Long-term prognostic value of quantitative-flow-ratio-concordant revascularization in stable coronary artery disease.

OBJECTIVES: Confirming the prognostic value of global QFR and evaluating the long-term prognosis of QFR-concordant therapy in stable coronary artery disease. BACKGROUND: Wire-based functional evaluation of coronary disease is linked to patient's prognosis. Quantitative Flow Ratio (QFR) is a newer index of computational physiology, linked to clinical outcomes and prognosis at 1 year follow-up. Long-term prognosis of QFR-concordant revascularization in stable coronary artery disease is however unknown hitherto. METHODS: Consecutive patients with stable coronary disease undergoing coronary angiography were included. Centralized and blinded QFR analysis of three coronary territories was performed. Three vessel QFR (3vQFR) was defined as the sum of the basal QFR of each coronary territory. QFR-concordant revascularization was met if all significant lesions (QFR ≤ 0.80) were revascularized and all non-significant lesions (QFR > 0.80) were not; otherwise, the case was defined as QFR-discordant revascularization. Patient-oriented composite end-point (POCE) of cardiac death, myocardial infarction and unscheduled revascularization was the primary endpoint. RESULTS: A total of 803 patients from six high-volume centers were included. Canadian Cardiovascular Society (CCS) class II angina was the most frequent (48.9%) clinical presentation. Median of follow-up was 68.8 months. 3vQFR was an independent predictor of POCE (HR 1.79 CI95% 1.01-3.18), with 2.75 as optimal cut-off value, irrespective of the therapy received. QFR-discordant revascularization (QFR+/Revascularization- or QFR-/Revascularization+) was an independent predictor of POCE in multivariate analysis (HR 1.65, CI 95% 1.03-2.64). CONCLUSION: Global burden of epicardial coronary atherosclerosis, as evaluated by 3vQFR, as well as QFR-discordant therapy are independent predictors of adverse clinical outcome at long-term follow-up in stable coronary artery disease.

Delirium education for family caregivers of patients in the intensive care unit: A pilot study.

Objectives: Delirium, an acute change in mental state, seen in hospitalized older adults is a growing public health concern with implications for both patients and caregivers; however, there is minimal research on educating caregivers about delirium. Utilizing family caregivers to assist with delirium management in acute care settings demonstrates improved health outcomes supporting the need for patient and family centered care. The primary aims of the study were to determine feasibility of implementing a delirium education video for caregivers of patients in an adult oncology intensive care unit and compare delirium knowledge to caregivers in a control group. Methods: A quasi-experimental design comprised of 31 family caregivers of adult patients in an oncology intensive care unit to determine feasibility of implementing a delirium education video. Results: The results demonstrate feasibility of implementing a caregiver education video in-person and virtually. While total delirium knowledge scores were not statistically significant, knowledge gained within the delirium presentation subgroup was significant (p = .05). Conclusion: This study demonstrates feasibility of implementing a caregiver education video and findings support further research in this area. Innovation: Collaborating with caregivers to develop virtual video education for delirium allows for a versatile approach to connect with caregivers to support their caregiving role.

Clinical, histological, and molecular features of gliomas in adults with neurofibromatosis type 1.

BACKGROUND: People with NF1 have an increased prevalence of central nervous system malignancy. However, little is known about the clinical course or pathologic features of NF1-associated gliomas in adults, limiting clinical care and research. METHODS: Adults (≥18 years) with NF1 and histologically confirmed non-optic pathway gliomas (non-OPGs) at Johns Hopkins Hospital, Memorial Sloan Kettering Cancer Center, and Washington University presenting between 1990 and 2020 were identified. Retrospective data were collated, and pathology was reviewed centrally. RESULTS: Forty-five patients, comprising 23 females (51%), met eligibility criteria, with a median of age 37 (18-68 years) and performance status of 80% (30%-100%). Tissue was available for 35 patients. Diagnoses included infiltrating (low-grade) astrocytoma (9), glioblastoma (7), high-grade astrocytoma with piloid features (4), pilocytic astrocytoma (4), high-grade astrocytoma (3), WHO diagnosis not reached (4) and one each of gliosarcoma, ganglioglioma, embryonal tumor, and diffuse midline glioma. Seventy-one percent of tumors were midline and underwent biopsy only. All 27 tumors evaluated were IDH1-wild-type, independent of histology. In the 10 cases with molecular testing, the most common genetic variants were NF1, EGFR, ATRX, CDKN2A/B, TP53, TERT, and MSH2/3 mutation. While the treatments provided varied, the median overall survival was 24 months [2-267 months] across all ages, and 38.5 [18-109] months in individuals with grade 1-2 gliomas. CONCLUSIONS: Non-OPGs in adults with NF1, including low-grade tumors, often have an aggressive clinical course, indicating a need to better understand the pathobiology of these NF1-associated gliomas.

