"Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients".

OBJECTIVES: To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is. BACKGROUND: Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed. METHODS: A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT) analyses were performed. RESULTS: Mean and maximal postdilatation pressure were 17±3.80 and 20 atmospheres (atm) respectively. Postdilatation balloon/scaffold diameter ratio was 1.01. A total of 39,590 struts were analyzed. Mean, minimal and maximal scaffold diameter were respectively: 3.09±0.34mm, 2.88±0.31mm and 3.31±0.40mm. Mean eccentricity index was 0.13±0.05. ISA percentage was 1.42% with a total of 564 malapposed struts. 89 struts were identified as disrupted, which represents a percentage of disrupted struts of 0.22%. At 30days, none of our patients died, suffered from stroke, stent thrombosis or needed target lesion revascularization (TLR). CONCLUSIONS: NC balloon HPP of BVS at more than 17atm (up to 20atm) is safe during PCI and allows to achieve better angiographic and clinical results.

Seguridad y eficacia del stent capturador de células progenitoras de endotelio en el infarto agudo de miocardio con elevación del ST. Estudio GENIA / Safety and efficacy of endothelial progenitor cell capture stent in ST-elevation acute myocardial infarction. GENIA study

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Acceso axilar en el implante percutáneo de la válvula aórtica: optimización del tratamiento endovascular de la estenosis aórtica severa / Axillary approach for transcatheter aortic valve implantation: optimization of the endovascular treatment for the aortic valve stenosis

Introducción y objetivos. Validar el acceso axilar como una opción eficaz y segura para el implante percutáneo de válvula aórtica percutánea CoreValve®, en pacientes con contraindicación para el acceso femoral, en tres hospitales españoles. Métodos. Incluimos a pacientes con estenosis aórtica severa sintomática y alto riesgo quirúrgico o contraindicación para cirugía, seleccionados por un equipo multidisciplinario para implante percutáneo de válvula aórtica; además, los pacientes tenían contraindicación para el abordaje arterial femoral. Resultados. Incluimos a 19 de los 186 pacientes (10,2%) a los que se implantó una válvula percutánea entre noviembre de 2008 y marzo de 2010. La media de edad era 78,3±8,65 años y el 73,7% eran varones. El EuroSCORE logístico medio de la muestra fue del 28,7%±16,3%. La tasa de éxito de implante fue del 100%. Tras el implante, el gradiente transvalvular máximo pasó de 81,7±21,5 a 15,8±5,5 mmHg, y ningún paciente presentó insuficiencia aórtica residual > 2. La mortalidad total, con un seguimiento medio de 9,2±3,2 meses, fue del 10,5%, con nula mortalidad intraoperatoria y a los 30 días. La incidencia total de complicaciones mayores atribuibles al procedimiento fue del 15,7%. Se implantó marcapasos definitivo por bloqueo auriculoventricular en 8 pacientes (44,4%). Conclusiones. El uso del acceso axilar en pacientes seleccionados para implante percutáneo de válvula aórtica CoreValve® con contraindicación para el acceso femoral es seguro y eficaz y proporciona excelentes resultados en términos de éxito del implante y mortalidad, tanto intrahospitalaria como a los 30 días (AU)

Introduction and objectives: To validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals. Methods: We included patients with severe symptomatic aortic stenosis at very high or prohibitive surgical risk, selected by a multidisciplinary team, for transcatheter aortic valve implantation, and had contraindication to the femoral approach. Results: We included 19 of 186 (10.5%) patients, who were implanted a percutaneous aortic valve, between November 2008 and March 2010. Themean age was 78.3 (standard deviation [SD] +/- 8.65) years and 73.7% were males. The mean logistic EuroSCORE was 28.7% (SD +/- 16.3%). The procedural success rate was 100%. After the procedure the maximum transvalve gradient decreased from 81.7 mmHg (SD +/- 21.5) to 15.8 mmHg (SD +/- 5.5), and no patient presented residual aortic regurgitation >2. The all-cause mortality, with a mean follow-up time of 9.2 (SD +/- 3.2) months was 10.5%, and the in-hospital and 30-day mortality rates were 0%. The global incidence of major complications due to the procedure was 15.7%. Definitive pacemaker implantation was carried out for atrioventricular block in 8 patients (44.4%). Conclusions: The axillary approach for transcatheter aortic valve implantation using the CoreValveW and contraindication to the femoral approach is safe and efficient for selected patients, with excellent results in terms of success implantation and in hospital and 30-day mortality (AU)

