Guia de recomanacions per a la persona afectada de malaltia coronària

Malalties coronàries; Tractament; RecomanacionsCoronary diseases; Treatment; RecommendationsEnfermedades coronarias; Tratamiento; RecomendacionesAquesta Guia pretén aportar informació senzilla i útil per a totes aquelles persones interessades a saber una mica més sobre el seu cor i per entendre i seguir activament tots els consells que rebran dels professionals sanitaris

Resonance-Based microwave technique for body implant sensing

There is an increasing need for safe and simple techniques for sensing devices and prostheses implanted inside the human body. Microwave wireless inspection may be an appropriate technique for it. The implanted device may have specific characteristics that allow to distinguish it from its environment. A new sensing technique based on the principle of differential resonance is proposed and its basic parameters are discussed. This technique allows to use the implant as a signal scattering device and to detect changes produced in the implant based on the corresponding change in its scattering signature. The technique is first tested with a canonic human phantom and then applied to a real in vivo clinical experiment to detect coronary stents implanted in swine animalsPeer ReviewedPostprint (published version

Impact of triple therapy in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention

Background and Purpose: Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplate- let therapy: aspirin plus clopidogrel) in patients > 75 years of age with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). Methods: A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT) was analyzed. All outcomes were evaluated at 1- year of follow-up. Results: Five hundred and eighty-five patients, 289 (49%) of whom were > 75 years of age (79.6 ± 3.4 years; 33% women) were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA 2 DS 2 VASc score: 4.23 ± 1.51 vs 3.76 ± 1.40, p = 0.007 and a higher bleeding risk (HAS-BLED > 3: 88.6% vs 79.2%, p = 0.02) than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01 - 0.70, p = 0.004). Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53 - 17.57, p = 0.008). The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38); however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12 - 0.86, p = 0.02). Conclusions In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associ- ated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding

Ex vivo assessment and in vivo validation of non-invasive stent monitoring techniques based on microwave spectrometry

Some conditions are well known to be directly associated with stent failure, including in-stent re-occlusion and stent fracture. Currently, identification of these high-risk conditions requires invasive and complex procedures. This study aims to assess microwave spectrometry (MWS) for monitoring stents non-invasively. Preliminary ex vivo data are presented to move to in vivo validation. Fifteen mice were assigned to receive subcutaneous stent implantations (n = 10) or sham operations (n = 5). MWS measurements were carried out at 0, 2, 4, 7, 14, 22, and 29 days of follow-up. Additionally, 5 stented animals were summited to micro-CT analyses at the same time points. At 29 days, 3 animals were included into a stent fracture subgroup and underwent a last MWS and micro-CT analysis. MWS was able to identify stent position and in-stent stenosis over time, also discerning significant differences from baseline measures (P < 0.001). Moreover, MWS identified fractured vs. non-fractured stents in vivo. Taken together, MWS emerges as a non-invasive, non-ionizing alternative for stent monitoring. MWS analysis clearly distinguished between in-stent stenosis and stent fracture phenomena

Denervación renal en el tratamiento de la hipertensión arterial. Posicionamiento conjunto de la SEH-LELHA y la ACI-SEC

Hypertension is the most prevalent cardiovascular risk factor. Despite pharmacological treatment, a high percentage of patients do not achieve an adequate blood pressure control. Renal sympathetic denervation is a minimally invasive intervention for the management of hypertension involving the interruption of the renal artery sympathetic nervous system using a catheter-based approach. The early studies showed promising results, but the controversial results coming from the SYMPLICITY HTN-3 trial sent this technique into oblivion. Over the last 3 years, new clinical trials have appeared including new devices used in different populations, which definitively proves the effectiveness of renal sympathetic denervation. This joint position statement from the Spanish Society of Hypertension-Spanish League for Combating High Blood Pressure (SEH-LELHA), and the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) reviews the evidence available on the efficacy and safety profile of renal sympathetic denervation for the management of hypertension. Based on the results of clinical trials, recommendations have been established on what patients may be eligible for renal sympathetic denervation and under what circumstances

Regional differences in STEMI care in Spain. Data from the ACI-SEC Infarction Code Registry

