Percutaneous left atrial appendage closure in patients with gastrointestinal bleeding associated with oral anticoagulants.

INTRODUCTION: Percutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources. MATERIALS AND METHODS: Prospective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC. RESULTS: 43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean ± SD) 7.29 ± 5 vs 0.42 ± 1.3 (p < 0.001); endoscopic procedures were 4.34 ± 2.85 vs 0.27 ± 0.76 (p < 0.001); and hospitalizations 2.67 ± 2.14 vs 0.03 ± 0.17 (p < 0.001), with a hospital stay of 21.5 ± 17.3 vs 0.09 ± 0.5 days (p < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 ± 1.2g/dl to 12.4 ± 2.2g/dl (p < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6-65). CONCLUSIONS: LAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources.

A Spitting-Cobra-Like Coronary-Pulmonary Artery Fistula in a Patient With Angina.

A 78-year-old woman with a history of hypertension, hyperlipidemia, and asthma was referred to her cardiologist for chest pain and dyspnea on exertion. After performing stress echocardiography, it was determined that closure of the fistula with coils was indicated. This case highlights that coronary fistula could be an unusual entity of angina, clinically improving after the occlusion procedure.

Triflusal en pacientes con hipersensibilidad al ácido acetilsalicílico tratados con stent coronario / Triflusal in patients with aspirin hypersensitivity treated with coronary stent implantation

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Hidroneumopericardio iatrogénico tras pericardiocentesis / Iatrogenic Hidropneumopericardium after Pericardiocentesis

El hidroneumopericardio se define por la presencia de líquido y aire en la cavidad pericárdica. Se trata de una afección infrecuente en los adultos, habitualmente asociada a buen pronóstico, pero que puede resultar potencialmente grave. Presentamos el caso de un paciente trasplantado renal que debutó con taponamiento cardíaco y que precisó pericardiocentesis; varios días después, presentó un cuadro de dolor torácico debido a un hidroneumopericardio iatrogénico. Las pruebas de imagen son claves en la obtención de este diagnóstico.

Hydropneumopericardium is defined by the accumulation of serous fluid and gas in the pericardial sac. It is uncommon in adults, usually associated with favorable outcomes; yet, it may be severe occasionally. We present the case of a kidney transplant patient who developed cardiac tamponade requiring pericardiocentesis. Several days after the procedure, the patient presented chest pain due to iatrogenic hydropneumopericardium. Image tests are essential to make this diagnosis.

[Acute reperfusion therapy in elderly women with acute myocardial infarction with ST-segment elevation: efficacy in the reduction of their mortality]. / Tratamiento de revascularización en fase aguda del infarto de miocardio con elevación del segmento ST en mujeres ancianas: eficacia en la reducción de su mortalidad.

BACKGROUND AND OBJECTIVE: Elderly patients with acute coronary syndromes, particularly elderly women, suffer higher mortality and more morbidity than their younger counterparts. We try to document the outcome, treatment received and prognostic factors in this group. PATIENTS AND METHOD: All data for ST-segment elevation myocardial infarction in women aged >/= 75 admitted to our hospital from 2002 to 2007 were retrospectively collected, including epidemiological and clinical variables, vascular complications, in-hospital outcome and middle-term follow-up. These data were analysed and compared depending on reperfusion therapy or not on admission. We determined the causes of not receiving this therapy and the causes of mortality. RESULTS: A total of 195 females were identified. Mean age was 82.7, diabetics 33% and 41% had anterior wall myocardial infarction. Killip III-IV was found in 26.2%. 25.6% of patients underwent reperfusion therapy. In-hospital mortality was 28.7% and 6-months mortality was 39.8%. During one-year follow-up, the major cardiac events rate in these patients was 45.7%. Age, left bundle-branch block o pacemaker rhythm in the electrocardiogram, delayed admission and medical decision were associated with lower reperfusion therapy rates. Death rate was clearly lower (2.7 times) in treated patients although relative risk of bleeding complications was higher. The absence of reperfusion therapy, high Killip on admission and low left ventricular ejection fraction were independently associated with higher mortality. CONCLUSIONS: Acute myocardial infarction in elderly women remains a high morbidity and mortality pathology. This group is less likely to receive acute reperfusion therapies, which have apparently been proven to improve outcome and decrease the mortality rate.

