"INTERGROWTH21st vs customized fetal growth curves in the assessment of the neonatal nutritional status: a retrospective cohort study of gestational diabetes".

BACKGROUND: Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers. METHODS: This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. The nutritional status of newborns was assessed using the ponderal index. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios. RESULTS: Two hundred thirty-one pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%). CONCLUSIONS: In pregnant women with DMG, the ability of customized fetal growth curves to identify newborns with alterations in nutritional status appears to exceed that of INTERGROWTH21st.

High First Trimester Levels of TSH as an Independent Risk Factor for Gestational Diabetes Mellitus: A Retrospective Cohort Study.

Although numerous articles have found an association between alterations in thyroid function and the risk of gestational diabetes mellitus (GDM), other studies have failed to demonstrate this association. This may be due to the different cut-off points used to define subclinical hypothyroidism. We aim to clarify the role of thyroid stimulating hormone (TSH) level in GDM within pregnant women with normal free thyroxine (fT4) levels. This retrospective cohort study was performed in 6775 pregnant women. The association between TSH and GDM was assessed by bivariate and multivariate logistic regression. Pregnant women with subclinical hypothyroidism are at significantly greater risk for GDM when compared with euthyroid pregnant women (OR = 1.85; 95% CI = 1.36-2.52). We have also observed that TSH levels increase the risk of GDM within euthyroid pregnant women, since the TSH levels between 2.5 and 4.71 showed a higher risk of GDM than those whose TSH levels are between 0.31 and 2.49 (OR = 1.54; 95% CI = 1.28-1.84). In addition, pregnant women with positive thyroid antibodies have almost 2.5 times the risk of developing GDM (OR = 2.47; 95% CI = 1.57-3.89). Our results support that in pregnant women with normal fT4 levels, higher first trimester TSH level implies a higher risk of GDM.

Genetic Profile of Patients with Limb-Girdle Muscle Weakness in the Chilean Population.

Hereditary myopathies are a group of genetically determined muscle disorders comprising more than 300 entities. In Chile, there are no specific registries of the distinct forms of these myopathies. We now report the genetic findings of a series of Chilean patients presenting with limb-girdle muscle weakness of unknown etiology. Eighty-two patients were explored using high-throughput sequencing approaches with neuromuscular gene panels, establishing a definite genetic diagnosis in 49 patients (59.8%) and a highly probable genetic diagnosis in eight additional cases (9.8%). The most frequent causative genes identified were DYSF and CAPN3, accounting for 22% and 8.5% of the cases, respectively, followed by DMD (4.9%) and RYR1 (4.9%). The remaining 17 causative genes were present in one or two cases only. Twelve novel variants were identified. Five patients (6.1%) carried a variant of uncertain significance in genes partially matching the clinical phenotype. Twenty patients (24.4%) did not carry a pathogenic or likely pathogenic variant in the phenotypically related genes, including five patients (6.1%) presenting an autoimmune neuromuscular disorder. The relative frequency of the different forms of myopathy in Chile is like that of other series reported from different regions of the world with perhaps a relatively higher incidence of dysferlinopathy.

Seroprevalence of viral infections in domestic cats in Costa Rica.

A cross-sectional survey of a convenient sample of domestic cats from Costa Rica's greater metropolitan area was carried out to determine the prevalence of antibodies against feline herpesvirus type 1 (FHV-1), feline parvovirus (FPV), feline immunodeficiency virus (FIV) and antigens of feline leukemia virus (FeLV). Blood samples were collected from at least 96 cats from June 1998 to December 2001; data related to the individual cats and household variables were obtained using a questionnaire. Antibodies against FHV-1 were found in 71.9% of the cats sampled, but only 25.0% of them had a history of previous vaccination. The prevalence of FPV was 92.8%, and all positive cats showed protective antibodies titres; however, only 16.5% of them were previously vaccinated. Antigens of FeLV were detected in 16.7% of the sampled cats; 11 (64.7%) of the 17 positive cats were older than 1 year at the time of testing. No differences were found between the percentage of seropositive males and females. Antibodies against FIV were detected in 8.8% of the samples tested; 8 (88.8%) of the seropositive cats were older than 1 year of age, and a greater proportion of seropositive males (66.6%) was found.

