The trichome pattern diversity of Cardamine shares genetic mechanisms with Arabidopsis but differs in environmental drivers.

Natural variation in trichome pattern (amount and distribution) is prominent among populations of many angiosperms. However, the degree of parallelism in the genetic mechanisms underlying this diversity and its environmental drivers in different species remain unclear. To address these questions, we analyzed the genomic and environmental bases of leaf trichome pattern diversity in Cardamine hirsuta, a relative of Arabidopsis (Arabidopsis thaliana). We characterized 123 wild accessions for their genomic diversity, leaf trichome patterns at different temperatures, and environmental adjustments. Nucleotide diversities and biogeographical distribution models identified two major genetic lineages with distinct demographic and adaptive histories. Additionally, C. hirsuta showed substantial variation in trichome pattern and plasticity to temperature. Trichome amount in C. hirsuta correlated positively with spring precipitation but negatively with temperature, which is opposite to climatic patterns in A. thaliana. Contrastingly, genetic analysis of C. hirsuta glabrous accessions indicated that, like for A. thaliana, glabrousness is caused by null mutations in ChGLABRA1 (ChGL1). Phenotypic genome-wide association studies (GWAS) further identified a ChGL1 haplogroup associated with low trichome density and ChGL1 expression. Therefore, a ChGL1 series of null and partial loss-of-function alleles accounts for the parallel evolution of leaf trichome pattern in C. hirsuta and A. thaliana. Finally, GWAS also detected other candidate genes (e.g. ChETC3, ChCLE17) that might affect trichome pattern. Accordingly, the evolution of this trait in C. hirsuta and A. thaliana shows partially conserved genetic mechanisms but is likely involved in adaptation to different environments.

Impacto de CYP2C19*2 en la reactividad plaquetar en pacientes con síndrome coronario agudo tratados con clopidogrel / Relevance of CYP2C19*2 regarding platelet reactivity in patients with acute coronary syndrome treated with clopidogrel

Fundamento y objetivo: El valor de los polimorfismos PON1-Q192R, CYP2C19*2 y *17 en la identificación del paciente pobre respondedor a clopidogrel es controvertido. Evaluamos la relación de los polimorfismos señalados con la reactividad plaquetar y el pronóstico a medio plazo en pacientes con síndrome coronario agudo remitidos para cateterismo cardíaco. Pacientes y método: Se incluyeron prospectivamente 247 pacientes con síndrome coronario agudo. En todos se dispuso del genotipo (CYP2C19*2, CYP2C19*17, PON1-Q192R). Medimos la reactividad plaquetar con VerifyNow®. Se registraron episodios adversos intrahospitalarios (muerte, infarto periprocedimiento) y durante el seguimiento (muerte, infarto de miocardio, angina, accidente cerebrovascular, trombosis del stent). Resultados: Los portadores de alelos *2 de CYP2C19 presentaron una mayor reactividad plaquetar residual (PRU, media [DE] de 252 [76] frente a 287 [74], p = 0,002). Los portadores de alelos *17 de CYP2C19*17 o de alelos T(Q) de PON1-Q192R no presentaron una reactividad distinta (p > 0,05). En un modelo multivariado para la predicción de pobre respuesta a clopidogrel, la contribución de CYP2C19*2 fue modesta (Wald = 7,5; odds ratio [OR] para ≥ 1 alelo *2 = 2.786, intervalo de confianza del 95% [IC 95%] 1.337-5.808). Fueron factores protectores independientes la hemoglobina basal (OR 0,666, IC 95% 0,555-0,801) y el uso concomitante de estatinas (OR 0,376, IC 95% 0,162-0,873). El índice de masa corporal fue un factor de riesgo (OR 1.074, IC 95% 1.005-1.148). Los polimorfismos estudiados no predijeron episodios adversos. Conclusiones: El polimorfismo de CYP2C19*2 influyó en la respuesta a clopidogrel de forma modesta, pero no condicionó un pronóstico distinto en pacientes con síndrome coronario agudo. Los polimorfismos de PON1-Q192R y CYP2C19*17 no influyeron en la reactividad plaquetar ni el pronóstico (AU)

