Long-term (5 years) effects of bosentan in patients with pulmonary arterial hypertension.

INTRODUCTION AND OBJECTIVES: Bosentan has proven efficacy in pulmonary hypertension in the short term. Little is known about its effects beyond 2 to 3 years. Our objective was to analyze the efficacy and safety of bosentan in the long term (5 years) in patients treated in our center. METHODS: This retrospective study sequentially analyzed clinical, functional, and laboratory parameters in a series of patients treated initially with bosentan as monotherapy from 2002 to 2009 in a single hospital. Treatment success was defined as survival without clinical worsening that required additional pulmonary vasodilators. RESULTS: We included 20 patients (70% women, mean age 46 ± 14 years, 65% congenital heart disease), with a median follow-up of 64 months. One patient required withdrawal of bosentan due to adverse effects. At 4 months, significant improvements were achieved in hemodynamic, clinical and functional parameters. Clinical and functional benefits persisted at 5-year follow-up. Overall 5-year survival after beginning bosentan therapy was 95% (84%-100%). Treatment success at 1, 2, 3, 4 and 5 years was 95% (84%-100%), 83% (65%-100%), 78% (58%-98%), 61% (38%-84%), and 41% (16%-66%), respectively. The group with better outcomes had NT-proBNP levels at 1 year <400 pg/mL (P=.013). CONCLUSIONS: In our series, treatment success with bosentan in monotherapy was maintained in 78% at 3-year follow-up and 41% at 5-year follow-up. The group with long-term success showed significantly lower NT-proBNP levels at 1-year follow-up. Survival at 5 years in our series was 95%.

[Primary percutaneous angioplasty. An analysis of reperfusion delays, their determining factors and their prognostic implications]. / Angioplastia primaria en nuestro medio. Análisis de los retrasos hasta la reperfusión, sus condicionantes y su implicación pronóstica.

INTRODUCTION AND OBJECTIVES: The optimum treatment for patients with ST-segment elevation acute myocardial infraction (AMI) is primary percutaneous coronary intervention (PCI), provided that the door-to-balloon time is less than 90 min. The aims of this study were to determine actual treatment times in our patients, to investigate the effect of different factors in reducing those times, and to evaluate the impact of any delay on prognosis. METHODS: The study involved patients who underwent primary or rescue PCI at our center between January 2005 and October 2007. Treatment times, clinical and angiographic characteristics, and follow-up findings at 1 and 12 months were recorded prospectively. RESULTS: Overall, 389 PCIs were performed: 361 primary and 28 rescue interventions. The median total duration of ischemia was 235 [interquartile range, 170-335] min. The median door-to-balloon time was 79 [53-104] min. The door-to-balloon time was shorter when the ambulance service was able to notify the on-duty cardiologist, who alerted the interventional cardiology team. The difference was 30 [60-90] min (P< .01). Patients who arrived at the emergency department by their own means had the longest door-to-balloon time (100 min vs. 74 min; P< .01). A door-to-balloon time >120 min was associated with higher mortality at 30 days; multivariate analysis showed a clearly increasing trend. CONCLUSIONS: The door-to-balloon time at our center was in line with current recommendations, with the time being markedly shorter for patients for whom the ambulance service was able to give advanced warning. A shorter time was associated with a trend towards lower 30-day mortality.

Efectos a largo plazo (5 años) de bosentán en pacientes con hipertensión arterial pulmonar / Long-term (5 Years) effects of bosentan in patients with pulmonary arterial hypertension

Introducción y objetivos. Bosentán ha demostrado eficacia en el tratamiento de la hipertensión pulmonar a corto plazo. Sus efectos después de 2-3 años son poco conocidos. Nuestro objetivo es analizar la eficacia y la seguridad a largo plazo (5 años) del bosentán en los pacientes tratados en nuestra unidad. Métodos. Se analizaron en forma retrospectiva y secuencial diversos parámetros clínicos, funcionales y analíticos en una serie unicéntrica de pacientes tratados con bosentán en monoterapia desde 2002 hasta 2009. El éxito terapéutico se definió como supervivencia sin eventos clínicos o deterioro que requiriese adición de otros vasodilatadores pulmonares. Resultados. La serie incluye a 20 pacientes (el 70% mujeres; media de edad, 46±14 años; el 65% con cardiopatías congénitas), con una mediana de seguimiento de 64 meses. A corto plazo, se observó una mejoría significativa de parámetros hemodinámicos, clínicos y funcionales, que en los dos últimos se mantuvo a los 5 años. La supervivencia total a 5 años fue del 95% (84-100%). El éxito terapéutico se mantuvo a 1, 2, 3, 4 y 5 años en el 95% (84-100%), el 83% (65-100%), el 78% (58-98%), el 61% (38-84%) y el 41% (16-66%), respectivamente. El grupo con mejor evolución a largo plazo se caracterizó por cifras de NT-proBNP al año < 400 pg/ml (p=0,013). Conclusiones. En esta serie, el éxito terapéutico obtenido con bosentán en monoterapia se mantuvo en el 78% a 3 años y en el 41% a 5 años. El grupo con éxito a largo plazo mostró valores más bajos de NT-proBNP al año del tratamiento. La supervivencia a 5 años fue del 95% (AU)

