Facteurs associés à la sténose coronaire conventionnelle stent de récidive.

RESUMENLa reestenosis es la principal limitación del intervencionismo coronario percutáneo con stent a mediano y largo plazo con frecuentes recurrencias después de un primer episodio. Con el objetivo de identificar facto-res asociados a la recurrencia de la misma, se realizó un estudio de cohorte retrospectiva en el hospital “Hermanos Ameijeiras” donde se incluyeron 166 pacientes con reestenosis luego del implante de stent coronarios convencionales entre enero del 2010 y diciembre del 2013. Para determinar las variables asociadas con el comportamiento reestenótico recidivante se practicó un análisis univariado y multivariado (regresión logística). El 69,3% fueron hombres, 101(60.8%) presentaron angina estable, 44% tuvieron reestenosis difusa y la arteria descendente anterior estuvo afectada en 92 pacientes. Fueron tratados mediante angioplastia coronaria 130 pacientes, en el 54.2% se implantaron stents convencionales y la tasa de éxitoangiográfico fue del 97,7%. La reestenosis recidiva en un 25,3% de los casos. El patrón morfológico difuso constituyó la única variable que se asoció de forma independiente (p=0.037) a la recurrencia de la reesteno-sisintrastent.Palabras clave: stent metálicos no recubiertos, reestenosis._________________________________________________________________________________AbstractStent restenosis is the main medium and long term limitation of percutaneous coronary intervention with stent. With the objective of characterizing the clinical, angiographic and therapeutic contexts of patients with this complication, a descriptive, retrospective and transverse study was carried out in “Hermanos Ameijeiras” Teaching Hospital with 166 patients with restenosis after bare metal stent implant between January 2006 and December 2010. To determine variables associated with recidivantrestenotic tendency, a univariate and multivariate (logistic regression) analysis was carried out. 69.3% were men, 101(60.8%) had stable angina,44% had diffuse restenosis and the left anterior descending artery was the afected vessel in 92 patients. 130 patients were treated with coronary angioplasty, in 54.2% bare metal stents were deployed and the angiographic success rate was 97.7%. Recidivance ocurred in 25.3% of the cases. The diffuse morphologicalpattern was the only variable associated independently to recurrent intrastent restenosis.Key words: bare metal stent, restenosi

Facteurs associés à la sténose coronaire conventionnelle stent de récidive.

RESUMENLa reestenosis es la principal limitación del intervencionismo coronario percutáneo con stent a mediano y largo plazo con frecuentes recurrencias después de un primer episodio. Con el objetivo de identificar facto-res asociados a la recurrencia de la misma, se realizó un estudio de cohorte retrospectiva en el hospital “Hermanos Ameijeiras” donde se incluyeron 166 pacientes con reestenosis luego del implante de stent coronarios convencionales entre enero del 2010 y diciembre del 2013. Para determinar las variables asociadas con el comportamiento reestenótico recidivante se practicó un análisis univariado y multivariado (regresión logística). El 69,3% fueron hombres, 101(60.8%) presentaron angina estable, 44% tuvieron reestenosis difusa y la arteria descendente anterior estuvo afectada en 92 pacientes. Fueron tratados mediante angioplastia coronaria 130 pacientes, en el 54.2% se implantaron stents convencionales y la tasa de éxitoangiográfico fue del 97,7%. La reestenosis recidiva en un 25,3% de los casos. El patrón morfológico difuso constituyó la única variable que se asoció de forma independiente (p=0.037) a la recurrencia de la reesteno-sisintrastent.Palabras clave: stent metálicos no recubiertos, reestenosis._________________________________________________________________________________AbstractStent restenosis is the main medium and long term limitation of percutaneous coronary intervention with stent. With the objective of characterizing the clinical, angiographic and therapeutic contexts of patients with this complication, a descriptive, retrospective and transverse study was carried out in “Hermanos Ameijeiras” Teaching Hospital with 166 patients with restenosis after bare metal stent implant between January 2006 and December 2010. To determine variables associated with recidivantrestenotic tendency, a univariate and multivariate (logistic regression) analysis was carried out. 69.3% were men, 101(60.8%) had stable angina,44% had diffuse restenosis and the left anterior descending artery was the afected vessel in 92 patients. 130 patients were treated with coronary angioplasty, in 54.2% bare metal stents were deployed and the angiographic success rate was 97.7%. Recidivance ocurred in 25.3% of the cases. The diffuse morphologicalpattern was the only variable associated independently to recurrent intrastent restenosis.Key words: bare metal stent, restenosi

Management and outcome of mechanically ventilated patients after cardiac arrest

Introduction: The aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. Methods: We performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period. We included 812 patients receiving MV after cardiac arrest. We collected data on demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios, determining which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and occurrence of acute respiratory distress syndrome (ARDS) and pneumonia acquired during ICU stay at 48 hours after admission. Results: Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (V T ) (1998: mean 8.9 (standard deviation (SD) 2) ml/kg actual body weight (ABW), 2010: 6.7 (SD 2) ml/kg ABW; 2004: 9 (SD 2.3) ml/kg predicted body weight (PBW), 2010: 7.95 (SD 1.7) ml/kg PBW) and increased positive end-expiratory pressure (PEEP) (1998: mean 3.5 (SD 3), 2010: 6.5 (SD 3); P <0.001). Patients included from 2010 had more sepsis, cardiovascular dysfunction and neurological failure, but 28-day hospital mortality was similar over time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO 2 <60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher V T , and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay. Conclusions: Protective mechanical ventilation with lower V T and higher PEEP is more commonly used after cardiac arrest. The incidence of pulmonary complications decreased, while other non-respiratory organ failures increased with time. The application of protective mechanical ventilation and the prevention of single and multiple organ failure may be considered to improve outcome in patients after cardiac arrest