Sticking with the Pointy End? Molecular Configuration of Chloro Boron-Subphthalocyanine on Cu(111).

In this combined low-temperature scanning tunneling microscopy (STM) and density functional theory (DFT) study, we investigate self-assembly of the dipolar nonplanar organic semiconductor chloro boron-subphthalocyanine (ClB-SubPc) on Cu(111). We observe multiple distinct adsorption configurations and demonstrate that these can only be understood by taking surface-catalyzed dechlorination into account. A detailed investigation of possible adsorption configurations and the comparison of experimental and computational STM images demonstrates that the configurations correspond to "Cl-up" molecules with the B-Cl moiety pointing toward the vacuum side of the interface, and dechlorinated molecules. In contrast to the standard interpretation of adsorption of nonplanar molecules in the phthalocyanine family, we find no evidence for "Cl-down" molecules where the B-Cl moiety would be pointing toward the Cu surface. We show computationally that such a configuration is unstable and thus is highly unlikely to occur for ClB-SubPc on Cu(111). Using these assignments, we discuss the different self-assembly motifs in the submonolayer coverage regime. The combination of DFT and STM is essential to gain a full atomistic understanding of the surface-molecule interactions, and our findings imply that phthalocyanines may undergo surface-catalyzed reactions hitherto not considered. Our results also indicate that care has to be taken when analyzing possible adsorption configurations of polar members of the phthalocyanine family, especially when they are adsorbed on comparably reactive surfaces like Cu(111).

Desarrollo psicomotor a los 18 meses de edad cronológica en recién nacidos de pretérminos extremos: comparación entre edad cronológica y edad corregida / Psychomotor development at 18 months of chronological age in extreme preterm infants: comparison between chronological age and corrected age

En recién nacidos pretérmino extremo (RNPTE) históricamente se ha utilizado la edad corregida (ECo) en la evaluación del desarrollo psicomotor (DSM). Existe controversia en la evidencia respecto de utilidad de esta práctica y riesgo de sobrecorregir. OBJETIVOS: escribir DSM a 18 meses edad cronológica (ECr) en RNPTE, y compararlo con DSM según ECo. OBJETIVO SECUNDARIO: evaluar presencia de patologías o complicaciones de prematurez, en pacientes con retraso en algún área de DSM según ECr. Pacientes y MÉTODO: Estudio de cohorte prospectivo que incluyó RNPTE nacidos en Hospital San José entre Enero y Octubre 2016 con seguimiento en Hospital Roberto del Río. Se aplicó test de Bayley III a 18 meses de ECr y se comparó resultados con ECo. El retraso en algún área según ECr implicó una evaluación clínica neurológica. RESULTADOS: Nacieron 111 pacientes RNPTE entre enero-octubre 2016, 55 participaron del estudio. Según ECr catalogaron 30 pacientes normales y 21 en riesgo. Según ECo, 46 fueron catalogados normales y 5 en riesgo. Los 4 pacientes con retraso según ECr, persistieron en retraso al evaluar según ECo. Evaluación neurológica en pacientes con retraso evidenció trastornos neurológicos que explicaban esta condición. CONCLUSIÓN: Evaluar DSM en RNPTE a 18 meses de ECr permitiría detección de pacientes con riesgo de retraso, a diferencia de lo evaluado por Eco, que es relevante para seguimiento neurológico estrecho. Todos los RNPTE con retraso de DSM en algún área presentan un trastorno neurológico severo que lo explica y no es un desarrollo "madurativo" enlentecido de la prematurez.

