06). Target lesion and vessel revascularizations occurred in 8.4% compared with 3.3% (P = .15) and in 13.3% compared with 3.3% (P = .01) in the titanium and everolimus groups, respectively. Angiographic follow-up at 9 months showed significantly less late lumen loss in the everolimus group (in-segment, 0.52 [standard deviation, 0.58) mm vs -0.05 [0.32] mm; in-stent, 0.76 [0.54] mm vs 0.13 [0.31] mm; P < .0001). CONCLUSIONS: The everolimus-eluting stent is superior to the titanium stent for clinical and angiographic end points in diabetic patients with lesions at moderate risk of restenosis.

Insuficiencia mitral aguda severa resuelta mediante angioplastia / No disponible

No disponible

Fisiopatología del miocardio isquémico. Importancia de la frecuencia cardiaca / The pathophysiology of myocardial ischemia. The importance of heart rate

La isquemia miocárdica es un fenómeno plurifactorial que produce un cambio hacia el metabolismo anaerobio en la célula muscular. Los cambios inducidos pueden ser reversibles en un primer momento antes de llegar al daño irreversible con muerte celular. El aumento en el aporte de oxígeno o la reducción de los requerimientos energéticos del miocardio protegen de la isquemia miocárdica. Desde el punto de vista fisiopatológico, el control y la reducción de la frecuencia cardiaca añadidos al restablecimiento del flujo coronario pueden ser la piedra angular en el tratamiento de esta afección (AU)

Myocardial ischemia is a multifactorial phenomenon that shifts muscle cells towards an anaerobic metabolism. At first, before irreversible damage leads to cell death, the resulting changes are reversible. Both an increase in oxygen supply and a reduction in myocardial energy demand can protect against myocardial ischemia. From a pathophysiological point of view, control of or a reduction in heart rate, combined with the re-establishment of coronary flow, can provide the cornerstone of treatment for this condition (AU)

[Interventional cardiology in 2005]. / Cardiología intervencionista 2005.

Drug-eluting stents have been shown to reduce the rate of restenosis significantly in all types of lesion, patient and clinical context without increasing thrombotic complications. Although their high cost limits the extent to which they can replace bare-metal stents, their use will increase inexorably in coming years. In addition to stents containing sirolimus and paclitaxel, which have already been approved, two additional drug-eluting stents have appeared on the market this year: one elutes tacrolimus and the other, ABT578 (a rapamycin analogue). Now that the restenosis rate has been dramatically reduced, the main limitations on percutaneous coronary intervention (PCI) stem from problematic lesions such as those at bifurcations and chronic total occlusions. Although these lesions can be tackled more often and more successfully than in the past, the results obtained are very different from those achieved with other types of lesion. With improvements in safety and long-term efficacy, the number of indications for PCI has expanded to include patients with multivessel disease, left main coronary artery disease, left ventricular dysfunction, and diabetes, conditions in which surgical revascularization was thought necessary only a few years ago. Acute coronary syndromes now make up an increasing proportion of indications for PCI, both in absolute and relative terms. One future challenge is the early identification and treatment of vulnerable plaques before they manifest clinically in the form of irreversible complications such as sudden death or acute myocardial infarction. The use of multislice computed tomography, such as 64-slice detector systems, has considerably increased the sensitivity, specificity, and positive and negative predictive values of diagnosis to around 90%, though diagnostic accuracy may be considerably less in patients with severe coronary calcification, stents, or cardiac arrhythmias. Although the technique is straightforward for patients, the image reconstruction process is time-consuming, few centers currently offer the technique, and radiation exposure is several times that with conventional invasive coronary angiography. It appears that the main application of the technique is in ruling out coronary disease in low-risk patients rather than being part of the diagnostic work-up in those with a high probability of coronary artery disease.