Introduction and objectives: Geographical and organizational differences between different autonomous communities (AC) can generate differences in care for ST-segment elevation myocardial infarction (STEMI). A total of 17 heart attack code programs have been compared in terms of incidence rate, clinical characteristics, reperfusion therapy, delay to reperfusion, and 30-day mortality. Methods: National prospective observational study (83 centers included in 17 infarction networks). The recruitment period was 3 months (April 1 to June 30, 2019) with clinical follow-up at 30 days. Results: 4366 patients with STEMI were included. The incidence rate was variable between different AC (P <.0001), as was gender (P =.003) and the prevalence of cardiovascular risk factors (P <.0001). Reperfusion treatment was primary angioplasty (range 77.5%-97.8%), fibrinolysis ( range 0%-12.9%) or no treatment (range 2.2%- 13.5%). The analysis of the delay to reperfusion showed significant differences (P <.001) for all the intervals analyzed. There were significant differences in 30-days mortality that disappeared after adjusting for clinical and healthcare network characteristics. Conclusions: Large differences in STEMI care have been detected between the different AC, in terms of incidence rate, clinical characteristics, reperfusion treatment, delay until reperfusion, and 30-day mortality. The differences in mortality disappeared after adjusting for the characteristics of the patient and the care network

Rationale and design of the Concordance study between FFR and iFR for the assessment of lesions in the left main coronary artery. The ILITRO-EPIC-07 Trial

Introduction and objectives: Patients with left main coronary artery (LMCA) stenosis have been excluded from the trials that support the non-inferiority of the instantaneous wave-free ratio (iFR) compared to the fractional flow reserve (FFR) in the decision-making process of coronary revascularization. This study proposes to prospectively assess the concordance between the two indices in LMCA lesions and to validate the iFR cut-off value of 0.89 for clinical use. Methods: National, prospective, and observational multicenter registry of 300 consecutive patients with intermediate lesions in the LMCA (angiographic stenosis, 25% to 60%. A pressure gudiewire study and determination of the RFF and the iFR will be performed: in the event of a negative concordant result (FFR > 0.80/iFR > 0.89), no treatment will be performed; in case of a positive concordant result (FFR 0.80/iFR 0.89), an intravascular echocardiography will be performed and revascularization will be delayed if the minimum lumen area is > 6 mm(2). The primary clinical endpoint will be a composite of cardiovascular death, LMCA lesion-related non-fatal infarction or need for revascularization of the LMCA lesion at 12 months. Conclusions: Confirm that an iFR-guided decision-making process in patients with intermediate LMCA stenosis is clinically safe and would have a significant clinical impact. Also, justify its systematic use when prescribing treatment in these potentially high-risk patients