In extreme preterm newborns (EPN), corrected age (CoA) has historically been used to evaluate psychomotor development (PSD). There is controversy in the evidence regarding this practice's usefulness and the risk of overcorrection. OBJECTIVE: To describe PSD at 18 months of chronological age (ChrA) in EPN and compare it with CoA. SECONDARY OBJECTIVE: to evaluate the presence of pathologies or complications of prematurity in patients with delay in any area using ChrA. PATIENTS AND METHOD: Cohort prospective study that included EPN patients born in San José Hospital between January and October 2016 with follow-up in Roberto del Río Hospital. Bayley III test was applied at 18 months ChrA and its results were compared with CoA. Delay in any area according to ChrA implied a clinical neurological evaluation. RESULTS: 111 EPN were born in San José Hospital (January-October 2016), 55 participated in the study. According to ChrA, 30 patients were cataloged as normal and 21 at risk. According to CoA, 46 were classified as normal and 5 at risk. The 4 patients with delay according to ChrA persisted in this category when evaluated with CoA. Neurological evaluation in patients with delay evidenced neurological disorders that explained this condition. CONCLUSION: Assessing PSD in EPN at 18 months ChrA allows early detection of patients with risk of developmental delay, regarding the use of CoA, with importance of a neurological follow-up of this group. All patients with delay in PSD had a severe neurological disorder that explained this delay, which was not just a slow "madurative" development of prematurity. .

[Clinical utilization of the coronary pressure wire]. / Utilización habitual de la guía de presión intracoronaria. Experiencia de un centro.

INTRODUCTION: Earlier studies have established the value of coronary pressure wires for diagnosing and monitoring the treatment of patients with coronary artery disease. In this study we demonstrated their usefulness in the daily clinical practice of a catheterization laboratory. MATERIAL AND METHODS: A retrospective study of the use of pressure wires in our laboratory between October 1998 and November 2000. The pressure wire was inserted whenever the interventional cardiologist considered it to be indicated. In all cases, pressures were recorded with a Waveguide Cardiometrics 0.014 guide (Endosonics) and hyperemia was induced by intracoronary adenosine. RESULTS: Two hundred fifty-three lesions were studied in 190 patients. Indications were functional evaluation of lesions of intermediate severity for 82% (9% intrastent restenoses); guidance of balloon PTCA for 5%; and fulfillment of a research protocol for 13%. Twenty-six percent of lesions considered to be of moderate severity based on angiography were treated as a consequence of the pressures measured by the wire. A decision to begin or continue a procedure was based on wire pressures in 24% and intervention was avoided in 60%. No major complications attributable to the wire were observed. A lesion was dissected in one patient (0.5%) but it was treated without consequences. Twenty pressure wires (11%) failed to work properly during the procedure, fourteen of them (7%) before insertion. The wire could not be advanced across the lesion in one case. CONCLUSIONS: The pressure wire is useful in the daily clinical practice of a catheterization laboratory. Its most common indication is the evaluation of lesions of intermediate or unknown severity, and use is associated with few complications.

[Angiographic results of thrombectomy performed with two new devices in lesions with intracoronary thrombus]. / Resultados angiográficos del empleo de dos nuevos dispositivos de trombectomía en lesiones coronarias con elevado contenido trombótico.

INTRODUCTION AND OBJECTIVE: The presence of intracoronary thrombus is associated with less favorable results of percutaneous coronary interventions. In recent years, new devices have been designed to improve the outcome of these procedures when an intracoronary thrombus is present. The results of two new systems of thrombectomy used in a single center are analyzed. METHODS: Prospective observational registry of the use of two thrombectomy devices, X-SIZER (EndiCOR Medical Inc., San Clemente, California, USA) and RESCUE (Boston Scientific Scimed, Inc., Maple Grove, Minnesota, USA), between 1 June 2000 and 15 February 2002. RESULTS. One hundred thirty-nine devices were used in 137 patients (112 RESCUE and 27 X-SIZER). The main indication was primary angioplasty for acute myocardial infarction (80%). In 7 patients (5%), unscheduled thrombectomy was performed for unexpected complications that appeared during the procedure. In 75% of patients, IIb/IIIa inhibitors were given. In 10 cases (7%) the device did not reach the lesion. Complications derived from the use of the device were recorded in 3 cases (2.1%). TIMI flow improved from 1.28 1.1 before thrombectomy to 2.31 1.2 after the procedure. Improvement in the thrombus image was observed in 86%. The intervention was successful in 86%. CONCLUSIONS: Thrombectomy with X-Sizer and Rescue improved the angiographic thrombus image in most cases and was associated to a low complication rate. Its efficacy compared to the conventional technique should be assessed in future trials.

