RESUMO
Introducción y objetivos: Los armazones vasculares bioabsorbibles (AVB) tienen el potencial de restaurar la vasomotilidad, pero se desconocen las implicaciones clínicas. En este estudio se evalúan la angina y la isquemia a largo plazo tras el implante de AVB y stents farmacoactivos metálicos (SFAm). Métodos: Estudio multicéntrico, que incluyó a pacientes tras 24 ± 6 meses de evolución sin eventos a los que se realizó ecografía de estrés y se aplicó el Seattle Angina Questionnaire (SAQ). El objetivo primario fue el resultado positivo en la ecografía de estrés. Resultados: Se incluyó a 102 pacientes tratados con AVB y 106 con SFAm, sin diferencias basales significativas. Se produjo recurrencia de la angina en 18 pacientes (17,6%) con AVB frente a 25 (23,5%) con SFAm (p = 0,37), pero los resultados del SAQ fueron significativamente mejores en el grupo AVB (frecuencia de angina, 96.0 ± 8.0 frente a 89,2 ± 29,7; p = 0,02). La ecografía de estrés fue positiva en 11/92 (11,9%) con AVB frente a 9/96 (9,4%) con SFAm (p = 0,71) y se indujo angina en 2/102 (1,9%) frente a 7/106 (6,6%) (p = 0,18), pero el desempeño en el ejercicio fue mejor con AVB incluso en aquellos con tests positivos (duración del ejercicio, 9,0 ± 2,0 frente a 7,7 ± 1,8 min; p = 0,02). Un análisis por puntuación de propensión de tratamiento ofreció resultados similares. Conclusiones: El objetivo primario fue comparable en ambos grupos. La recurrencia de la angina fue similar entre los tratados con AVB y con SFAm. El mejor estado funcional, medido por SAQ y nivel de ejercicio, detectado en pacientes con AVB tendría que confirmarse en futuros estudios
Introduction and objectives: Bioresorbable vascular scaffolds (BVS) have the potential to restore vasomotion but the clinical implications are unknown. We sought to evaluate angina and ischemia in the long-term in patients treated with BVS and metallic drug-eluting stents (mDES). Methods: Multicenter study including patients with 24 ± 6 months of uneventful follow-up, in which stress echocardiography was performed and functional status was assessed by the Seattle Angina Questionnaire (SAQ). The primary endpoint was a positive result in stress echocardiography. Results: The study included 102 patients treated with BVS and 106 with mDES. There were no differences in the patients' baseline characteristics. Recurrent angina was found in 18 patients (17.6%) in the BVS group vs 25 (23.5%) in the mDES group (P = .37), but SAQ results were significantly better in the BVS group (angina frequency 96.0 ± 8.0 vs 89.2 ± 29.7; P = .02). Stress echocardiography was positive in 11/92 (11.9%) of BVS patients vs 9/96 (9.4%) of mDES patients in the (P = .71) and angina was induced in 2/102 (1.9%) vs 7/106 (6.6%) (P = .18), respectively, but exercise performance was better in the BVS group even in those with positive tests (exercise duration 9.0 ± 2.0 minutes vs 7.7 ± 1.8 minutes; P = .02). A propensity score matching analysis yielded similar results. Conclusions: The primary endpoint was similar in both groups. In addition, recurrent angina was similar in patients with BVS and mDES. The better functional status, assessed by means of SAQ and exercise performance, detected in patients receiving BVS should be confirmed in further studies
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Angina Pectoris/epidemiologia , Isquemia Miocárdica/epidemiologia , Stents Farmacológicos/estatística & dados numéricos , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Ecocardiografia sob Estresse/métodos , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Exercício Físico , Implantes Absorvíveis , Prótese VascularRESUMO
