[Neurological complications of cardiac catheterization]. / Complicaciones neurológicas del cateterismo cardíaco.

AIMS: To describe the neurological complications of cardiac catheterization, together with its risk factors and pathogenic mechanisms. METHOD: Over the past few years there has been a marked increase in the number of interventions involving cardiac catheterizations. For this very reason, we can expect a proportional rise in the number of complications. The incidence of neurological pathologies secondary to heart interventions oscillates between 0.01 and 0.4% of procedures performed. The most frequent clinical pictures are cerebrovascular disease, neuro ophthalmological syndromes and peripheral neuropathies, due to damage done to the median, femoral and lateral femoral cutaneous nerves, and to the lumbar plexus. The most usual mechanisms are cerebral ischemia originated by embolisms and direct compression of the peripheral nerves. Factors increasing the likelihood of complications are old age, the presence of classic vascular risk factors and, probably, the patient s being female. More risk is involved in mitral and aortic valvuloplasties and non elective revascularization procedures. The personal experience of the operator and the overall activity of the department of haemodynamics where the physician works are factors that are very closely linked to the incidence of complications. CONCLUSIONS: Knowledge about neurological illness secondary to cardiac catheterization and its mechanisms of production may allow us to identify higher risk patients, to develop protocols to prevent it and to apply early therapeutic measures.

Complicaciones neurológicas del cateterismo cardíaco / Neurological complications of cardiac catheterization

Objetivos. Describir las complicaciones neurológicas del cateterismo cardíaco (CC), así como sus factores de riesgo y mecanismos patogénicos. Desarrollo. En los últimos años, se ha incrementado notablemente el número de CC. Por este motivo se espera un aumento proporcional de sus complicaciones. La incidencia de patología neurológica secundaria al intervencionismo cardíaco oscila entre el 0,01 y el 0,4 por ciento de los procedimientos. Los cuadros clínicos más frecuentes son la enfermedad cerebrovascular, los síndromes neurooftalmológicos y las neuropatías pariféricas, por afectación de los nervios mediano, femoral, femorocutáneo y del plexo lumbar. Los mecanismos más habituales son la isquemia cerebral de origen embólico y la compresión directa de los nervios periféricos. La edad avanzada, la presencia de factores clásicos de riesgo vascular y, probablemente, el sexo femenino se asocian con una mayor incidencia de complicaciones. Las valvulopatías mitral y aórtica y los procedimientos de revascularización no electivos conllevan mayor riesgo. La experiencia personal del operador y la actividad global de la unidad de hemodinámica donde trabaja, son factores muy relacionados con la incidencia de complicaciones. Conclusiones. El conocimiento de la patología neurológica secundaria al CC y sus mecanismos de producción puede permitir identificar a los pacientes de mayor riesgo, establecer protocolos para su prevención y aplicar medidas terapéuticas de forma precoz (AU)

[Preoperative coronary angiography in valve patients. Criteria for indication in a determined population]. / Coronariografía preoperatoria en pacientes valvulares. Criterios de indicación en una determinada población.

BACKGROUND AND PURPOSE: The indication for preoperative coronary angiography in patients with valvular heart disease depends on the prevalence of coronary disease in these patients, which differs among different geographical areas. Our aim was to determine the indication criteria for preoperative coronary angiography in our population. METHODS: We studied retrospectively the prevalence of significant coronary disease in 511 consecutive patients with valvular disease diagnosed by non-invasive methods, who underwent preoperative coronary angiography from August/1991 to July/1996. We analyzed in each patient: demographic data, symptoms and presence of risk factors for coronary artery disease. We considered that preoperative coronary angiography had to be performed on patients who had a coronary artery disease prevalence > or = 5%. RESULTS: Mean age was 64 +/- 10 years (51% male). There was mitral valvulopathy in 135 patients, aortic in 234 and combined mitro-aortic in 142. Angina was present in 30% of patients, and risk factors for coronary artery disease in 52%. The prevalence of significant coronary disease was 20.3%. It was significantly higher in patients with angina (35.3% versus 13.8% in patients without angina) and in those with risk factors (28% versus 12.2% in patients without risk factors); no differences between valvulopathies were found. Age was significantly higher in patients with coronary disease (69 +/- 8 versus 63 +/- 10 years). Multivariate analysis showed three independent predictors for significant coronary disease: 1) age; 2) previous angina, and 3) risk factors. Regarding the prevalence of significant coronary disease in patients neither angina nor risk factors was < 5% in males who were under 60 years old (1 man; 3.3%) and in females under 65 years old (2 women; 3.5%). CONCLUSIONS: In our reference population and in others with a similar cardiovascular profile, preoperative coronary angiography is indicated in males who are > or = 60 years old and in females who are > or = 65 years old, and in younger patients who present angina or risk factors, regardless of the valvulopathy present.

[Clinical characteristics and hospital mortality of acute myocardial infarction in elderly patients treated with thrombolytic agents]. / Características clínicas y mortalidad hospitalaria del infarto agudo de miocardio en ancianos tratados con fármacos trombolíticos.

OBJECTIVES: This study describes the clinical features of elderly patients with acute myocardial infarction treated with thrombolytics and the effect of such therapy on in-hospital mortality rates in these patients. METHODS AND RESULTS: A group of 463 consecutive patients older than 70 years with an acute myocardial infarction was studied. This population was divided into two groups: 157 patients who received thrombolytic therapy (group A) and 306 patients who did not (group B). Patients in group A were younger (77 vs 79 years; p = 0.01) and had a lower prevalence of females (32.5% vs 44.1%; p = 0.01), prior myocardial infarction (14% vs 28%; p = 0.0008), hypertension (38% vs 48%; p = 0.03), diabetes (17% vs 26%; p = 0.02), class Killip 3 at entry (3.5% vs 14%; p = 0.001), a higher frequency of Q wave MI (88% vs 50%; p = 0.0001), inferior location of MI (51% vs 32%; p = 0.00007) and Killip 1 (70% vs 57%; p = 0.01) compared to group B. No significant differences on the inhospital mortality between either group were observed (25.5% vs 24.8%; p = 0.88). However, the thrombolysis was associated with higher mortality in patients with left ventricular dysfunction at entry (41% vs 84%; p = 0.0008) and in those patients with a delay of more than four hours from the onset of symptoms to admission (19% versus 30%; p < 0.1). CONCLUSIONS: 1) In the elderly with acute myocardial infarction, thrombolytic therapy is administered to a lower risk population; 2) our findings do not confirm the benefits of chemical thrombolysis on cardiac mortality in the elderly, and 3) in selected subgroups (Killip > 2 at entry, symptoms delay > 4 hours) the risk/benefit ratio of thrombolytic therapy should be reevaluated. However, care needs to be taken in evaluating the data because this study was not blinded and the number of patients included was relatively small.