Estenosis aórtica y lesión severa de tronco coronario: tratamiento percutáneo exitoso / Severe aortic valve stenosis with co-existing critical obstruction of the main left coronary artery

Abstracts: Successful treatment following percutaneous angioplasty (PTCA) and percutaneous trans aortic valve aortic valve stenosis and critical obstruction of the main left coronary artery is presented. Due to a very high estimated surgical risk the patient underwent PTCA of the main left trunk followed, a week later, by trans catheter implantation of an aortic valve (TAVI). The procedure was uneventful, and the clinical condition of the patient was excellent at one year (Functional class I).

Síndrome de tako-tsubo, caracterización clínica y evolución a un año plazo / Tako-tsubo syndrome: analysis of 37 cases

Background: Tako-tsubo Syndrome (TTS) is characterized by transient regional systolic dysfunction of the left ventricle (LV), mimicking myocardial infarction. It accounts for 0.9-1.2% of all acute coronary syndromes (ACS). Aim: To describe the incidence and characteristics of TTS within our population. Material and Methods: All patients diagnosed with ACS and TTS were selected from a clinical registry of all the coronary angiographies done in our hospital. Clinical features during initial presentation, hospital evolution and one year follow-up were analyzed. Results: The first case diagnosed in our hospital occurred in 2001. Since then, 4,433 coronary angiographies were done to patients with ACS until 2014 and 37 corresponded to TTS (0.83% incidence). The mean age of patients was 64 years, 73% were female, and 62% had hypertension. All patients had an identifiable trigger factor, abnormal EKG and elevated troponin. The coronary angiography did not show lesions in 97%. However, all had the characteristic extensive segmental-motility alteration with a mean ejection fraction of 44%. All patients were treated initially as an ACS. Seven patients had complications, namely acute cardiac failure in six and stroke in one. No patient died. At one year of follow-up, 100% showed normal segmental motility and ejection fraction, no patient had a new episode of TTS and all were alive. Conclusions: TTS is rare and the incidence found in this study is slightly lower than that reported elsewhere. TTS mimics ACS and it should be suspected by its clinical, electrocardiographic and enzymatic particularities. Coronary angiography helps to rule out other diagnosis. All patients normalize motility and ventricular function, which is the definitive differential feature respect to ACS.

[Giant coronary artery fistula: Report of one case]. / Fístula coronaria gigante. Presentación clínica, caracterización angiográfica, tratamiento y seguimiento a largo plazo: Caso clínico.

Coronary artery fistulae are abnormal connections between a coronary artery and any cardiac chamber or other vessels. Most of them have a congenital origin. We report a 60 years old woman referring a history of progressive dyspnea and orthopnea during the last year. A continuous heart murmur was audible in the third and fourth intercostal spaces at the left sternal border. Electrocardiogram was normal and echocardiography showed mild dilation of right cavities and an image suggesting a dilated right coronary artery with flow to right atrium. Coronary angiography was performed, showing a normal left coronary artery and a very large, tortuous right coronary artery with an extensive communication to coronary venous sinus. Surgical treatment was decided and was performed without incidents. The patient is well after five years of follow up.

Fístula coronaria gigante. Presentación clínica, caracterización angiográfica, tratamiento y seguimiento a largo plazo: caso clínico / Giant coronary artery fistula: report of one case

Coronary artery fistulae are abnormal connections between a coronary artery and any cardiac chamber or other vessels. Most of them have a congenital origin. We report a 60 years old woman referring a history of progressive dyspnea and orthopnea during the last year. A continuous heart murmur was audible in the third and fourth intercostal spaces at the left sternal border. Electrocardiogram was normal and echocardiography showed mild dilation of right cavities and an image suggesting a dilated right coronary artery with flow to right atrium. Coronary angiography was performed, showing a normal left coronary artery and a very large, tortuous right coronary artery with an extensive communication to coronary venous sinus. Surgical treatment was decided and was performed without incidents. The patient is well after five years of follow up.

Amelioration of persistent left ventricular function impairment through increased plasma ascorbate levels following myocardial infarction.