Cardiología intervencionista 2005 / Interventional Cardiology in 2005

Los stents liberadores de fármacos (DES) reducen de forma importante la tasa de reestenosis en todo tipo de lesiones, pacientes y situaciones clínicas, y todo ello sin aumentar las complicaciones trombóticas. Su alto precio impide la sustitución del stent convencional por los DES, pero su utilización va inexorablemente en aumento (el 38% del consumo total de stents en España en 2004). A los stents ya comercializados de rapamicina y paclitaxel se han unido en 2005 otros 2 DES (uno de tacrolimus y otro de ABT578, fármacos de acción similar a la rapamicina). Paliado (que no resuelto) el problema de la reestenosis, las limitaciones del intervencionismo coronario percutáneo (ICP) se sitúan en torno a determinados tipos de lesión (bifurcación, oclusión total crónica) que, aunque se abordan más frecuentemente y con mayor éxito que en el pasado, sus resultados distan mucho de los obtenidos en otro tipo de lesiones. De la posibilidad de tratar con seguridad y bajo riesgo de reestenosis un mayor número de lesiones surge la ampliación de las indicaciones de ICP a pacientes con enfermedad multivaso, tronco, disfunción ventricular severa y diabetes mellitus, situaciones clínicas que fueron patrimonio de la cirugía hasta hace muy poco. El ICP en los síndromes coronarios agudos (SCA) ha supuesto un incremento en términos absolutos y relativos del número de procedimientos, tras demostrarse que la estrategia invasiva supone un beneficio clínico a corto, medio y largo plazo. El reto de los próximos años será identificar (mediante marcadores séricos o técnicas de imagen) y tratar a los pacientes en etapas subclínicas del SCA antes de que se produzcan complicaciones irreversibles, como muerte súbita o infarto agudo de miocardio (IAM). Las nuevas técnicas de diagnóstico no invasivo (TC multicorte) han mejorado de forma sustancial su capacidad diagnóstica, de forma que con los equipos de 64 detectores, la sensibilidad, la especificidad y los valores predictivos positivo y negativo rondan el 90% para la detección de lesiones que precisan revascularización, aunque estas cifras pueden ser sensiblemente inferiores en pacientes taquicárdicos, arrítmicos, obesos, con calcificación coronaria severa o stents. La técnica es sencilla para el paciente, pero la reconstrucción tridimensional lleva entre 30 y 60 min, la disponibilidad actual es escasa y la dosis de radiación recibida por el paciente cuadruplica la de la coronariografía convencional. Con todos estos elementos en consideración, su indicación principal sería descartar enfermedad coronaria en pacientes con bajo riesgo de experimentarla, reservar la coronariografía convencional para aquellos pacientes en los que los datos clínicos y las pruebas no invasivas apuntaran hacia una alta probabilidad de cardiopatía isquémica y necesidad de revascularización (AU)

Drug-eluting stents have been shown to reduce the rate of restenosis significantly in all types of lesion, patient and clinical context without increasing thrombotic complications. Although their high cost limits the extent to which they can replace bare-metal stents, their use will increase inexorably in coming years. In addition to stents containing sirolimus and paclitaxel, which have already been approved, two additional drug-eluting stents have appeared on the market this year: one elutes tacrolimus and the other, ABT578 (a rapamycin analogue). Now that the restenosis rate has been dramatically reduced, the main limitations on percutaneous coronary intervention (PCI) stem from problematic lesions such as those at bifurcations and chronic total occlusions. Although these lesions can be tackled more often and more successfully than in the past, the results obtained are very different from those achieved with other types of lesion. With improvements in safety and long-term efficacy, the number of indications for PCI has expanded to include patients with multivessel disease, left main coronary artery disease, left ventricular dysfunction, and diabetes, conditions in which surgical revascularization was thought necessary only a few years ago. Acute coronary syndromes now make up an increasing proportion of indications for PCI, both in absolute and relative terms. One future challenge is the early identification and treatment of vulnerable plaques before they manifest clinically in the form of irreversible complications such as sudden death or acute myocardial infarction. The use of multislice computed tomography, such as 64-slice detector systems, has considerably increased the sensitivity, specificity, and positive and negative predictive values of diagnosis to around 90%, though diagnostic accuracy may be considerably less in patients with severe coronary calcification, stents, or cardiac arrhythmias. Although the technique is straightforward for patients, the image reconstruction process is time-consuming, few centers currently offer the technique, and radiation exposure is several times that with conventional invasive coronary angiography. It appears that the main application of the technique is in ruling out coronary disease in low-risk patients rather than being part of the diagnostic work-up in those with a high probability of coronary artery disease (AU)

