[Previous restenosis as a prognostic indicator in new conventional stent implantation at a different location]. / El comportamiento reestenótico previo como predictor pronóstico ante nueva implantación de stent convencional en distinta localización.

INTRODUCTION AND OBJECTIVES: The aim was to determine whether data on restenosis of a previous stent are useful for predicting outcome in patients who need to undergo a second conventional stent implantation at a different location because of coronary disease progression. METHODS: The study included 80 patients who, during 2000-2004, underwent a second conventional (i.e., not drug-eluting) stent implantation for de novo lesions at a different location to that of the previous stent. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction, or the need for target lesion revascularization (TLR). RESULTS: One year after the second procedure, the cumulative incidence of MACE was significantly higher in patients who experienced significant restenosis of the previous stent than in those who did not (40.6% vs 12.5%, P=.004). Univariate predictors of MACE were: evidence of previous stent restenosis, previous myocardial infarction, and a small vessel (< or =2.75 mm). However, the only independent predictor (Cox regression) of a MACE was previous stent restenosis (hazard ratio 3.85, 95% confidence interval, 1.46-10.18; P=.007). At one year, the TLR rate was also higher in patients with previous stent restenosis (31.3% vs 8.3%; P=.008), in those with small vessels, and in diabetics. Previous stent restenosis and a small vessel were independent predictors of TLR. CONCLUSIONS: Restenosis of a previous stent is a strong predictor of major adverse events in patients undergoing a second conventional stent implantation at a different location because of coronary disease progression.

El comportamiento reestenótico previo como predictor pronóstico ante nueva implantación de stent convencional en distinta localización / Previous restenosis as a prognostic indicator in new conventional stent implantation at a different location

Introducción y objetivos. Averiguar si, en pacientes que requieren un segundo procedimiento de implante de stent convencional en una nueva localización por progresión de enfermedad coronaria, la información aportada por la respuesta reestenótica frente al stent previo es útil para predecir la evolución. Métodos. Se incluye a los 80 pacientes que recibieron un segundo procedimiento de implante de stent convencional (no farmacoactivo) sobre lesiones de novo de distinta localización de la del stent previo en el período 2000-2004. Se definió como evento mayor la ocurrencia de muerte, infarto no mortal o necesidad de revascularización de la lesión diana de novo (RLD). Resultados. Al año del segundo procedimiento, los pacientes que habían evidenciado reestenosis significativa del stent del procedimiento previo tuvieron una incidencia de eventos mayores superior a los pacientes sin reestenosis previa (el 40,6 frente al 12,5%; p = 0,004). Los predictores univariables de eventos mayores fueron la evidencia de reestenosis previa, el infarto previo, y el vaso pequeño (<= 2,75 mm), aunque el único predictor independiente de eventos (regresión de Cox) fue la reestenosis previa (hazard ratio = 3,85; intervalo de confianza del 95%, 1,46-10,18; p = 0,007). La RLD al año fue también mayor en los pacientes con reestenosis previa (el 31,3 frente al 8,3%; p = 0,008), en vasos pequeños y en diabéticos, siendo predictores independientes los dos primeros. Conclusiones. El comportamiento reestenótico frente a un stent previo es un potente predictor de eventos mayores en pacientes que reciben un segundo procedimiento de implante de stent convencional en distinta localización por progresión de su enfermedad coronaria (AU)

Introduction and objectives. The aim was to determine whether data on restenosis of a previous stent are useful for predicting outcome in patients who need to undergo a second conventional stent implantation at a different location because of coronary disease progression. Methods. The study included 80 patients who, during 2000-2004, underwent a second conventional (i.e., not drug-eluting) stent implantation for de novo lesions at a different location to that of the previous stent. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction, or the need for target lesion revascularization (TLR). Results. One year after the second procedure, the cumulative incidence of MACE was significantly higher in patients who experienced significant restenosis of the previous stent than in those who did not (40.6% vs 12.5%, P=.004). Univariate predictors of MACE were: evidence of previous stent restenosis, previous myocardial infarction, and a small vessel (<=2.75 mm). However, the only independent predictor (Cox regression) of a MACE was previous stent restenosis (hazard ratio 3.85, 95% confidence interval, 1.46-10.18; P=.007). At one year, the TLR rate was also higher in patients with previous stent restenosis (31.3% vs 8.3%; P=.008), in those with small vessels, and in diabetics. Previous stent restenosis and a small vessel were independent predictors of TLR. Conclusions. Restenosis of a previous stent is a strong predictor of major adverse events in patients undergoing a second conventional stent implantation at a different location because of coronary disease progression (AU)

[Prevalence of depression and associated medical and psychosocial factors in elderly hospitalized patients with heart failure in Spain]. / Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España.

INTRODUCTION AND OBJECTIVES: This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. METHODS: The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. RESULTS: In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for > or =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). CONCLUSIONS: Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

Prevalencia de depresión, y factores biomédicos y psicosociales asociados, en ancianos hospitalizados con insuficiencia cardiaca en España / Prevalence of Depression and Associated Medical and Psychosocial Factors in Elderly Hospitalized Patients With Heart Failure in Spain

Introducción y objetivos. En este trabajo se estima la prevalencia de depresión y se identifican los factores biomédicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en España. Métodos. Se estudió a 433 pacientes ≥ 65 años ingresados de urgencia en 4 hospitales españoles desde enero de 2000 hasta junio de 2001, con diagnóstico principal o secundario de insuficiencia cardiaca. Se consideró que había depresión ante la presencia de 3 síntomas en la Escala de Depresión Geriátrica de 10 ítems. Resultados. Del total de pacientes estudiados, 210 (48,5%) presentaron depresión. Las cifras correspondientes fueron 71 (37,6%) en varones y 139 (57,0%) en mujeres. La depresión fue más frecuente en los pacientes con las siguientes características: grado funcional III-IV de la NYHA (odds ratio ajustada [ORa] = 2,00; intervalo de confianza [IC] del 95%, 1,23-3,24); peor puntuación en los aspectos físicos de la calidad vida (ORa = 3,14; IC del 95%,1,98-4,99); dependencia en 1 o 2 actividades básicas de la vida diaria (ABVD) (ORa = 2,52; IC del 95%, 1,41-4,51); dependencia en 3 o más ABVD (ORa = 2,47; IC del 95%, 1,20-5,07); limitación en alguna actividad instrumental de la vida diaria (ORa = 2,20; IC del 95%, 1,28- 3,79); hospitalización previa por insuficiencia cardiaca (ORa = 1,71; IC del 95%, 1,93-5,45); estaban solos en casa más de 2 h al día (ORa = 3,24; IC del 95%, 1,93- 5,45); menor satisfacción con el médico de atención primaria (ORa = 1,90; IC del 95%, 1,14-3,17). Conclusiones. La depresión es muy frecuente en los ancianos hospitalizados con insuficiencia cardiaca, y se asocia con varios factores biomédicos y psicosociales. Esta elevada frecuencia, el peor pronóstico de la insuficiencia cardiaca en presencia de síntomas depresivos y la existencia de instrumentos diagnósticos sencillos y un tratamiento eficaz apoyan el cribado sistemático de la depresión en estos pacientes (AU)

Introduction and objectives. This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. Methods. The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. Results. In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for ≥3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17). Conclusions. Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients (AU)