Cardiac paraganglioma: stent in right coronary artery prior to surgery resection.

Cardiac paragangliomas are extremely rare. Sometimes surgical resection is a challenge owing to the proximity of vital structures and coronary arteries involvement. We report a case of a 34-year-old man with cardiac paragangliomas located between right atrium and right ventricle with a feeding blood supply from collaterals of the right coronary artery. In this case, we implanted a covered single stent (PK Papyrus®) in the right coronary artery with the objective of embolizing collateral branches and to reinforce the coronary artery wall. Although tumour mass was not reduced, vascularization was minimized, and this hybrid strategy made the surgery easier and safer.

Contribution of interventional cardiology to the collective dose in Spain.

INTRODUCTION AND OBJECTIVES: To estimate the contribution of interventional cardiology (IC) to the collective dose in Spain. METHODS: Using the information on frequencies of examinations sourced from the Spanish Society of Cardiology and the patient dose values obtained by the national DOCCACI programme. RESULTS: The fraction of the collective dose per million inhabitants derived from IC was 34 man-Sv (a total of 1600 man-Sv in Spain with 46.5 million inhabitants). The contribution of the IC derived from the medical use of x-rays in Spain resulted in 0.66% of the procedures and 4% of the x-ray collective dose. CONCLUSIONS: Even if this collective radiation dose may seem moderate, at an individual level this medical practice delivers the greatest doses and, therefore, optimisation remains of paramount importance.

Impacto de la circulación colateral en el pronóstico a largo plazo de los pacientes tratados con angioplastia primaria / Impact of coronary collaterals on long-term prognosis in patients treated with primary angioplasty

Introducción y objetivos: El efecto beneficioso de la circulación colateral (CC) coronaria en pacientes con infarto agudo de miocardio con elevación del segmento ST es controvertido. Se investigó su impacto antes de la reperfusión con angioplastia primaria (AP) en el pronóstico a largo plazo de estos pacientes. Métodos: Estudio observacional retrospectivo de una cohorte de 947 pacientes tratados con AP y flujo de grado TIMI ≤ 1 en un centro entre 2005 y 2013. Tras emparejar por puntuación de propensión, se obtuvieron 2 grupos de 175 pacientes emparejados por el grado de CC (Rentrop 0-1 frente a 2-3). En la cohorte emparejada se determinó el impacto de la CC en la mortalidad total, la mortalidad cardiovascular y un combinado de eventos cardiovasculares tras una mediana de seguimiento de 864 [intervalo intercuartílico, 396-1.271] días. Resultados: Del total de 947 pacientes incluidos, 735 (78%) tenían Rentrop 0-1 y 212 (22%), Rentrop 2-3. Durante el seguimiento, 105 fallecieron, 71 de causa cardiovascular. En la cohorte emparejada, la tasa de mortalidad total fue similar entre los grupos (Rentrop 0-1 [8,8%] frente a Rentrop 2-3 [6,3%]; HR = 1,22; IC95%, 0,50-2,94; p = 0,654). Tampoco hubo diferencias en la mortalidad cardiovascular (Rentrop 0-1, [4,6%] frente a Rentrop 2-3 [2,3%]; sub-HR = 0,49; IC95%, 0,14-1,62; p = 0,244) ni en el combinado de eventos muerte cardiovascular, reinfarto, revascularización del vaso diana y cirugía de revascularización coronaria (Rentrop 0-1 [18,8%] frente a Rentrop 2-3 [13,1%]; sub-HR = 0,68; IC95%, 0,40-1,15; p = 0,157). Conclusiones: En esta serie contemporánea, la presencia de buena CC antes de la AP no se asoció a mejor pronóstico de los pacientes en cuanto a eventos clínicos a largo plaz (AU)