PURPOSE: Percutaneous coronary angioplasty (PCA) has been demonstrated to reduce mortality and morbidity and thereby improve the prognosis of patients undergoing acute myocardial infarctions (AMIs). However, this procedure paradoxically increases the initial damage as the result of a condition known as 'myocardial reperfusion injury'. Oxidative stress may contribute to the mechanism of this injury. The goal of the present study was to ascertain whether high plasma ascorbate levels could ameliorate the reperfusion injuries that occur after the successful restoration of blood flow. METHODS: Patients from three clinical centers of the public health system were included in the study. The groups were formed by either-sex patients with a diagnosis of ST-segment elevation myocardial infarction with an indication for primary PCA. Only the patients who presented with their first myocardial infarction were enrolled. Ascorbate was administered through an infusion given prior to the restoration of the coronary flow, which was then followed by oral treatment with vitamin C (500 mg/12 hours) plus vitamin E (400 IU/day) for 84 days. The left ventricular ejection fraction (LVEF) was determined by using cardiac magnetic resonance on days 6 and 84 following the onset of the reperfusion. In addition, the microvascular function was assessed by an angiographic evaluation using the Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade (TMPG). The results were grouped according to the plasma ascorbate concentration achieved immediately following the onset of reperfusion into either the HA group (high ascorbate, >1 mmol/l) or the LA group (low ascorbate, <1 mmol/l). The biochemical parameters were analyzed throughout the protocol. RESULTS: The LVEF of the HA group was significantly higher than that of the LA group, values on day 84 in the HA group were 33% higher than those of the LA group. The amelioration of the LVEF was accompanied by an improvement in the microvascular dysfunction, after PCA, 95% of the patients in the HA group achieved a TMPG of 2-3, in the LA group only 79% of patients showed a TMPG of 2-3. CONCLUSIONS: These data are consistent with the protective effect of high plasma levels of ascorbate against the oxidative challenge caused by reperfusion injury in patients subjected to PCA following an AMI. Further studies are needed to elucidate the mechanism accounting for this beneficial antioxidant effect.

The effectiveness of antioxidant vitamins C and E in reducing myocardial infarct size in patients subjected to percutaneous coronary angioplasty (PREVEC Trial): study protocol for a pilot randomized double-blind controlled trial.

BACKGROUND: Acute myocardial infarction (AMI) is the leading cause of mortality worldwide. Oxidative stress has been involved in the ischemia-reperfusion injury in AMI. It has been suggested that reperfusion accounts for up to 50% of the final size of a myocardial infarct, a part of the damage likely to be prevented.Therefore, we propose that antioxidant reinforcement through vitamins C and E supplementation should protect against the ischemia-reperfusion damage, thus decreasing infarct size.The PREVEC Trial (Prevention of reperfusion damage associated with percutaneous coronary angioplasty following acute myocardial infarction) seeks to evaluate whether antioxidant vitamins C and E reduce infarct size in patients subjected to percutaneous coronary angioplasty after AMI. METHODS/DESIGN: This is a randomized, 1:1, double-blind, placebo-controlled clinical trial.The study takes place at two centers in Chile: University of Chile Clinical Hospital and San Borja Arriarán Clinical Hospital.The subjects will be 134 adults with acute myocardial infarction with indication for percutaneous coronary angioplasty.This intervention is being performed as a pilot study, involving high-dose vitamin C infusion plus oral administration of vitamin E (Vitamin-treatment group) or placebo (Control group) during the angioplasty procedure. Afterward, the Vitamin-treatment group receives oral doses of vitamins C and E, and the Control group receives placebo for 84 days after coronary angioplasty.Primary outcome is infarct size, assessed by cardiac magnetic resonance (CMR), measured 6 and 84 days after coronary angioplasty.Secondary outcomes are ejection fraction, measured 6 and 84 days after coronary angioplasty with CMR, and biomarkers for oxidative stress, antioxidant status, heart damage, and inflammation, which will be measured at baseline, at the onset of reperfusion, 6 to 8 hours after revascularization, and at hospital discharge. DISCUSSION: The ischemia-reperfusion event occurring during angioplasty is known to increase myocardial infarct size. The cardioprotective benefits of high doses of vitamin C combined with vitamin E have not been fully explored. The PREVEC Trial seeks to determine the suitability of the therapeutic use of vitamins C and E against the reperfusion damage produced during angioplasty.Patient recruitment opened in February 2013. The trial is scheduled to end in March 2016. TRIAL REGISTRATION: ISRCTN56034553.

