Implantación de un protocolo de angio-TC coronaria basado en el índice de masa corporal: reducción de dosis, calidad de imagen y rendimiento diagnóstico / Implementing a coronary CT angiography protocol based on the body mass index: radiation dose reduction, image quality, and diagnostic performance

Objetivos: Valorar la relación entre el score de calcio coronario y la elección posterior del kilovoltaje según el criterio del radiólogo en un protocolo estándar (PE) de angio-TC coronaria (aTCC) para descartar enfermedad coronaria. Cuantificar la reducción de la radiación ionizante después de vincular el kilovoltaje al índice de masa corporal en un protocolo de baja dosis (PBD) con reconstrucción iterativa de modelado. Valorar la calidad de imagen y el rendimiento diagnóstico del PBD. Material y método: Las características antropométricas, el score de calcio, los niveles de kilovoltaje y los valores de dosis estimada específica para el tamaño (SSDE) y del producto dosis-longitud fueron comparados entre un grupo de 50 pacientes con PBD reclutados prospectivamente y una cohorte histórica adquirida con el PE. Estos parámetros, el número de segmentos coronarios no valorables sin y con tolerancia de fase, la atenuación y la relación señal-ruido en la aorta ascendente en el PBD fueron correlacionados con una calidad de imagen de nivel excelente según una escala semicuantitativa. El rendimiento diagnóstico por paciente fue calculado usando la revaloración clínica a los 24 meses como el método diagnóstico de referencia, incluyendo las pruebas derivadas. Resultados: En el PE existía una relación entre la presencia de calcio coronario y la elección de kilovoltajes altos (p=0,02), que desaparecía en el PBD (p=0,47). Los valores de SSDE y de DLP en el PBD fueron significativamente inferiores y presentaron menor dispersión que en el PE (9,22 mGy [RIQ 7,84-12,1 mGy] y 97 mGy*cm [RIQ 78-134 mGy*cm] contra 26,5 mGy [RIQ 21,3-36,3 mGy] y 253 mGy*cm [RIQ 216-404 mGy*cm]; p <0,001 para las comparaciones de las medianas y de las dispersiones entre ambos grupos)...(AU)

Objectives: To evaluate the relation between the coronary calcium score and the posterior choice of kilovoltage according to radiologists’ criteria in a standard coronary CT angiography protocol to rule out coronary disease. To quantify the reduction in ionizing radiation after linking kilovoltage to patients’ body mass index in a low-dose protocol with iterative model reconstruction. To evaluate the image quality and diagnostic performance of the low-dose protocol. Material and methods: We compared anthropometric characteristics, calcium score, kilovoltage levels, size-specific dose estimates (SSDE), and the dose-length product (DLP) between a group of 50 patients who were prospectively recruited to undergo coronary CT angiography with a low-dose protocol and a historical group of 50 patients who underwent coronary CT angiography with the standard protocol. We correlated these parameters, the number of coronary segments that could not be evaluated with and without temporal padding, the attenuation, and the signal-to-noise ratio in the ascending aorta in the low-dose protocol with excellent imaging quality according to a semiquantitative scale. To calculate the diagnostic performance per patient, we used 24-month clinical follow-up including all tests as the gold standard. Results: In the standard protocol, the presence of coronary calcium correlated with the selection of high kilovoltage (P=0.02); this correlation was not found in the low-dose protocol (P=0.47). Median values of SSDE and DLP were significantly (P<0.001) lower and less dispersed in the low-dose protocol [9.22 mGy (IQR 7.84-12.1 mGy) vs. 26.5 mGy (IQR 21.3-36.3 mGy) in the standard protocol] and [97mGy*cm (IQR 78-134mGy*cm) vs. 253mGy*cm (IQR 216-404mGy*cm) in the standard protocol], respectively...(AU)

Lipoprotein (a) is a predictor of non-achievement of LDL-C goals in patients with chronic heart disease. / Lipoproteína (a) es un factor predictor de no consecución de objetivos de C-LDL en pacientes con cardiopatía isquémica crónica.

INTRODUCTION AND OBJECTIVES: Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease, and to assess its influence on the achievement of LDL-C targets. METHOD: We conducted a cross-sectional study in a cardiology department in Spain. A total of 870 patients with stable coronary artery disease had their lipid profile determined, including Lp(a). Patients were stratified into 2 groups according to Lp(a)>50mg/dL and Lp(a)≤50mg/dL. The association of Lp(a)>50mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis. RESULTS: The prevalence of Lp(a)>50mg/dL was 30.8%. Patients with Lp(a)>50mg/dL had higher baseline (142.30±47.54 vs. 130.47±40.75mg/dL; p=0.0001) and current (72.91±26.44 vs. 64.72±25.30mg/dL; p=0.0001), despite the fact that they were treated with more high-potency statins (77.2 vs. 70.9%; p=0.058) and more combination lipid-lowering therapy (37.7 vs. 25.7%; p=0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a)>50mg/dL. Independent predictors of having elevated Lp(a) levels>50mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08-2.14), combination lipid-lowering therapy with ezetimibe (OR 2.0; 95% CI 1.45-2.73) and failure to achieve a LDL-C ≤55mg/dL (OR 2.3; 95% CI 1.63-3.23). CONCLUSIONS: Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients.

Implementing a coronary CT angiography protocol based on the body mass index: Radiation dose reduction, image quality, and diagnostic performance.