El tratamiento conservador parece la mejor opción para los aneurismas coronarios sin estenosis / Conservative treatment is apparently the best option in coronary aneurysms without associated stenosis

Los aneurismas coronarios son una patología infrecuente, con una incidencia variable según la población estudiada. La causa más frecuente es la aterosclerosis coronaria, por lo que suele asociarse a estenosis en las coronarias. Realizamos una revisión de todos los estudios angiográficos efectuados en los últimos 10 años en nuestro laboratorio, más de 12 000 pacientes. Trece pacientes mostraron dilataciones aneurismáticas en las coronarias sin relación con estenosis adyacentes. El motivo de ingreso fue un síndrome coronario agudo en la mayoría de los casos, lo que pone de manifiesto la elevada morbilidad asociada de esta patología. Tiene una clara relación con el sexo masculino, sin que hayamos podido encontrar una explicación para esta asociación. A pesar de la ausencia de estenosis coronarias asociadas, creemos que la enfermedad aterosclerótica podría ser su causa etiológica. Debido a la ausencia de grandes registros no se conoce la evolución real de los aneurismas coronarios sin estenosis significativas asociadas y de probable etiología aterosclerótica. En función de nuestra experiencia y de la revisión bibliográfica efectuada, el tratamiento farmacológico conservador es una buena opción en la mayor parte de los pacientes, con buen pronóstico en la evolución a mediano y largo plazo.

Evolución a corto y medio plazo del infarto agudo de miocardio transmural en mujeres ancianas. ¿Son tratadas correctamente? / Short- and mid-term outcomes of Q-wave acute myocardial infarction in elderly women. Are they receiving appropriate treatment?

Objetivos: dado que el infarto agudo de miocardio (IAM) con onda Q es una afección con elevada mortalidad en mujeres ancianas, intentamos conocer cuál es su evolución actual, su tratamiento y los factores que condicionan el pronóstico. Material y métodos: estudio descriptivo que incluyó a todas las mujeres >= 75 años con diagnóstico de IAM transmural en el período 2002-2005. Se analizaron las variables epidemiológicas, clínicas, complicaciones vasculares y la evolución durante la estancia intrahospitalaria y a medio plazo. Se compararon estas variables según hubieran recibido en fase aguda terapia de reperfusión o no, y se registró el motivo de no recibir ese tratamiento. Resultados: se incluyó a 152 mujeres; la edad media fue de 82,2 ± 6,2 años. Un 34,2% eran diabéticas y con IAM anterior en el 40,8%; el 27% tenía un grado Killip III-IV. Se realizó tratamiento de revascularización en fase aguda al 21,1%. La mortalidad intrahospitalaria fue del 25,8% y la acumulada a 6 meses del 37,3%. La incidencia de eventos mayores al año fue 43,8%. No recibir terapia de reperfusión estuvo condicionado por. la edad, el bloqueo de la rama izquierda, la demora en acudir al hospital y por decisión médica. La mortalidad fue 3,3 veces menor en el grupo tratado, aunque con un riesgo relativo de complicación hemorrágica del 2,5. Además de la ausencia de tratamiento revascularizador, el grado Killip y la fracción de eyección fueron predictores independientes de mortalidad. Conclusiones: el IAM en las ancianas continúa siendo una afección con elevada morbimortalidad. A pesar del beneficio observado, estas pacientes reciben escasa terapia de reperfusión en fase aguda, aunque no existe contraindicación formal en la mitad de los casos

Objectives: Q-wave acute myocardial infarction leads to high mortality in elderly women. The aim of this study was to determine current outcomes, treatment and prognostic factors in these patients. Material and methods: all women aged >=75 with Q-wave acute myocardial infarction admitted to our hospital from 2002-2005 were included in this descriptive study. Epidemiological and clinical variables, vascular complications, intra-hospital outcomes, and mid-term follow-up were analyzed and compared depending on whether reperfusion therapy was administered on admission or not. The reasons for not administering this therapy were recorded. Results: we included 152 women. The mean age was 82.2 years (SD 6.2). A total of 34.2% had diabetes and 40.8% had anterior myocardial infarction. Killip class III-IV was found in 27.0%. Reperfusion therapy was administered to 21.1% of the patients. Intra-hospital mortality was 25.8% and 6-month mortality was 37.3%. The incidence of major cardiac events at 1 year was 43.8%. Non-administration of reperfusion therapy was related to age, left bundle-branch block, delayed admission, and medical decision. Mortality was 3.3 times lower in treated patients, although the relative risk of hemorrhagic complications was 2.5 times higher than that in non-treated patients. Independent predictors of mortality were lack of reperfusion therapy, high Killip class on admission, and low ejection fraction. Conclusions: acute myocardial infarction in elderly women continues to cause high morbidity and mortality. Reperfusion therapy is little used in this group of patients, despite the observed benefits. Half these patients have no contraindications for reperfusion therapy

[Drug eluting stents: long term results in clinical practice. Comparison between rapamycin and paclitaxel eluting stents]. / Resultados a largo plazo del empleo de stents recubiertos de fármacos en la práctica clínica habitual. Comparación entre los stents liberadores de rapamicina y los stents liberadores de paclitaxol.