Perfusión y función ventricular en SPECT cardiaco y coronariografía del mismo día según localización en enfermedad de un vaso / Single-photon emission computed tomography for the assessment of ventricular perfusion and function

Single-photon emission computed tomography (SPECT) can be used as a non-invasive tool for the assessment of coronary perfusion. Aim: To assess ventricular perfusion and function by SPECT in patients with single vessel coronary artery disease. Material and Methods: Among patients with indications for a coronary artery angiography, those with significant lesions in one vessel, were selected for the study. Within 24 hours, cardiac SPECT examinations on basal conditions and after high doses of dipyridamole, were performed. SPECT data from 38 patients with a low probability of coronary artery disease was used for comparisons. Results: Ten patients aged 61 ± 8 years (seven men) were studied. Visual analysis of SPECT revealed signs suggestive of ischemia in eight patients. The remaining two patients did not have perfusion disturbances. SPECT detected eight of ten abnormal vessels reported in the coronary artery angiography. There were two false negative results Summed stress, summed rest and summed difference scores were 9.78 ± 6.51, 3.22 ± 5.07 and 6.33 ± 4.97, respectively. The ejection fractions under stress and at rest were 53 ± 11.7% and 61 ± 15.7% respectively (p < 0.01). The figures for the control group were 69.1 ± 13.5% and 75.2 ± 12.04% respectively (significantly different from patients). Two patients had a summed motion score above 14.9. Likewise, two patients had a summed thickening score above 10.9. Conclusions: SPECT detected 80% of coronary lesions found during coronary artery angiography. Visual analysis of perfusion is highly reliable for diagnosis. Quantitative parameters must be considered only as reference parameters.

Microvascular coronary flow comparison in acute myocardial infarction angioplasty treated with a mesh covered stent (MGUARD stent) versus bare metal stent: MICAMI-MGUARD.

BACKGROUND: Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). OBJECTIVE: Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). METHODS: Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). RESULTS: At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30days follow up, but no clinical events at 6 months follow up. CONCLUSIONS: In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

[Single-photon emission computed tomography for the assessment of ventricular perfusion and function]. / Perfusión y función ventricular en SPECT cardiaco y coronariografía del mismo día según localización en enfermedad de un vaso.

BACKGROUND: Single-photon emission computed tomography (SPECT) can be used as a non-invasive tool for the assessment of coronary perfusion. AIM: To assess ventricular perfusion and function by SPECT in patients with single vessel coronary artery disease. MATERIAL AND METHODS: Among patients with indications for a coronary artery angiography, those with significant lesions in one vessel, were selected for the study. Within 24 hours, cardiac SPECT examinations on basal conditions and after high doses of dipyridamole, were performed. SPECT data from 38 patients with a low probability of coronary artery disease was used for comparisons. RESULTS: Ten patients aged 61 ± 8 years (seven men) were studied. Visual analysis of SPECT revealed signs suggestive of ischemia in eight patients. The remaining two patients did not have perfusion disturbances. SPECT detected eight of ten abnormal vessels reported in the coronary artery angiography. There were two false negative results Summed stress, summed rest and summed difference scores were 9.78 ± 6.51, 3.22 ± 5.07 and 6.33 ± 4.97, respectively. The ejection fractions under stress and at rest were 53 ± 11.7% and 61 ± 15.7% respectively (p < 0.01). The figures for the control group were 69.1 ± 13.5% and 75.2 ± 12.04% respectively (significantly different from patients). Two patients had a summed motion score above 14.9. Likewise, two patients had a summed thickening score above 10.9. CONCLUSIONS: SPECT detected 80% of coronary lesions found during coronary artery angiography. Visual analysis of perfusion is highly reliable for diagnosis. Quantitative parameters must be considered only as reference parameters.

