Liberal red blood cell transfusions impair quality of life after cardiac surgery.

BACKGROUND: The optimal blood management after cardiac surgery remains controversial. Moreover, blood transfusions may have an impact on long-term outcomes. OBJECTIVE: The aim of this study is to characterize the impact of liberal red blood cell transfusions on Health-Related Quality of life (HRQoL) after cardiac surgery. METHODS: We studied a cohort of 205 consecutive patients after ICU discharge. Baseline characteristics and clinical data were recorded, and HRQoL was assessed using the EuroQoL-5D instrument, applied 6 months after ICU discharge. A specific question regarding the improvement in the quality of life after the surgical intervention was added to the HRQoL questionnaire. Risk factors related to impaired quality of life were identified using univariate comparisons and multivariate regression techniques. RESULTS: The median (interquartile range, IQR) of transfused red blood cells was 3 (1-4). Among 205 patients, 178 were studied 6 months after discharge. Impairment in at least one dimension of the EuroQoL-5D questionnaire was observed in 120 patients, with an overall score of 0.8 (IQR 0.61-1). The number of red blood cell transfusions was related to an impaired HRQoL (OR 1.17 per additional unit, 95% confidence interval 1.03-1.36, p=0.03), a trend to lower visual analog scale score (coefficient -0.75 per additional unit, 95% confidence interval -1.61 to 0.1, p=0.09) and an absence of improvement in HRQoL after surgery compared to the previous status (OR 1.13, 95% confidence interval 1.03-1.25, p=0.01). CONCLUSIONS: Liberal red blood cell transfusions increase the risk of impaired HRQoL after cardiac surgery.

A search for cyclophilin-A gene (PPIA) variation and its contribution to the risk of atherosclerosis and myocardial infarction.

Cyclophilin A is secreted by vascular smooth muscle cells in response to inflammatory stimuli, and could thus contribute to atherosclerosis. We hypothesized that the genetic variation at the cyclophilin A gene (PPIA) could affect the risk for developing atherosclerosis and myocardial infarction. This study included 250 myocardial infarction patients (all male and < 60 years; 95% are smokers). All these cases had at least one atherosclerotic diseased coronary vessel. DNA was obtained from patients and from 250 healthy controls. The variation at the PPIA gene was determined in the patients through single-strand conformation analysis and direct sequencing of seven polymerase chain reaction fragments. Allele and genotype frequencies were compared between patients and controls. The effect of a promoter polymorphism (-11 G/C) on gene expression was in vitro analysed with luciferase-reporter assays. We found two common polymorphisms in the PPIA promoter (-11 G/C) and the 5' non-translated (+36 G/A) regions. Cells transfected with luciferase-plasmids containing the -11 G had significantly higher luciferase activity. Genotype frequencies for these polymorphisms did not differ between patients and controls. In conclusion, we reported a functional variant in the PPIA promoter. However, the PPIA variation did not significantly contribute to the risk of suffering from myocardial infarction among patients with atherosclerotic diseased vessels.

La técnica de superposición de cúspides en TAVI con dispositivo autoexpandible optimiza la profundidad del implante y reduce la necesidad de marcapasos permanente / Cusp-overlapping TAVI technique with a self-expanding device optimizes implantation depth and reduces permanent pacemaker requirement