[Comparison of intracoronary ultrasound expansion parameters in coronary stents implanted with or without balloon predilatation. A randomized intravascular ultrasound study]. / Comparación de parámetros de expansión stents implantados con técnica convencional o directa. Estudio aleatorizado con ultrsonidos intracoronarios.

INTRODUCTION AND OBJECTIVES: Coronary stenting without balloon predilatation is a safe technique associated with similar clinical results and lower costs, use of contrast and exposure to radiation in comparison to stenting with predilatation. After direct stenting, expansion may be reduced if the stenotic lesion was not predilatated. This study compared a). stent expansion with and without balloon predilatation (direct stenting), observed by intracoronary ultrasound, and b). angiographic results after 6 months and 1 year with the two implantation techniques. PATIENTS AND METHOD: 100 consecutive lesions eligible for direct stenting were randomized to stent implantation with or without balloon predilatation. Only

[Direct Stenting without Predilation: a Single-Center Experience with 1,000 Lesions]. / Implante de stent directo sin predilatación: experiencia de un centro en 1.000 lesiones.

INTRODUCTION: Direct stenting has been shown to save costs, procedural time, radiation, and contrast use. We analyze the results of direct stenting in daily practice. MATERIAL AND METHODS: We retrospectively analyzed the interventions in the first 1,000 lesions that were treated with direct stenting at our center. Primary success, dissection, need for additional dilation, embolism, stent loss, and side branch occlusion were the variables assessed. RESULTS: Direct stenting was attempted in 1,000 lesions in 784 patients (age 63 11 years, females 21%, diabetes 37%). Primary or rescue angioplasty was performed in 8%. One or more thrombi were found in 16%, bifurcation in 9%, calcification in 5%, angulation in 2.3%, and tortuosity in 3.2%. The reference diameter was 3.0 0.5 mm. The primary success rate was 93.1%. Failure of direct stenting (6.9%) was associated with the circumflex artery in 38%, calcification in 26%, angulation in 22%, and tortuosity in 31%. In 39 lesions, additional dilation with different balloons was required. Additional stenting was required for dissection in 40 lesions and secondary to incomplete coverage of the lesion in 27. Thrombus embolism occurred in 7 lesions, 6 of them with a previously visible thrombus and one in a vein graft. Stent embolisms occurred in 6 cases, 4 of which were retrieved. Four side branches became occluded, but 2 of them were recovered at the end of the procedure. CONCLUSIONS: Direct stenting is a safe technique with low percentage of dissection, need for postdilation, thrombus embolism, and side br

[Time intervals in primary angioplasty from onset of symptoms until restoration of blood flow]. / Intervalos de tiempo transcurridos en la realización de la angioplastia primaria: desde el inicio de los síntomas hasta la restauración del flujo.