[Coronary angiography: indications, results and complications in 5.000 consecutive patients]. / Angiografía coronaria: indicación, resultados y complicaciones en 5.000 pacientes consecutivos.

BACKGROUND: There are guidelines about equipment, premises, personnel, indications and complications rates for coronary angiography, that every center performing this procedure should adhere. AIM: To report the experience with 5.000 coronary angiographies and to assess the compliance of the center with the current guidelines. MATERIAL AND METHODS: Prospective registry of 5.000 patients aged 60+/-11 years (3.475 males) subjected to coronary angiography since 1992, assessing all aspects of the procedure with special emphasis on complications. RESULTS: The indications for 80% of procedures was suspected coronary atherosclerosis. The main risk factors were hypertension and smoking. Coronary atherosclerosis was demonstrated in 62%, mainly one vessel disease. These were two deaths due to the procedure (0.04%), three patients (0.06%) had an acute myocardial infarction or a stroke. These figures are lower than referential values. CONCLUSIONS: In this center, coronary angiography is a safe procedure, with complications rates that are even lower than referential values.

[Acute and long-term clinical results of bare metal coronary stenting]. / Resultados clínicos inmediatos y alejados del implante de stents metálicos no recubiertos. Se justifica un reemplazo total por los stents liberadores de drogas?

BACKGROUND: Since the introduction of stents in 1994, improved clinical results have boosted the development of coronary angioplasty in Chile. Drug eluting stents, that have a reduced rate of restenosis, are being increasingly used. AIM: To assess the acute and long-term results of bare metal stent implantation. PATIENTS AND METHODS: Acute and long-term clinical, procedural and angiographic results were assessed in non acute myocardial infarction patients undergoing coronary stent implantation between August 1996 and December 2003. RESULTS: During the study period, 932 patients aged 30 to 87 years (194 women) had at least one stent implanted. Twenty two percent were diabetic, 33% had recent myocardial infarction, 53% unstable angina and 22% stable angina. Angiographic and clinical success were 99.6% and 98.2%, respectively. In hospital death was 0.5%. During a mean follow-up of 19.1 months, all cause mortality was 3.9%, cardiac death 1.9% and survival free of major cardiac ischemic events was 85.3%. Only 6.4% of lesions underwent target vessel revascularization (TVR). Independent predictors of TVR were previous surgery, left anterior descending artery, small post stent minimum luminal diameter. Ostial location, in-stent restenosis, and younger age were non significant predictors. CONCLUSIONS: Acute and long-term results of bare metal stents in this population were excellent. An intriguingly low rate of TVR was seen. Selective bare metal stenting should continue in lesions and patients with a low risk of clinical restenosis.

Angiografía coronaria: indicación, resultados y complicaciones en 5.000 pacientes consecutivos / Coronary angiography: indications, results and complications in 5.000 consecutive patients

Background: There are guidelines about equipment, premises, personnel, indications and complications rates for coronary angiography, that every center performing this procedure should adhere. Aim: To report the experience with 5.000 coronary angiographies and to assess the compliance of the center with the current guidelines. Material and methods: Prospective registry of 5.000 patients aged 60±11 years (3.475 males) subjected to coronary angiography since 1992, assessing all aspects of the procedure with special emphasis on complications. Results: The indications for 80 percent of procedures was suspected coronary atherosclerosis. The main risk factors were hypertension and smoking. Coronary atherosclerosis was demonstrated in 62 percent, mainly one vessel disease. These were two deaths due to the procedure (0.04 percent), three patients (0.06 percent) had an acute myocardial infarction or a stroke. These figures are lower than referential values. Conclusions: In this center, coronary angiography is a safe procedure, with complications rates that are even lower than referential values.

Successful percutaneous closure of paraprosthetic aorto-right ventricular leak using the Amplatzer duct occluder.

A 55-year-old male with persisting aorto-right ventricular paraprosthetic leak after mitroaortic valve replacement was hospitalized for recurrent heart failure. Depressed left ventricular ejection fraction and severe pulmonary hypertension with increased right and left ventricular filling pressures were associated with significant left to right shunting through the leak. Elective closure of the leak was obtained with a 6-4 mm Amplatzer duct occluder. No complications were observed, and the patient experienced complete resolution of heart failure symptoms, with NYHA class I heart failure 12 months after discharge.