Background and objective: Previous studies have shown that the metabolism of P2Y12 receptor blockers is influenced not only by CYP2C19*2 but also by PON1-Q192R alelles. We aimed to evaluate the impact of CYP2C19*2 and PON1-Q192R polymorphisms carriage in platelet reactivity and clinical outcome in patients with ischemic heart disease undergoing cardiac catheterization. Patients and method: We recruited prospectively patients with acute coronary syndrome undergoing cardiac catheterization (n = 247). We evaluated the genotype (CYP2C19*2, CYP2C19*17, PON1-Q192R) with TaqMan1 assay and platelet aggregometry in all patients. We assessed both in and out-of-hospital events (unstable angina, periprocedural and spontaneous myocardial infarction, myocardial infarction, all-cause death, stent thrombosis and stroke) during follow-up. Results: Carriers of CYP2C19*2 alleles showed a significant higher residual platelet reactivity (PRU, mean [SD], 252 [76] vs. 287 [74], P = .002). Carriers of PON1-Q192R CT(RQ) and TT(QQ) alleles and CYP2C19*17 did not present a different response to clopidogrel. In a multivariable setting for the prediction of platelet reactivity, the contribution of CYP2C19*2 was modest (Wald = 7.5; odds ratio [OR] for 1 alelle *2 = 2,786, 95% confidence interval [95% CI] 1,337-5,808). Independent predictors were baseline hemoglobin levels (g/dL, OR .666, 95% CI .555-.801) and the use of statins (OR .376, 95% CI .162-.873). Body mass index was a risk factor (OR 1,074, CI 95% 1,005-1,148). Studied polymorphisms did not predict an adverse outcome (AU)

[Relevance of CYP2C19 2 regarding platelet reactivity in patients with acute coronary syndrome treated with clopidogrel]. / Impacto de CYP2C19 2 en la reactividad plaquetar en pacientes con síndrome coronario agudo tratados con clopidogrel.

BACKGROUND AND OBJECTIVE: Previous studies have shown that the metabolism of P2Y12 receptor blockers is influenced not only by CYP2C19 2 but also by PON1-Q192R alelles. We aimed to evaluate the impact of CYP2C19 2 and PON1-Q192R polymorphisms carriage in platelet reactivity and clinical outcome in patients with ischemic heart disease undergoing cardiac catheterization. PATIENTS AND METHOD: We recruited prospectively patients with acute coronary syndrome undergoing cardiac catheterization (n=247). We evaluated the genotype (CYP2C19 2, CYP2C19 17, PON1-Q192R) with TaqMan(®) assay and platelet aggregometry in all patients. We assessed both in and out-of-hospital events (unstable angina, periprocedural and spontaneous myocardial infarction, myocardial infarction, all-cause death, stent thrombosis and stroke) during follow-up. RESULTS: Carriers of CYP2C19 2 alleles showed a significant higher residual platelet reactivity (PRU, mean [SD], 252 [76] vs. 287 [74], P=.002). Carriers of PON1-Q192R CT(RQ) and TT(QQ) alleles and CYP2C19 17 did not present a different response to clopidogrel. In a multivariable setting for the prediction of platelet reactivity, the contribution of CYP2C19 2 was modest (Wald=7.5; odds ratio [OR] for ≥ 1 alelle 2=2,786, 95% confidence interval [95% CI] 1,337-5,808). Independent predictors were baseline hemoglobin levels (g/dL, OR .666, 95% CI .555-.801) and the use of statins (OR .376, 95% CI .162-.873). Body mass index was a risk factor (OR 1,074, CI 95% 1,005-1,148). Studied polymorphisms did not predict an adverse outcome. CONCLUSIONS: CYP2C19 2 polymorphism influenced moderately platelet reactivity but did not show an impact on clinical outcome in patients with acute coronary syndrome. Neither CYP2C19 17 nor PON1-Q192R polymorphisms showed an impact upon platelet reactivity or outcome.