OBJECTIVES: To evaluate the relation between the coronary calcium score and the posterior choice of kilovoltage according to radiologists' criteria in a standard coronary CT angiography protocol to rule out coronary disease. To quantify the reduction in ionizing radiation after linking kilovoltage to patients' body mass index in a low-dose protocol with iterative model reconstruction. To evaluate the image quality and diagnostic performance of the low-dose protocol. MATERIAL AND METHODS: We compared anthropometric characteristics, calcium score, kilovoltage levels, size-specific dose estimates (SSDE), and the dose-length product (DLP) between a group of 50 patients who were prospectively recruited to undergo coronary CT angiography with a low-dose protocol and a historical group of 50 patients who underwent coronary CT angiography with the standard protocol. We correlated these parameters, the number of coronary segments that could not be evaluated with and without temporal padding, the attenuation, and the signal-to-noise ratio in the ascending aorta in the low-dose protocol with excellent imaging quality according to a semiquantitative scale. To calculate the diagnostic performance per patient, we used 24-month clinical follow-up including all tests as the gold standard. RESULTS: In the standard protocol, the presence of coronary calcium correlated with the selection of high kilovoltage (p = 0.02); this correlation was not found in the low-dose protocol (p = 0.47). Median values of SSDE and DLP were significantly (p < 0.001) lower and less dispersed in the low-dose protocol [9.22 mGy (IQR 7.84-12.1 mGy) vs. 26.5 mGy (IQR 21.3-36.3 mGy) in the standard protocol] and [97 mGy cm (IQR 78-134 mGy cm) vs. 253 mGy cm (IQR 216-404 mGy cm) in the standard protocol], respectively. The overall quality of the images obtained with the low-dose protocol was considered good or excellent in 96% of the studies. The parameters associated with image quality in a multivariable model (C statistic = 0.792) were heart rate (estimated coefficient, -0,12 [95% confidence interval: -0.2, -0.04]; p < 0.01) and the SSDE (estimated coefficient, -0,26 [95% confidence interval: -0.51, -0.01]; p < 0.05). The CAD-RADS modifier for a not fully evaluable or diagnostic study was used on two occasions (4%); the final measures for the diagnosis of coronary disease were sensitivity 100%, specificity 94%, and efficacy 94%. CONCLUSIONS: In the standard protocol, the radiologist selects higher kilovoltage for CT angiography studies for patients whose previous calcium score indicates the presence of coronary calcium. In the low-dose protocol, linking kilovoltage with body mass index enables the dose of radiation to be reduced by 65% while obtaining excellent or good image quality in 96% of studies and excellent diagnostic performance.

Factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria / Factors that influence health literacy in patients with coronary artery disease / Fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana

Objetivo: investigar los factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria. Método: estudio transversal, que incluyó 122 pacientes con enfermedades coronarias (60,7% del sexo masculino; 62,07±8,8 años); se evaluó la alfabetización en salud y el conocimiento específico sobre la enfermedad mediante entrevistas con los participantes, utilizando el Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Los datos fueron descritos por medidas de tendencia central y frecuencias. Los factores que influyen en la alfabetización en salud se determinaron mediante un modelo de regresión lineal. El nivel de significación adoptado fue del 5%. El estudio fue aprobado por el Comité de Ética e Investigación. Resultados: la edad y la hipertensión mostraron una relación inversa y significativa con la alfabetización en salud. Por otro lado, un mayor nivel educativo y tener empleo se asociaron con puntajes más altos en el instrumento de alfabetización en salud. El conocimiento específico sobre la enfermedad no influyó en la alfabetización en salud. Las variables del modelo de regresión explicaron el 55,3% de alfabetización inadecuada. Conclusión: en el presente estudio, se concluyó que el conocimiento sobre la enfermedad no influye en la alfabetización en salud, pero los profesionales deben considerar los factores sociodemográficos y clínicos para planificar las intervenciones.

Objective: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. Methods: a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. Results: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. Conclusion: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.

Objetivo: investigar os fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana. Método: estudo transversal, incluindo 122 pacientes com coronariopatias (60,7% do sexo masculino; 62,07±8,8 anos); letramento em saúde e conhecimento específico da doença foram avaliados por meio de entrevista com os participantes, pelo Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Os dados foram descritos por medidas de tendência central e frequências. Fatores que influenciam o letramento em saúde foram determinados por modelo de regressão linear. O nível de significância adotado foi de 5%. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. Resultados: idade e hipertensão apresentaram uma relação inversa e significativa com letramento em saúde. Por outro lado, maior escolaridade e estar empregado associaram-se com maiores pontuações no instrumento de letramento em saúde. O conhecimento específico da doença não influenciou o letramento em saúde. As variáveis do modelo de regressão explicaram 55,3% do letramento inadequado. Conclusão: no presente estudo o conhecimento sobre a doença não influência o letramento em saúde, mas os profissionais devem considerar os fatores sociodemográficos e clínicos para planejar as intervenções.

Valor pronóstico a 10 años de la angiografía coronaria por TAC en pacientes asintomáticos con diabetes tipo 2 / Ten-year prognostic value of coronary CT angiography in asymptomatic patients with type 2 diabetes

Introducción y objetivos: La escala UKPDS (acrónimo inglés de «Estudio Prospectivo de Diabetes del Reino Unido») tiene un valor limitado para la predicción de eventos de enfermedad arterial coronaria (EAC). El estudio pretende investigar el valor añadido de la angiografía coronaria por tomografía computarizada (ACTC) sobre la escala de riesgo UKPDS para la predicción a 10 años de eventos cardiacos adversos en pacientes asintomáticos con diabetes tipo 2. Métodos: Se evaluó a 589 pacientes diabéticos asintomáticos sin historia de EAC a quienes se les realizó una ACTC. El objetivo principal estaba compuesto por muerte cardiaca, infarto de miocardio no mortal, angina inestable que requiere hospitalización y revascularización. Se estimó la habilidad de discriminación y reclasificación para modelos de predicción que incluían combinaciones de la categoría UKPDS, gravedad de estenosis y puntuación de calcio arterial coronario por ACTC. Resultados: La incidencia del objetivo primario fue del 12,4%. A lo largo de 10 años de seguimiento, los pacientes sin placa ateroesclerótica por ACTC tendieron a tener un bajo ratio de eventos coronarios en tanto que aquellos con EAC obstructiva tuvieron una mayor ratio de eventos, independientemente de la categoría de riesgo de la escala UKPDS. EL modelo que solo incluyó la categoría UKPDS tuvo un índice C de Harrell de 0,658; añadiendo el grado de estenosis coronaria al modelo se incrementó significativamente el índice C en 0,066 (p=0,004), en tanto que la adición del CSC incrementó el índice C en solo 0,039 (p=0,056). Globalmente, la información de la ACTC añadida a la categoría de riesgo UKPDS mejoró el ratio de reclasificación para la predicción del objetivo primario. Conclusiones: En pacientes asintomáticos con diabetes tipo 2, la información de la ACTC para EAC...(AU)

