Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II

Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in di erent series. This study aimed to clarify the bleeding predictive factors that could influence these di erences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age 75 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or 75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 1.2; p = 0.029). Conclusions: In this high-risk population, GIB history and age 75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patient

Ticagrelor versus prasugrel in acute coronary syndrome: sex-specific analysis from the RENAMI Registry

BACKGROUND: The use of potent P2Y12 inhibitors (ticagrelor & prasugrel) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary interventions (PCI) is a class I recommendation. We performed a sex-specific analysis comparing the difference in efficacy and safety outcomes between ticagrelor and prasugrel in a real-world ACS population. METHODS: Data from the multicenter REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) for 4424 ACS patients who underwent PCI and were treated with ticagrelor or prasugrel between 2012 to 2016 were analyzed. Mean follow-up was 17±9 months. RESULTS: After propensity score matching, there was no significant difference in the occurrence of primary endpoint of net adverse cardiac events between ticagrelor and prasugrel in men (HR: 0.94; 95% CI: 0.69-1.29; P=0.71), or women (HR: 1.17; 95% CI: 0.63-2.20; P=0.62; P interaction [sex] = 0.40). Similarly, no differences were found in the occurrence of any of the secondary endpoints (MACE, all cause death, re-infarction, stent thrombosis, BARC major bleeding and BARC any bleeding) between the two P2Y12 groups between men and women. CONCLUSIONS: In this real-world ACS population, no relative difference in efficacy or safety outcomes were found between ticagrelor and prasugrel between sexes

Technological advances in the management of cardiovascular diseases: perspective of physicians and administrators

To the Editor, New technologies have improved the effectiveness of treatments for cardiovascular diseases, yet these technologies pose poorly explored challenges. Therefore, a study was conducted in Spain to find out about the perspective of doctors and administrators on the implications of technology in the management of coronary artery disease and peripheral arterial disease. The insights and perspectives of doctors and administrators were obtained using the Delphi method following the RAND/UCLA Appropriateness Method (RUAM).1 A scientific committee including 6 cardiologists, 1 vascular surgeon, and 1 interventional radiologist selected the panel of doctors (16 cardiologists, 3 endocrinologists, 3 vascular surgeons, 1 internist, and 1 surgeon specialized in diabetic foot disease), and administrators (12 administrators from both the public and private sectors) (annex 1 of the supplementary data). The doctors&#x2019; questionnaire had 112 items and the administrators&#x2019; one 79 (74 items were common to both panels). The panellists scored the relevance of each item on a scale from 1 (irrelevant) to 9 (maximum relevance). &#x00AB;Agreement&#x00BB; was defined as less than a third of the panelists giving scores from 1 to 3 to a given item, and less than a third gave scores from 7 to 9. &#x00AB;Low relevance&#x00BB; items were those whose median scores..

Avances tecnológicos en el tratamiento de las enfermedades cardiovasculares: perspectiva de médicos y administradores

Sr. Editor: Las nuevas tecnolog&#x00ED;as han mejorado la efectividad de los tratamientos de las enfermedades cardiovasculares, pero plantean retos insuficientemente explorados. Por esta raz&#x00F3;n, se llev&#x00F3; a cabo un estudio para conocer las percepciones de m&#x00E9;dicos y administradores sobre las implicaciones de la tecnolog&#x00ED;a en la atenci&#x00F3;n de la arteriopat&#x00ED;a coronaria y perif&#x00E9;rica en Espa&#x00F1;a. Se obtuvieron las percepciones de m&#x00E9;dicos y administradores utilizando el m&#x00E9;todo Delphi seg&#x00FA;n el RAND/UCLA Appropriateness Method (RUAM)1. Un comit&#x00E9; cient&#x00ED;fico, compuesto por 6 cardi&#x00F3;logos, 1 cirujano vascular y 1 radi&#x00F3;logo intervencionista, seleccion&#x00F3; el panel de m&#x00E9;dicos (16 cardi&#x00F3;logos, 3 endocrin&#x00F3;logos, 3 cirujanos vasculares, 1 internista y 1 cirujano especializado en pie diab&#x00E9;tico) y de administradores (12 administradores de los sectores p&#x00FA;blico y privado) (anexo 1 del material adicional). El cuestionario de m&#x00E9;dicos ten&#x00ED;a 112 &#x00ED;tems y el de administradores ten&#x00ED;a 79 &#x00ED;tems (74 eran comunes para ambos paneles). Los panelistas puntuaron la relevancia de cada &#x00ED;tem en una escala de 1 (irrelevante) a 9 (m&#x00E1;xima relevancia). Se defini&#x00F3; &#x00AB;acuerdo&#x00BB; cuando menos de un tercio de los panelistas puntu&#x00F3; el &#x00ED;tem en el rango 1-3 y menos de un tercio lo puntu&#x00F3; en el rango 7-9. Se clasificaron como de &#x00AB;relevancia baja&#x00BB; aquellos &#x00ED;tems cuya mediana de..