Introduction and objectives. Bosentan has proven efficacy in pulmonary hypertension in the short term. Little is known about its effects beyond 2 to 3 years. Our objective was to analyze the efficacy and safety of bosentan in the long term (5 years) in patients treated in our center. Methods. This retrospective study sequentially analyzed clinical, functional, and laboratory parameters in a series of patients treated initially with bosentan as monotherapy from 2002 to 2009 in a single hospital. Treatment success was defined as survival without clinical worsening that required additional pulmonary vasodilators. Results. We included 20 patients (70% women, mean age 46±14 years, 65% congenital heart disease), with a median follow-up of 64 months. One patient required withdrawal of bosentan due to adverse effects. At 4 months, significant improvements were achieved in hemodynamic, clinical and functional parameters. Clinical and functional benefits persisted at 5-year follow-up. Overall 5-year survival after beginning bosentan therapy was 95% (84%-100%). Treatment success at 1, 2, 3, 4 and 5 years was 95% (84%-100%), 83% (65%-100%), 78% (58%-98%), 61% (38%-84%), and 41% (16%-66%), respectively. The group with better outcomes had NT-proBNP levels at 1 year<400 pg="" ml=""> P=.013). Conclusions. In our series, treatment success with bosentan in monotherapy was maintained in 78% at 3-year follow-up and 41% at 5-year follow-up. The group with long-term success showed significantly lower NT-proBNP levels at 1-year follow-up. Survival at 5 years in our series was 95% (AU)

Angioplastia primaria en nuestro medio. Análisis de los retrasos hasta la reperfusión, sus condicionantes y su implicación pronóstica / Primary percutaneous angioplasty. An analysis of reperfusion delays, their determining factors and their prognostic implications

Introducción y objetivos. El mejor tratamiento para el IAM con elevación del ST es la ICPP siempre que el tiempo puerta-balón sea < 90 min. Presentamos nuestros tiempos reales y valoramos la influencia de determinados factores en su reducción, y la evolución en relación con el tiempo de demora. Métodos. Hemos recogido de manera prospectiva los tiempos, los datos clínicos y angiográficos y el seguimiento a 1 y 12 meses de los pacientes a los que se realizó una ICPP o de rescate en nuestro centro de enero de 2005 a octubre de 2007. Resultados. Se realizaron 389 angioplastias, 361 primarias y 28 de rescate. La mediana del tiempo de isquemia fue 235 [percentiles 25-75, 170-335] min. La mediana del TPG fue 79 [53-104] min. El TPG fue menor cuando el servicio de transporte urgente avisó al cardiólogo de guardia, quien puso en marcha la alerta de hemodinámica, con una diferencia de 30 [90-60] min (p < 0,01). Los pacientes que llegaron a la urgencia por sus propios medios presentaron el mayor tiempo puerta-guía (100 frente a 74 min; p < 0,01). El tiempo puerta-guía > 120 min se asoció a mayor mortalidad a 30 días y a una clara tendencia a aumentarla en el análisis multivariable. Conclusiones. El tiempo puerta-guía en nuestro medio se ajusta a las recomendaciones vigentes, con una clara reducción cuando el servicio de transporte urgente avisa con antelación. Su reducción se relaciona con una tendencia a una menor mortalidad a 30 días (AU)

Introduction and objectives. The optimum treatment for patients with ST-segment elevation acute myocardial infraction (AMI) is primary percutaneous coronary intervention (PCI), provided that the door-to-balloon time is less than 90 min. The aims of this study were to determine actual treatment times in our patients, to investigate the effect of different factors in reducing those times, and to evaluate the impact of any delay on prognosis. Methods. The study involved patients who underwent primary or rescue PCI at our center between January 2005 and October 2007. Treatment times, clinical and angiographic characteristics, and follow-up findings at 1 and 12 months were recorded prospectively. Results. Overall, 389 PCIs were performed: 361 primary and 28 rescue interventions. The median total duration of ischemia was 235 [interquartile range, 170-335] min. The median door-to-balloon time was 79 [53-104] min. The door-to-balloon time was shorter when the ambulance service was able to notify the on-duty cardiologist, who alerted the interventional cardiology team. The difference was 30 [60-90] min (P<.01). Patients who arrived at the emergency department by their own means had the longest door-to-balloon time (100 min vs. 74 min; P<.01). A door-to-balloon time >120 min was associated with higher mortality at 30 days; multivariate analysis showed a clearly increasing trend. Conclusions. The door-to-balloon time at our center was in line with current recommendations, with the time being markedly shorter for patients for whom the ambulance service was able to give advanced warning. A shorter time was associated with a trend towards lower 30-day mortality (AU)