Actualización en cardiología intervencionista 2004 / Update in Interventional Cardiology (2004)

Los stents liberadores de drogas con su doble efecto mecánico y farmacológico son muy eficaces en prevenir la reestenosis, hecho ya conocido en lesiones favorables y que este año ha quedado confirmado también en lesiones de alto riesgo. El número de angioplastias coronarias sigue aumentando (10% anual) como consecuencia del tratamiento invasivo de los síndromes coronarios agudos, la implantación de programas de angioplastia primaria y el tratamiento de pacientes más complejos. El diagnóstico y eventual tratamiento de las placas vulnerables es ahora un nuevo reto. La medicina regenerativa ha levantado grandes expectativas, y la investigación clínica ha precedido a la experimentación animal. De hecho, aspectos tan básicos como el tipo celular, su preparación, la vía de administración, el momento de aplicación o la medicación coadyuvante no están todavía aclarados; todavía están en discusión si las células aplicadas anidan o no en el tejido miocárdico. Con todo, la terapia celular se está aplicando ya y empiezan a aparecer los resultados de los primeros estudios. Las prótesis aórticas percutáneas están en fase avanzada de investigación clínica. En cuanto a los dispositivos de reducción de la regurgitación mitral, acaban de iniciar su fase de aplicación en humanos por lo que tardarán más en incorporarse a la clínica. Los dispositivos de cierre están ya bien desarrollados técnicamente, pero falta perfilar su indicación en determinadas entidades y su efectividad en otras. En el presente artículo se revisan estos y otros aspectos relevantes que durante este año han supuesto aportaciones de interés en el campo de la cardiología intervencionista (AU)

Drug-eluting stents have both mechanical and pharmacological properties and are very effective in the prevention of restenosis. This feature, already known for favorable lesions, has been confirmed this year for high-risk lesions. The number of percutaneous coronary procedures steadily continues to increase as invasive strategy for acute coronary syndromes and primary angioplasty for acute myocardial infarction are being implemented in more centers, and more complex patients are now considered suitable for angioplasty. Diagnosis and treatment of vulnerable plaques is now a new challenge. Regenerative medicine has raised great expectations, with clinical investigation running well before animal work in this field. Such basic features as cellular type, way of preparation and administration, best timing for application or adjuvant medication, are not still clear while evidence of seeding of implanted cells in myocardial tissue is still lacking. Nevertheless, cellular therapy is being applied in many centers around the world while initial clinical results have not been released yet. Aortic valves for percutaneous implantation are in a well-advanced phase of clinical investigation. The role of devices to treat mitral regurgitation is under preclinical investigation; first human experiences have just started and more time will be required for these new devices to enter the clinical setting. Closure devices are technically well developed but its usefullness and indications in several clinical circunstances are still to be determined. This article is a review of these and other relevant issues that during this year have represented significant advances in the field of interventional cardiology (AU)

[Impact of the management of a cardiac unit on cardiac care delivery. Evolution of clinical effectiveness indicators]. / Efecto de la gestión de un servicio de cardiología en la atención del paciente cardiológico. Evolución de los indicadores asistenciales.