Introducción y objetivos: Una profundidad más alta del implante percutáneo de una válvula aórtica autoexpandible minimiza el daño en el sistema de conducción y puede reducir las tasas de marcapasos permanente a 30 días. El objetivo es determinar la seguridad y la eficacia de modificar la técnica de implante clásica para el reemplazo percutáneo de la válvula aórtica a una técnica de proyección de superposición de cúspides (PSC) para lograr una profundidad más alta del implante y reducir la necesidad de marcapasos permanente. Métodos: Desde marzo de 2017 se incluyó a 226 pacientes consecutivos: 113 tratados con técnica de implante PSC frente a 113 casos consecutivos previos con implante clásico. La profundidad del implante se evaluó mediante 3 métodos en todos los pacientes (cúspide no coronaria a válvula cardiaca percutánea (VCP); media de cúspide no coronaria y cúspide coronaria izquierda a VCP y el borde más profundo de cúspide coronaria izquierda y cúspide no coronaria a VCP). Resultados: El grupo de PSC presentó una profundidad del implante menor que el del grupo de implante clásico (4,8±2,2 frente a 5,7±3,1 mm; p=0,011; 5,8±3,1 frente a 6,5±2,4 mm; p=0,095; 7,1±2,8 frente a 7,4±3,2 mm; p=0,392). A los 30 días de seguimiento, 40 pacientes (17,7%) requirieron el implante de marcapasos permanente, menos en el grupo de PSC (el 12,4 frente al 23%; p=0,036). La técnica de implante PSC protegió contra el evento principal (OR=0,45; IC95%, 0,21-0,97; p=0,043), con parecidos éxito del procedimiento y complicaciones. Conclusiones: La técnica de implante PSC es una simple modificación en el protocolo que proporciona una profundidad del implante más alta de la prótesis valvular autoexpandible con menores alteraciones de la conducción y tasas de marcapasos permanente (AU)

Introduction and objectives: This study aimed to determine the safety and efficacy of modifying the classic implantation technique for aortic transcatheter heart valve (THV) implantation to a cusp-overlap-projection (COP) technique to achieve a higher implantation depth and to reduce the burden of new permanent pacemaker implantation (PPMI) at 30 days. Aortic self-expanding THV carries an elevated risk for PPMI. A higher implantation depth minimizes the damage in the conduction system and may reduce PPMI rates. Methods: From March 2017, 226 patients were consecutively included: 113 patients were treated using the COP implantation technique compared with the previous 113 consecutive patients treated using the classic technique. In all patients, implantation depth was assessed by 3 methods (noncoronary cusp to the THV, mean of the noncoronary cusp and the left coronary cusp to the THV, and the deepest edge from the left coronary cusp and the noncoronary cusp to the THV). Results: The COP group had a lower implantation depth than the group treated with the classic technique (4.8 mm± 2.2 vs 5.7 mm± 3.1; P=.011; 5.8 mm± 3.1 vs 6.5 mm± 2.4; P=.095; 7.1 mm± 2.8 vs 7.4 mm±3.2; P=.392). Forty patients (17.7%) required a new PPMI after the 30-day follow-up but this requirement was significantly lower in the COP group (12.4% vs 23%, P=.036). The COP implantation technique consistently protected against the main event (OR, 0.45; 95%CI, 0.21-0.97; P=.043), with similar procedural success rates and complications. Conclusions: The COP implantation technique is a simple modification of the implantation protocol and provides a higher implantation depth of self-expanding-THV with lower conduction disturbances and PPMI rates (AU)

Quality of Life According to Urgency Status in De Novo Heart Transplant Recipients.

INTRODUCTION: Elective heart transplantation (HTX) aims to improve physical ability, increase survival, and improve health-related quality of life (HRQoL) in patients with chronic heart failure. Nevertheless, most patients who undergo urgent HTX are previously healthy, and a transplant could be perceived as a limitation. The aim of this study is to compare HRQoL between elective and urgent heart transplant recipients. METHODS: Cohort study including patients undergoing heart transplantation between January 1998 and March 2012 in a single center. Patients with retransplantation or multiorgan transplantation were excluded. Clinical variables including comorbidities were collected. For assessment of HRQoL, the Kansas City Cardiomyopathy Questionnaire (KCCQ) was completed by the survivors on March 2013. Univariate analysis (Mann-Whitney U test) was performed. RESULTS: Questionnaires were collected from 95 of 106 elective recipients and 28 of 33 urgent recipients. Urgent heart recipients were younger, with more cardiovascular risk factors, and ischemic etiology was the leading cause of transplant. All domain results were higher in elective heart transplant recipients, but after univariate analysis only the punctuation of the self-efficacy domain remained superior in the elective HTX group (87.5 vs 79.7, P = .034). CONCLUSION: Both urgent and elective heart transplant patients reported a good HRQoL, and there were no significant differences between their scores.

Left ventricular function after myocardial infarction: clinical and angiographic correlations.