Agreement between Murray law-based quantitative flow ratio (µQFR) and three-dimensional quantitative flow ratio (3D-QFR) in non-selected angiographic stenosis: A multicenter study.

BACKGROUND: The agreement between single-projection Murray-based quantitative flow ratio (mQFR) and conventional three-dimensional quantitative flow ratio (3D-QFR) has not been reported hitherto. METHODS: Patients from a multinational database were randomly selected for the study of agreement, according to sample size calculation. Both conventional 3D-QFR and mQFR were analyzed for all available arteries at a central corelab by independent analysts, blinded to each other's results. RESULTS: Ninety-eight coronary arteries from 35 patients were finally analyzed. Median 3D-QFR was 0.82 (interquartile range 0.78-0.87). The intraclass correlation coefficient for the absolute agreement between 3D-QFR and mQFR was 0.996 (95% confidence interval [CI]: 0.993-0.997); Lin's coefficient 0.996 (95% CI: 0.993-0.997), without constant or proportional bias (intercept = 0 and slope = 1 in orthogonal regression). As dichotomous variable, there was absolute agreement between mQFR and 3D-QFR, resulting in no single false positive or negative. Kappa index was 1 and the diagnostic accuracy 100%. CONCLUSIONS: mQFR using a single angiographic projection showed almost perfect agreement with standard 3D-QFR. These results encourage the interchangeable use of mQFR and 3D-QFR, which can be interesting to improve QFR feasibility in retrospective studies, wherein appropriate double angiographic projections might be challenging to obtain.

Impact of diabetes in patients waiting for invasive cardiac procedures during COVID-19 pandemic.

BACKGROUND: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. OBJECTIVES: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. METHODS: We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. RESULTS: Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p < 0.001] and cardiovascular mortality 4.9% vs 0.9% [p = 0.002] in patients with and without diabetes, respectively). In the multivariable analysis, diabetes remained as an independent risk factor both for overall and cardiovascular mortality. No significant interaction was found with other clinical variables. CONCLUSION: Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.

Consequences of canceling elective invasive cardiac procedures during Covid-19 outbreak.

BACKGROUND: During COVID-19 pandemic in Spain, elective procedures were canceled or postponed, mainly due to health care systems overwhelming. OBJECTIVE: The objective of this study was to evaluate the consequences of interrupting invasive procedures in patients with chronic cardiac diseases due to the COVID-19 outbreak in Spain. METHODS: The study population is comprised of 2,158 patients that were pending on elective cardiac invasive procedures in 37 hospitals in Spain on the 14th of March 2020, when a state of alarm and subsequent lockdown was declared in Spain due to the COVID-19 pandemic. These patients were followed-up until April 31th. RESULTS: Out of the 2,158 patients, 36 (1.7%) died. Mortality was significantly higher in patients pending on structural procedures (4.5% vs. 0.8%, respectively; p < .001), in those >80 year-old (5.1% vs. 0.7%, p < .001), and in presence of diabetes (2.7% vs. 0.9%, p = .001), hypertension (2.0% vs. 0.6%, p = .014), hypercholesterolemia (2.0% vs. 0.9%, p = .026) [Correction added on December 23, 2020, after first online publication: as per Dr. Moreno's request changes in p-values were made after original publication in Abstract.], chronic renal failure (6.0% vs. 1.2%, p < .001), NYHA > II (3.8% vs. 1.2%, p = .001), and CCS > II (4.2% vs. 1.4%, p = .013), whereas was it was significantly lower in smokers (0.5% vs. 1.9%, p = .013). Multivariable analysis identified age > 80, diabetes, renal failure and CCS > II as independent predictors for mortality. CONCLUSION: Mortality at 45 days during COVID-19 outbreak in patients with chronic cardiovascular diseases included in a waiting list due to cancellation of invasive elective procedures was 1.7%. Some clinical characteristics may be of help in patient selection for being promptly treated when similar situations happen in the future.

[Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience]. / Impacto de la COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia española.

INTRODUCTION AND OBJECTIVES: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. RESULTS: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. CONCLUSIONS: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience.

INTRODUCTION AND OBJECTIVES: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. RESULTS: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. CONCLUSIONS: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry).

Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access technique in the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n = 632) or percutaneous approach (puncture group, n = 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascular events (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates were lower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p = 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p = 0.03). At a mean follow-up of 323 days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p = 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population.

Comparación in vitro del comportamiento del irrigante durante dos técnicas de instrumentación con dos calibres de agujas para irrigación / Vitro comparison of the irrigant behavior during the implementation of two techniques of instrumentation with two caliber needles to irrigate

The success of endodontic therapy depends on cleaning and shaping the root canal system. There are two approaches to the root canal system debridement: Start at the apex and progressively enlarge the apical portion and then work coronally with increasingly larger instruments, or start with cervical flaring of the root canal and then progress apically using smaller instruments. The instrumentation is always associated to an irrigant solution, which is why the procedure is called chemo-mechanical preparation. The aim of this study was to compare and evaluate two manual instrumentation techniques (step-back and Crown-down) using different size irrigation needles (27G y 30G) and how this influences in the irrigant behavior. The study design was experimental with a nonprobabilistic convenientce sampling, with a 48 sample simulated in standardized transparent acrylic blocks of resin which were instrumented with the different techniques already mentioned and irrigated with different needle calibers after being divided in four groups. The data was obtained through a photographic record of each stage, they were also saved in a file and electronic forms to be analyzed later. The results obtained show that the lime more frequently allows that the irrigant occupies all the length of the conduct. Lime number 30 is used when implementing the telescopic technique; this is in the fifth stage of the process. However, the lime number 55 is used when implementing the Coronal-apical technique; this corresponds to the first stage. What is remarkable when implementing the Telescopic and Coronal-apical manual techniques of instrumentation associated to the conventional irrigation using 27G or 30G caliber irrigation needles is that it does not produce an appropriate irrigant liquid in the entire apical third.

Thrombosis of second-generation drug-eluting stents in real practice results from the multicenter Spanish registry ESTROFA-2 (Estudio Español Sobre Trombosis de Stents Farmacoactivos de Segunda Generacion-2).

OBJECTIVES: This study sought to evaluate second-generation drug-eluting stent (DES) thrombosis in clinical practice. BACKGROUND: First-generation DES are associated with a significant incidence of late thrombosis. There is paucity of data regarding real practice late thrombosis incidence and predictors with second-generation DES, zotarolimus-eluting stent (ZES), and everolimus-eluting stents (EES). METHODS: A prospective, large-scale, non-industry-linked multicenter registry was designed. Complete clinical-procedural data and systematic follow-up of all patients treated with these stents was reported in a dedicated registry supported by the Spanish Working Group on Interventional Cardiology. RESULTS: From 2005 to 2008, 4,768 patients were included in 34 centers: 2,549 treated with ZES, and 2,219 with EES. The cumulative incidence of definite/probable thrombosis for ZES was 1.3% at 1 year and 1.7% at 2 years and for EES 1.4% at 1 year and 1.7% at 2 years (p = 0.8). The increment of definite thrombosis between the first and second year was 0.2% and 0.25%, respectively. In a propensity score analysis, the incidence remained very similar. Ejection fraction (adjusted hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.95 to -0.99; p = 0.008), stent diameter (adjusted HR: 0.37; 95% CI: 0.17to 0.81; p = 0.01) and bifurcations (adjusted HR: 2.1; 95% CI: 1.14 to 3.7; p = 0.02) emerged as independent predictors of thrombosis. In the subgroup of patients with bifurcations, the use of ZES was independently associated with a higher thrombosis rate (adjusted HR: 4; 95% CI: 1.1 to 13; p = 0.03). CONCLUSIONS: In a real practice setting, the incidence of thrombosis at 2 years with ZES and EES was low and quite similar. The incidence of very late thrombosis resulted lower than was reported in registries of first-generation DES. In the subset of bifurcations, the use of ZES significantly increased the risk of thrombosis.

Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpañol sobre TROmbosis de stents FArmacoactivos).

OBJECTIVES: This study sought to assess the incidence, predictors, and outcome of drug-eluting stent(DES) thrombosis in real-world clinical practice. BACKGROUND: The DES thromboses in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. METHODS: We designed a large-scale, nonindustry-linked multicentered registry, with 20 centers in Spain. The participant centers provided follow-up data for their patients treated with DES, reporting a detailed standardized form in the event of any angiography-documented DES-associated thrombosis occurring. RESULTS: Of 23,500 patients treated with DES, definite stent thrombosis(ST) developed in 301: 24 acute, 125 subacute, and 152 late. Of the late, 62 occurred >1 year(very late ST). The cumulative incidence was 2% at 3 years. Antiplatelet treatment had been discontinued in 95 cases(31.6%). No differences in incidences were found among stent types. Independent predictors for subacute ST analyzed in a subgroup of 14,120 cases were diabetes, renal failure, acute coronary syndrome, ST-segment elevation myocardial infarction, stent length, and left anterior descending artery stenting, and for late ST were ST-segment elevation myocardial infarction, stenting in left anterior descending artery, and stent length. Mortality at 1-year follow-up was 16% and ST recurrence 4.6%. Older age, left ventricular ejection fraction <45%, nonrestoration of Thrombolysis In Myocardial Infarction flow grade 3, and additional stenting were independent predictors for mortality. CONCLUSIONS: The cumulative incidence of ST after DES implantation was 2% at 3 years. No differences were found among stent types. Patient profiles differed between early and late ST. Short-term prognosis is poor, especially when restoration of normal flow fails.

[The importance of investigating the internal thoracic artery before coronary artery surgery in Leriche's syndrome]. / Importancia del sondaje de la arteria mamaria antes de cirugía coronaria en el síndrome de Leriche.

Frequently, both peripheral and coronary artery disease are present in the same patient. In patients with abdominal aortic occlusion (i.e., Leriche's syndrome) or femoroiliac occlusion, collateral circulation to the lower extremities can originate in branches of the abdominal aorta or even in the internal thoracic artery (depending on the level of the occlusion). It is important to identify the origin of this circulation during diagnostic procedures, especially in patients who may need to undergo coronary revascularization surgery since, in cases where the majority of the collateral circulation originates in the internal thoracic artery, using the artery as a coronary graft could lead to acute ischemia of the lower extremities. We present three patients with Leriche's syndrome in whom the internal thoracic artery was the origin of the collateral circulation to the ipsilateral femoral artery.

Importancia del sondaje de la arteria mamaria antes de cirugía coronaria en el síndrome de Leriche / The importance of investigating the internal thoracic artery before coronary artery surgery in Leriche's syndrome

La enfermedad arterial periférica y la enfermedad coronaria frecuentemente coexisten en un mismo paciente. En los pacientes con oclusión de la aorta abdominal (síndrome de Leriche) o del eje femoroiliaco, la circulación colateral a extremidades inferiores puede originarse en ramas de la aorta abdominal o incluso en la arteria mamaria interna (en función del grado de la oclusión). Es importante filiar, durante el procedimiento diagnóstico, el origen de esta circulación, especialmente en los pacientes que pueden necesitar revascularización coronaria quirúrgica, ya que en los casos con circulación colateral procedente en su mayoría de la arteria mamaria interna, su uso como injerto coronario puede ocasionar isquemia aguda en las extremidades inferiores. Presentamos los casos de 3 pacientes con síndrome de Leriche y circulación colateral desde las arterias mamarias a las femorales homolaterales (AU)