Influencia del género en la mortalidad del infarto del miocardio tratado con angioplastía primaria / Impact of gender on mortality of patients with acude myocardial infarction managed with primary angioplasty

Antecedentes: El infarto del miocardio (IAM) tratado con trombolíticos tiene mayor mortalidad en mujeres que en hombres. Objetivo: Estudiar la mortalidad, según sexo, del IAM tratado mediante angioplastía primaria. Métodos: Se utilizaron los datos de los 3 últimos años del registro multicéntrico chileno de angioplastía coronaria (RENAC). Comparamos la mortalidad hospitalaria entre hombres y mujeres con IAM tratados con angioplastía primaria, ajustando las diferencias por edad, comorbilidad, número de vasos comprometidos, función ventricular y resultado de la angioplastía. Además se compararon entre ambos sexos la mortalidad por grupo etario y el intervalo entre el inicio de los síntomas y el tratamiento. Resultados: En el período analizado, en el RENAC existían 637 pacientes con IAM tratados con angioplastía primaria, 77 por ciento de los cuales eran hombres. La mortalidad hospitalaria fue 4.3 por ciento en hombres y 14 por ciento en mujeres (p<0.01). No hubo diferencias por sexo en el número de vasos comprometidos, fracción de eyección < 50 por ciento, uso de stents o en el éxito angiográfico (89 hombres vs 86 por ciento mujeres, ns). Las mujeres tenían mayor edad (65±12 vs 59±12 años, p<0.01), incidencia de diabetes (29 vs 19 por ciento, p<0.01) e hipertensión (78 vs 44 por ciento, p<0.01). En el análisis multivariado persistió el mayor riesgo de mortalidad en las mujeres (OR 3.29, 95 por ciento IC: 1.41-7.69, p = 0.006), pero sólo en el grupo > 70 años (24 vs 7 por ciento, p<0.01). Conclusión: En personas menores de 70 años, la angioplastía primaria permitiría disminuir la diferencia pronóstica del IAM entre mujeres y hombres.

La resistencia a aspirina en pacientes cardiovasculares chilenos es frecuente / Aspirin resistance is frecuent in chilean cardiovascular patients

Introducción: La aspirina se usa frecuentemente para la prevención y tratamiento de eventos isquémicos cardiovasculares. Estudios en población anglosajona han mostrado que entre 5-9 por ciento de los pacientes presentan resistencia total a la acción antiplaquetaria de aspirina. Objetivos: Conocer la prevalencia de resistencia a aspirina en enfermos cardiovasculares chilenos. Evaluar factores asociados a la resistencia. Pacientes y Métodos: Se estudian 68 pacientes (21 mujeres, ± 10 años) con enfermedades cardiovasculares estables usuarios de aspirina (100-325 mg/día). Se evalúan variables clínicas y de coagulación básica. Se estudió la agregación plaquetaria con agregómetro óptico en plasma rico en plaquetas con 3 agonista. Se definió Resistencia Total a la aspirina como. 1) agregación (20 por ciento con ácido araquidónico y 2) agregación > 70 por ciento con ADP y/o colágeno. Resultados: Siete pacientes (10,3 por ciento, IC 95 por ciento = 4,2-20,1 por ciento) cumplieron ambos criterios y se consideraron como resistentes totales, 34 (50 por ciento, IC 95 por ciento = 37,6-62,4 por ciento) cumplieron con sólo un criterio y se consideraron como resistentes parciales, y los 27 pacientes restantes (39,7 por ciento, IC 95 por ciento = 28,0-52,3 por ciento) no cumplieron con ninguno de los criterios y se clasificaron como respondedores a AAS. Hubo una mayor frecuencia de fumadores (55,6 vs 23,7 por ciento) en los pacientes con Resistencia Total, pero no alcanzó significación estadística (p = 0,06). Conclusiones: La mayoría de los pacientes cardiovasculares presentan algún grado de resistencia al AAS y un 10,3 por ciento presentan Resistencia Total. No encontramos diferencias significativas entre los los pacientes con y sin resistencia total a aspirina.