There is a paucity of information correlating the angiographic findings immediately after myocardial infarction with the clinical status before infarction. Therefore, the coronary anatomy, collateral circulation and quantitative left ventricular function were studied in 39 patients who underwent angiography within 3 weeks of a first transmural myocardial infarction. In all patients, the vessel supplying the infarct was totally occluded at the time of angiography. Patients without angina before infarction (Group I) had fewer coronary obstructions than did patients with a long history of angina before infarction (Group II) (1.5 +/- 0.5 versus 2.5 +/- 0.5, respectively, p less than 0.001) but worse overall and regional left ventricular function. These paradoxical differences between Groups I and II were evident in patients with anterior as well as inferior infarction. Patients in Group I had significantly lower collateral scores than did patients in Group II (0.6 +/- 0.8 versus 1.9 +/- 0.9, respectively, p less than 0.0001) and 13 of 22 patients in Group I had no collateral vessels compared with only 1 of 17 in Group II (p less than 0.001). Partial preservation of anterior wall function in Group II patients with anterior infarction was related both to the presence of collateral vessels and to the more distal obstruction of the left anterior descending coronary artery in these patients as compared with patients with anterior infarction in Group I. In contrast, in patients with inferior wall infarction, no relation could be found between the presence of collateral vessels and regional left ventricular function, although only two patients in this series with inferior infarction did not have collateral vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation mechanisms during myocardial ischemia in chronic unstable angina pectoris.

Unstable angina with a clinical duration of < 2 months is characterized angiographically by a high incidence of complex lesions. Some patients have ischemic rest pain syndromes of longer duration. Thus, we retrospectively analyzed, in blinded fashion, the clinical and angiographic findings in 52 patients with unstable angina of < 2 months' duration (group A), and compared the results with those of 32 patients with unstable angina of > 6 months' duration (group B). Group B had a greater number of diseased vessels and better collateral circulation, but had fewer eccentric lesions. There were no differences in age, left ventricular function, or history of prior myocardial infarction. Thus, chronic unstable angina is associated with more extensive coronary disease than unstable angina of shorter duration. The role of different anatomic substrata and collateral circulation is discussed.

Stenting the stent: initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis.

Stent restenosis constitutes a therapeutic challenge affecting an increasing number of patients. Conventional angioplasty and debulking techniques are currently used in these patients. However, the potential role of a second stent implantation in this setting (stenting the stent) remains unknown. Therefore, 65 consecutive patients (12 women, aged 62 +/- 11 years) undergoing stent implantation (42 elective and 23 unplanned) for the treatment of in-stent restenosis (diffuse [> 10 mm] in 39 [60%]) were studied. Angiographic success was obtained in all patients. Three patients developed hospital complications: 1 died from refractory heart failure and 2 suffered non-Q-wave myocardial infarctions. During follow-up (mean 17 +/- 11 months) 1 patient died (noncardiac cause) and only 9 (14%) required target vessel revascularization. Kaplan-Meier event-free survival (freedom from death, myocardial infarction, and target vessel revascularization) at 1 year was 84%. Using Cox analysis, patients with unstable symptoms, a short time to stent restenosis, nonelective stenting, and B2-C lesions tended to have poorer prognosis. After adjustment, nonelective stenting was associated (adjusted RR 2.9, 95% confidence interval [CI] 0.82 to 10.3, p = 0.09) with an adverse clinical outcome. On quantitative angiography (core lab) restenosis was found in 13 of 43 patients (30%) (75% of those eligible). Logistic regression analysis identify restenosis length (adjusted RR 1.43, 95% CI 1.04 to 2.14, p = 0.04), and time to restenosis (adjusted RR 0.67, 95% CI 0.47 to 0.94, p = 0.01) as the only independent predictors of recurrent restenosis. Thus, repeat coronary stenting is a safe and efficacious strategy for the treatment of patients with in-stent restenosis. Both elective and nonelective stenting provide excellent initial results. The long-term clinical and angiographic outcome of these patients is also favorable.

Double-chamber right ventricle in a 63-year-old woman.

Double-chamber right ventricle (DCRV) is a rare congenital heart disease consisting in right ventricular obstruction due to one or several anomalous muscle bundles that divide the right ventricle into two chambers. Because of the rarity of this anomaly in adults, we present the case of a 63-year-old woman suffering from this heart disease, being on the other hand, one of the few cases described in the literature in such an old patient.