Frequently, both peripheral and coronary artery disease are present in the same patient. In patients with abdominal aortic occlusion (i.e., Leriche's syndrome) or femoroiliac occlusion, collateral circulation to the lower extremities can originate in branches of the abdominal aorta or even in the internal thoracic artery (depending on the level of the occlusion). It is important to identify the origin of this circulation during diagnostic procedures, especially in patients who may need to undergo coronary revascularization surgery since, in cases where the majority of the collateral circulation originates in the internal thoracic artery, using the artery as a coronary graft could lead to acute ischemia of the lower extremities. We present three patients with Leriche's syndrome in whom the internal thoracic artery was the origin of the collateral circulation to the ipsilateral femoral artery (AU)

[Does intracoronary abciximab improve the outcome of percutaneous coronary interventions? A randomized controlled trial]. / 'Mejora el uso de abciximab intracoronario el resultado del intervencionismo percutáneo? Estudio prospectivo y aleatorizado.

INTRODUCTION AND OBJECTIVES: It has been clearly demonstrated that abciximab is useful in percutaneous coronary interventions. However, it is not known if intracoronary administration of the initial abciximab bolus improves outcome. Moreover, there may be safety concerns. METHODS: The study was a single-center prospective randomized trial that included all patients undergoing coronary angioplasty involving the use of abciximab. Patients were randomized to either intracoronary or intravenous administration of the abciximab bolus. The primary endpoint was the incidence of major adverse cardiac events (i.e., death, myocardial infarction, or the need for revascularization); secondary endpoints were hemorrhagic complications and the troponin-I level. RESULTS: The study included 137 patients; 72 received an intracoronary abciximab bolus and 65, an intravenous bolus. Clinical characteristics and baseline angiographic findings were similar in the two groups. All patients underwent coronary stent implantation. No difference was observed between the intracoronary bolus group and the intravenous bolus group in type of stent used (drug eluting stent 47.2% vs 50.8%, respectively), total stent length, or final TIMI flow grade (3 vs 2.97, respectively). The intervention success rates were also similar (98.5% vs. 99%, respectively). No complication associated with the administration route was reported. However, the level of the myocardial injury marker troponin I increased significantly in the intravenous bolus group. Clinical follow-up at 1 year did not reveal any difference in the incidence of major adverse cardiac events: 8.5% in the intracoronary bolus group versus 6.2% in the intravenous bolus group. CONCLUSIONS: Intracoronary administration of an abciximab bolus did not appear to be less safe or effective than intravenous administration. Less post-procedural myocardial damage was observed in the intracoronary bolus group.

¿Mejora el uso de abciximab intracoronario el resultado del intervencionismo percutáneo? Estudio prospectivo y aleatorizado / Does intracoronary abciximab improve the outcome of percutaneous coronary interventions? A randomized controlled trial

Introducción y objetivos. La utilidad del abciximab en el intervencionismo coronario percutáneo se ha demostrado plenamente. Sin embargo, se desconoce si la administración intracoronaria del bolo inicial puede aportar ventajas. Igualmente, podría haber dudas acerca de su seguridad. Métodos. Estudio en un solo centro, prospectivo y aleatorizado, en el que se incluyó a todos los pacientes en los que se realizó un intervencionismo coronario percutáneo con abciximab. Se aleatorizó a los pacientes para recibir un bolo de abciximab (ABX) intracoronario o intravenoso. Se analizaron la incidencia de MACE (muerte, reinfarto y necesidad de revascularización) como variable principal y las complicaciones hemorrágicas y las concentraciones de troponina I como variables secundarias. Resultados. Se incluyó a 137 pacientes (72 con ABX intracoronario y 65 con ABX intravenoso). Las características clínicas y los hallazgos angiográficos fueron similares en ambos grupos. Todos recibieron stents. No hubo diferencias en el tipo de stent utilizado (recubierto activo del 47,2 frente al 50,8%), la longitud total del stent y el flujo TIMI final (3 frente a 2,97). Los resultados del intervencionismo coronario percutáneo fueron similares: se realizó con éxito en el 98,5% de los pacientes del grupo ABX intracoronario y en el 99% del grupo ABX intravenoso. No se detectaron complicaciones derivadas de la vía de administración. En el grupo ABX intravenoso se observó una elevación significativa posprocedimiento de la troponina I. En el seguimiento clínico al año no se hallaron diferencias significativas en la incidencia de MACE (el 8,5% en el grupo ABX intracoronario frente al 6,2% en el grupo ABX intravenoso). Conclusiones. La administración intracoronaria del bolo de abciximab no parece menos segura que la intravenosa y es, al menos, igualmente eficaz. Se observó un menor grado de daño miocárdico posprocedimiento en el grupo ABX intracoronario

