Resultado del cierre incompleto de defecto tipo Gerbode con coil Nit-Occlud Lê VSD: hemolisis grave que precisa reintervención / Effect of incomplete closure of a Gerbode defect with the Nit-Occlud Lê VSD Coil: severe hemolysis requiring a second procedure

No disponible

Post-treatment platelet reactivity predicts long-term adverse events better than the response to clopidogrel in patients with non-ST-segment elevation acute coronary syndrome.

INTRODUCTION AND OBJECTIVES: Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS: Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography. RESULTS: Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 +/- 21% vs. 43 +/- 21%; P.049) and higher PPR (204 +/- 60 vs. 155 +/- 67 platelet reaction units [PRU]; p= 0.006) were significantly associated with MACE occurrence. Multivariate analysis confirmed PPR (OR per 10-unit increase: 1.12, 95%CI: 1.01-1.24; P.020) as an independent predictor of MACE. A PPR cut-off value of 175 PRU was associated with an adjusted OR for 1-year MACE occurrence of 3.9 (95%CI: 1.2-15.4; P.024). CONCLUSIONS: PPR predicts adverse long-term outcomes better than response to clopidogrel in patients with NSTEACS. Patients with PPR values above 175 PRU were identified as being at higher risk for adverse long-term events.

La reactividad plaquetaria post-tratamiento predice los eventos adversos a largo plazo mejor que la respuesta al clopidogrel en pacientes con síndrome coronario agudo sin elevación del ST / No disponible

Introducción y objetivos. Una peor respuesta al tratamiento antiagregante está relacionada con la recurrencia de eventos clínicos. El objetivo de este estudio es valorar la relación entre la respuesta al clopidogrel y la reactividad plaquetaria post-tratamiento (RPP) con la recurrencia de eventos adversos cardiovasculares a 1 año en pacientes con síndrome coronario agudo sin elevación del ST (SCASEST). Métodos. Estudio observacional, prospectivo de la respuesta al clopidogrel y RPP (analizador VerifyNow®) inmediatamente antes de la coronariografía diagnóstica. Resultados. De 179 pacientes incluidos (97 con intervencionismo coronario y 21 con cirugía coronaria), 161 (90%) completaron seguimiento a 1 año y 18 (11%) sufrieron eventos: 10 muertes, 6 infartos agudos de miocardio no fatales, 2 accidentes cerebrovasculares y 5 nuevas revascularizaciones. Una peor respuesta al clopidogrel (31% ± 21% frente a 43% ± 21%; p = 0,049) y una mayor RPP (204 ± 60 frente a 155 ± 67 unidades de reactividad plaquetaria [URP]; p = 0,006) se asociaron significativamente con la aparición de eventos. El análisis multivariable confirmó la RPP (odds ratio [OR] por incremento de 10 URP = 1,12; intervalo de confianza [IC] del 95%, 1,01-1,24; p = 0,020) como predictor independiente de eventos adversos cardiovasculares mayores. Un punto de corte de RRP de 175 URP se asoció con OR ajustada = 3,9 (IC del 95%, 1,2-15,4; p = 0,024) para la aparición de eventos. Conclusiones. La RPP predice la aparición de eventos adversos a largo plazo mejor que la respuesta al clopidogrel en pacientes con SCASEST. Los pacientes con valores de RPP > 175 URP presentan mayor riesgo de sufrir eventos adversos

Introduction and objectives: Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Methods: Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow® analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography. Results: Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 ± 21% vs. 43 ± 21%; P.049) and higher PPR (204 ± 60 vs. 155 ± 67 platelet reaction units [PRU]; p= 0.006) were significantly associated with MACE occurrence. Multivariate analysis confirmed PPR (OR per 10-unit increase: 1.12, 95%CI: 1.01-1.24; P.020) as an independent predictor of MACE. A PPR cut-off value of 175 PRU was associated with an adjusted OR for 1-year MACE occurrence of 3.9 (95%CI: 1.2-15.4; P.024). Conclusions: PPR predicts adverse long-term outcomes better than response to clopidogrel in patients with NSTEACS. Patients with PPR values above 175 PRU were identified as being at higher risk for adverse long-term events

Estimulación cardiaca temporal. Estimulación tras cirugía cardiaca / Temporary cardiac pacing. Pacing after cardiac surgery

La estimulación cardiaca temporal transvenosa es la modalidad de elección cuando se precisa estimulación cardiaca temporal continua, ya como puente a la resolución de la bradiarritmia o al implante del marcapasos definitivo. Generalmente es suficiente estimular el ventrículo derecho, salvo en situaciones hemodinámicas muy especiales como son el shock en el infarto de ventrículo derecho o la miocardiopatía hipertrófica obstructiva con bloqueo auriculoventricular. La estimulación cardiaca transcutánea es la más adecuada para solventar las situaciones de emergencia que requieren un soporte de estimulación cardiaca y en la mayoría de las profilácticas, con lo que en estas últimas se evita las potenciales complicaciones de la endovenosa. La estimulación epicárdica temporal tras la cirugía cardiaca, además de la contribución al tratamiento de las frecuentes alteraciones posquirúrgicas de la conducción, tiene un importante papel en la contribución al gasto cardiaco dependiente de la frecuencia y en la reducción o prevención de la fibrilación auricular postoperatoria. En los pacientes con disfunción ventricular izquierda y complejo QRS ancho preoperatorio, es deseable dejar implantados unos electrodos temporales en el ventrículo izquierdo, para poder realizar estimulación biventricular si fuese necesario. La decisión del momento más adecuado para la implantación de un marcapasos definitivo tras cirugía cardiaca es materia de controversia y debería ser individualizado para cada paciente (AU)

Temporary transvenous cardiac pacing is the treatment of choice when continuous temporary cardiac pacing is required, for example, as a bridge until a bradyarrhythmia has resolved or until permanent pacemaker implantation. Generally, right ventricular pacing is sufficient except under very special hemodynamic conditions, such as cardiogenic shock due to right ventricular myocardial infarction or obstructive hypertrophic cardiomyopathy with atrioventricular block. Transcutaneous cardiac pacing is the most appropriate technique for use in emergencies that require the support of cardiac pacing and for the majority of prophylactic applications, thereby avoiding, in these latter cases, the potential complications associated with the intravenous approach. In addition to contributing to the treatment of the conduction abnormalities that frequently occur after cardiac surgery, temporary post-surgery cardiac pacing also plays an important role in helping to increase heart rate-dependent cardiac output and in reducing or preventing postoperative atrial fibrillation. In patients who have left ventricular dysfunction and a wide QRS complex before surgery, it is advantageous to implant temporary leads in the left ventricle so that biventricular pacing can be implemented if necessary. There is some controversy about when is the most appropriate time for deciding to implant a permanent pacemaker, and this decision has to be taken individually for each patient (AU)