Introduction and objectives: The United Kingdom Prospective Diabetes Study (UKPDS) risk score has limited value for predicting coronary artery disease (CAD) events. We investigated the additive value of coronary computed tomography angiography (CCTA) on top of the UKPDS risk score in predicting 10-year adverse cardiac events in asymptomatic patients with type 2 diabetes. Methods: We evaluated 589 asymptomatic diabetic patients without a history of CAD who underwent CCTA. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization. We estimated the discrimination and reclassification ability for the prediction models, which included combinations of the UKPDS category, severity of stenosis, and coronary artery calcium score by CCTA. Results: The incidence of the primary outcome was 12.4%. During 10 years of follow-up, patients without plaque by CCTA tended to have a low CAD event rate, while those with obstructive CAD tended to have a high event rate, irrespective of the baseline UKPDS risk category. The model that included only the UKPDS category had a Harrell's c-index of 0.658; adding the degree of stenosis to the model significantly increased the c-index by 0.066 (P=.004), while adding coronary artery calcium score increased the c-index by only 0.039 (P=.056). Overall, CCTA information in addition to the UKPDS risk category improved the reclassification rate for predicting the primary outcome. Conclusions: In asymptomatic patients with type 2 diabetes, CCTA information for CAD provided significant incremental discriminatory power beyond the UKPDS risk score category for predicting 10-year adverse coronary events.(AU)

Tomografía computarizada coronaria en urgencias: importancia de la experiencia del radiólogo / Coronary computed tomography in emergencies: the importance of the radiologist's experience

Introducción: La incorporación de la angiografía coronaria por tomografía computarizada (ACTC) a la atención sanitaria en las urgencias hospitalarias hace necesaria una adecuada capacitación para la interpretación de esta prueba de imagen. Esta capacitación puede afectar al grado de concordancia interobservador de los radiólogos que evalúan dichos estudios. Objetivo: Evaluar la concordancia interobservador en función de la experiencia en la interpretación de ACTC realizadas a pacientes que acuden a urgencias por dolor torácico agudo (DTA) con probabilidad baja-intermedia de síndrome coronario agudo (SCA). Materiales y método: Estudio de concordancia interobservador en la evaluación de ACTC realizadas en contexto urgente utilizando CAD-RADS como registro de resultados. Se crearon parejas de observadores entre un total de 8 evaluadores (4 staff y 4 en formación). Se estimó el grado de concordancia global y entre subgrupos de acuerdo con su experiencia mediante el coeficiente kappa. Resultados: La concordancia fue sustancial entre radiólogos experimentados y en formación (k= 0,627; IC95%: 0,436-0,826), así como para todas las parejas de evaluadores (k=0,661; IC95%: 0,506-0,823) para todas las categorías CAD-RADS en conjunto. El grado de acuerdo del grupo de radiólogos experimentados fue superior al de los radiólogos en formación en todos los análisis realizados. La concordancia fue excelente para CAD-RADS global (k= 0,950; IC95%: 0,896-1) y para CAD-RADS ≥ 4 (k = 1), observando un menor acuerdo para CAD-RADS ≥ 3 (k= 0,754; IC95%: 0,246-1,255). Los valores del personal en formación para estas categorías fueron k= 0,623, k= 0,596 y k= 0,473, respectivamente. Conclusión: La concordancia entre radiólogos staff en la evaluación de ACTC realizadas a pacientes en el contexto de urgencias es excelente. El grado de acuerdo es menor cuando el personal inexperto forma parte de las parejas analizadas...(AU)

Introduction: Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists’ skills can affect the interobserver agreement in evaluating these studies. Objective: To determine the interobserver agreement according to radiologists’ experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. Materials and methods: We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. Results: The agreement was substantial between experienced radiologists and residents (k = 0.627; 95%CI: 0.436 – 0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506 – 0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896 – 1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k = 0.754; 95% CI: 0.246 – 1.255). The agreement for the residents for these categories was k= 0.623, k=0.596, and k=0.473, respectively. Conclusion: The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists...(AU)

Resultados intrahospitalarios tras tratamiento percutáneo frente a quirúrgico en pacientes con estenosis aórtica y enfermedad arterial coronaria concomitante / In-hospital outcomes following percutaneous versus surgical intervention in the treatment of aortic stenosis and concomitant coronary artery disease

Introducción y objetivos: La enfermedad coronaria (EC) es frecuente en pacientes con estenosis aórtica; sin embargo, la estrategia terapéutica óptima sigue siendo objeto de debate. Investigamos los resultados periprocedimiento en pacientes sometidos a implante percutáneo de válvula aórtica con intervención coronaria percutánea (TAVI/ICP) frente al recambio valvular aórtico con injerto de derivación de arteria coronaria (RVAo/CABG) en pacientes con estenosis aórtica con EC.Métodos: Con los datos de alta del Sistema Nacional de Salud Español, se identificaron 6.194 pacientes (5.217 RVAo/CABG y 977 TAVI/ICP) entre 2016 y 2019. Se realizó un análisis emparejado por puntuación de propensión ajustado por características basales. El objetivo primario fue la mortalidad hospitalaria, Los objetivos secundarios fueron las complicaciones hospitalarias y rehospitalización cardiovascular a 30 días.Resultados: Tras el emparejamiento, se seleccionaron 774 parejas de pacientes. La mortalidad total hospitalaria fue más frecuente en el grupo quirúrgico (3,4 frente a 9,4%, p <0,001), al igual que el ictus periprocedimiento (0,9 frente a 2,2%, p=0,004), fallo renal agudo (4,3 frente a 16,0%, p <0,002), transfusión (9,6 frente a 21,1%, p <0,001) y neumonía intrahospitalaria (0,1 frente a 1,7%, p=0,001). La implantación de marcapasos permanente fue más frecuente en el tratamiento percutáneo (12,0 frente a 5,7%, p <0,001). Los centros de menor volumen (< 130 procedimientos por año) tuvieron mayor mortalidad hospitalaria para ambos procedimientos: TAVI/ICP (3,6 frente a 2,9%, p <0,001) y RVAo/CABG (9,3 frente a 6,8%, p <0,001). La rehospitalización cardiovascular a 30 días no difirió entre los grupos.(AU)

Introduction and objectives: Concomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD.Methods: Using discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission.Results: Matching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P <.001) as was periprocedural stroke (0.9% vs 2.2%; P=.004), acute kidney injury (4.3% vs 16.0%, P <.001), blood transfusion (9.6% vs 21.1%, P <.001), and hospital-acquired pneumonia (0.1% vs 1.7%, P=.001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P <.001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P <.001) and SAVR/CABG (8.3 vs 6.8%, P <.001). Thirty-day cardiovascular readmission did not differ between groups.Conclusions: In this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation.(AU)

Coronary computed tomography in emergencies: The importance of the radiologist's experience.