[Registry of activities of the Section of Hemodynamics and Interventional Cardiology in 1997]. / Registro de actividad de la Sección de Hemodinámica y Cardiología Intervencionista del año 1997.

The results of the Spanish Registry of Hemodynamic and Interventional Cardiology in 1997 are presented. The Registry collects the activity of 83 centers which constitute all the cardiac catheterization laboratories in Spain. The main activity was adult cardiac catheterization in 75 centers and exclusively pediatric cardiac catheterization in 8. A total of 72,370 diagnostic catheterization procedures, 80% coronary angiographies (57,960; 1,462 per million inhabitants), were performed which represents a 13% total increase compared to 1996. Coronary intervention increased by 23% compared to 1996, for a total number of 18,545 procedures. The ratio of coronary interventions per million inhabitants was 468. Success rates of coronary interventions (91.3%) and complications (3.7%) were similar to those registered in previous years. In the specific field of revascularization devices, there has been a dramatic increase in the use of stents. In 1997, coronary stents were employed in 11,417 cases (a 61% increase compared to 1996) which represents 61.5% of all coronary revascularizations procedures. A total of 14,170 prosthesis were implanted, 72% in a elective way, with a low rate of complications (0.95% subacute closure; 1.45% myocardial infarction and 0.75% mortality). Compared to 1996, directional coronary atherectomy (92 procedures) showed a slight decrease, whereas rotational atherectomy (554 procedures) increased by 49% with double the number of centers performing this technique. As in previous years, a slight decrease (7% compared to 1996) in adult valvuloplasties (559 vs 599) was noted. Pediatric interventional procedures decreased by 17% (465 vs 558 procedures) compared to the 1996 Registry.

[The Registry of the Activities of the Hemodynamics and Interventional Cardiology Section in 1998]. / Registro de Actividad de la Sección de Hemodinámica y Cardiología Intervencionista del año 1998.

The results of the Spanish Registry of Hemodynamic and Interventional Cardiology of the Spanish Society of Cardiology in 1998 are hereby presented. The Registry collects the activity of 82 centers, which constitutes all the cardiac catheterization laboratories in Spain. The main activity was adult cardiac catheterization in 75 centers, and exclusively pediatric cardiac catheterization in 7. A total of 74,364 diagnostic catheterization procedures, 80% coronary angiographies (59,321; 1,498 per million inhabitants), were performed, which represents a 2.8% total increase compared to 1997. Coronary intervention increased by 8.6% compared to 1997, for a total number of 20,146 procedures. The ratio of coronary interventions per million inhabitants was 509. Success rates of coronary interventions (94%) and complications (2.3%) are similar to those registered in previous years, and in 9.7% of the cases, IIb-IIIa glicoprotein inhibitors were used. A 8.6% of the procedures were performed in order to treat an acute myocardial infarction. Coronary stenting is, continues to be the main device for coronary intervention. In 1998, coronary stents were employed in 14,497 cases (a 27% increase compared to 1997) which represents the 72% of all coronary revascularizations procedures. A total of 19,378 prosthesis were implanted, 83% in a elective way and 12.9% primary stenting, with a low rate of complications (1.5% subacute closure, 1.5% myocardial infarction and 0.94% mortality). Compared to 1997, directional coronary atherectomy (83 procedures) showed a slight decrease, whereas rotational atherectomy (549 procedures) has stabilized the number of procedures and centers performing this technique. As in previous years, a slight decrease (9% compared to 1997) in adult valvuloplasties (505 vs 559) were noted. Pediatric interventional procedures increased by 20% (557 vs 465 procedures) compared to the 1997 Registry.

[Spanish Registry of the Section of Hemodynamic and Interventional Cardiology Activity for 1999]. / Registro de actividad de la Sección de Hemodinámica y Cardiología Intervencionista del año 1999.

