Embolization of percutaneous left atrial appendage closure devices: Timing, management and clinical outcomes.

BACKGROUND: Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication. OBJECTIVES: We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry. METHODS: Patient characteristics, imaging findings and procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes. RESULTS: Sixty-seven centers contributed data. Device embolization occurred in 108 patients. In 70.4 % of cases, it happened within the first 24 h of the procedure. The device was purposefully left in the LA and the aorta in two (1.9 %) patients, an initial percutaneous retrieval was attempted in 81 (75.0 %) and surgery without prior percutaneous retrieval attempt was performed in 23 (21.3 %) patients. Two patients died before a retrieval attempt could be made. In 28/81 (34.6 %) patients with an initial percutaneous retrieval attempt a second, additional attempt was performed, which was associated with a high mortality (death in patients with one attempt: 2.9 % vs. second attempt: 21.4 %, p < 0.001). The primary outcome (bailout surgery, cardiogenic shock, stroke, TIA, and/or death) occurred in 47 (43.5 %) patients. Other major complications related to device embolization occurred in 21 (19.4 %) patients. CONCLUSIONS: The majority of device embolizations after LAA closure occurs early. A percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was unsuccessful. CONDENSED ABSTRACT: This dedicated multicenter registry examined timing, management, and clinical outcome of device embolization. Early embolization (70.4 %) was most frequent. As a first rescue attempt, percutaneous retrieval was preferred in 75.0 %, followed by surgical removal (21.3 %). In patients with a second retrieval attempt a higher mortality (death first attempt: 2.9 % vs. death second attempt: 24.1 %, p < 0.001) was observed. Mortality (10.2 %) and the major complication rate after device embolization were high.

Recalibrating populism measurement tools: Methodological inconsistencies and challenges to our understanding of the relationship between the supply- and demand-side of populism.

The analysis of the congruence between the demand- and supply-side of populism is key to understand the relationship between citizens and populist parties, and to what extent this is mainly a "pull" or "push" phenomenon. Although the study of populism has experienced an unprecedented growth across social sciences during the last decade, research directly addressing this connection remains scarce. Moreover, most existing tools used to measure populism have not been created paying much consideration to their compatibility with those applied in the other side of this demand-supply divide. This article critically revisits the influential Comparative Study of Electoral Systems (CSES) Module 5 dataset to illustrate shortcomings regarding current efforts to measure the demand- and supply-sides of populism. We show that according to CSES data the, often presumed, correspondence between "populist" attitudes and likelihood of voting for "populist parties" is only partial and country specific. But more importantly, we identify three main potential sources of such mismatch linked to instrumental issues: (i) problems with the choice, design and operationalization of attitudinal survey items; (ii) problems in the assessment of parties' populism; and (iii) instrument biases that make them more effective with some varieties of populism than with others. These methodological limitations are hindering our ability to settle longstanding theoretical debates concerning the correspondence between the demand- and supply-side, the relative centrality of attributes, and varieties of populism. Therefore, we invite scholars working in this field to update existing measurement tools, or develop new ones, considering the multidimensionality of this latent construct, the diversity of movements, and the need to apply consistent criteria and operationalization techniques when assessing degrees of populism in citizens and parties.

Amortization of gene replacement therapies: A health policy analysis exploring a mechanism for mitigating budget impact of high-cost treatments.