INTRODUCTION: Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists' skills can affect the interobserver agreement in evaluating these studies. OBJECTIVE: To determine the interobserver agreement according to radiologists' experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. MATERIALS AND METHODS: We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. RESULTS: The agreement was substantial between experienced radiologists and residents (k=0.627; 95%CI: 0.436-0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506-0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896-1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k=0.754; 95% CI: 0.246-1.255). The agreement for the residents for these categories was k=0.623, k=0.596, and k=0.473, respectively. CONCLUSION: The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists. These findings should be taken into consideration when implementing coronary CTA in emergency departments and in the organisation of radiological staff for interpreting and reporting this imaging test.

Impacto clínico de la extensión del miocardio en riesgo en pacientes sometidos a intervención percutánea de la válvula aórtica / Clinical impact of the extent of jeopardized myocardium in patients undergoing transcatheter aortic valve intervention

Introducción y objetivos La enfermedad coronaria (EC) se encuentra en el 30-50% de los pacientes con estenosis aórtica (EA) grave que reciben tratamiento intervencionista. Todavía no está claro cuál es el mejor tratamiento de la EAC en pacientes con EA sometidos a implante percutáneo de válvula aórtica (TAVI). El objetivo del estudio fue analizar el impacto clínico del miocardio en riesgo en pacientes con EAC y EA grave tratados con TAVI. Métodos Se incluyó a pacientes consecutivos sometidos a TAVI en nuestro hospital. En presencia de EAC, el miocardio en riesgo antes del procedimiento se clasificó utilizando la puntuación de riesgo (JS) de la British Cardiovascular Intervention Society (BCIS). La población de estudio se dividió en 3 grupos: pacientes sin EAC concomitante (grupo No-EAC), pacientes con EAC y BCIS-JS ≤ 4 (grupo EAC BCIS-JS ≤ 4) y pacientes con EAC concomitante y BCIS-JS> 4 (grupo EAD BCIS -JS> 4). El objetivo primario del estudio fueron los eventos cardiovasculares y cerebrovasculares adversos mayores (MACCE). Resultados Se incluyó a un total de 403 pacientes: 223 No-EAD, 94 EAC BCIS-JS ≤ 4 y 86 EAC BCIS-JS> 4. Con 3 meses de seguimiento [rango 104 – 3.296 días], los pacientes sin EAC y los pacientes con EAC con BCIS-JS ≤ 4 tuvieron una mejor supervivencia libre de MACCE en comparación con aquellos con revascularización menos extensa (BCIS-JS> 4) (p=0,049). Este resultado se debió en parte a una reducción significativa de la mortalidad (p=0,031). En el análisis multivariado, el BCIS-JS residual ≤ 4 y la clase III-IV de la NYHA predijeron MACCE de forma independiente. Conclusiones En pacientes con EAC y EA grave, la extensión del miocardio en riesgo antes del TAVI influye en los resultados clínicos (AU)

Introduction and objectives Coronary artery disease (CAD) is found in 30%-50% of patients with severe aortic stenosis (AS) undergoing treatment. The best management of CAD in AS patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear. We investigated the clinical impact of the extent of jeopardized myocardium in patients with concomitant CAD and severe AS treated by TAVI. Methods Consecutive patients who underwent TAVI procedures at our hospital were identified. In the presence of CAD, the myocardium jeopardized before TAVI was graded using the British Cardiovascular Intervention Society (BCIS) jeopardy score (JS). The study population was divided in 3 groups: patients without concomitant CAD (no-CAD), patients with CAD and BCIS-JS ≤ 4 (CAD BCIS-JS ≤ 4) and patients with concomitant CAD and BCIS-JS> 4 (CAD BCIS-JS> 4). The primary study endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Results A total of 403 patients entered the study: 223 no-CAD, 94 CAD BCIS-JS ≤ 4 and 86 CAD BCIS-JS> 4. At> 3 months of follow-up [range 104–3296 days], patients without CAD and CAD patients with BCIS-JS ≤ 4 had better survival free from MACCE compared with those with less extensive revascularization (BCIS-JS> 4) (P=.049). This result was driven by a significant reduction in death (P=.031). On multivariate analysis, residual BCIS-JS ≤ 4 and NYHA class III-IV independently predicted MACCE. Conclusions In patients with concomitant CAD and severe AS, the extent of jeopardized myocardium before TAVI impacts on clinical outcomes (AU)

Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time? / Revascularización completa mediante ICP en pacientes con STEMI y enfermedad coronaria multivaso, ¿cuál es el momento adecuado?

Abstract Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.

Resumen Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.

Ten-year prognostic value of coronary CT angiography in asymptomatic patients with type 2 diabetes.

INTRODUCTION AND OBJECTIVES: The United Kingdom Prospective Diabetes Study (UKPDS) risk score has limited value for predicting coronary artery disease (CAD) events. We investigated the additive value of coronary computed tomography angiography (CCTA) on top of the UKPDS risk score in predicting 10-year adverse cardiac events in asymptomatic patients with type 2 diabetes. METHODS: We evaluated 589 asymptomatic diabetic patients without a history of CAD who underwent CCTA. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization. We estimated the discrimination and reclassification ability for the prediction models, which included combinations of the UKPDS category, severity of stenosis, and coronary artery calcium score by CCTA. RESULTS: The incidence of the primary outcome was 12.4%. During 10 years of follow-up, patients without plaque by CCTA tended to have a low CAD event rate, while those with obstructive CAD tended to have a high event rate, irrespective of the baseline UKPDS risk category. The model that included only the UKPDS category had a Harrell's c-index of 0.658; adding the degree of stenosis to the model significantly increased the c-index by 0.066 (P=.004), while adding coronary artery calcium score increased the c-index by only 0.039 (P=.056). Overall, CCTA information in addition to the UKPDS risk category improved the reclassification rate for predicting the primary outcome. CONCLUSIONS: In asymptomatic patients with type 2 diabetes, CCTA information for CAD provided significant incremental discriminatory power beyond the UKPDS risk score category for predicting 10-year adverse coronary events.