The results of the Spanish Registry of Hemodynamic and Interventional Cardiology in 1999 are presented. The activity of 90 centers representing all the cardiac catheterization laboratories in Spain is reported, with 83 centers performing mainly adult cardiac catheterization and 7 centers exclusively carrying out pediatric cardiac catheterization. In 1999, a total of 82,805 diagnostic catheterization procedures, 79% being coronary angiographies (65,234; 1,637 per million inhabitants), were performed, representing a total increase of 11.4% compared to 1998. Compared to 1998, coronary intervention increased by 14.2%, with a total number of 23,010 procedures. The ratio of coronary interventions per million inhabitants was 590. Success rates for coronary interventions (94%) and complications (2.2%) were similar to those registered in previous years, and in 12.4% of the cases IIb-IIIa glycoprotein inhibitors were used. Ten point two per cent of the procedures were performed to treat acute myocardial infarction. Coronary stenting is the main device for coronary intervention. In 1999, coronary stents were used in 17,783 cases (23% increase compared to 1998), representing 77.3% of all coronary revascularization procedures. A total of 22,946 prostheses were implanted, 87% electively and 21.4% as a primary stenting procedure, with a low rate of complications (0.85% subacute closure, 1.95% myocardial infarction and 0.9% mortality). Compared to 1998, both directional coronary atherectomy (52 procedures) and rotational atherectomy (473 procedures) showed a slight decrease.A slight increase (4% compared to 1998) was reported in adult valvuloplasties (525 vs 505)while pediatric interventional procedures increased by 21% (678 vs 557 procedures) compared to 1998. In conclusion, we would like to underline the high degree of laboratory participation in the Registry, and despite the increase in activity, the current rates remain lower than European figures.

[Spontaneous calcific embolization in calcified aortic valve stenosis. A case report]. / Embolia cálcica espontánea en la estenosis valvular aórtica calcificada. Presentación de un caso.

Calcific embolism from an aortic stenosis is an uncommon event that can be seen after cardiac surgery or left heart catheterization but extremely rare in a spontaneous way. We report a case of a patient with calcified aortic stenosis presenting a spontaneous calcareous embolism in the retinal artery. We review the literature about this problem as well.

[The long-term evolution of patients with senile aortic stenosis undergoing percutaneous valve dilatation]. / Evolución a largo plazo de los pacientes con estenosis aórtica senil sometidos a dilatación valvular percutánea.

The long-term follow-up of 35 patients with mean age of 74.3 +/- 8 years (64-86) who underwent percutaneous aortic valvuloplasty (PAV) is presented. The mean duration of the follow-up study was 33 months (range 1-48). Global mortality was 42% (14 patients) and was related to post-PAV aortic valvular area (47% mortality in less than 0.7 cm2 area group vs 28% in greater than or equal to 0.7 cm2 group) and left ventricular ejection fraction (67% in EF less than 35% group vs 35% in EF greater than or equal to 35% group). The actuarial probability of remaining alive and free of symptoms and of cardiac surgery or new PAV was 57, 41, 33, and 20% at 1, 2, 3 and 4 years. After PAV clinical improvement was obtained in most of the patients (68%), but only 42% of those with successful dilatation remain asymptomatic after a 24 months period (85 +/- 28 mmHg, p = NS). Transvalvular gradient studied by Doppler decreased immediately after PAV (92.8 +/- 26 mmHg vs 51 +/- 16 mmHg, p less than 0.001), but returned to baseline values after 12 months. These results show that PAV yields a clinical improvement in most of the patients, but this improvement is transitory, does not modify the natural history of the disease and has a high degree of restenosis. Thus, its use must be limited to a reduced group of patients who are not candidates for cardiac surgery.

[Coronary spasm and heart arrest caused by ventricular fibrillation]. / Espasmo coronario y parada cardíaca por fibrilación ventricular.

We report the cases of three young men, heavy smokers, without previous heart disease and who were resuscitated after cardiac arrest due to ventricular fibrillation attributed to coronary spasm. All of them complained of atypical chest pain and the exercise testing, echocardiogram and coronary angiography were normal. The first case was diagnosed by Holter monitoring and by provocative testing with intracoronary ergonovine; the second by provocative testing with intracoronary acetylcholine and the third by Holter monitoring. The patients were treated with a calcium antagonist and/or nitrates and in the follow up they remained asymptomatic.