[Contemporary practice of the coronary angioplasty in Chile. Final report of the Chilean National Coronary Angioplasty Registry (RENAC) 2001-2002]. / Práctica contemporánea de la angioplastia coronaria en Chile. Informe final del Registro Nacional de Angioplastia Coronaria (RENAC) 2001-2002.

BACKGROUND: Coronary angioplasty was introduced in Chile in 1982, but only after the introduction of stents it became commonplace. However the results of this procedure at the national level remain largely unknown. AIM: To assess the results and characteristics of coronary angioplasty and develop a national registry in Chile (RENAC). PATIENTS AND METHODS: All centers performing angioplasty were invited to contribute prospectively with the clinical, angiographic, procedural characteristics and results of all consecutive coronary angioplasty procedures attempted between June 2001 and October 2002. RESULTS: In 10 centers, 1768 lesions were treated in 1484 procedures (22.98% in women). Mean age was 60.8 +/- 11.3 years old. Diabetes was found in 21.8%, hypertension in 60.2%, dyslipidemia in 52.0%, active smoking in 40.0%, renal failure in 6.2%. Myocardial infarction was recent in 28.4% and acute in 19.7%. Forty eight percent of patients had unstable angina and 15.5% had stable angina. Fifty three percent of patients had single vessel disease and 71%, normal left ventricular eyection fraction. One vessel was treated in 90.6% of patients and 81.7% of lesions were treated with stents, 17.9% only with baloon and in 0.4% with atherectomy. Angiographic success was obtained in 95.2%. Clinical success was obtained in 92.2%, and 95.1% In patients without acute myocardial infarction. Overall inhospital death was 2.2%. In patients without myocardial infarction, the figure was 1.1%. CONCLUSIONS: Coronary angioplasty in Chile is performed mostly for the treatment of acute coronary syndromes. Stents are the most frequently used devices. The high success, low mortality and complications observed are comparable to North American registries.

Desbalance autonómico y procoagulación debido a contaminación atmosférica en Santiago: un estudio prospectivo / Autonomic imbalance and procoagulation due to Santiago’s atmospheric pollution: a prospective study

La contaminación atmosférica (CA) está asociada a aumento de morbilidad cardiovascular a través de mecanismos poco conocidos. Postulamos que la CA por partículas finas se asocia a disminución de la variabilidad de la frecuencia cardíaca (VFC) y a aumento de parámetros procoagulantes. Métodos: Cohorte prospectiva de 6 meses de duración en Santiago (n=88; edad 57±1 años; 44 pts.s con enfermedad coronaria y 44 controles pareados por edad, sexo y comuna de residencia). En cada sujeto se realizó Holter de arritmias de 24 hrs y se determinó proteína C reactiva, viscosidad plasmática, hematocrito y recuento de plaquetas durante un episodio de aumento de la CA y 6 meses después. Se obtuvieron los niveles diarios contemporáneos de partículas PM 2,5 y se analizaron sus efectos sobre la VFC y sobre los parámetros circulantes utilizando modelos aditivos generalizados con ajuste por condiciones meteorológicas, condición caso/control, edad, sexo, índice de masa corporal, colesterol total y HDL, presión arterial sistólica y diastólica, creatinina y uso de aspirina o de betabloqueadores. Resultados: Las concentraciones elevadas de partículas PM 2,5 en el aire los días previos a la medición se asociaron en forma independiente y significativa (p<0,05) con aumento de la FC y disminución en la desviación standard de los intervalos RR normales (SDNN). Se observó además una asociación independiente y significativa (p<0,05) con aumento de la viscosidad plasmática, hematocrito, VHS y del recuento de plaquetas. Conclusiones: Los resultados muestran que la CA por partículas pequeñas disminuye la VFC y aumenta parámetros circulantes de procoagulación, que podrían ser mecanismos que expliquen un aumento de la morbimortalidad cardiovascular debido a CA.