In-hospital outcomes following percutaneous versus surgical intervention in the treatment of aortic stenosis and concomitant coronary artery disease.

INTRODUCTION AND OBJECTIVES: Concomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD. METHODS: Using discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission. RESULTS: Matching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P <.001) as was periprocedural stroke (0.9% vs 2.2%; P=.004), acute kidney injury (4.3% vs 16.0%, P <.001), blood transfusion (9.6% vs 21.1%, P <.001), and hospital-acquired pneumonia (0.1% vs 1.7%, P=.001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P <.001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P <.001) and SAVR/CABG (8.3 vs 6.8%, P <.001). Thirty-day cardiovascular readmission did not differ between groups. CONCLUSIONS: In this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation.

Clinical impact of the extent of jeopardized myocardium in patients undergoing transcatheter aortic valve intervention.

INTRODUCTION AND OBJECTIVES: Coronary artery disease (CAD) is found in 30%-50% of patients with severe aortic stenosis (AS) undergoing treatment. The best management of CAD in AS patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear. We investigated the clinical impact of the extent of jeopardized myocardium in patients with concomitant CAD and severe AS treated by TAVI. METHODS: Consecutive patients who underwent TAVI procedures at our hospital were identified. In the presence of CAD, the myocardium jeopardized before TAVI was graded using the British Cardiovascular Intervention Society (BCIS) jeopardy score (JS). The study population was divided in 3 groups: patients without concomitant CAD (no-CAD), patients with CAD and BCIS-JS ≤ 4 (CAD BCIS-JS ≤ 4) and patients with concomitant CAD and BCIS-JS> 4 (CAD BCIS-JS> 4). The primary study endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS: A total of 403 patients entered the study: 223 no-CAD, 94 CAD BCIS-JS ≤ 4 and 86 CAD BCIS-JS> 4. At> 3 months of follow-up [range 104-3296 days], patients without CAD and CAD patients with BCIS-JS ≤ 4 had better survival free from MACCE compared with those with less extensive revascularization (BCIS-JS> 4) (P=.049). This result was driven by a significant reduction in death (P=.031). On multivariate analysis, residual BCIS-JS ≤ 4 and NYHA class III-IV independently predicted MACCE. CONCLUSIONS: In patients with concomitant CAD and severe AS, the extent of jeopardized myocardium before TAVI impacts on clinical outcomes.

Fibrinogen-to-albumin ratio is related to the severity of coronary artery disease in chronic kidney disease patients undergoing coronary angiography.

OBJECTIVES: This study was to explore the potential relationship between the fibrinogen-to-albumin ratio (FAR) and the presence and severity of coronary artery disease (CAD) in stage 3-5 predialysis chronic kidney disease (CKD) patients. DESIGN: This study included 978 patients undergoing coronary angiography (CAG). CAD was defined as the presence of obstructive stenosis>50% of the lumen diameter in any of the four main coronary arteries. Gensini scores (GSs), left main coronary artery (LMCA) and three-vessel coronary artery disease (TVD) were used to elevate the severity of CAD. RESULTS: The adjusted odds ratios of CAD were 3.059 (95% CI: 1.859-5.032) and 2.670 (95% CI: 1.605-4.441) in the third and fourth quartiles of FAR compared with the first quartile, respectively. Among 759 patients diagnosed with CAD, multivariate logistic regression analysis showed that FAR (at the 0.01 level) was significantly positively associated with the presence of LMCA (adjusted OR=1.177, 95% CI 1.067-1.299, P=0.001) or TVD (adjusted OR=1.154, 95% CI 1.076-1.238, P<0.001), and a higher GS (adjusted OR=1.152, 95% CI 1.073-1.238, P<0.001). CONCLUSIONS: FAR levels were independently associated with the presence and severity of CAD in stage 3-5 predialysis CKD patients.

Fibrinogen-to-albumin ratio is related to the severity of coronary artery disease in chronic kidney disease patients undergoing coronary angiography / La relación fibrinógeno/albúmina está relacionada con la gravedad de la enfermedad arterial coronaria en pacientes con enfermedad renal crónica tratados mediante a angiografía coronaria

Objectives: This study was to explore the potential relationship between the fibrinogen-to-albumin ratio (FAR) and the presence and severity of coronary artery disease (CAD) in stage 3–5 predialysis chronic kidney disease (CKD) patients.Design: This study included 978 patients undergoing coronary angiography (CAG). CAD was defined as the presence of obstructive stenosis>50% of the lumen diameter in any of the four main coronary arteries. Gensini scores (GSs), left main coronary artery (LMCA) and three-vessel coronary artery disease (TVD) were used to elevate the severity of CAD. Results: The adjusted odds ratios of CAD were 3.059 (95% CI: 1.859–5.032) and 2.670 (95% CI: 1.605–4.441) in the third and fourth quartiles of FAR compared with the first quartile, respectively. Among 759 patients diagnosed with CAD, multivariate logistic regression analysis showed that FAR (at the 0.01 level) was significantly positively associated with the presence of LMCA (adjusted OR=1.177, 95% CI 1.067–1.299, P=0.001) or TVD (adjusted OR=1.154, 95% CI 1.076–1.238, P<0.001), and a higher GS (adjusted OR=1.152, 95% CI 1.073–1.238, P<0.001). Conclusions: FAR levels were independently associated with the presence and severity of CAD in stage 3–5 predialysis CKD patients. (AU)