Cuando la resistencia a los bloqueadores del receptor de adenosindifosfato centra toda la atención, ¿la resistencia a la aspirina tiene algo que decir? / With so much attention paid to adenosine diphosphate receptor blockers, is there still a role for aspirin resistance?

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Uso de olmesartán en la prevención o retraso de la nefropatía diabética: algunas consideraciones. Respuesta / Olmesartan for the prevention or delay of diabetic nephropathy: some considerations. Response

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Aumento de mortalidad asociado a olmesartán en pacientes diabéticos para la prevención o retraso de microalbuminuria: ¿es una causa de preocupación? / Increased mortality in patients with diabetes associated with olmesartan for the prevention/delay of microalbuminuria onset: a matter of concern?

No disponible

Homeostatic control of polyamine levels under long-term salt stress in Arabidopsis: changes in putrescine content do not alleviate ionic toxicity.

Salt stress has been frequently studied in its first osmotic phase. Very often, data regarding the second ionic phase is missing. It has also been suggested that Putrescine or/and Spermine could be responsible for salt resistance. In order to test this hypothesis under long-term salt stress, we obtained Arabidopsis thaliana transgenic plants harboring pRD29A::oatADC or pRD29A::GUS construction. Although Putrescine was the only polyamine significantly increased after salt acclimation in pRD29A::oatADC transgenic lines, this rendered in no advantage to this kind of stress. The higher Spermine levels found in WT and transgenic lines when compared to control conditions along with no increment on Putrescine levels in WT plants under salt acclimation, leads us to analyze Spermine effect on pADC1 and pADC2 expression. Increasing levels of this polyamine inhibits these promoters expression while enhances pRD29A expression, making Spermine the polyamine responsible for salt acclimation, and the transgenic lines developed in this work suitable for studying Putrescine roles in conditions where its biosynthesis would be inhibited in the WT genotype.

The EXTREME registry: titanium-nitride-oxide coated stents in small coronary arteries.

OBJECTIVES: We sought to explore the immediate results of Titan2 stent implantation in small coronary arteries, as well as the incidence of major adverse cardiac events (MACE) at six months follow-up. BACKGROUND: The safety of Titan2 stent has been confirmed in several studies in real-life unselected populations. METHODS: We enrolled 311 consecutive patients admitted for percutaneous intervention for at least one significant (50%) de novo lesion in a native small coronary artery (2.0-2.75 mm). All lesions were treated with Titan2 stent implantation. Patients were prospectively followed up for at least six months. The primary endpoint was MACE at six months follow-up [death, myocardial infarction (MI), or target vessel revascularization (TVR)]. Secondary endpoints included angiographic and clinical procedural success, in-hospital MACE, target lesion revascularization (TLR) during follow-up, and stent thrombosis. RESULTS: The mean age was 67.3 +/- 10.9 years (65.9% males). A total of 356 Titan2 stents were implanted in 353 lesions. Angiographic and clinical procedural success was achieved in 344 (97.5%) patients. No case of in-hospital MACE or acute stent thrombosis was reported. Clinical follow-up was completed for an average of 8 +/- 2 months. Two patients (0.7%) died, and 6 (2.1%) developed MI. TLR was performed in 12 (4.2%) and TVR in 16 (5.5%) patients, all were clinically driven. Cumulative MACE occurred in 20 (6.9%) patients. One patient suffered subacute stent thrombosis, but no late stent thrombosis. CONCLUSIONS: Titan2 stent implantation in small coronary arteries achieves excellent immediate outcome, with a low incidence of MACE at mid-term follow-up.

Heart-hand syndrome.

Heart-hand syndromes show substantial clinical and genetic heterogeneity. The unusual case of a patient with a heart-hand syndrome consisting of preaxial polydactylia, postaxial syndactylia, parachute mitral valve, mild subaortic stenosis, and double outlet right ventricle is presented and discussed. The importance of distinguishing Holt-Oram syndrome from its phenocopies and other heart-hand syndromes is underlined.