INTRODUCTION AND OBJECTIVE: A limitation to the widespread use of primary angioplasty is delayed reperfusion. Most current data are from clinical trials and there is little information about the use of primary angioplasty in clinical practice. The objective of this study was to analyze the duration of each stage leading to primary angioplasty in a hospital where it is the treatment of choice for acute myocardial infarction. PATIENTS AND METHOD: Prospective observational study of patients admitted to our hospital from April 2000 to August 2001 for acute myocardial infarction with an indication for reperfusion. The time intervals from onset of symptoms until the end of angioplasty were analyzed. RESULTS: Primary angioplasty was performed in 201 of 218 patients with an indication for reperfusion (92%). Median values (percentiles 25-75) were: Time 1 (onset of symptoms-hospital arrival): 91 (50-150) minutes. Time 2 (hospital arrival-call to interventional team): 20 (10-49) minutes. Time 3: (call to interventional team-team arrival): 15 (0-20) minutes. Time 4: (team arrival patient arrival at the catheterization laboratory): 10 (5-15) minutes. Time 5 (patient arrival-opening of coronary artery): 20 (15-30) minutes. Time 6 (opening of coronary artery-TIMI III flow): 10 (0-25) minutes. CONCLUSIONS: The most time-consuming stage in primary angioplasty was from the onset of symptoms until patient arrival at the hospital (Time 1). Inside the hospital, the most time-consuming stage was the diagnosis and decision to perform angioplasty (Time 2). The rates of primary angioplasty could be increased if delays in reperfusion were reduced with respect to those considered acceptable in current practice guidelines.

[Program of coronary angioplasty in acute myocardial infarction in the region of Murcia (Spain). APRIMUR Registry]. / Proyecto de un plan de accesibilidad al intervencionismo coronario en el infarto agudo de miocardio en la Región de Murcia (España). Registro APRIMUR.

INTRODUCTION AND OBJECTIVES: The geographic characteristic and healthcare facilities of the region of Murcia, Spain, are enough to assure that coronary angioplasty can be carried out in acute myocardial infarction according to current guidelines. The development of a regional program for coronary intervention in acute myocardial infarction may increase the number of patients who would benefit from reperfusion therapy in general and primary angioplasty in particular. MATERIAL AND METHODS: The program was initiated in April 2000 and had four steps: 1) Establishment of primary angioplasty as the treatment of choice of acute myocardial infarction in the regional reference hospital. 2) Application of phase 1 to a second hospital located 10 kilometers away from the reference hospital. 3) Extension of phase 1 to the entire city of Murcia. 4) Provision of facilities for coronary angioplasty in acute myocardial infarction to all patients in the region. RESULTS: Between January 2000 and August 2001, 392 angioplasties were performed for acute myocardial infarction. Primary angioplasty was performed in 92% and 85% of the patients with an indication for reperfusion therapy in phase 1 and 2, respectively. The median delay (indication to beginning of procedure) was 25 and 35 minutes in phases 1 and 2, respectively. Total mortality was 11,5% (5,2% in patients without shock at admission). CONCLUSIONS: The design of a regional program of primary angioplasty may increase the number of patients who receive reperfusion therapy in compliance with current recommendations for the treatment of acute myocardial infarction.

Coexistence of racemic and homochiral two-dimensional lattices formed by a prochiral molecule: dicarboxystilbene on Cu(110).

Dicarboxystilbene, a molecule that becomes chiral in the adsorbed state through the loss of its improper axis of rotation, forms long-range "handed" structures when adsorbed on Cu(110) as revealed by scanning tunnelling microscopy. We show that these structures are created from chiral "adsorption complex" building blocks, giving rise to a complete set of racemic and enantiomerically pure structural assemblies. We interpret the formation of these structures in terms of a balance between hydrogen bond mediated intermolecular interactions and the adsorbate-surface structural relationship and discuss the reasons for temperature-induced conversion from the metastable enantiomerically pure to the racemic structure.

Púrpura de Schõnlein-Henoch: manifestaciones clínicas más frecuentes y actualización del tratamiento esteroidal / Schõnlein-Henoch purpura: clinical manifestations and updates in steroidal treatment

El púrpura de Schõnlein-Enoch corresponde a la vasculitis más frecuente en pediatría, afecta principalmente vasos pequeños de la piel, articulaciones, tracto gastrointestinal y riñones. este artículo revisa la actualización del tratamiento esteroidal.