With gene replacement therapies (GRTs) increasingly and rapidly reaching the healthcare marketplace, the vast potential for improving patient health is matched by the potential budgetary impact for healthcare payers. GRTs are highly valuable given their potential life-extending or even curative benefits and may provide significant cost-offsets compared with standard of care. Current healthcare systems are, however, struggling to fund such valuable but costly therapies. Some payers have already implemented specific financing models to account for the new treatment paradigms, but these do not address the budget impact in the year of acquisition or administration of these costly technologies. This health policy analysis aimed to assess the rationale and feasibility of amortization, within the context of financing healthcare technologies, and specifically GRTs. Amortization is an accounting concept applied to intangible assets that allows for spreading the cost an intangible asset over time, allowing for repayment to occur via interest and principal payments sufficient to repay the intangible asset in full by its maturity. Our systematic scoping review on the amortization of healthcare technologies found a very small literature base with even that being unclear and inconsistent in its understanding of the issues. Where amortization was proposed as a solution for funding costly, but highly valuable GRTs, the concept was not fully investigated in detail, nor was the feasibility of the approach fully challenged. However, by providing clear definitions of relevant concepts along with an example of amortization models applied to some example GRTs, we propose that amortization can offer a promising method for funding of extraordinarily high-value healthcare technologies, thereby increasing market and patient access for these technologies. Nonetheless, healthcare accounting principles and financing guidelines must evolve to apply amortization to the rapidly developing GRTs.

Controversy in the classification of appendicitis and utilization of postoperative antibiotics.

BACKGROUND: There is wide variability and considerable controversy regarding the classification of appendicitis and the need for postoperative antibiotics. This study aimed to assess interrater agreement with respect to the classification of appendicitis and its influence on the use of postoperative antibiotics amongst surgeons and surgical trainees. METHODS: A survey comprising 15 intraoperative images captured during appendectomy was distributed to surgeons and surgical trainees. Participants were asked to classify severity of disease (normal, inflamed, purulent, gangrenous, perforated) and whether they would prescribe postoperative antibiotics. Statistical analysis included percent agreement, Krippendorff's alpha for interrater agreement, and logistic regression. RESULTS: In total, 562 respondents completed the survey: 206 surgical trainees, 217 adult surgeons, and 139 pediatric surgeons. For classification of appendicitis, the statistical interrater agreement was highest for categorization as gangrenous/perforated versus nongangrenous/nonperforated (Krippendorff's alpha = 0.73) and lowest for perforated versus nonperforated (Krippendorff's alpha = 0.45). Fourteen percent of survey respondents would administer postoperative antibiotics for an inflamed appendix, 44% for suppurative, 75% for gangrenous, and 97% for perforated appendicitis. Interrater agreement of postoperative antibiotic use was low (Krippendorff's alpha = 0.28). The only significant factor associated with postoperative antibiotic utilization was 16 or more years in practice. CONCLUSIONS: Surgeon agreement is poor with respect to both subjective appendicitis classification and objective utilization of postoperative antibiotics. This survey demonstrates that a large proportion (59%) of surgeons prescribe antibiotics after nongangrenous or nonperforated appendectomy, despite a lack of evidence basis for this practice. These findings highlight the need for further consensus to enable standardized research and avoid overtreatment with unnecessary antibiotics.

Triflusal in Patients with Acute Coronary Syndrome and Acetylsalicylic Acid Hypersensitivity.

BACKGROUND: Acetylsalicylic acid hypersensitivity (ASAH) limits therapeutic options in patients with acute coronary syndrome (ACS), who benefit from dual antiplatelet therapy (DAPT), especially when undergoing stent implantation. Our aim was to evaluate the safety and efficacy of triflusal in patients with ACS and ASAH. METHODS AND RESULTS: Two-center retrospective study of patients diagnosed with ACS and ASAH from January 1, 2000, to May 1, 2020. Sixty-six patients were treated with triflusal. ASAH was confirmed with tests in 15 patients (22.7%). Forty-nine patients (74.2%) presented history of other drug allergies. Fifty-nine patients (89.4%) underwent stent implantation. DAPT was prescribed for ≥12 months in 54 patients. No adverse reactions to triflusal were reported. During a median follow-up of 5.12 years [IQR 2.7-9.9], rate of cardiovascular (CV) mortality was 6.1%, nonfatal myocardial infarction 12.1%, and ischemic stroke 4.5%. No cases of definite stent thrombosis occurred. Bleeding Academic Research Consortium grade ≥2 was observed in 3 patients during follow-up. CONCLUSION: In this series of patients presenting with ACS and ASA hypersensitivity, triflusal showed good tolerability and was associated with a low rate of CV and bleeding events.