Introduction and objectives. It has been clearly demonstrated that abciximab is useful in percutaneous coronary interventions. However, it is not known if intracoronary administration of the initial abciximab bolus improves outcome. Moreover, there may be safety concerns. Methods. The study was a single-center prospective randomized trial that included all patients undergoing coronary angioplasty involving the use of abciximab. Patients were randomized to either intracoronary or intravenous administration of the abciximab bolus. The primary endpoint was the incidence of major adverse cardiac events (i.e., death, myocardial infarction, or the need for revascularization); secondary endpoints were hemorrhagic complications and the troponin-I level. Results. The study included 137 patients; 72 received an intracoronary abciximab bolus and 65, an intravenous bolus. Clinical characteristics and baseline angiographic findings were similar in the two groups. All patients underwent coronary stent implantation. No difference was observed between the intracoronary bolus group and the intravenous bolus group in type of stent used (drug eluting stent 47.2% vs 50.8%, respectively), total stent length, or final TIMI flow grade (3 vs 2.97, respectively). The intervention success rates were also similar (98.5% vs. 99%, respectively). No complication associated with the administration route was reported. However, the level of the myocardial injury marker troponin I increased significantly in the intravenous bolus group. Clinical follow-up at 1 year did not reveal any difference in the incidence of major adverse cardiac events: 8.5% in the intracoronary bolus group versus 6.2% in the intravenous bolus group. Conclusions. Intracoronary administration of anabciximab bolus did not appear to be less safe or effective than intravenous administration. Less postprocedural myocardial damage was observed in the intracoronary bolus group

¿Se puede mejorar la eficiencia en procedimientos cardiológicos percutáneos? Dispositivos hemostáticos vasculares femorales / Can the efficiency of percutaneous cardiologic procedures be improved? Femoral hemostatic closure devices

Objetivo: Demostrar que, tras la realización de un cateterismo cardíaco, los dispositivos hemostáticos para el cierre femoral consiguen una mejoría en la calidad de la atención recibida por el paciente, junto con una disminución del gasto sanitario, a través de una reducción de estancia hospitalaria. Método: Estudio descriptivo en dos grupos consecutivos de pacientes sometidos a cateterismo cardíaco: un grupo de estudio (103 pacientes) en el que se utilizaron los dispositivos en el año 2002, y otro (año 2001) en el que no (116 pacientes). Análisis del efecto de estos dispositivos hemostáticos sobre la reducción de la estancia media hospitalaria (mediante movilización precoz, reducción de las complicaciones vasculares mayores) y, con ello, la disminución del gasto sanitario. Resultados: Se obtuvo una disminución en la aparición de complicaciones vasculares mayores tras el procedimiento (únicamente 3 casos y nunca en relación con el uso del dispositivo), así como una reducción clara y notable de la estancia media en los pacientes en los que se utilizaron los dispositivos de sellado vascular de colágeno (2,3 frente a 3,1 días). La reducción de la estancia media hospitalaria fue del 33 por ciento, con un ahorro por paciente de 72,51 e, que llegó a ser de 332,83 e en caso de que el procedimiento fue intervencionista. Conclusiones: El uso de estos dispositivos mejora la eficiencia en procedimientos cardiológicos percutáneos. El beneficio se produce tanto en procedimientos diagnósticos como en los intervencionistas (AU)