Utilización habitual de la guía de presión intracoronaria. Experiencia de un centro / Clinical utilization of the coronary pressure wire

Introducción. Estudios previos han establecido el valor de la guía de presión en el diagnóstico y optimización del tratamiento de la enfermedad coronaria. En este trabajo mostramos su utilización como herramienta integrada en la actividad cotidiana de un laboratorio de hemodinámica. Material y métodos. Estudio retrospectivo sobre el empleo de la guía de presión en un solo centro entre octubre de 1998 y noviembre de 2000. El empleo de la guía de presión quedó a criterio del intervencionista. Se utilizaron en todos los procedimientos adenosina intracoronaria y la guía Waveguire Cardiometrics 0,014 de Endosonics®. Resultados. Se estudiaron 253 lesiones en 190 pacientes. Las indicaciones fueron: en el 82 por ciento valoración de estenosis angiográficamente moderadas; en el 5 por ciento optimización de la ACTP con balón, y en el 13 por ciento protocolos de investigación. El 26 por ciento de las lesiones moderadas angiográficamente fueron tratadas a consecuencia del resultado de la guía. En un 24 por ciento de las lesiones la guía condicionó el inicio o continuación de la intervención, y en un 60 por ciento la evitó. No se observaron complicaciones mayores debidas al uso de la guía, aunque en un paciente se produjo una disección coronaria finalmente sin secuelas. Veinte guías (11 por ciento) disfuncionaron durante el procedimiento y 14 (7 por ciento) antes de ser introducidas en el paciente. No se consiguió pasar la lesión en un caso. Conclusiones. La guía de presión es una herramienta integrable en la práctica habitual de un laboratorio de hemodinámica. Su indicación más frecuente es la valoración de lesiones de gravedad intermedia, y se asocia a un número mínimo de complicaciones (AU)

Resultados angiográficos del empleo de dos nuevos dispositivos de trombectomía en lesiones coronarias con elevado contenido trombótico / Angiographic Results of Thrombectomy Performed with Two New Devices in Lesions with Intracoronary Thrombus

Introducción y objetivo. La presencia de trombo intracoronario se asocia a peores resultados durante la angioplastia coronaria. En los últimos años se han desarrollado diversos dispositivos de trombectomía para mejorar los resultados de la angioplastia en presencia de trombo. En este trabajo se analizan los resultados de la utilización de dos nuevos dispositivos de trombectomía en un solo centro. Métodos. Registro prospectivo, observacional del empleo de dos dispositivos de trombectomía: X-Sizer (EndiCOR Medical Inc., San Clemente, California, EE.UU.) y Rescue (Boston Scientific Scimed Inc., Maple Grove, Minnesota, EE.UU.) entre el 1 de junio de 2000 y el 15 de febrero de 2002.Resultados. Se utilizaron 139 dispositivos en 137 pacientes (112 Rescue y 27 X-Sizer). La principal indicación fue la angioplastia primaria (80 por ciento). En 7 pacientes (5 por ciento) se realizó después de que se produjeran complicaciones en procedimientos sin trombectomía programada. Se emplearon antagonistas plaquetarios IIb/IIIa en el 75 por ciento de los procedimientos. En 10 ocasiones (7 por ciento) no se logró el acceso del dispositivo a la lesión. Se observaron complicaciones en 3 (2,1 por ciento) procedimientos. El flujo TIMI pasó de 1,28 ñ 1,1 antes de la trombectomía a 2,31 ñ 1,2 tras ella. Se observó una mejoría de la imagen de trombo en el 86 por ciento y éxito final en el 86 por ciento de las intervenciones. Conclusiones. La trombectomía con los dispositivos X-Sizer y Rescue logra una reducción de la imagen angiográfica de trombo en la mayoría de los procedimientos, asociándose a una baja tasa de complicaciones. Sus ventajas frente a la técnica convencional deben evaluarse en futuros ensayos clínicos aleatorios (AU)

Implante de stent directo sin predilatación: experiencia de un centro en 1.000 lesiones / Direct stenting without predilation: a single-center experience with 1.000 lesions

