ABSTRACT
A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients.
Subject(s)
Atrial Fibrillation/complications , Atrial Fibrillation/therapy , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/therapy , HumansABSTRACT
BACKGROUND: Troponin I concentrations are frequently elevated following percutaneous coronary intervention (PCI) even in procedures without complications and are considered, by some, as predictive of long-term morbidity and mortality. We assessed whether post-PCI troponin I concentrations bore any relationship to clinical, angiographic and in-laboratory minor adverse events indicative of myocardial injury and evaluated, in follow-up, whether these levels are useful as a predictive markers of adverse events. METHODS: Patients (n=147) who were scheduled for PCI for stent placement were prospectively studied. In-laboratory events recorded were protracted chest pain, electrocardiographic changes, slow flows, dissections and lateral branch affectation. Troponin I and creatinine kinase MB fraction (CK-MB) mass were measured at baseline and post-procedure. Mean clinical follow-up was for 10.4+/-3.6 months. RESULTS: During PCI, at least one adverse event occurred in 34% of patients and, in 38% of them, there was an elevation of troponin I as compared to 5.1% of those patients without any adverse event (relative risk=7.4; P<0.001). Elevation of troponin I concentrations occurred in 16.3% of all patients, 79.2% associated with an AE. CK-MB was elevated in 15.6% of patients. On multivariate analysis, protracted chest pain, lateral branch involvement and slow flow remained statistically significant in relation to post-procedure elevations of troponin I concentrations. Clinical follow-up showed a poorer prognosis in patients who had had elevated troponin I concentrations. CONCLUSIONS: In-laboratory adverse event predict elevated post-procedure troponin I concentrations which are associated with myocardial injury. These elevations, in turn, predict poorer medium-term clinical outcomes.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Heart Injuries/diagnosis , Heart Injuries/etiology , Stents , Troponin I/blood , Aged , Biomarkers/blood , Creatine Kinase/blood , Creatine Kinase, MB Form , Female , Follow-Up Studies , Heart Injuries/blood , Humans , Isoenzymes/blood , Male , Middle Aged , Predictive Value of Tests , PrognosisABSTRACT
The influence of atrial fibrillation (AF) on the clinical pattern of patients with chronic renal insufficiency on hemodialysis remains unknown despite the cardiovascular pathology in these patients being well documented and being the primary cause of death in this patient population. The objective of this study was to compare the long-term outcome in those patients on our dialysis unit in sinus rhythm with those in AF.
Subject(s)
Atrial Fibrillation/diagnosis , Atrial Fibrillation/epidemiology , Atrial Function/physiology , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Renal Dialysis , Age Distribution , Aged , Albumins/analysis , Comorbidity , Female , Follow-Up Studies , Humans , Incidence , Ischemic Attack, Transient/epidemiology , Kidney Failure, Chronic/diagnosis , Male , Middle Aged , Multivariate Analysis , Prognosis , Spain/epidemiology , Stroke/epidemiology , Survival Analysis , Thromboembolism/epidemiology , TimeABSTRACT
Objetivo: Presentar nuestra experiencia en la implantacisn de un Sistema de Aseguramiento de la Calidad normalizado, en dos Servicios de Radiodiagnsstico de dos hospitales de la red sanitaria de la Comunidad Autsnoma del Pams Vasco: Hospital Comarcal del Bidasoa de Hondarribia dependiente del Servicio Vasco de Salud-Osakidetza y del Hospital M.a Cristina de Cruz Roja de San Sebastian. Desarrollo metodolsgico: Siendo el objetivo final del proyecto que nos ocupa la Certificacisn del Sistema de Calidad, el alcance de la primera etapa consistis en un estudio pormenorizado de la Norma ISO 9002 al ser ista la aplicable a las actividades de un Servicio de Radiodiagnsstico. Tras analizar los requisitos que dicha norma contiene en sus 20 apartados, la segunda etapa se centrs en su adaptacisn a la practica clmnica y organizativa de nuestros Servicios. Esto supuso una revisisn general de los mismos, y consecuentemente una elaboracisn-actualizacisn de nuestros Manuales de Procedimientos y Protocolos, lo cual constituys el nzcleo del soporte documental del denominado +Manual de Calidad;. La tercera etapa, solapada con la anterior incluys la implantacisn progresiva de lo documentalmente establecido, generando los correspondientes registros de las actividades llevadas a cabo. Resultado: Tras superar una auditorma de certificacisn en la que los auditores comprobaron que en la practica diaria se llevaban a cabo las diferentes actividades tal y como se definman en los diversos documentos del Manual de Calidad, los dos Servicios anteriormente mencionados obtuvieron el correspondiente Certificado emitido por dos organismos diferentes, debidamente acreditados para ello (AENOR y DET NORSKE VERITAS, respectivamente) (AU)