Objetivo. Validar la escala pronóstica EAHFE-3D en una cohorte externa de pacientes atendidos por insuficiencia cardiaca aguda (ICA). Método. Estudio de cohortes multipropósito que incluyó pacientes con ICA en 3 centros hospitalarios del País Vasco entre 2011 y 2013. Se recogieron los datos demográficos (edad), clase funcional basal (New York Heart Association), clínicos (presión arterial sistólica y saturación de oxígeno basal), analíticos (natremia) y terapéuticos (ventilación mecá- nica no invasiva e inotrópicos y vasopresores) en el servicio de urgencias (SU) necesarios para el cálculo de la escala EAHFE-3D. La variable de resultado principal fue la mortalidad a tres días de la llegada al SU. Resultados. Analizamos 717 pacientes con información completa. El intercepto β el modelo fue 0,5 (IC95%: -2,7- 3,7) y la pendiente α fue de 1,3 (IC95%: 0,4-2,2). El área bajo la curva AUC (ROC) fue 0,76 (IC95%: 0,58-0,94). Conclusiones. La escala EAHFE-3D presentó una buena capacidad predictiva en nuestra muestra, no diferente a la obtenida por los autores originales, aunque no ha mostrado buena calibración. Se recomienda continuar con el proceso de validación antes de ser implementada en la práctica clínica (AU)
Objective. To validate the EAHFE-3D scale, based on the Acute Heart Failure in Emergency Departments registry, in a cohort of patients attended for acute heart failure. Methods. Study of a multipurpose cohort of patients with acute heart failure in 3 hospitals in the Basque Country between 2011 and 2013. We extracted age, baseline New York Heart Association functional class, systolic blood pressure, baseline arterial oxygen saturation, sodium level in blood, and emergency department treatments (noninvasive mechanical ventilation, use of inotropic agents and vasopressors) in order to calculate each patient's EAHFE-3D score. The main outcome variable was mortality within 3 days of arrival at the emergency department. Results. The patient sample for score validation consisted of 717 patients with complete information. The model's intercept was 0.5 (95% CI, -2.7 to 3.7) and the slope was 1.3 (95% CI, 0.4 to 2.2). The area under the receiver operating characteristic curve was 0.76 (95% CI, 0.58 to 0.94). Conclusions. The EAHFE-3D scale's ability to discriminate was good in this patient sample and similar to that reported by the authors who developed the scale; however, calibration was poor. The scale should be studied further before it is applied in clinical practice (AU)
Assuntos
Humanos , Insuficiência Cardíaca/diagnóstico , Prognóstico , Índice de Gravidade de Doença , Tomada de Decisão Clínica/métodos , Estudos de Coortes , Curva ROC , 28599 , Intervalos de ConfiançaRESUMO
OBJECTIVES: To validate the EAHFE-3D scale, based on the Acute Heart Failure in Emergency Departments registry, in a cohort of patients attended for acute heart failure. MATERIAL AND METHODS: Study of a multipurpose cohort of patients with acute heart failure in 3 hospitals in the Basque Country between 2011 and 2013. We extracted age, baseline New York Heart Association functional class, systolic blood pressure, baseline arterial oxygen saturation, sodium level in blood, and emergency department treatments (noninvasive mechanical ventilation, use of inotropic agents and vasopressors) in order to calculate each patient's EAHFE-3D score. The main outcome variable was mortality within 3 days of arrival at the emergency department. RESULTS: The patient sample for score validation consisted of 717 patients with complete information. The model's intercept was 0.5 (95% CI, -2.7 to 3.7) and the slope was 1.3 (95% CI, 0.4 to 2.2). The area under the receiver operating characteristic curve was 0.76 (95% CI, 0.58 to 0.94). CONCLUSION: The EAHFE-3D scale's ability to discriminate was good in this patient sample and similar to that reported by the authors who developed the scale; however, calibration was poor. The scale should be studied further before it is applied in clinical practice.