Frequency and Reasons of Dual Antiplatelet Therapy Discontinuation and Switching of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome Treated with Stent Implantation.

BACKGROUND: Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. METHODS AND RESULTS: In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88-4.94, p = 0.099]). CONCLUSIONS: DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.

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

No disponible

Transcatheter closure of a complex atrial septal defect after occluder device embolization.

Percutaneous closure is nowadays considered the treatment of choice of ostium secundum atrial septal defects (ASD). However, transcatheter closure can be highly challenging when we face an ASD with complex morphological features. The combination of different imaging modalities can be very helpful. This case shows the great value of using both intracardiac and real time 3D transesophageal echocardiography for the percutaneous closure of a complex iatrogenic ASD after device embolization.

Targeted analysis of omega-6-derived eicosanoids in human serum by SPE-LC-MS/MS for evaluation of coronary artery disease.

A targeted approach has been applied to quantitative analysis of eicosanoids derived from omega-6 fatty acids in serum from individuals diagnosed with coronary artery disease (CAD). The target metabolites were series-2 prostaglandins, thromboxane B2, hydroxyeicosatetraenoic acids, and hydroxyoctadecadienoic acids. The method was based on SPELC-MS/MS in selected reaction monitoring mode for highly selective and sensitive determination of the target eicosanoids. The combination of SPE and LC-MS/MS involved the benefits from both direct analysis of serum without a step for protein precipitation and fully automation of the analysis. The method allowed comparison of omega-6-derived eicosanoids in serum from patients diagnosed with CAD and from control individuals. The effect of treatment with aspirin on the profile of the target compounds was evaluated through its incidence on the different pathways. Finally, the serum levels of the target metabolites in patients diagnosed with CAD were also statistically examined according to the severity of the coronary lesion stratified as stable angina, non-ST-elevation acute coronary syndrome, and acute myocardial infarction.

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.

Population-based comparison of open vs laparoscopic esophagogastric fundoplication in children: application of the Agency for Healthcare Research and Quality pediatric quality indicators.

BACKGROUND/PURPOSE: Increasing national focus on patient safety has promoted development of the pediatric quality indicators (PDIs), which screen for preventable events during provision of health care for children. Our objective is to apply these safety metrics to compare 2 surgical procedures in children, specifically laparoscopic and open esophagogastric fundoplication for gastroesophageal reflux. METHODS: A retrospective analysis using 20 years of data from national representative state inpatient databases through the Healthcare Cost and Utilization Project was conducted. Patients younger than 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification, codes for open or laparoscopic esophagogastric fundoplication were included. Pediatric quality indicators were linked to each patient's profile. Demographics, comorbidities, outcomes, and 8 selected PDIs between open and laparoscopic fundoplications were compared using Pearson χ(2) tests and t tests. RESULTS: Of 33,533 patients identified, 28,141 underwent open and 5392 underwent laparoscopic fundoplication. Comorbidities occurred more frequently in open surgery. In-hospital mortality, length of stay, and hospital charges were less in laparoscopic surgery. Of the 8 PDIs evaluated, decubitus ulcer (P = .04) and postoperative sepsis (P = .003) had decreased rates with laparoscopic surgery compared with open. CONCLUSION: Laparoscopic fundoplication for gastroesophageal reflux in children can be performed safely compared with the open approach with equivalent or improved rates of PDIs.