BACKGROUND AND OBJECTIVE: Drug eluting stents have demonstrated their superiority versus bare metal stents in the reduction of restenosis and major adverse cardiac events. Most studies do not identificate differences between rapamycin and paclitaxel eluting stent. PATIENTS AND METHOD: Retrospective study. We identified all patients treated with rapamycin eluting stents or paclitaxel eluting stents during 2003 and 2004 in our center. We analized major adverse cardiac events incidence in the whole group and we investigated for differences between paclitaxel and rapamicin groups. RESULTS: 170 patients were included. 98 treated with rapamycin eluting stents and 72 with paclitaxel eluting stents. Medium follow up was 365 days. There were no differences between groups in demographic or periprocedural variables. The incidence of major adverse cardiac events was 3.5% in the entire group (2.0% in rapamycin group and 5.6% in paclitaxel group; p = 0.43). CONCLUSIONS: Drug eluting stents show a low incidence of major adverse cardiac events when they are utilized in usual clinical practice. With regard to this, we have not found differences between most used devices in our environment, rapamycin eluting stents and paclitaxel eluting stents.

Resultados a largo plazo del empleo de stents recubiertos de fármacos en la práctica clínica habitual. Comparación entre los stents liberadores de rapamicina y los stents liberadores de paclitaxol / Drug eluting stents: long term results in clinical practice. Comparison between rapamycin and paclitaxel eluting stents

Fundamento y objetivo: Los stents liberadores de fármacos han logrado una reducción en la incidencia de eventos clínicos y reestenosis respecto a los stents convencionales. La mayoría de los trabajos no muestra diferencias entre los stents liberadores de rapamicina y de paclitaxol. Pacientes y método: Estudio retrospectivo en el que se seleccionó a todos los pacientes tratados con stents recubiertos de rapamicina o paclitaxol durante los años 2003 y 2004 en nuestro centro. Analizamos la incidencia de eventos cardíacos mayores adversos en el total de pacientes y estudiamos si hubo diferencias entre ambos tipos de stents. Resultados: Se incluyó a 170 pacientes, 98 tratados con stent de rapamicina y 72 con stent de paclitaxol, con un seguimiento medio de 395 días. No hubo diferencias demográficas entre ambos grupos ni en las variables relacionadas con el procedimiento. La incidencia de eventos cardíacos mayores fue del 3,5% (el 2,0% en el grupo rapamicina y el 5,6% en el de paclitaxol; p = 0,43). Conclusiones: Los stents liberadores de fármacos presentan una baja incidencia de eventos cardíacos mayores cuando son utilizados en la práctica clínica habitual. A este respecto, no hemos hallado diferencias entre los dispositivos más utilizados en nuestro medio, el stent liberador de rapamicina y el liberador de paclitaxol

Background and objective: Drug eluting stents have demonstrated their superiority versus bare metal stents in the reduction of restenosis and major adverse cardiac events. Most studies do not identificate differences between rapamycin and paclitaxel eluting stent. Patients and method: Retrospective study. We identified all patients treated with rapamycin eluting stents or paclitaxel eluting stents during 2003 and 2004 in our center. We analized major adverse cardiac events incidence in the whole group and we investigated for differences between paclitaxel and rapamicin groups. Results: 170 patients were included. 98 treated with rapamycin eluting stents and 72 with paclitaxel eluting stents. Medium follow up was 365 days. There were no differences between groups in demographic or periprocedural variables. The incidence of major adverse cardiac events was 3.5% in the entire group (2.0% in rapamycin group and 5.6% in paclitaxel group; p = 0.43). Conclusions: Drug eluting stents show a low incidence of major adverse cardiac events when they are utilized in usual clinical practice. With regard to this, we have not found differences between most used devices in our environment, rapamycin eluting stents and paclitaxel eluting stents

[Coronary aneurysms not associated to stenosis of coronary arteries. Conservative treatment and evolution in six patients]. / Aneurismas coronarios no asociados a estenosis en las arterias coronarias. Tratamiento conservador y evolución en un registro de 6 casos.

Coronary artery aneurysms are a relatively infrequent finding with an incidence of 1-2% per year. The most frequent cause is atherosclerosis and, in that case, they are always associated to stenosis of coronary arteries. We reviewed the coronary angiographic studies performed in the past seven years and we identified six patients that were admitted with an acute coronary syndrome, whose angiographic studies showed the presence of aneurysms in, at least, one of the coronary arteries. In these patients, we found no relation between aneurysms and distal or proximal stenosis. Although there was no angiographic evidence of classical coronary atherosclerosis, we think that atherosclerotic disease could have been the etiological cause, due to injury of the endothelium and media by deposits of lipids, smooth muscle cells, collagen, macrophages, and T-lymphocytes that would have damaged the adventitia layers of the vessel wall, stimulating "vasa-vasorum" neovascularization. The evolution of coronary aneurysms without associated stenosis in the same coronary artery and without another potentially treatable cause is unknown. Due to the limited literature regarding this issue and, taking into account our experience, we feel that, in these cases, medical treatment might be a good option as we detected no major cardiac events in any patient at mid and long-term follow up.