Axillary approach for transcatheter aortic valve implantation: optimization of the endovascular treatment for the aortic valve stenosis.

INTRODUCTION AND OBJECTIVES: To validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals. METHODS: We included patients with severe symptomatic aortic stenosis at very high or prohibitive surgical risk, selected by a multidisciplinary team, for transcatheter aortic valve implantation, and had contraindication to the femoral approach. RESULTS: We included 19 of 186 (10.5%) patients, who were implanted a percutaneous aortic valve, between November 2008 and March 2010. The mean age was 78.3 (standard deviation [SD]±8.65) years and 73.7% were males. The mean logistic EuroSCORE was 28.7% (SD±16.3%). The procedural success rate was 100%. After the procedure the maximum transvalve gradient decreased from 81.7 mmHg (SD±21.5) to 15.8 mmHg (SD±5.5), and no patient presented residual aortic regurgitation >2. The all-cause mortality, with a mean follow-up time of 9.2 (SD±3.2) months was 10.5%, and the in-hospital and 30-day mortality rates were 0%. The global incidence of major complications due to the procedure was 15.7%. Definitive pacemaker implantation was carried out for atrioventricular block in 8 patients (44.4%). CONCLUSIONS: The axillary approach for transcatheter aortic valve implantation using the CoreValve(®) and contraindication to the femoral approach is safe and efficient for selected patients, with excellent results in terms of success implantation and in hospital and 30-day mortality.

Intervencionismo coronario percutáneo en paciente con prótesis aórtica percutánea CoreValve® / Percutaneous coronary intervention in a patient with a Corevalve® aortic valve prosthesis

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La insuficiencia renal crónica se asocia a un peor pronóstico tras implante de stent liberador de sirolimus / Chronic renal failure is associated with worse outcome after implantation of sirolimus eluting stent

Fundamento y objetivos: La insuficiencia renal crónica (IRC) es una patología emergente en los países desarrollados, asociándose esta además con una elevada prevalencia de enfermedad coronaria. Nuestro objetivo es determinar la influencia de la IRC en la aparición de eventos cardiovasculares adversos tras implante de un stent liberador de sirolimus (SLS) en una población no seleccionada.Pacientes y método: Estudio retrospectivo de una cohorte de 461 pacientes a los que se les implantó, de forma consecutiva, uno o más stents liberadores de sirolimus entre septiembre de 2002 y diciembre de 2005 en nuestro centro. Evaluamos la incidencia de eventos adversos durante el seguimiento y su relación con la IRC. Utilizamos la ecuación de MDRD para el cálculo del filtrado glomerular.Resultados: El tiempo medio de seguimiento fue de 42 (DS±13) meses. La edad media fue 61,3 (DS±11,8) años, y el 85,5% eran varones. En total presentaban IRC 50 (11%) pacientes. En un modelo multivariado ajustado por edad, sexo, fracción de eyección, clase killip y la presencia de hipertensión, DM, anemia o trombosis del stent, la IRC se comportó como un potente predictor de mortalidad tanto al año como al final del seguimiento (RR=3,82; intervalo de confianza del 95%, 1,41–10,33, p=0,008) y como un factor independiente de riesgo aumentado de restenosis (RR=3,47; IC del 95%, 1,01–11,97; p=0,045) comparado con los pacientes sin IRC. Aunque con una mayor tendencia hacia el grupo de pacientes con IRC, no se observaron diferencias significativas en la incidencia de trombosis del stent (8% frente a 3,4% respectivamente, p=0,109) ni en la necesidad de nueva revascularización sobre el vaso diana (18,8% frente a 10,8% respectivamente, p=0,094).Conclusiones: La presencia de IRC en pacientes con enfermedad coronaria se asocia con un aumento en la incidencia de restenosis y es un potente predictor de mortalidad tras el implante de un stent liberador de sirolimus (AU)