[Adult congenital anomalies of the coronary arteries described over 31 years of angiographic studies in the Asturias Principality: main angiographic and clinical characteristics]. / Anomalías congénitas de las arterias coronarias del adulto descritas en 31 años de estudios coronariográficos en el Principado de Asturias: principales características angiográficas y clínicas.

OBJECTIVE: The aim of this study was to determine the incidence of adult congenital anomalies of the coronary arteries over 31 years of angiographic studies, describing their angiographic and clinical characteristics. The results have been compared with the main series published. METHODS: The diagnostic angiographic reports done in the Principado de Asturias from 1968 to 1999 are reviewed. In those in which a congenital anomaly was diagnosed, the clinical report and the angiography were studied. The initial course of the anomaly was defined following angiographic criteria. RESULTS: Thirteen thousand five hundred reports were reviewed describing 75 patients with 75 anomalies (0.5%) including: anomalous origin of the left circumflex coronary artery (n = 24), coronary artery fistulae (n = 21), both coronary arteries arising from the left coronary sinus (n = 15), single coronary arteries (n = 6), both coronary arteries arising from the right coronary sinus (n = 2), separated origin of anterior descending and left circumflex coronary arteries (n = 3), anterior descending artery arising from the right coronary sinus (n = 2), and others (n = 1). Angiographic studies were done because of: angina (59%), dysnea (25%), atypical chest pain (7%), syncope (3%), dizziness (3%) and palpitations (3%). The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, anterior in the anterior descending arteries and retroaortic, septal and combined, in the left coronaries. CONCLUSIONS: Adult congenital anomalies of the coronary arteries are not very common and are usually casual findings of diagnostic angiographic studies. Left circumflex coronary artery anomalies are the most frequently diagnosed.

[Thyroid cancer treatment]. / Le traitement des cancers du corps thyroïde.

INTRODUCTION: Thyroid diseases are common although cancer is rare. There are some controversial issues concerning the extent of surgical treatment of thyroid cancer. MATERIALS AND METHODS: We have studied 614 cases of thyroidectomy inducing 82 of mostly papillary and follicular thyroid cancers. RESULTS AND DISCUSSION: We observed that differentiated thyroid cancer has a predilection for the right lobe and one third of papillary tumors are multifocal. We have seen that fine needle aspiration cytology is the most useful preoperative study. Intraoperative frozen biopsy has a good specificity but sensitivity is low in our series, specially for follicular neoplasms. The treatment in our series consisted in total thyroidectomy and, in differentiated cancers, postoperative I-131. Survival is very good for differentiated cancers. Prognosis is poor for anaplastic carcinoma in the short term.

[Heart hydatidosis diagnoses with bidimensional echocardiography]. / Hidatidosis cardíaca diagnosticada por ecocardiografía bidimensional.

A case of calcificated intramyocardiac hydatid cyst is presented. The initial diagnosis was coronary artery disease and the onset was chest pain and typical abnormalities of the electrocardiogram. The diagnosis of hydatid disease was suspected from chest roentgenogram and confirmed by two-dimensional echocardiography and left ventriculography. Coronary arteriography was normal and surgical treatment successfully carried out.

Impact of reperfusion strategy on outcomes in very elderly patients with acute myocardial infarction.

AIM: The best reperfusion strategy for patients of advanced age (either primary-angioplasty or thrombolysis) after a ST-segment elevation myocardial infarction (STEMI) remains controversial. Aim of the study was to test differences in morbidity and mortality regarding the reperfusion strategy adopted. METHODS: From 2007-2012, 182 patients ≥85 year-old with STEMI were admitted to the coronary care unit of two tertiary centers. Data regarding baseline characteristics, clinical presentation, reperfusion strategy adopted and outcomes were retrospectively reviewed. The relation between the type of reperfusion therapy and outcomes was evaluated. RESULTS: Median age was 86.8±6.9 years (range 85-96). Most patients (54.4%) were woman. Anterior wall STEMI was the main electrocardiographic location (45.1%). A conservative treatment was seen in 64 patients (35.2%), thrombolysis in 41 (22.5%) and primary-angioplasty in the remaining 77 patients (42.3%). A total of 56 patients died (30.8%). The mortality rate in the thrombolysis group (21.9%) was similar than that found in the primary-angioplasty group (15.6%) (P=0.45). No difference was found in a subgroup analysis of high risk patients (i.e. anterior wall STEMI, Killip class ≥2). Morbidity rates were also similar between both therapeutic groups (thrombolisys 58.5% vs. primary-angioplasty 46.7%, P=0.22). Morbidity and mortality rates were much higher among those patients treated conservatively than that found in patients who received any of the reperfusion strategies (54.6% vs. 17.8%, P<0.0001 and 79.7% vs. 50.8%, P<0.0001, respectively). CONCLUSIONS: Mortality and morbidity among very elderly patients with STEMI are extremely high. No differences were found between primary-angioplasty and fibrinolysis with regard to outcomes. A conservative treatment was associated with a worse prognosis.