Objetivos: Este estudio pretendía explorar la relación potencial entre la relación fibrinógeno/albúmina (FAR) y la presencia y la gravedad de la enfermedad arterial coronaria (EAC) en pacientes con enfermedad renal crónica (ERC) en estadio 3-5 en la etapa prediálisis. Diseño: Este estudio incluyó a 978 pacientes tratados mediante angiografía coronaria. La EAC se definió como la presencia de estenosis obstructiva > 50% del diámetro de la luz de cualquiera de las 4 arterias coronarias principales. Se utilizaron las puntuaciones de Gensini (GS), la enfermedad de la arteria coronaria izquierda (EACI) y la EAC de 3 vasos (ETV) para evaluar la gravedad de la EAC. Resultados: Los cocientes de posibilidades de EAC fueron 3,059 (IC del 95%: 1,859-5,032) y 2,670 (IC del 95%: 1,605-4,441) en el tercer y el cuarto cuartiles de la FAR en comparación con el primer cuartil, respectivamente. Entre los 759 pacientes diagnosticados de EAC, el análisis de regresión logística de múltiples variables mostró que la FAR (al nivel 0,01) presentaba una asociación positiva significativa con la presencia de EACI (OR ajustada = 1,177, IC del 95%: 1,067-1,299, p = 0,001) o ETV (OR ajustada=1,154, IC del 95%: 1,076-1,238, p < 0,001) y una puntuación GS mayor (OR ajustada = 1,152, IC del 95%: 1,073-1,238, p < 0,001). Conclusiones: Los niveles de FAR se asociaron de manera independiente con la presencia y la gravedad de EAC en los pacientes con ERC en estadio 3-5 en la etapa prediálisis. (AU)

The rs4783961 and rs708272 genetic variants of the CETP gene are associated with coronary artery disease, but not with restenosis after coronary stenting / Los polimorfismos rs4783961 y rs708272 del gen CETP son asociados con la enfermedad arterial coronaria y no con la restenosis tras el implante de un stent coronario

Abstract Objective: We evaluated whether cholesteryl ester transfer protein (CETP) gene polymorphisms are associated with the presence of coronary artery disease (CAD) and/or restenosis in patients with coronary stent. Methods: Two polymorphisms of the CETP gene [−971 A/G (rs4783961), and Taq1B A/G (rs708272)] were genotyped by 5'exonuclease TaqMan assays in 219 patients with CAD (66 patients with restenosis and 153 without restenosis) and 607 control individuals. Results: The distribution of polymorphisms was similar in patients with and without restenosis. However, when the whole group of patients (with and without restenosis) was compared to healthy controls, under dominant model, the G allele of the Taq1B A/G polymorphism was associated with increased risk of CAD (odds ratio [OR] = 1.48, pCDom = 0.032). In the same way, under codominant, dominant, and additive models, the A allele of the −971 A/G polymorphisms was associated with an increased risk of developing CAD (OR = 2.03, pCCo-dom = 0.022, OR = 1.83, pCDom = 0.008, and OR = 1.39, pCAdd = 0.011, respectively). In addition, the linkage disequilibrium showed that the "AG" haplotype was associated with increased risk of developing CAD (OR = 1.28, p = 0.03). Conclusion: This study demonstrates that CETP Taq1B A/G and CETP −971 A/G polymorphisms are associated with an increased risk of developing CAD, but no association with restenosis was observed.

Resumen Objetivo: Evaluamos si los polimorfismos del gen CETP están asociados con la presencia de enfermedad arterial coronaria (EAC) y/o restenosis en pacientes con stent coronario. Métodos: En este estudio se genotiparon dos polimorfismos del gen CETP [−971 A/G (rs4783961) y Taq1B A/G (rs708272)] mediante ensayos de 5'exonucleasa TaqMan en 219 pacientes con EAC (66 pacientes con restenosis y 153 sin restenosis), y 607 individuos de control. Resultados: La distribución de polimorfismos fue similar en pacientes con y sin restenosis. Sin embargo, cuando se comparó todo el grupo de pacientes (con y sin restenosis) con controles sanos, bajo el modelo dominante el alelo G del polimorfismo Taq1B A/G se asocia con un mayor riesgo de EAC (OR = 1.48, pCDom = 0.032). De la misma manera, bajo los modelos co-dominante, dominante y aditivo, el alelo A de los polimorfismos −971 A/G se asocia con un mayor riesgo de desarrollar EAC (OR = 2.03, pCCo-dom = 0.022, OR = 1.83, pCDom = 0,008 y OR = 1.39, pCAdd = 0.011, respectivamente). Adicionalmente, el desequilibrio de ligamiento mostró que el haplotipo "AG" se asocia con un mayor riesgo de desarrollar EAC (OR = 1.28, p = 0.03). Conclusión: En resumen, este estudio demuestra que los polimorfismos CETP Taq1B A/G y CETP −971 A/G están asociados con un mayor riesgo de desarrollar CAD, pero no se observó asociación con restenosis.

Ejercicio aeróbico versus concurrente sobre la interleucina-6 en pacientes con enfermedad arterial coronaria: Una revisión sistemática / Aerobic Versus Concurrent Exercise on Interleukin-6 in Patients with Coronary Arterial Disease: A Systematic Review

Resumen El ejercicio aeróbico (EA) ha demostrado ser beneficioso para la supervivencia del paciente con enfermedad arterial coronaria (EAC) y la disminución de la interleucina 6 (IL-6). Sin embargo, hay poco evidencia del efecto del entrenamiento concurrente (EC). Propósito: Analizar el efecto del EA versus EC sobre la IL-6 en pacientes con EAC. Metodología: Se desarrolló con base en los acuerdos PRISMA, se realizó una búsqueda de los artículos científicos mediante bases de datos electrónicas. Los términos de búsqueda (frase booleana) fueron los siguientes: ("coronary artery disease" OR ''cardiac disease'' OR "cardiovascular disease") AND (''exercise'' OR ''training'' OR "cardiac rehabilitation") AND ("IL-6" OR "Interleukin-6" OR "inflammatory markers"). Las búsquedas se realizaron entre agosto y diciembre de 2019. Resultados: Se revisaron un total de 2516 estudios, de los cuales se incluyeron 10 estudios que cumplieron con los criterios de elegibilidad. Se analizaron un total de 413 pacientes. Se encontró una mejoría entre un 5% y un 74% con el EA y entre un 2.3% y 58.8% con el EC. Ambas modalidades disminuye significativamente la IL-6, independientemente de la edad, sesiones de entrenamiento semanales y de la etapa inicial de los pacientes con EAC, pero aquellos estudios que utilizaron una alta intensidad o un volumen superior a 30 minutos presentaron mayores beneficios. Conclusión: Tanto el EA como el EC son beneficiosos en la disminución de la IL-6 en pacientes con EAC. Esta revisión sistemática deja la posibilidad de continuar investigando el comportamiento de la alta intensidad en la disminución de la IL-6.