[Treatment of acute myocardial infarction by primary angioplasty on-site compared with treatment following interhospital transfer: short- and long-time clinical outcomes]. / Tratamiento del infarto agudo de miocardio con angioplastia primaria in situ frente a transferencia interhospitalaria para su realización: resultados clínicos a corto y largo plazo.

INTRODUCTION AND OBJECTIVES: Primary angioplasty is the treatment of first choice for patients with ST-segment elevation acute myocardial infarction. However, its use is limited as the majority of patients present at hospitals without a catheterization laboratory. The objective of this study was to determine short- and long-term outcomes of systematically implementing a primary angioplasty program at two hospitals, one of which did not have a catheterization laboratory. METHODS: This prospective observational study involved consecutive patients with acute myocardial infarction and an indication for reperfusion therapy who were admitted to the two participating hospitals (Hospital 1 had a catheterization laboratory, while Hospital 2 did not) between January 2000 and April 2001. Clinical follow-up was performed at 1, 6 and 12 months. RESULTS: The study included 222 patients: 158 in Hospital 1 and 64 in Hospital 2. The median (interquartile range) delays from door to angiography at Hospital 1 and Hospital 2 were 49.5 min (30.0-88.0 min) and 62.5 min (53.5-93.7 min), respectively (P=.001), and from symptoms to angiography, 162.5 min (105.0-247.5 min) and 187.5 min (131.2-288.7 min), respectively (P=.04). In-hospital and 1-year mortality rates were 12.2% and 15.3%, respectively, with no difference between the hospitals. The hospital of origin was not a determinant of either in-hospital mortality (odds ratio [OR]=1.42, 95% confidence interval [CI], 0.3-7.8) or 1-year mortality (HR=2.04, 95% CI, 0.74-5.61). CONCLUSIONS: Patients with ST-segment elevation acute myocardial infarction who require interhospital transfer for primary angioplasty have a similar clinical outcome to those who are admitted to a hospital at which the procedure is available, provided transfer is undertaken under optimal conditions (i.e., with a suitable means of transport and a short transfer time).

Tratamiento del infarto agudo de miocardio con angioplastia primaria in situ frente a transferencia interhospitalaria para su realización: resultados clínicos a corto y largo plazo / Treatment of acute myocardial infarction by primary angioplasty on-site compared with treatment following interhospital transfer: short- and long-time clinical outcomes

Introducción y objetivos. La angioplastia primaria es la estrategia de primera elección en el tratamiento de los pacientes con infarto con elevación del segmento ST. Sin embargo, su aplicación es reducida, ya que la mayoría de los pacientes acude a hospitales sin laboratorio de hemodinámica. Estudiamos los resultados clínicos a corto y largo plazo de un programa de aplicación sistemática de angioplastia primaria en 2 hospitales, uno de ellos sin laboratorio de hemodinámica. Métodos. Estudio prospectivo, observacional, de pacientes con infarto e indicación de reperfusión, ingresados de forma consecutiva en 2 hospitales entre enero de 2000 y abril de 2001 (hospital 1 con sala de hemodinámica y hospital 2 sin ésta). Se realizó seguimiento clínico al mes y a los 6 y 12 meses. Resultados. Se incluyó a 222 pacientes, 158 en el hospital 1 y 64 en el hospital 2. Las medianas (percentiles 25-75) de retraso en minutos en el hospital 1 frente al hospital 2 fueron: tiempo «puerta-angiografía» 49,5 (30-88) frente a 62,5 (53,5-93,7), p = 0,001; tiempo «síntomas-angiografía» 162,5 (105-247,5) frente a 187,5 (131,2-288,7), p = 0,04. La mortalidad hospitalaria y al año de seguimiento fue del 12,2 y el 15,3%, respectivamente, sin diferencias entre los hospitales. El hospital de procedencia no resultó un determinante de mortalidad hospitalaria (odds ratio = 1,42; intervalo de confianza [IC] del 95%, 0,3-7,8) ni al año de seguimiento (riesgo relativo = 2,04; IC del 95%, 0,74-5,61). Conclusiones. Los pacientes con infarto agudo de miocardio con elevación del segmento ST que precisan traslado interhospitalario para recibir angioplastia primaria tienen una evolución clínica similar a la de los pacientes que ingresan en hospitales con disponibilidad para esa técnica, si ésta se aplica en condiciones óptimas (medio de transporte adecuado y tiempo corto de traslado) (AU)