Introduction and objectives: The beneficial effect of coronary collateral circulation (CC) in patients with ST-segment elevation myocardial infarction is controversial. The aim of this study was to evaluate the impact of CC before reperfusion with primary angioplasty (PA) on the long-term prognosis of these patients. Methods: Retrospective observational study of a cohort of 947 patients treated with PA and TIMI grade ≤ 1 flow in a single center from 2005 to 2013. Propensity score matching was used to create 2 groups of 175 patients each, matched by the degree of CC (Rentrop 0-1 vs Rentrop 2-3). In the matched cohort, we determined the impact of CC on total mortality, cardiovascular mortality, and a combined adverse cardiovascular event endpoint for a median follow-up of 864 (interquartile range, 396-1271) days. Results: Of a total of 947 patients included, 735 (78%) had Rentrop 0 to 1 and 212 (22%) had Rentrop 2 to 3. During follow-up, 105 patients died, 71 from cardiovascular causes. In the matched cohort, the total mortality rate was similar between the 2 groups (Rentrop 0-1 [8.8%] vs Rentrop 2-3 [6.3%]; HR = 1.22; 95%CI, 0.50-2.94; P = .654). There were no differences in cardiovascular mortality (Rentrop 0-1 [4.6%] vs Rentrop 2-3 [2.3%]; sHR = 0.49; 95%CI, 0.14-1.62; P = .244) or the composite endpoint including cardiovascular death, reinfarction, target vessel revascularization, and coronary artery bypass surgery (Rentrop 0-1 [18.8%] vs Rentrop 2-3 [13.1%]; sHR = 0.68; 95%CI, 0.40-1.15; P = .157). Conclusions: In this contemporary series, the presence of good CC before PA was not associated with better long-term clinical outcomes (AU)

Impact of Coronary Collaterals on Long-term Prognosis in Patients Treated With Primary Angioplasty.

INTRODUCTION AND OBJECTIVES: The beneficial effect of coronary collateral circulation (CC) in patients with ST-segment elevation myocardial infarction is controversial. The aim of this study was to evaluate the impact of CC before reperfusion with primary angioplasty (PA) on the long-term prognosis of these patients. METHODS: Retrospective observational study of a cohort of 947 patients treated with PA and TIMI grade ≤ 1 flow in a single center from 2005 to 2013. Propensity score matching was used to create 2 groups of 175 patients each, matched by the degree of CC (Rentrop 0-1 vs Rentrop 2-3). In the matched cohort, we determined the impact of CC on total mortality, cardiovascular mortality, and a combined adverse cardiovascular event endpoint for a median follow-up of 864 (interquartile range, 396-1271) days. RESULTS: Of a total of 947 patients included, 735 (78%) had Rentrop 0 to 1 and 212 (22%) had Rentrop 2 to 3. During follow-up, 105 patients died, 71 from cardiovascular causes. In the matched cohort, the total mortality rate was similar between the 2 groups (Rentrop 0-1 [8.8%] vs Rentrop 2-3 [6.3%]; HR = 1.22; 95%CI, 0.50-2.94; P = .654). There were no differences in cardiovascular mortality (Rentrop 0-1 [4.6%] vs Rentrop 2-3 [2.3%]; sHR = 0.49; 95%CI, 0.14-1.62; P = .244) or the composite endpoint including cardiovascular death, reinfarction, target vessel revascularization, and coronary artery bypass surgery (Rentrop 0-1 [18.8%] vs Rentrop 2-3 [13.1%]; sHR = 0.68; 95%CI, 0.40-1.15; P = .157). CONCLUSIONS: In this contemporary series, the presence of good CC before PA was not associated with better long-term clinical outcomes.

Five-year clinical performance of a biodegradable polymer-coated biolimus-eluting stent in unselected patients.

OBJECTIVE: To evaluate the long-term follow-up of the unrestricted use of a biodegradable polymer-coated drug-eluting stent in patients undergoing percutaneous coronary intervention (PCI). METHODS: The Nobori 2 study was a prospective, multicentre, observational registry evaluating the safety and the efficacy of the biodegradable polymer biolimus-eluting stent (BP-BES) among 3067 patients recruited at 125 international sites. The primary combined endpoint was a composite of cardiac death, myocardial infarction and target-lesion revascularisation (TLR). RESULTS: Five-year follow-up was available in 2738 (89.3%) patients. The combined endpoint occurred in 268 patients (10%, 95% CIs 8.9% to 11.3%) at 5 years, with 3.9% of events during the first year and 6.2% during years 1-5 of follow-up. Cumulative rates of TLR and definite/probable stent thrombosis were 5.3% (95% CI 4.5% to 6.3%) and 1.1% (95% CI 0.8% to 1.6%), respectively. Between 1 and 5 years, TLR and very late stent thrombosis rates were 3.5% (95% CI 2.8% to 4.4%) and 0.6% (95% CI 0.3% to 1.1%), respectively. Previous PCI (HR, 2.05, 95% CI 1.68 to 2.50), moderate-to-severe renal disease (HR, 1.89, 95% CI 1.30 to 2.74) and peripheral vascular disease (HR, 1.86, 95% CI 1.38 to 2.52) were the three most powerful independent predictors of the combined endpoint at 5 years. CONCLUSIONS: The final 5-year follow-up of the Nobori 2 registry demonstrates the safety and effectiveness of the BP-BES in an unselected, broadly inclusive cohort of PCI patients, highlighting the excellent performance of this coronary stent technology after polymer biodegradation. TRIAL REGISTRATION NUMBER: ISRCTN81649913; Results.