Aneurismas coronarios no asociados a estenosis en las arterias coronarias: Tratamiento conservador y evolución en un registro de 6 casos / Coronary aneurysms not associated to stenosis of coronary arteries: conservative treatment and evolution in six patients

Los aneurismas coronarios son una patología relativamente infrecuente, con una incidencia anual del 1-2%. La causa más frecuente es la ateroesclerosis coronaria y en este caso se suelen asociar a estenosis en las arterias coronarias. Revisamos todos los estudios angiográficos realizados en los últimos 7 años y recogimos los casos de 6 pacientes ingresados por síndrome coronario agudo a los que se realizó coronariografía, demostrando dilataciones aneurismáticas en las arterias coronarias sin relación con estenosis proximales o distales. A pesar de la ausencia de estenosis coronarias, pensamos que la enfermedad ateroesclerótica podría ser la causa mediante: lesión del endotelio y la elástica interna con el depósito de lípidos, células musculares lisas, colágeno, macrófagos y linfocitos T, con afectación final de las capas media y adventicia, y neoformación de vasa-vasorum. Se desconoce la evolución de los aneurismas coronarios sin estenosis significativas asociadas y sin otra causa etiológica tratable. A tenor de la escasa literatura publicada al respecto y con nuestra experiencia creemos que el tratamiento médico conservador podría ser una buena opción en estos casos. En el seguimiento a medio-largo plazo no se registraron eventos cardíacos mayores en ningún paciente.

Coronary artery aneurysms are a relatively infrequent finding with an incidence of 1-2% per year. The most frequent cause is atherosclerosis and, in that case, they are always associated to stenosis of coronary arteries. We reviewed the coronary angiographic studies performed in the past seven years and we identified six patients that were admitted with an acute coronary syndrome, whose angiographic studies showed the presence of aneurysms in, at least, one of the coronary arteries. In these patients, we found no relation between aneurysms and distal or proximal stenosis. Although there was no angiographic evidence of classical coronary atherosclerosis, we think that atherosclerotic disease could have been the etiological cause, due to injury of the endothelium and media by deposits of lipids, smooth muscle cells, collagen, macrophages, and T-lymphocytes that would have damaged the adventitia layers of the vessel wall, stimulating "vasa-vasorum" neovascularization. The evolution of coronary aneurysms without associated stenosis in the same coronary artery and without another potentially treatable cause is unknown. Due to the limited literature regarding this issue and, taking into account our experience, we feel that, in these cases, medical treatment might be a good option as we detected no major cardiac events in any patient at mid and long-term follow up.

[Conservative management of a post infarction intramyocardial dissecting hematoma]. / Tratamiento conservador de un hematoma disecante intramiocárdico postinfarto.

Intramyocardial dissecting hematoma is an infrequent complication of subacute myocardial infarction. Pathological findings consist of a cavity filled with blood, the outer wall of which is the myocardium and pericardium and the inner wall, which faces the ventricular cavity, is part of the myocardium and endocardium. There is scarce information on the subject and the management of these patients continues to be debated. However, there is a certain preference for surgical repair of the defect. Cases in which conservative treatment is a therapeutic option have been reported. We report the case of a patient with an intramyocardial dissecting hematoma after acute anterolateral myocardial infarction who was treated conservatively and achieved a satisfactory outcome in the intermediate-to-long term period.

Tratamiento conservador de un hematoma disecante intramiocárdico postinfarto / Conservative management of a post infarction intramyocardial dissecting hematoma

El hematoma disecante intramiocárdico es una complicación infrecuente de la fase subaguda del infarto agudo de miocardio. El hallazgo anatomopatológico es una cavidad sanguínea limitada exteriormente por miocardio y pericardio, y hacia la cavidad ventricular por el resto del miocardio y el endocardio. Existe cierta controversia respecto a la actitud a seguir y, aunque hay cierta preferencia por el tratamiento quirúrgico de reparación del defecto, se han descrito casos en los que el seguimiento médico podría ser una opción válida. Presentamos el caso de un hematoma disecante intramiocárdico secundario a un infarto agudo de miocardio anterolateral que se trató de forma conservadora, con una evolución satis-factoria a medio-largo plazo (AU)