Background and objectives: Chronic renal failure (CRF) is an emergent pathology in industrialized countries and is associated with high prevalence of coronary artery disease. Our aim is to determine the influence of CRF in the appearance of adverse cardiovascular events after sirolimus-eluting stent implantation in a non selected cohort.Patients and methods: Observational retrospective study with a cohort of 461 patients who received one or more sirolimus-eluting stent between September 2002 and December 2005 at our institution. We evaluated the incidence of adverse cardiovascular events during the follow-up period and their relation with chronic kidney disease. We used the abbreviated Modification of Diet in Renal Disease (MDRD) equation to calculate the GFR.Results: The mean follow-up was 42 months (SD±13) and the mean age was 61±11 years and 85 percent of the group were men. Chronic renal failure was present in 50 patients, 11 percent of the cohort. In a multivariate model, after adjustment for age, sex, left ventricle election fraction, anemia, diabetes, hypertension, Killip class and stent thrombosis, chronic renal failure was an independent predictive factor of death from any cause (hazard ratio, 3.82; 95 percent confidence interval, 1.41–10.33, p=0.008), and an significant risk factor for restenosis (hazard ratio 3.47; 95 percent confidence interval, 1.01–11.97, p=0.045). Significant differences were not found in thrombosis between patients with or without CRF (8% vs 3.4%, p=0,109), although a trend was observed in the CRF group. There no were statistical association with need for a new target vessel revascularization (TVR) after coronary intervention either (18.8% versus 10.5%, p=0.094). Conclusions: The presence of chronic renal failure in patients with coronary disease is associated with higher risk of restenosis and is a potent predictor of mortality after sirolimus-eluting stent implantation

[Chronic renal failure is associated with worse outcome after implantation of sirolimus eluting stent]. / La insuficiencia renal crónica se asocia a un peor pronóstico tras implante de stent liberador de sirolimus.

BACKGROUND AND OBJECTIVES: Chronic renal failure (CRF) is an emergent pathology in industrialized countries and is associated with high prevalence of coronary artery disease. Our aim is to determine the influence of CRF in the appearance of adverse cardiovascular events after sirolimus-eluting stent implantation in a non selected cohort. PATIENTS AND METHODS: Observational retrospective study with a cohort of 461 patients who received one or more sirolimus-eluting stent between September 2002 and December 2005 at our institution. We evaluated the incidence of adverse cardiovascular events during the follow-up period and their relation with chronic kidney disease. We used the abbreviated Modification of Diet in Renal Disease (MDRD) equation to calculate the GFR. RESULTS: The mean follow-up was 42 months (SD ± 13) and the mean age was 61 ± 11 years and 85 percent of the group were men. Chronic renal failure was present in 50 patients, 11 percent of the cohort. In a multivariate model, after adjustment for age, sex, left ventricle election fraction, anemia, diabetes, hypertension, Killip class and stent thrombosis, chronic renal failure was an independent predictive factor of death from any cause (hazard ratio, 3.82; 95 percent confidence interval, 1.41-10.33, p = 0.008), and an significant risk factor for restenosis (hazard ratio 3.47; 95 percent confidence interval, 1.01-11.97, p = 0.045). Significant differences were not found in thrombosis between patients with or without CRF (8% vs 3.4%, p = 0,109), although a trend was observed in the CRF group. There no were statistical association with need for a new target vessel revascularization (TVR) after coronary intervention either (18.8% versus 10.5%, p = 0.094). CONCLUSIONS: The presence of chronic renal failure in patients with coronary disease is associated with higher risk of restenosis and is a potent predictor of mortality after sirolimus-eluting stent implantation.