Abordaje transulnar con arteria radial homolateral ocluida: descripción de la vascularización del antebrazo y seguimiento a largo plazo / Transulnar Approach With Ipsilateral Radial Occlusion: Forearm Vascular Anatomical Description and Long-term Follow-up

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Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups.

INTRODUCTION AND OBJECTIVES: The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. METHODS: We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. RESULTS: Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. CONCLUSIONS: Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time.

El uso del acceso radial en la angioplastia primaria: resultados en 1.029 pacientes consecutivos y análisis en subgrupos desfavorables / Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups

INTRODUCCIÓN Y OBJETIVO:S: El acceso radial reduce las complicaciones vasculares tras la angioplastia primaria. El objetivo es examinar la factibilidad del acceso radial sistemático en la angioplastia primaria y evaluar cómo afecta a los subgrupos menos favorables. MÉTODOS: Se ha analizado a 1.029 pacientes consecutivos con síndrome coronario agudo con elevación del segmento ST tratados con angioplastia primaria. RESULTADOS: En el 93,1% de los pacientes, el acceso radial ha sido el acceso primario. La tasa de éxito de angioplastia primaria fue del 95,9%, y el 87,6% de los pacientes estaban libres de eventos clínicos a los 30 días del procedimiento. La tasa de cruce vascular fue del 3,0%, estable durante el periodo estudiado. La edad mayor de 75 años (odds ratio = 2,50; intervalo de confianza del 95%, 1,09-5,71; p = 0,03) y la historia de cardiopatía isquémica previa (odds ratio = 2,65, intervalo de confianza del 95%, 1,12-6,24; p = 0,02) fueron predictores de necesidad de cruce. En las mujeres y los mayores de 75 años, el uso del acceso femoral primario fue mayor. Sin embargo, en este subgrupo de pacientes el acceso radial no afectó a los tiempos de reperfusión ni al éxito de la angioplastia, aunque sí se observó una mayor tasa de cruce (el 10,9 frente al 2,6%; p = 0,006). En los pacientes en shock cardiogénico, el acceso radial se utilizó en el 51,5% de los casos, con tiempos de reperfusión y tasas de éxito de la angioplastia similares a los del acceso femoral, aunque con mayor necesidad de cruce. CONCLUSIONES: El acceso radial se puede utilizar de manera segura y eficaz en la mayoría de las angioplastias primarias. En mujeres de edad avanzada y en pacientes en shock, aumenta la necesidad de cruce sin penalizar los tiempos de reperfusión

INTRODUCTION AND OBJECTIVES: The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. METHODS: We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. RESULTS: Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. CONCLUSIONS: Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time

Actualización en cardiología intervencionista / Update on interventional cardiology

En el presente artículo se hace una revisión de las publicaciones y los estudios presentados más relevantes en el ámbito de la cardiología intervencionista en el año 2012. El intervencionismo coronario en el contexto del infarto con elevación del ST ocupa un lugar destacado con estudios que confirman la importancia de reducir los tiempos de reperfusión y otros que evalúan diferentes dispositivos y estrategias farmacológicas en la angioplastia primaria. Los estudios comparativos entre stents farmacoactivos de diferentes generaciones son múltiples e indican una progresión positiva en eficacia y especialmente en seguridad. Con las nuevas generaciones de stents farmacoactivos, la trombosis tardía resulta casi equivalente a la de los stents metálicos. Los resultados con stents en la lesión del tronco común o en la enfermedad multivaso también se han abordado en importantes ensayos. Entre las técnicas de diagnóstico intracoronario, destacan los estudios de correlación entre técnicas de imagen y de presión intracoronaria. El intervencionismo cardiaco estructural y concretamente el implante de válvula aórtica y la reparación mitral continúan generando muchas publicaciones, especialmente la primera. Finalmente, la denervación renal ocupa ya un lugar destacado en la literatura médica (AU)