Abstract Aerobic exercise (AE) has been shown to be beneficial for the survival of patients with CAD and the decrease in interleukin 6 (IL-6). However, there is little evidence of the effect of concurrent training (CT). Purpose: To analyze the effect of AE versus CT on IL-6 in patients with CAD. Methodology: It was developed based on the PRISMA agreements; scientific articles were searched through electronic databases. The search terms (Boolean phrase) were the following: ("coronary artery disease" OR '' cardiac disease '' OR "cardiovascular disease") AND ('' exercise '' OR '' training '' OR "cardiac rehabilitation") AND ("IL-6" OR "Interleukin-6" OR "inflammatory markers") NOT ("animals" OR "rat"). The searches were conducted between August and December 2019. Results: A total of 2516 studies were reviewed, of which 10 studies that met the eligibility criteria were included. A total of 413 patients were analyzed. An improvement was found between 5% and 74% with the AE and between 2.3% and 58.8% with the CT. Both modalities significantly decrease IL-6, regardless of age, weekly training sessions, and the initial stage of patients with CAD; however, those studies that used a high intensity or a volume greater than 30 minutes showed greater benefits. Conclusion: Both EA and CT are beneficial in reducing IL-6 in patients with CAD. This systematic review leaves the possibility of continuing to investigate the behavior of high intensity in the decrease of IL-6.

Resumo O exercício aeróbio (EA) demonstrou beneficiar a sobrevivência dos pacientes com doença arterial coronária (DAC) e diminuir a interleucina 6 (IL-6). No entanto, há poucas evidências do efeito do treino simultâneo (TC). Objetivo: Analisar o efeito da EA versus TC na IL-6 em pacientes com DAC. Metodologia: Com base nos acordos PRISMA, foi realizada uma pesquisa de artigos científicos utilizando bases de dados eletrônicas. Os termos de busca (frase booleana) foram os seguintes: (''doença arterial coronária'' OU ''doença cardíaca'' OU ''doença cardiovascular'') E (''exercício'' OU ''treinamento'' OU ''reabilitação cardíaca'') E (''IL-6'' OU ''Interleucina-6'' OU ''marcadores inflamatórios''). As pesquisas foram realizadas entre agosto e dezembro de 2019. Resultados: Um total de 2516 estudos foram revistos, dos quais foram incluídos 10 estudos que preenchiam os critérios de elegibilidade. Foram analisados um total de 413 pacientes. A melhoria foi encontrada entre 5% e 74% com a EA e entre 2,3% e 58,8% com o TC. Ambas as modalidades diminuíram significativamente a IL-6, independentemente da idade, das sessões semanais de treinamento e do estágio inicial dos pacientes com DAC, mas os estudos que utilizaram alta intensidade ou volume superior a 30 minutos tiveram maiores benefícios. Conclusão: Tanto a EA como a TC são benéficas para a redução da IL-6 em pacientes com DAC. Esta revisão sistemática deixa espaço para uma investigação mais aprofundada sobre o comportamento de baixa intensidade da IL-6.

Síndrome coronario agudo en el paciente joven / Acute coronary syndrome in the young patient

Resumen Las enfermedades del sistema circulatorio constituyen la primera causa de muerte en el mundo. En Colombia, la enfermedad cardíaca isquémica se ubica como la principal causa de muerte, tanto en hombres como en mujeres. En la población femenina es la causa de más de la mitad de las muertes, cercana al 53%. La enfermedad isquémica en jóvenes, definidos como aquellos menores de 45 años, se ha descrito en cohortes en hasta un 11,6%, con una menor tasa de mortalidad. La dificultad para el abordaje de estos pacientes es mayor, dado que, al consultar al servicio de urgencias, pocas veces se sospecha enfermedad cardíaca isquémica.

Abstract The diseases of the circulatory system constitute the leading cause of death in the world. In Colombia, ischemic heart disease is the main cause of death, both in men and women, being within the group of women the cause of more than half of the deaths, close to 53%. Ischemic disease in young people, defined as those under 45 years old, has been described in cohorts around to 11.6%, with a lower mortality rate. The difficulty in addressing these patients is higher, given that, when consulting the emergency department, ischemic heart disease is rarely suspected.

Efecto del Programa de Rehabilitación Cardiaca del Hospital San Vicente Paúl sobre parámetros bioquímicos, antropométricos y funcionales en pacientes con cardiopatía isquémica del 1º de enero del 2014 al 31 de diciembre del 2015 / Effect of the Cardiac Rehabilitation Program of the Hospital San Vicente Paúl on biochemical, anthropometric and functional parameters in patients with ischemic heart disease from January 1, 2014 to December 31, 2015

Resumen Introducción y objetivos: Los programas de rehabilitación cardiaca (RHC) son considerados como los más eficaces entre las intervenciones de prevención secundaria. El cual su función es mejorar la sobrevida como así también, la calidad de vida de estos enfermos. El objetivo fundamental de este trabajo es analizar el impacto de un Programa de Rehabilitación Cardiaca en pacientes portadores de cardiopatía isquémica con respecto a parámetros bioquímicos, antropométricos y funcionales. Pacientes y métodos: Fue un estudio observacional retrospectivo, unicéntrico, con seguimiento de 3 años. Se incluyo un total de 228 pacientes. Con criterios de inclusión: >18 años, con EAC y al menos una comorbilidad de riesgo cardiovascular que completaran el PRC. Se excluyó enfermedad valvular sin cardiopatía isquémica preexistente, infarto agudo al miocardio reciente, ángor inestable, obstrucción del tracto de salida del ventrículo izquierdo, y los que no cumplieron el PRC. Resultados: De los 228 pacientes que se incluyeron el PRC del HSVP el 70,7% eran hombres y el 29,3% eran mujeres con diagnóstico de cardiopatía isquémica. El promedio de edad era de 60.2 +- 11.4 años en total entre hombres y mujeres. El peso de los pacientes masculinos previo al ingreso del PRC fue de 77,7 kg +-13,2 kg, y las mujeres 69,7 kg +- 13,1 kg. Al final del fue de 75,5 kg +-13,1 kg y el de las mujeres era de 68,3 +- 13,1 kg. En la caminata de 6 minutos el promedio de mujeres al inicio fue de 390,0 mts y el de los hombres de 386,6, y la segunda vez posterior a la rehabilitación en hombres fue de 595,8 +- 107,2 y el de las mujeres fue de 549+-102,4. Los niveles de PCR de los hombres al inicio del programa fue de 1,2 +-2,4 mg/dL y el de las mujeres fue de 1,5 +- 1,9 mg/dL al finalizar los hombres tuvieron un promedio de 1,8+-3,0 Conclusiones: Los PRC dependen de la participación de profesionales de la salud que trabajen en equipo para alcanzar resultados finales, los cuales están basados no solo en el ejercicio sino también en el cambio de estilo de vida del paciente, por lo tanto, necesita de servicios asociados como fisioterapia, nutrición, psicología.