Introduction and objectives. Primary angioplasty is the treatment of first choice for patients with ST-segment elevation acute myocardial infarction. However, its use is limited as the majority of patients present at hospitals without a catheterization laboratory. The objective of this study was to determine short- and long-term outcomes of systematically implementing a primary angioplasty program at two hospitals, one of which did not have a catheterization laboratory. Methods. This prospective observational study involved consecutive patients with acute myocardial infarction and an indication for reperfusion therapy who were admitted to the two participating hospitals (Hospital 1 had a catheterization laboratory, while Hospital 2 did not) between January 2000 and April 2001. Clinical follow-up was performed at 1, 6 and 12 months. Results. The study included 222 patients: 158 in Hospital 1 and 64 in Hospital 2. The median (interquartile range) delays from door to angiography at Hospital 1 and Hospital 2 were 49.5 min (30.0-88.0 min) and 62.5 min (53.5-93.7 min), respectively (P=.001), and from symptoms to angiography, 162.5 min (105.0-247.5 min) and 187.5 min (131.2-288.7 min), respectively (P=.04). In-hospital and 1-year mortality rates were 12.2% and 15.3%, respectively, with no difference between the hospitals. The hospital of origin was not a determinant of either in-hospital mortality (odds ratio [OR]=1.42, 95% confidence interval [CI], 0.3-7.8) or 1-year mortality (HR=2.04, 95% CI, 0.74-5.61). Conclusions. Patients with ST-segment elevation acute myocardial infarction who require interhospital transfer for primary angioplasty have a similar clinical outcome to those who are admitted to a hospital at which the procedure is available, provided transfer is undertaken under optimal conditions (i.e., with a suitable means of transport and a short transfer time) (AU)

[Comparison between theoretical an actual intracoronary stent dimensions in non-complex lesions]. / Comparación entre dimensiones teóricas y reales del stent intracoronario en lesiones no complejas.

The minimum in-stent lumen diameter is a predictor of restenosis. Stent dimensions provided by manufacturers are derived from in vitro tests. The aim of this study was to compare actual stent dimensions obtained by angiography and intracoronary ultrasound with dimensions that would be expected theoretically for a given inflation pressure in a cohort of 100 non-complex lesions suitable for direct stenting. Significant differences were found between the theoretical diameters and those observed by angiography and ultrasound. The actual-to-theoretical diameter ratio was 0.83 (0.09) when measured using angiography and 0.78 (0.10), using intravascular ultrasound. In lesions without severe calcification, stent dimensions were significantly smaller than indicated by the manufacturer. Nominal figures should not be used as reference values for stent implantation.

Comparación entre dimensiones teóricas y reales del stent intracoronario en lesiones no complejas / Comparison between theoretical an actual intracoronary stent dimensions in non-complex lesions

El diámetro luminal mínimo intra-stent es predictor de reestenosis. Las dimensiones suministradas por el fabricante son el resultado de pruebas in vitro. El objetivo del trabajo es comparar las dimensiones reales, mediante angiografía y ultrasonidos, con las teóricas en una cohorte prospectiva de 100 lesiones no complejas susceptibles a priori de stenting directo. Se encontraron diferencias significativas entre los diámetros teóricos y reales por angiografía y ultrasonidos intracoronarios; la relación diámetro real/teórico por angiografía fue de 0,83 ± 0,09 y por ultrasonidos intracoronarios, 0,78 ± 0,10. Las medidas reales obtenidas en lesiones sin calcificación severa son significativamente inferiores que las teóricas. Las medidas nominales no deberían utilizarse como medida de referencia en el implante