This article provides a detailed review of the most important studies on interventional cardiology reported in publications or presentations during the year 2012. With regard to coronary interventions, ST-elevation myocardial infarction is extensively addressed in studies focusing on the relevance of reducing the reperfusion time and the utility of various devices and pharmacological strategies in primary angioplasty. Multiple comparative studies involving different generations of drug-eluting stents are available and indicate a favorable progression in terms of safety and efficacy. The risk of late thrombosis with the new generations of drug-eluting stents seems to be equivalent to that observed with bare-metal stents. The clinical outcomes with these stents in the elderly, in left main coronary artery, or in multivessel disease have also been the subject of important trials. Among the studies on intracoronary diagnostic techniques, those correlating imaging and pressure-based techniques are of special interest. The percutaneous treatment of structural heart disease, particularly transcatheter aortic valve implantation, followed by mitral repair, continues to be the subject of a great number of publications. Finally, renal denervation is currently being widely discussed in the literature (AU)

Update on interventional cardiology.

This article provides a detailed review of the most important studies on interventional cardiology reported in publications or presentations during the year 2012. With regard to coronary interventions, ST-elevation myocardial infarction is extensively addressed in studies focusing on the relevance of reducing the reperfusion time and the utility of various devices and pharmacological strategies in primary angioplasty. Multiple comparative studies involving different generations of drug-eluting stents are available and indicate a favorable progression in terms of safety and efficacy. The risk of late thrombosis with the new generations of drug-eluting stents seems to be equivalent to that observed with bare-metal stents. The clinical outcomes with these stents in the elderly, in left main coronary artery, or in multivessel disease have also been the subject of important trials. Among the studies on intracoronary diagnostic techniques, those correlating imaging and pressure-based techniques are of special interest. The percutaneous treatment of structural heart disease, particularly transcatheter aortic valve implantation, followed by mitral repair, continues to be the subject of a great number of publications. Finally, renal denervation is currently being widely discussed in the literature.

Actualizacion en cardiologia intervencionista / Update on interventional cardiology

En el presente artículo se hace una revisión de las publicaciones y los estudios presentados más relevantes en el ámbito de la cardiología intervencionista. En cuanto al intervencionismo coronario, el contexto del infarto con ST alto ocupa un lugar destacado, con estudios que establecen la importancia de los tiempos adecuados y otros que confirman la seguridad de los stents farmacoactivos. Los estudios comparativos entre stents farmacoactivos de diferentes generaciones son múltiples e indican una progresión positiva en eficacia y seguridad. Los resultados con estos en la lesión del tronco común o en la enfermedad multivaso se abordan también en importantes ensayos. Entre las técnicas de diagnostico intracoronario destaca latomografia de coherencia óptica aplicada al estudio de los stents farmacoactivos. El intervencionismo cardiaco estructural, concretamente el implante percutaneo de válvula aortica, suscita un interés cada vez mayor, y más tras la publicación del primer estudio aleatorizado que ha arrojado resultados positivos (AU)

This article contains a review of the most important studies on interventional cardiology reported in either publications or presentations. In the area of coronary interventions, ST-elevation myocardial infarction continues to take center place: recent studies have confirmed the importance of timely intervention and the safety of drug-eluting stents. The numerous studies that have compared different generations of drugeluting stents indicate that there has been a steady improvement in safety and efficacy. In addition, the use of stents in the left main coronary artery and in multivessel disease have also been investigated in major studies. Of the different intracoronary diagnostic techniques, optical coherence tomography is highlighted by this review, particularly for its use in the study of drug-eluting stents. There is increasing interest in the percutaneous treatment of structural heart disease, specifically percutaneous aortic valve implantation,especially following the publication of the first randomized trial, which produced encouraging results (AU)

Uso de dispositivo Amplatzer ® para el cierre de fístulas broncopleurales, un procedimiento híbrido mediante broncoscopia y radiología / Use of Amplatzer ® device for closure of bronchopleural fistulas, a hybrid procedure using bronchoscopy and radiology

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