Real world comparison of the MGuard Stent versus the bare metal stent for ST elevation myocardial infarction (the REWARD-MI study).

AIM: The MGuard Stent (MGS) was designed to prevent distal embolization of thrombus and has been shown to improve microcirculation in ST-elevation myocardial infarction (STEMI). However, there are no real world data comparing it with the bare metal stent (BMS). The aim of this study is to determine the efficacy and safety of the MGS in STEMI in the real world compared to the BMS. METHODS AND RESULTS: In total, 262 patients were included from a single centre, of which 35.9% had an MGS implanted. Two groups of 79 patients were established after propensity score matching, and they were similar in terms of baseline and periprocedural variables. The mean follow-up was 321 ± 12.94 days. There was no difference in mortality (7.6% in both groups), major adverse cardiac events (20.3% vs. 12.7%, P = 0.198), non-cardiac mortality, or non-fatal myocardial infarction (6.3% in both groups). Target lesion revascularization (TLR) was significantly higher in the MGS group (11.4% (9) vs. 1.3% (1) P < 0.01; RR 10.02 [1.23-81.16]). CONCLUSION: Our study is the first to compare the MGS with the BMS in STEMI in the real world, and it also appears to confirm that although the MGS is a safe device in STEMI that is not associated with increased mortality, it is associated with a higher long-term TLR rate. © 2014 Wiley Periodicals, Inc.

[Myocardial revascularization in patients with chronic renal failure]. / Revascularización miocárdica en pacientes con insuficiencia renal crónica.

The incidence of chronic renal failure has increased in the last years in industrialized countries. In Spain the prevalence of this pathology is estimated at 10-12% of the population, and the stages III-V of the disease, corresponding to the estimated glomerular filtration rate less than 60 ml/min/m2, represent the 5%. From the cardiovascular point of view, both chronic and acute coronary syndrome is a very important subgroup of patients because of the increased association between chronic renal failure and coronary artery disease. In fact, ACS is the main cause of death in patients with advanced chronic renal failure. Frequently, this kind of patients are excluded from prospective randomized clinical trials, consequently scientific evidence is not available to guide the therapy of coronary revascularization.

[Congenital anomalies of the origin of the coronary arteries. The diagnostic and therapeutic aspects]. / Anomalías congénitas del origen de las arterias coronarias. Aspectos diagnósticos y terapéuticos.

We report 5 cases of congenital coronary artery anomalies. Two involving the right coronary artery arise from the left sinus of Valsalva, two of the circumflex artery arise from the right sinus of Valsalva and a patient with the left coronary artery arise from the right coronary ostium and passes obliquely posteriorly behind the right ventricular outflow tract and the aorta suffering an acute myocardial infarction and coronary artery by-pass surgery was performed in the acute phase.

[Electrocardiographic patterns in hypertensive patients without atherosclerotic coronary disease. Influence of the left ventricular mass]. / Patrones electrocardiográficos en hipertensos sin coronariopatía aterosclerosa. Influencia de la masa ventricular izquierda.

BACKGROUND: ECG ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy or ischaemia. Hypertensive patients with abnormalities in ST-T segment in DI, aVL and/or V5-V6 underwent an echocardiographic study in order to assess left ventricular structure. All of them, in addition to the electric changes, showed typical or non-typical thoracic discomfort, showing a normal coronariographic study. METHODS: Hypertensive patients with ST-T segment changes were classified as follows: group A, 12 patients (8 women, 4 men, mean age 63.6 +/- 7.2 years) with ECG image of left ventricular overload pattern; group B, 9 patients (3 men, 6 women, mean age 62.3 +/- 6.3 years) with flat ST segment depression; and group C, 10 patients (3 men, 7 women, mean age 62.4 +/- 9.7 years) without changes on the ST-T segment with flat or negative T wave. Control group is made up 12 hypertensive patients (7 women, 5 men, mean age 61.6 +/- 7.6 years) with normal ECG. We assess by echocardiography interventricular septal thickness (IVST) and left ventricular posterior wall thickness (PWT) in mm, left ventricular end-diastolic diameter (DTD) in mm, left ventricular mass (LVM) in grs, and the mass index (MI) in g/m2. RESULTS: IVST, PWT, LVM and MI were significantly (p < 0.05) higher in the groups A, B and C than in the control group. No statistically significant differences were observed between the A, B and C groups. Stepwise discriminant analysis showed that the only parameter with independent value for discriminating between control, group and group ABC (the union of groups A, B and C) was IVST. CONCLUSION: In hypertensive patients without coronariopathy, ST-T changes identify a group with greater left ventricular mass. The different electrocardiographic patterns considered were not associated with a significantly different left ventricular mass.