The minimum in-stent lumen diameter is a predictor of restenosis. Stent dimensions provided by manufacturers are derived from in vitro tests. The aim of this study was to compare actual stent dimensions obtained by angiography and intracoronary ultrasound with dimensions that would be expected theoretically for a given inflation pressure in a cohort of 100 non-complex lesions suitable for direct stenting. Significant differences were found between the theoretical diameters and those observed by angiography and ultrasound. The actual-to-theoretical diameter ratio was 0.83 (0.09) when measured using angiography and 0.78 (0.10), using intravascular ultrasound. In lesions without severe calcification, stent dimensions were significantly smaller than indicated by the manufacturer. Nominal figures should not be used as reference values for stent implantation

[Short- and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease in patients who are poor candidates for surgical revascularization]. / Resultados a corto y medio plazo del intervencionismo coronario percutáneo sobre el tronco coronario común izquierdo no protegido en pacientes malos candidatos para revascularización quirúrgica.

INTRODUCTION AND OBJECTIVES: Surgical revascularization is the procedure of choice for unprotected left main coronary artery stenosis, but it may be unsuitable in some patients. We report short- and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery stenosis in a series of patients who were poor candidates for surgery. PATIENTS AND METHOD: Descriptive study of a historic cohort of consecutive patients with unprotected left main coronary artery stenosis who were not candidates for surgery, treated with percutaneous coronary intervention at a single center between April 1999 and December 2003. RESULTS: A total of 83 patients (mean age 72 [9] years) were included. Twenty patients (24%) were in shock on presentation. Surgery was considered unsuitable because of unacceptable surgical risk, poor condition of the distal vessels or comorbid conditions in 61 (73.5%) patients, or acute myocardial infarction in 22 (27%). An intraaortic balloon pump was used in 34 (40%); abciximab in 30 (36%) and stenting in 79 (95%) procedures. The intervention was considered successful in 76 patients (92%). Total in-hospital mortality was 28.9% (55% in patients with acute myocardial infarction and 20% in those without acute myocardial infarction). Median follow-up was 17 months. Average survival was 19.7 (2) months. Eighteen (22%) patients were hospitalized again for a new ischemic event, and 14 (17%) underwent revascularization. In 9 cases (10.8%) a new angioplasty was performed, and in 5 (6.0%) surgical revascularization was necessary. CONCLUSIONS: Percutaneous coronary intervention is an option for revascularization in left main coronary artery stenosis in patients who are poor candidates for surgery, although in-hospital and long-term mortality remain high.

Utility of the fractional flow reserve in the evaluation of angiographically moderate in-stent restenosis.

AIMS: The evaluation of in-stent restenosis (ISR) is usually based on angiographic quantification. This evaluation is sometimes difficult and it has not an accurate clinical correlation. Fractional flow reserve (FFR) measured by intracoronary pressure wire has demonstrated its value in determining the functional repercussion of coronary stenosis. The aim of this study was to evaluate the relation between quantitative angiography-FFR in borderline in-stent restenotic lesions and the accuracy of FFR in deciding the treatment of ISR. METHODS AND RESULTS: Quantitative angiographic values of 65 lesions in 62 patients with angiographically moderate ISR are compared with the FFR value obtained by pressure wire. An FFR value<0.75 was considered significant. Patients with non-revascularized ISR (FFR > or = 0.75) were clinically followed during a year. An FFR value > or = 0.75 was obtained in 41 lesions (63%), 21 of them with stenosis > or = 50%. The co-efficient of correlation between parameters of quantitative angiography and FFR value was <0.5. No events related to the non-treated lesions were observed. CONCLUSIONS: A poor correlation between angiographic quantification and FFR of moderate ISR was found. Conservative management of moderate 40-70% in-stent restenotic lesions with FFR value > or = 0.75 is safe avoiding unnecessary revascularizations based solely on the angiography.