Abstract Effect of the Cardiac Rehabilitation Program of the Hospital San Vicente Paúl on biochemical, anthropometric and functional parameters in patients with ischemic heart disease from January 1, 2014 to December 31, 2015 Introduction and objectives: Cardiac Rehabilitation Programs, are considered the most effective programs among secondary prevention interventions. The function is to improve survival as well as the quality of life of these patients. The main objective of this work is to analyze the impact of Cardiac Rehabilitation Program in patients with ischemic heart disease with the respect biochemical, anthropometric and functional parameters. Patients and method: A observational, retrospective single-center, study with a 3-year-follow up. A total of 228 patients were included, witch 70.7% were men with an average of 60.2+-11.4 years. The inclusion criteria were: > 18 years with CAD and at least one cardiovascular risk comorbidity and completed the Cardiac Rehabilitation Program. Valvular disease without pre-existing ischemic heart disease, recent acute myocardial infarction, unstable angina, left ventricular outflow tract obstruction, and those who did not went to the Program. Results: The 228 patients who were included in the HSVP CRP, 70.7% were men and 29.3% were women with a diagnosis of ischemic heart disease. The average age was 60.2 + - 11.4 years in total between men and women. The weight of male patients prior to admission to the CRP was 77.7 kg + -13.2 kg, and women 69.7 kg + -13.1 kg. At the end of the program, the weight of the men was 75.5 kg + -13.1 kg and that of the women was 68.3 + - 13.1 kg. The total waist circumference at the start of the program was 100.1 ± 11.4 cm. In women the average was 98.4 + - 12.7cm, that of men was 101.1 + - 10.8 cm. At the end of the program, the total average of men and women was 96.7 + - 11.0, the average of women at the end of the program was 96.2 + - 12.6 cm and of men was 96. 9 + - 10. In the 6-minute walk, the average of women at the beginning was 390.0 meters and that of men was 386.6, and the second time after rehabilitation in men was 595.8 + - 107.2 and the of women it was 549 + -102.4. In men, the previous total cholesterol was 154.8 + -39.7 mg / dL and that of women was 162.0 + -40.2 mg / dL and at the end of the program the value of men was 161 .6 + -46.0 mg / dL and 170.8 + -41.8 mg / dL for women. The CRP levels of the men at the beginning of the program was 1.2 + -2.4 mg / dL and that of the women was 1.5 + - 1.9 mg / dL at the end of the program, the men had an average of 1.8 + -3.0. Conclusion: The Cardiac Rehabilitation Program depends on the partipation of health professionals care who work as a team to achieve final results, witch are based not only on exercise but also on the change in the patient's lifestyle, therefore, they need associated services such as physiotherapy, nutrition, psychology.

Enfermedad arterial coronaria y sus características clínico-angiográficas: Realidad de un centro de atención terciaria privado en Angola / Coronary artery disease and its clinical-angiographic characteristics: Reality of a private tertiary care center in Angola

RESUMEN Introducción: La enfermedad arterial coronaria ha experimentado un aumento entre los angolanos debido a la transición epidemiológica resultante de los nuevos estilos de vidas desfavorables para la salud cardiovascular. Objetivo: Realizar una caracterización clínico-angiográfica de los pacientes con sospecha de enfermedad arterial coronaria llevados a coronariografía. Método: Estudio observacional retrospectivo, realizado en la Clínica Girassol, con 450 pacientes llevados a coronariografía durante enero del 2012 a diciembre del 2018. Se incluyeron variables clínicas (sexo, edad, tipo de procedimiento, factores de riesgo, indicación clínica) y angiográficas (vía de acceso, vasos afectados, dominancia coronaria, estrategia de tratamiento y complicaciones). Resultados: Predominó el sexo masculino (71,6%) con edad media de 59,7(11,2 años. La hipertensión arterial fue el factor de riesgo predominante (76,0%). El 56,2% de los procedimientos fueron realizados de urgencia siendo el síndrome coronario agudo con elevación del ST (37,3%) el más frecuente. La mayoría de los procedimientos (81,1%) fueron por vía femoral. La descendente anterior estuvo afectada en el 37,6% de los casos y la dominancia derecha fue la más prevalente (94,0%). El hematoma femoral constituyó la complicación más frecuente (0,9%). Conclusiones: En los pacientes intervenidos predominó el sexo masculino, las edades avanzadas, la hipertensión arterial y la realización urgente del procedimiento, mayoritariamente por síndromes coronarios agudos con elevación del segmento ST, con muy baja incidencia de complicaciones.

ABSTRACT Introduction: Coronary artery disease has progressively increased among Angolans due to the epidemiological transition resulting from new lifestyles unfavorable to cardiovascular health. Objective: To perform a clinical-angiographic characterization of patients suspected of coronary artery disease undergoing coronary angiography. Method: Retrospective observational study, conducted at Clínica Girassol, with 450 patients who underwent coronary angiography from January 2012 to December 2018. Clinical variables such as sex, age, type of procedure, risk factors, clinical indication, and angiographic features (access route, vessels involved, coronary dominance, treatment strategy and complications) were included. Results: Male sex predominated (71.6%) with a mean age of 59.7±11.2 years. Hypertension was the predominant risk factor (76.0%). Emergency procedures accounted for 56.2% of the interventions; ST-segment elevation acute coronary syndrome (37.3%) was the most frequent. Most of the procedures (81.1%) were performed via the femoral artery. The left anterior descending artery was involved in 37.6% of the cases and right dominance was the most prevalent (94.0%). Femoral hematoma was the most frequent complication (0.9%). Conclusions: The patients who underwent surgery were predominantly male, older, hypertensive, and required urgent procedures, mostly for ST-segment elevation acute coronary syndromes, with very low rates of complications.