[Pericarditis in the acute phase of myocardial infarction: incidence and clinical significance]. / Pericarditis en la fase aguda del infarto de miocardio: incidencia y significado clínico.

STUDY OBJECTIVE: To evaluate the incidence and the clinical significance of pericarditis in the acute myocardial infarction. DESIGN: Retrospective study. SETTING: The Coronary Care Unit of a University Hospital. PATIENTS AND METHODS: We have studied 668 consecutive patients with their first acute myocardial infarction admitted at the Coronary Care Unit, Hospital General de Galicia, Santiago de Compostela, Spain, in the years 1983 to 1988. Pericarditis was defined as the presence of a pericardial friction rub on auscultation during the hospital course. Pericarditis was noted in 86 patients (12.8%), who were considered as group A. The remain 582 patients were considered as group B. Statistical analysis was carried out using the BMDP statistical package. MAIN RESULTS: Pericarditis occurred in 12.8% of the patients. Patients with, compared to those without, pericarditis had a lower age (59.0 +/- 12.4 years; p = .0005), and a higher percentage of males (86.1% versus 75.6%; p = .038), an a higher percentage of smokers (63.9% versus 48.6%; p = .01). The delay to the hospital admission was greater in group A (12.6 +/- 18.5 hours versus 8.0 +/- 11.7 hours; p = .0024). Pericarditis more often occurred in the setting of anterior wall myocardial infarction and in Q-wave infarct. The group A had a higher CPK peak (1877.5 +/- 1548.9 UI/L versus 1240.2 +/- 961.5 UI/I; p = .001) and a higher peak of CK-MB (213.7 +/- 134.7 UI/L versus 160.8 +/- 112.9 UI/L; p = .001). In-hospital mortality was significantly lower in group A (6.9% versus 17.2%; p = .016). The multivariate analysis by stepwise logistic regression identified the Q- wave myocardial infarct, the age, the delay to the hospital admission, the peak of MB creatine kinase and location of infarct as the only independent predictive variables for the pericarditis occurrence. CONCLUSIONS: We conclude that the pericarditis in the setting of Q-wave myocardial infarction, with anterior wall location, and is related to transmural extension of the myocardial necrosis.

[Clinical and prognostic implications of age in acute myocardial infarct]. / Implicaciones clínicas y pronósticas de la edad en el infarto agudo de miocardio.

The purpose of this study was to evaluate the clinical characteristics and the factors related to early mortality in the acute myocardial infarction of the geriatric population. We studied 814 consecutive patients with their first acute myocardial infarction admitted to the coronary care unit at tha Hospital General de Galicia. 401 patients were older than 65 years (Group A) and 413 were younger (Group B). Group A was found a significantly lower percentage of males (64.7% versus 88.4%; p less than 0.001) and smokers (46.7% versus 72.7%; p less than 0.001; and older patients showed a greater incidence of diabetes mellitus (28.1% versus 15.2%; p less than 0.001) and arterial hypertension (45.6% versus 31.7%; p less than 0.01). In the geriatric population, the clinical course of the acute myocardial infarction is characterized by a greater incidence of heart failure (35.3% versus 11.1%; p less than 0.001), cardiogenic shock (18% versus 5.7%; p less than 0.001) and post-acute myocardial infarction angina pectoris (18.3% versus 12.2%; p less than 0.05). Early mortality (first month) was significantly higher in elderly patients (22.7% versus 6.3%; p less than 0.001). The multivariate analysis by stepwise logistic regression identified cardiogenic shock, age and heart failure as the only independent predictive variables for early mortality. We conclude that early mortality in the acute myocardial infarction is high and related to severe degrees of pump failure and age.