Liberal red blood cell transfusions impair quality of life after cardiac surgery / La transfusión liberal de concentrado de hematíes deteriora la calidad de vida después de la cirugía cardíaca

Background: The optimal blood management after cardiac surgery remains controversial. Moreover, blood transfusions may have an impact on long-term outcomes. Objective: The aim of this study is to characterize the impact of liberal red blood cell transfusions on Health-Related Quality of life (HRQoL) after cardiac surgery. Methods: We studied a cohort of 205 consecutive patients after ICU discharge. Baseline characteristics and clinical data were recorded, and HRQoL was assessed using the EuroQoL-5D instrument, applied 6 months after ICU discharge. A specific question regarding the improvement in the quality of life after the surgical intervention was added to the HRQoL questionnaire. Risk factors related to impaired quality of life were identified using univariate comparisons and multivariate regression techniques. Results: The median (interquartile range, IQR) of transfused red blood cells was 3 (1-4). Among 205 patients, 178 were studied 6 months after discharge. Impairment in at least one dimension of the EuroQoL-5D questionnaire was observed in 120 patients, with an overall score of 0.8 (IQR 0.61-1). The number of red blood cell transfusions was related to an impaired HRQoL (OR 1.17 per additional unit, 95% confidence interval 1.03-1.36, p=0.03), a trend to lower visual analog scale score (coefficient −0.75 per additional unit, 95% confidence interval −1.61 to 0.1, p=0.09) and an absence of improvement in HRQoL after surgery compared to the previous status (OR 1.13, 95% confidence interval 1.03-1.25, p=0.01). Conclusions: Liberal red blood cell transfusions increase the risk of impaired HRQoL after cardiac surgery

Antecedentes: El manejo óptimo de la sangre después de cirugía cardíaca sigue siendo controvertido. Objetivo: Analizar el impacto de la transfusión liberal de concentrado de hematíes (CdH) sobre la calidad de vida relacionada con la salud (CVRS) después de la cirugía cardíaca. Métodos: Se estudió una cohorte de 205 pacientes consecutivos. Se registraron las características basales y los datos clínicos, y se evaluó la CVRS utilizando el EuroQoL-5D, 6 meses después del alta de la UCI. Se añadió una pregunta específica sobre la mejoría de la CVRS tras la cirugía cardiaca. Los factores de riesgo relacionados con la alteración de la CVRS se identificaron mediante el uso de comparaciones univariadas y técnicas de regresión multivariante. Resultados: La mediana (rango intercuartílico [IQR]) de los CdH transfundidos fue de 3 (1-4). De 205 pacientes, 178 fueron estudiados 6 meses después del alta, 120 pacientes (67%) mostraron deficiencias en alguna dimensión del cuestionario EuroQoL-5D, con un puntaje general de 0,8 (IQR: 0,61-1). El número de transfusiones de CdH se relacionó con una CVRS deteriorada (OR: 1,17 por unidad adicional; intervalo de confianza del 95%: 1,03-1,36; p=0,03), menor escala analógica visual (coeficiente: −0,75 por unidad adicional, intervalo de confianza del 95%: −1,61-0,1; p=0,09) y una ausencia de mejoría en la CVRS después de la cirugía en comparación con el estado previo (OR: 1,13; intervalo de confianza del 95%: 1,03-1,25; p=0,01). Conclusión: La transfusión liberal de CdH aumenta el riesgo de deterioro de la CVRS después de la cirugía cardíaca