OBJETIVO: Validar la escala pronóstica EAHFE-3D en una cohorte externa de pacientes atendidos por insuficiencia cardiaca aguda (ICA). METODO: Estudio de cohortes multipropósito que incluyó pacientes con ICA en 3 centros hospitalarios del País Vasco entre 2011 y 2013. Se recogieron los datos demográficos (edad), clase funcional basal (New York Heart Association), clínicos (presión arterial sistólica y saturación de oxígeno basal), analíticos (natremia) y terapéuticos (ventilación mecánica no invasiva e inotrópicos y vasopresores) en el servicio de urgencias (SU) necesarios para el cálculo de la escala EAHFE-3D. La variable de resultado principal fue la mortalidad a tres días de la llegada al SU. RESULTADOS: Analizamos 717 pacientes con información completa. El intercepto ß el modelo fue 0,5 (IC95%: 2,7- 3,7) y la pendiente α fue de 1,3 (IC95%: 0,4-2,2). El área bajo la curva AUC (ROC) fue 0,76 (IC95%: 0,58-0,94). CONCLUSIONES: La escala EAHFE-3D presentó una buena capacidad predictiva en nuestra muestra, no diferente a la obtenida por los autores originales, aunque no ha mostrado buena calibración. Se recomienda continuar con el proceso de validación antes de ser implementada en la práctica clínica.
Assuntos
Insuficiência Cardíaca/mortalidade , Doença Aguda , Pressão Sanguínea , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/sangue , Humanos , Masculino , Oxigênio/sangue , Prognóstico , Sistema de Registros , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Sódio/sangue , Espanha/epidemiologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/tendências , Doenças Cardiovasculares/complicações , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Doenças Cardiovasculares/mortalidade , Infarto do Miocárdio/reabilitaçãoRESUMO
INTRODUCTION AND OBJECTIVES: Bioresorbable vascular scaffolds (BVS) have the potential to restore vasomotion but the clinical implications are unknown. We sought to evaluate angina and ischemia in the long-term in patients treated with BVS and metallic drug-eluting stents (mDES). METHODS: Multicenter study including patients with 24 ± 6 months of uneventful follow-up, in which stress echocardiography was performed and functional status was assessed by the Seattle Angina Questionnaire (SAQ). The primary endpoint was a positive result in stress echocardiography. RESULTS: The study included 102 patients treated with BVS and 106 with mDES. There were no differences in the patients' baseline characteristics. Recurrent angina was found in 18 patients (17.6%) in the BVS group vs 25 (23.5%) in the mDES group (P = .37), but SAQ results were significantly better in the BVS group (angina frequency 96.0 ± 8.0 vs 89.2 ± 29.7; P = .02). Stress echocardiography was positive in 11/92 (11.9%) of BVS patients vs 9/96 (9.4%) of mDES patients in the (P = .71) and angina was induced in 2/102 (1.9%) vs 7/106 (6.6%) (P = .18), respectively, but exercise performance was better in the BVS group even in those with positive tests (exercise duration 9.0 ± 2.0minutes vs 7.7 ± 1.8minutes; P = .02). A propensity score matching analysis yielded similar results. CONCLUSIONS: The primary endpoint was similar in both groups. In addition, recurrent angina was similar in patients with BVS and mDES. The better functional status, assessed by means of SAQ and exercise performance, detected in patients receiving BVS should be confirmed in further studies.
Assuntos
Angina Pectoris/terapia , Stents Farmacológicos , Ecocardiografia sob Estresse/métodos , Isquemia Miocárdica/terapia , Intervenção Coronária Percutânea/instrumentação , Tecidos Suporte , Implantes Absorvíveis , Idoso , Angina Pectoris/diagnóstico , Estudos de Coortes , Eletrocardiografia/métodos , Everolimo/farmacologia , Feminino , Seguimentos , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Intervenção Coronária Percutânea/métodos , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária , Fatores de Tempo , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Fatores de Risco , Liraglutida/uso terapêuticoAssuntos
Reabilitação Cardíaca/normas , Doenças Cardiovasculares/prevenção & controle , Terapia por Exercício/normas , Publicações Periódicas como Assunto , Idoso , Doenças Cardiovasculares/epidemiologia , Saúde Global , Humanos , Morbidade/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Taxa de Sobrevida/tendênciasAssuntos
Reabilitação Cardíaca , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Dietoterapia , Dislipidemias/epidemiologia , Exercício Físico , Hipertensão/epidemiologia , Fumar/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/terapia , Dieta Mediterrânea , Dislipidemias/terapia , Humanos , Hipertensão/terapia , Comportamento de Redução do Risco , Fumar/terapia , Abandono do Hábito de FumarRESUMO