Revascularización miocárdica en pacientes con insuficiencia renal crónica / Myocardial revascularization in patients with chronic renal failure

En los últimos años, la insuficiencia renal crónica ha experimentado un importante aumento en los países occidentales. Se estima que en España la prevalencia de esta enfermedad oscila entre el 10 y el 12% de la población, de la cual el 5% se halla entre los estadios III-V, que es la que se corresponde con un índice de filtrado glomerular estimado menor de 60 ml/min/m2. Desde el punto de vista cardiovascular, se trata de un subgrupo de pacientes muy importante, dada la asociación elevada existente entre la insuficiencia renal crónica y la enfermedad arterial coronaria, tanto en su forma crónica, como en forma de episodio coronario agudo. Esta última es la causa más frecuente de muerte en los pacientes con insuficiencia renal crónica avanzada. Con frecuencia, se excluye a estos pacientes de los ensayos clínicos aleatorizados y prospectivos, por lo que actualmente no disponemos de una evidencia científica contundente que nos indique cuál es el mejor tratamiento de revascularización en estos pacientes (AU)

The incidence of chronic renal failure has increased in the last years in industrialized countries. In Spain the prevalence of this pathology is estimated at 10-12% of the population, and the stages III-V of the disease, corresponding to the estimated glomerular filtration rate less than 60 ml/min/m2, represent the 5%. From the cardiovascular point of view, both chronic and acute coronary syndrome is a very important subgroup of patients because of the increased association between chronic renal failure and coronary artery disease. In fact, ACS is the main cause of death in patients with advanced chronic renal failure. Frequently, this kind of patients are excluded from prospective randomized clinical trials, consequently scientific evidence is not available to guide the therapy of coronary revascularization (AU)

Revascularización miocárdica en pacientes con diabetes: estado actual y perspectivas / Myocardial revascularization in diabetic patients: current state and future perspectives

La diabetes mellitus constituye un factor de riesgo importante de padecerenfermedades cardiovasculares, como la enfermedad arterial coronaria,la enfermedad cerebrovascular o la enfermedad arterial periférica. Así,con respecto a la población general, los pacientes con diabetes presentanuna prevalencia hasta 10 veces superior de aterosclerosis con enfermedadarterial coronaria signifi cativa asociada, y un riesgo de padeceralgún episodio cardiovascular de 2 a 4 veces también superior. En consecuencia,las enfermedades cardiovasculares, en especial la enfermedadarterial coronaria, son la principal causa de muerte de los pacientes condiabetes. Por ello, es muy importante la prevención y el correcto tratamientode la enfermedad cardiovascular en este tipo de pacientes. En este artículose revisan las indicaciones actuales sobre las distintas técnicas derevascularización miocárdica y sus perspectivas futuras en el tratamientode la enfermedad arterial coronaria del paciente con diabetes(AU)

Diabetes mellitus represents an important risk factor to develop cardiovasculardiseases as coronary artery disease, cerebral vasculardisease or peripheral artery disease. Diabetic patients have a prevalenceof atherosclerosis with significant coronary artery disease tentimes higher than in the general population, and the risk of cardiovascularadverse events is two to four times greater. Consequently,cardiovascular diseases and specifically, significant coronary arterydisease, are the main cause of death in people with diabetes. Preventionand optimal treatment are especially important in this particularpopulation. In this article we have reviewed the current indicationsfor the different techniques of myocardial revascularization, andthe future perspectives of these techniques in the treatment of thecoronary artery disease in the diabetic patient(AU)