Introducción. El implante directo de stent ha demostrado un ahorro en costes, tiempo, radiación y contraste. Analizamos los resultados del implante directo en la actividad de un centro.Material y métodos. Estudiamos retrospectivamente las intervenciones de las primeras 1.000 lesiones tratadas con stent directo. Se analizó el éxito primario, disección, necesidad de posdilatación, embolización, pérdida de stent y afectación de ramas laterales.Resultados. Se trataron 1.000 lesiones en 784 pacientes. Edad 63 ñ 11, mujeres 21 por ciento, diabetes 37 por ciento, angioplastia primaria o rescate 8 por ciento, trombo 16 por ciento, bifurcación 9 por ciento, calcificación 5 por ciento, angulación 2,3 por ciento, tortuosidad 3,2 por ciento. Diámetro de referencia 3,0 ñ 0,5 mm. Éxito primario: 93,1 por ciento. El fracaso (6,9 por ciento) se asoció a localización en circunfleja en 38 por ciento, calcificación en 26 por ciento, angulación en 22 por ciento y tortuosidad en 31 por ciento. En 39 lesiones se requirió posdilatación con balón diferente, en 40 lesiones stent adicional por disección y en 27 por cobertura incompleta. Hubo embolización de trombo en 7 lesiones, seis con imagen de trombo previo y una en safena. Embolizaron 6 stents, de los cuales cuatro se recuperaron. Se ocluyeron 4 ramas laterales y dos de ellas también se pudieron recuperar.Conclusiones. El implante directo de stent es una técnica segura con un bajo porcentaje de disección, necesidad de posdilatación, embolización de trombo y oclusión de ramas. Estos resultados, unidos a los de estudios previos referidos al ahorro en tiempo, coste, radiación y contraste, avalan las ventajas de esta técnica en lesiones seleccionadas (AU)

Trombosis subaguda con tratamiento antiagregante en una población no seleccionada de stents intracoronarios: incidencia y predictores / Subacute stent thrombosis in a nonselected population using antiplatelet Therapy: frequency and predictors

Introducción. Tras la implantación de stents intracoronarios, el tratamiento con ticlopidina y ácido acetilsalicílico ha conseguido incidencias de trombosis subaguda del 0 por ciento en poblaciones seleccionadas y con ultrasonidos intracoronarios.Objetivo. Evaluar la incidencia y los predictores de trombosis subaguda, en una población no seleccionada, usando sólo antiagregación plaquetaria. Métodos. Se estudiaron 285 stents implantados consecutivamente con éxito en 268 lesiones de 226 pacientes. Se usó dilatación a altas presiones, sin ultrasonidos intracoronarios. El protocolo postimplante incluyó ticlopidina y ácido acetilsalicílico durante cuatro semanas, sin anticoagulación. Se consideró trombosis subaguda del stent la aparición, tras las primeras 24 h y durante el primer mes, de muerte, infarto agudo de miocardio u oclusión angiográfica del stent con flujo TIMI 0-I. Resultados. Se produjeron 4 eventos (1,7 por ciento): tres pacientes presentaron infarto agudo de miocardio no fatal extrahospitalario, con trombosis angiográfica del stent, y un paciente falleció por infarto agudo de miocardio hospitalario. En los tres casos de infarto agudo de miocardio no fatal, los pacientes estaba tomando ácido acetilsalicílico sin ticlopidina (p < 0,001) y el stent había sido implantado en un vaso < 3 mm (p = 0,07). Tras el alta hospitalaria, tres (17 por ciento) de los 18 pacientes con abandono inadvertido de ticlopidina presentaron trombosis subaguda, frente a ninguno de los 25 pacientes que tomaron ticlopidina sin ácido acetilsalicílico. Tras excluir los pacientes con abandono de ticlopidina, la incidencia fue del 0,5 por ciento. Conclusión. Tras el implante de stents intracoronarios en una población no seleccionada, la antiagregación con ticlopidina y ácido acetilsalicílico permite alcanzar incidencias de trombosis subaguda cercanas al 1 por ciento. La ticlopidina parece tener el papel preventivo fundamental, máxime en situaciones predisponentes, como los vasos pequeños (AU)