Tiempos de hemostasia en el cateterismo cardíaco transradial con introductor 5F

El acceso radial para los procedimientos cardíacos está bien establecido y su uso es generalizado. La baja incidencia de las complicaciones vasculares y la deambulación inmediata posibilitan el alta precoz del paciente. Los tiempos de hemostasia para el introductor radial 5F con vendaje compresivo convencional no están establecidos en la literatura. Objetivo: Validar los tiempos de hemostasia radial con vendaje convencional en los cateterismos diagnósticos con 5F. Material y métodos: Desde el 6 de julio hasta el 9 de septiembre de 2004, se realizó un estudio piloto prospectivo consecutivo en el que se incluyeron 144 pacientes que cumplieron los criterios de inclusión/exclusión. Posterior al procedimiento, se randomizaron en dos grupos de hemostasia de 60 minutos (protocolo 1) y 90 (protocolo 2). Se valoraron las complicaciones en la compresión, tras cambio de apósito y al alta del paciente. Resultados: La media de edad fue de 67,5 (33-89), con una media de IMC de 27 (17- 40,5) y 35 eran mujeres. Las complicaciones durante la compresión fueron 11 sangrados en cada grupo (14,9% y 15,7% respectivamente). Hubo 3 hematomas (4,1%) en el protocolo 1, y 4 en el protocolo 2 (5,7%). No se encontraron diferencias estadísticamente significativas entre los grupos. Todas las complicaciones se resolvieron antes del alta y no hubo ningún hematoma mayor. Conclusiones: Los tiempos de hemostasia radial para introductor 5F en procedimientos diagnósticos se establecen en 60 minutos sin aumento en la incidencia de las complicaciones

Tiempos de hemostasia en el cateterismo cardíaco transradial con introductor 5F

El acceso radial para los procedimientos cardíacos está bien establecido y su uso es generalizado. La baja incidencia de las complicaciones vasculares y la deambulación inmediata posibilitan el alta precoz del paciente. Los tiempos de hemostasia para el introductor radial 5F con vendaje compresivo convencional no están establecidos en la literatura. Objetivo: Validar los tiempos de hemostasia radial con vendaje convencional en los cateterismos diagnósticos con 5F. Material y métodos: Desde el 6 de julio hasta el 9 de septiembre de 2004, se realizó un estudio piloto prospectivo consecutivo en el que se incluyeron 144 pacientes que cumplieron los criterios de inclusión/exclusión. Posterior al procedimiento, se randomizaron en dos grupos de hemostasia de 60 minutos (protocolo 1) y 90 (protocolo 2). Se valoraron las complicaciones en la compresión, tras cambio de apósito y al alta del paciente. Resultados: La media de edad fue de 67,5 (33-89), con una media de IMC de 27 (17- 40,5) y 35 eran mujeres. Las complicaciones durante la compresión fueron 11 sangrados en cada grupo (14,9% y 15,7% respectivamente). Hubo 3 hematomas (4,1%) en el protocolo 1, y 4 en el protocolo 2 (5,7%). No se encontraron diferencias estadísticamente significativas entre los grupos. Todas las complicaciones se resolvieron antes del alta y no hubo ningún hematoma mayor. Conclusiones: Los tiempos de hemostasia radial para introductor 5F en procedimientos diagnósticos se establecen en 60 minutos sin aumento en la incidencia de las complicaciones

An aortic root geometric model, based on transesophageal echocardiographic image sequences (TEE), for biomechanical simulation

Aortic valve (AoV) stenosis is one of the most common valvular diseases. Assessing the aortic valve function could provide crucial information towards a better understanding of the disease, where numerical simulation will have an important role to play. The main scope of this work is to find an aortic root (AR) patient specific geometric model, which could be used for simulation purposes. Several models were followed to obtain an AR geometry implementing them in open source tools. Necessary parameters were obtained from 2D echo images. In order to test the obtained AR geometry, a finite element study was performed solving a fixed mesh fluid structure interaction (FSI) model. The fluid was supposed to be laminar and the tissues were modeled as St. Venant-Kirchhoff materials. Obtained results for the 1-way FSI study are compared with the published ones for structural and 2-way FSI studies showing similar results. An AR geometric reconstruction from clinic data is suited for numerical simulation

Long-term clinical outcomes after bioresorbable and permanent polymer drug-eluting stent implantation: final five-year results of the CENTURY II randomised clinical trial

The aim of this study was to establish the long-term safety and efficacy of a sirolimus-eluting stent with bioresorbable polymer (BP-SES; Ultimaster) by comparison with an everolimus-eluting stent with permanent polymer (PP-EES; XIENCE)