Se podría definir la comorbilidad como el conjunto de enfermedades de un determinado paciente no relacionadas con el diagnóstico principal que tienen implicaciones trascendentes en la mortalidad, los resultados clínicos, la proporción de complicaciones, la clase funcional, las estancias hospitalarias y la intensidad del tratamiento. La comorbilidad es habitual en los pacientes dislipémicos y, como en otros, ocasiona modificaciones en la atención que reciben. En este sentido, es deseable que el cardiólogo conozca las indicaciones de tratamiento y los objetivos en las diferentes situaciones clínicas en que un paciente dislipémico puede presentarse, no solo en función de su riesgo total, sino de otras condiciones como la diabetes mellitus y el síndrome metabólico o la enfermedad renal crónica, o en situaciones concretas comunes como el síndrome coronario agudo, la insuficiencia cardiaca, el trasplante, las enfermedades autoinmunitarias o las infecciosas como el virus de la inmunodeficiencia humana. Es también importante conocer los aspectos más relevantes de las dislipemias familiares más comunes, por el elevado riesgo cardiovascular que comportan y por las evidencias que señalan que el diagnóstico y el tratamiento precoz cambian muy significativamente el pronóstico (AU)
Comorbidity can be defined as the occurrence in a particular patient of a number of diseases that are not related to the principal diagnosis and which have substantial implications for the risk of death, clinical outcomes, the development of complications, functional class, the period of hospitalization and treatment intensity. Comorbidity is frequently present in patients with dyslipidemia and, as with other patients, it leads to alterations in the care received. It is important that the cardiologist is aware of both the indications for treatment and treatment objectives in the different clinical contexts in which dyslipidemic patients can present, not only with respect to the patients overall risk but also with regard to the presence of other conditions, such as diabetes, metabolic syndrome or chronic kidney disease, and in commonly encountered specific clinical situations involving, for example, acute coronary syndrome, heart failure, transplantation, autoimmune disease or infectious disease, such as human immunodeficiency virus infection. It is also important to have an understanding of the principle characteristics of the more common forms of familial hyperlipidemia because they are associated with a high cardiovascular risk and because the evidence indicates that early diagnosis and treatment can have a substantial effect on prognosis (AU)
Assuntos
Humanos , Hiperlipidemia Familiar Combinada/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Anticolesterolemiantes/uso terapêutico , Hipolipemiantes/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Comorbidade , Diabetes Mellitus/fisiopatologia , Síndrome Metabólica/complicações , Hiperlipidemia Familiar Combinada/diagnóstico , Síndrome Coronariana Aguda/complicações , Hiperlipoproteinemia Tipo III/complicações , Insuficiência Renal Crônica/complicaçõesRESUMO
El tabaquismo es una enfermedad adictiva crónica con frecuentes recidivas y la primera causa de muerte evitable en el mundo. Es uno de los principales factores de riesgo de enfermedad vascular aterosclerótica coronaria y no coronaria. Los cardiólogos hemos sido muy sensibles al control de otros factores de riesgo cardiovascular como la diabetes mellitus, la hipertensión arterial y la dislipemia, pero nos hemos preocupado poco del tratamiento del hábito tabáquico. Por lo tanto, debemos esforzarnos mucho más para conseguir una reducción del consumo de tabaco en nuestros pacientes. En esta revisión analizamos la relación entre tabaco y enfermedad vascular y, con base en nuestra experiencia, describimos las bases del abordaje y el tratamiento del hábito tabáquico, resaltando la capacidad real que tenemos de deshabituar, al menos, a una tercera parte de los pacientes (AU)
Smoking is addictive and smokers who have stopped frequently return to the habit. It is the principal preventable cause of death worldwide and one of the main risk factors for the development of both coronary and non-coronary atherosclerotic vascular disease. Cardiologists have been very careful about controlling other cardiovascular risk factors such as diabetes mellitus, dyslipidemia and hypertension, but have been less concerned about promoting smoke cessation. We should, therefore, make a much greater effort to reduce tobacco consumption among our patients. This article contains a review of the relationship between smoking and vascular disease and, based on our own experience, we describe the fundamentals of how we approach and treat tobacco addiction, while highlighting the real potential we have to help at least one-third of our patients to break the habit (AU)