INTRODUCTION AND OBJECTIVES: Cardiac care is one of the most important and rapidly rising costs in the healthcare system. Therefore, any improvement can produce significant savings. We analyze the evolution of classical clinical effectiveness indexes in a cardiac unit after a change in clinical management. METHODS: We reviewed overall clinical effectiveness indexes and the most significant DRGs of a cardiac unit and general hospital between 1992 and 2000. A change in management (optimization of time for studies, responsibility of professionals for tasks, close follow-up, and preventive problem management) was introduced in September 1995 by team members without a parallel change in the hospital. Clinical effectiveness indexes were compared before and after the organizational change and compared with the rest of the hospital. RESULTS: There was a progressive improvement in clinical effectiveness indexes in the hospital (reduction of 22% in length of stay). On the other hand, a significant improvement was also noted in the cardiac unit starting the month after implementing the new management strategy (reduction of 54% in the duration of the hospital stay; 9.74 days preintervention vs 4.97 days postintervention; p < 0.001). Improvement has been progressive throughout the years of follow-up. Overall indexes and specific DRG indicators improved. CONCLUSIONS: A change in management strategy can have a significant impact on cardiac care and improve clinical effectiveness. Therefore, the attitude of a small team can have a significant impact on healthcare.

Efecto de la gestión de un servicio de cardiología en la atención del paciente cardiológico. Evolución de los indicadores asistenciales / Impact of the management of a cardiac unit on cardiac care delivery. Evolution of clinical effectiveness indicators

Introducción y objetivos. La asistencia cardiológica supone un coste importante y progresivamente creciente del sistema sanitario. Su optimización puede, por tanto, conllevar un importante ahorro. Se analiza la evolución de los indicadores de hospitalización en un servicio de cardiología en el que se aplica un cambio de gestión.Métodos. Se revisan los indicadores de hospitalización globales y los de los grupos relacionados por el diagnóstico (GRD) más representativos del servicio entre los años 1992 y 2001. En septiembre de 1995 se inicia el proceso de reorganización (optimización de demoras, responsabilización del personal en determinadas actividades, seguimiento y solución de problemas) por iniciativa del propio servicio, y sin cambio simultáneo en el resto del hospital. Se comparan los indicadores asistenciales antes y después de la intervención, así como con la evolución seguida por el resto del hospital.Resultados. El hospital mejora progresivamente en los indicadores asistenciales (reducción del 22 por ciento en estancia media). El servicio de cardiología presenta una mejoría desde el mes siguiente a la aplicación de las medidas (reducción del 54 por ciento en estancia media; 9,74 días preintervención frente a 4,97 días postintervención; p < 0,001).La mejoría aparece tanto en los indicadores globales, como en los específicos de los GRD seleccionados.Conclusiones. La aplicación de sencillas medidas de gestión puede conseguir una mejora en la eficiencia de la asistencia cardiológica, con la consiguiente optimización de recursos. La actitud de un grupo reducido de profesionales puede tener un impacto significativo en la asistencia sanitaria (AU)

Guías de práctica clínica de la sociedad española de cardiología sobre requerimientos y equipamiento en hemodinámica y cardiología intervencionista / Guidelines of the Spanish Society of Cardiology on Requirements and Equipment in Hemodynamic and Interventional Cardiology

En los últimos 20 años, el trabajo en el laboratorio de hemodinámica ha sufrido una profunda transformación y, sin abandonar su finalidad diagnóstica, los procedimientos intervencionistas han adquirido un papel protagonista. El papel del laboratorio de hemodinámica ha evolucionado desde el estudio de la anatomía y función cardíaca, con finalidades únicamente diagnósticas y de evaluación de potenciales candidatos para la cirugía, a una vertiente terapéutica de tratamiento intervencionista percutáneo mediante técnicas basadas casi exclusivamente en catéteres. A medida que han ido apareciendo nuevas modalidades diagnósticas y terapéuticas dentro del laboratorio, los requerimientos humanos y técnicos, así como el nivel de formación y competencia del personal envuelto, se ha ido modificando. La finalidad de este documento es actualizar los requerimientos y equipamientos de los laboratorios de cateterismo cardíaco para la realización de estudios diagnósticos y de intervencionismo terapéutico (AU)