[Comparison of intracoronary ultrasound expansion parameters in coronary stents implanted with or without balloon predilatation. A randomized intravascular ultrasound study]. / Comparación de parámetros de expansión stents implantados con técnica convencional o directa. Estudio aleatorizado con ultrsonidos intracoronarios.

INTRODUCTION AND OBJECTIVES: Coronary stenting without balloon predilatation is a safe technique associated with similar clinical results and lower costs, use of contrast and exposure to radiation in comparison to stenting with predilatation. After direct stenting, expansion may be reduced if the stenotic lesion was not predilatated. This study compared a). stent expansion with and without balloon predilatation (direct stenting), observed by intracoronary ultrasound, and b). angiographic results after 6 months and 1 year with the two implantation techniques. PATIENTS AND METHOD: 100 consecutive lesions eligible for direct stenting were randomized to stent implantation with or without balloon predilatation. Only

[Direct stenting without predilatation: influence of stent diameter on the immediate results]. / Implante de stent sin predilatación: influencia del diámetro del stent en los resultados inmediatos.

The influence of stent diameter in a direct stenting technique was analyzed. We retrospectively identified 987 consecutive lesions in 773 patients in whom direct stenting was attempted. Lesions were divided into two groups: group 1, nominal stent diameter 2.5 mm (237 lesions) and group 2, > or =2.75 mm (n=750). Differences between groups were found in age (64.4 [10.4] vs 62.3 [11] P=.009), female sex (33.2% vs 17%; P<.0001), diabetes (44% vs 33.1%; P=.003), tortuosity (5.4% vs 2.5%; P=.034), reference diameter (2.5 [0.3] vs 3.3 [0.6]; P<.0001) and location in distal segments (44.5% vs 29.4%; P<.0001). Primary deployment (85.5% vs 95.5%; P<.0001) and postdilatation success rates (1.9% vs 4.8%; P=.039) were higher in group 2, with no differences in vessel dissection rate (4.7% vs 4.4%; P=.85). Direct stenting with 2.5 mm stents was associated with a lower success rate than larger stents. Vessel tortuosity, angulation, calcification, lesion severity and distal location were also associated with a higher failure rate. The predictive power of our model was 0.87 (95% CI, 0.82-0.92).

Implante de stent sin predilatación: influencia del diámetro del stent en los resultados inmediatos / Direct stenting without predilatation: influence of stent diameter on the immediate results

Se analiza la influencia del diámetro del stent en el implante directo. Identificamos retrospectivamente 987 lesiones consecutivas, en 773 pacientes, tratadas con stenting directo. En el grupo 1, el diámetro nominal del stent fue de 2,5 mm (n = 237 lesiones) y en el grupo 2, 2,75 mm (n = 750 lesiones). Se encontraron diferencias en la edad (64,4 ñ 10,4 frente a 62,3 ñ 11; p = 0,009), ser mujer (33,2 frente a 17 por ciento, p < 0,0001), diabetes (44 frente a 33,1 por ciento; p = 0,003), tortuosidad (5,4 frente a 2,5 por ciento; p = 0,034), diámetro de referencia (2,5 ñ 0,3 frente a 3,3 ñ 0,6; p < 0,0001) y localización en los segmentos distales (44,5 frente a 29,4 por ciento; p < 0,0001). El éxito primario (85,5 frente a 95,5 por ciento; p < 0,0001) y posdilatación (1,9 frente a 4,8 por ciento; p = 0,039) fue superior en el grupo 2, sin diferencias en la tasa de disección (4,7 frente a 4,4 por ciento; p = 0,85).El stenting directo con stents de 2,5 mm tiene una tasa de éxito primario menor que los stents de mayor calibre. La tortuosidad, angulación, calcificación, grado de estenosis y localización en segmentos más distales también se asociaron a una mayor tasa de fracaso primario. El poder predictivo del modelo fue del 0,87 (IC del 95 por ciento, 0,82-0,92) (AU)