Síndrome coronària aguda i angioplàstia primària

Tot i la seva curta vida –la primera angioplàstia coronària la va dur a terme Andreas Grüntzig l’any 1977-, l’intervencionisme coronari percutani ha representat una revolució en el tractament de la patologia coronària. L’objectiu d’aquesta tesi és analitzar diferents condicionants de l’angioplàstia coronària en pacients amb infart de miocardi amb elevació del segment ST (IAMEST) i/o xoc cardiogènic, que estan relacionats amb el pronòstic: 1) Condicionants temporals (I). Anàlisi del retard fins a la reperfusió en funció del lloc on es realitza el primer contacte amb el sistema assistencial . • Anàlisis de los tiempos de atención en pacientes con infarto agudo de miocardio tratados con angioplastia primaria según su procedencia y según el horario de realización del procedimiento. Rev Esp Cardiol 2011;64(6):476-483. 2) Condicionants temporals (II). Anàlisi dels canvis en el retard fins a la reperfusió després de la integració d’una xarxa local dins d’una xarxa regional d’atenció a l’infart, el Codi Infart a Catalunya. • Integration of a local into a regional primary angioplasty action plan (the Catalan Codi Infart network) reduces time to reperfusion. Int J Cardiol 2013;168(4):4354-4357. 3) Condicionants funcionals i anatòmics. Anàlisi del paper de l’accés transradial en pacients amb xoc cardiogènic. • Transradial percutaneous coronary intervention in cardiogenic shock: a single-center experience. Am Heart J 2013;165(3):280-285. 4) Condicionants anatòmics. Anàlisi del paper de l’accés transradial en pacients amb edat ≥75 anys amb IAMEST en els que es realitza angioplàstia primaria. • Results of primary percutaneous intervention in patients ≥75 years treated by the transradial approach. Am J Cardiol 2014;113(3):452-456. Per la realització d’aquest treball s’ha confeccionat un registre prospectiu observacional de pacients consecutius tractats amb angioplàstia en el context de l’IAMEST i/o de xoc cardiogènic atesos en un centre terciari entre 2007 i 2013. En la primera etapa del registre (2007-2010) es va objectivar que l’anàlisi dels diferents intervals de temps entre l’inici dels símptomes i la reperfusió permet identificar punts febles del sistema on es produeixen demores no justificades; i que el lloc on es realitzava el primer contacte mèdic (hospital amb disponibilitat d’angioplàstia primària, hospital sense disponibilitat d’angioplàstia primaria o atenció extrahospitalària pel SEM) tenia una influència en el retard. La realització de la intervenció en horari laboral o en horari de guàrdia no influïa en el retard, en contra del que havien suggerit altres publicacions. Amb la posada en marxa del Codi Infart, l’any 2010, es va millorar l’organització de la xarxa amb un increment del nombre de pacients que van rebre tractament de reperfusió i un increment en l’angioplàstia primària com a tractament d’elecció, amb una disminució del retard fins a la reperfusió quan es comparava amb el període previ. L’anàlisi dels pacients amb xoc cardiogènic va mostrar que l’accés radial és factible en dues terceres parts dels pacients i que l’absència de pols radial era la principal causa de triar la via femoral com a alternativa. Una troballa interessant va ser la relació entre l’accés radial i la disminució de la mortalitat en l’anàlisi multivariant. En els pacients amb edat ≥75 anys als quals es va practicar angioplàstia primària l’accés radial va ésser possible en quasi bé tots els casos (>95%). Tot i la complexitat dels pacients, el seguiment va demostrar una incidència de mortalitat i esdeveniments cardíacs majors significativament inferior a la que s’havia reportat prèviament en aquest subgrup de pacients quan el procediment es realitzava per accés transfemoral.Despite its short life-the first coronary angioplasty was carried out by Andreas Grüntzig in 1977-percutaneous coronary interventions have represented a revolution in the treatment of coronary disease. The objective of this thesis is to analyze different factors of coronary angioplasty in patients with myocardial infarction with ST segment elevation (STEMI) and / or cardiogenic shock, which are related to the prognosis: 1) Time Factors (I). Analysis of delay to reperfusion depending on where the first medical contact was made. • Anàlisis de los tiempos de atención en pacientes con infarto agudo de miocardio tratados con angioplastia primaria según su procedencia y según el horario de realización del procedimiento. Rev Esp Cardiol 2011;64(6):476-483. 2) Time Factors (II). Analysis of changes in the delay to reperfusion after integrating a local network within a regional network, the Codi Infart Network in Catalonia. • Integration of a local into a regional primary angioplasty action plan (the Catalan Codi Infart network) reduces time to reperfusion. Int J Cardiol 2013;168(4):4354-4357. 3) Anatomical and Functional Factors. Analysis of the role of transradial access in patients with cardiogenic shock. • Transradial percutaneous coronary intervention in cardiogenic shock: a single-center experience. Am Heart J 2013;165(3):280-285. 4) Anatomical Factors. Analysis of the role of transradial access in patients aged ≥75 years with STEMI treated with primary angioplasty. • Results of primary percutaneous intervention in patients ≥75 years treated by the transradial approach. Am J Cardiol 2014;113(3):452-456. We made a prospective observational registry of consecutive patients treated with angioplasty in the context of STEMI and / or cardiogenic shock between 2007 and 2013. In the first phase of the registry (2007-2010) the analysis of different time intervals between symptom onset and reperfusion permited to identify weaknesses in the system and unjustified delays. The place where the first contact medical was made (hospital with or without 7/24 PCI or outpatient care by SEM) had an influence on the delay. The performance of the operation at work or on call time did not affect the delay, contrary to what had suggested other publications. With the launch of the Codi Infart in 2010, the improvement in the organization of the network was related to an increase in the number of patients who received reperfusion therapy and an increase in primary angioplasty as the treatment of choice with a reduction of the delay to reperfusion when compared with the previous period. The analysis of patients with cardiogenic shock showed that radial access was feasible in 2/3 of patients and that the absence of radial pulse was the main femoral approach. We find a relationship between radial access and decreased mortality in the multivariate analysis. In patients aged ≥75 years who underwent primary angioplasty radial access was possible in almost all cases (> 95%). Despite the complexity of patient monitoring showed an incidence of mortality and major cardiac events was significantly lower than that previously reported in this subgroup of patients when the procedure is performed by transfemoral access