Vasoespasmo coronario asintomático y arritmias ventriculares graves / Asymptomatic Coronary Artery Spasm and Severe Ventricular Arrhythmias

El vasoespasmo coronario generalmente evoluciona con episodios de dolor torácico y elevación del ST. No obstante, existen casos de vasoespasmo sin dolor torácico con taquiarritmias ventriculares documentadas. Su incidencia se desconoce y debe incluirse en el diagnóstico diferencial de taquicardia o fibrilación ventricular idiopática. En esta presentación se describe el caso de un paciente con historia de dos cuadros sincopales sin cardiopatía estructural aparente. La monitorización electrocardiográfica continua objetivó episodios de elevación del ST que conducían a taquicardia ventricular polimorfa. Con el diagnóstico de vasoespasmo coronario asintomático se inició tratamiento con calcioantagonistas y se implantó un cardiodesfibrilador automático.

Coronary artery spasm usually results in episodes of chest pain and ST-segment elevation. However, it may occasionally occur in the absence of angina with documented severe ventricular arrhythmias. The incidence of this condition is unknown and should be included in the differential diagnosis of idiopathic ventricular tachycardia or fibrillation. We describe the case of a patient with a history of two episodes of syncope without apparent structural heart disease. Continuous ECG monitoring revealed the presence of episodes of ST-segment elevation leading to polymorphic ventricular tachycardia. Asymptomatic coronary artery spasm was diagnosed and treatment with calcium channel blockers was initiated; an implantable cardioverter defibrillator device was implanted.

Benchmarking the quality of care of infants with low-risk gastroschisis using a novel risk stratification index.

BACKGROUND: The nationwide mortality of neonates with gastroschisis was compared to determine whether significant variations in outcome occurred at the hospital level. METHODS: Utilizing a previously developed risk-stratification index, low-risk neonates with gastroschisis were identified by a score of < or = 2. Only hospitals that had a record of treating >25 low-risk neonates were included in the analysis. Hospital performance in treating infants with gastroschisis was categorized into moderate and extreme outliers. RESULTS: A total of 4,344 neonates with gastroschisis were identified at 506 individual hospitals. Low-risk neonates had an overall mortality of 2.9% compared with high-risk neonates whose overall mortality was 24.4%. Forty hospitals treated >25 low-risk neonates in the years studied for a total of 1,775 low-risk patients. The mean, in-hospital mortality of this cohort was 3.1% (range, 0-14.3). Eight hospitals were moderate outliers with mortality rates between 3.8% and 8.0%. Two hospitals were extreme outliers with mortality rates of 8.6% and 14.3%. CONCLUSION: A substantial variation exists in the mortality of neonates with low-risk gastroschisis across hospitals. Further improvements in survival may, thus, depend on targeting quality improvement initiatives to standardization of operative approaches as well improvements in nonoperative factors such as neonatal intensive care unit practices, nurse-to-patient ratios, and levels of intensivist staffing.

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 / Acute reperfusion therapy in elderly women with acute myocardial infarction with ST-segment elevation: efficacy in the reduction of their mortality

Fundamento y objetivo: Los ancianos que presentan un síndrome coronario agudo, y especialmente las mujeres, constituyen un subgrupo con elevadísima morbimortalidad. Intentamos conocer su evolución, tratamiento recibido y factores que determinan su pronóstico. Pacientes y método: Se recogieron retrospectivamente datos de las mujeres de 75 años o más ingresadas en nuestro hospital por infarto de miocardio (IAM) transmural (años 2002-2007), y se incluyeron variables epidemiológicas, las complicaciones vasculares y la incidencia de episodios hospitalarios y a medio plazo. Los datos se analizaron según hubiesen recibido o no tratamiento de repercusión al ingreso. Se investigaron los factores asociados a la ausencia de tratamiento revascularizador y a la mortalidad. Resultados: Se incluyeron 195 mujeres, con una edad media de 82,7 años. Un 33% eran diabéticas, el 41% presentó IAM de localización anterior y un 26,2% mostraba grados Killip III-IV al ingreso. Se realizó tratamiento de revascularización en fase aguda al 25,6%. La mortalidad intrahospitalaria fue del 28,7% y la mortalidad a los 6 meses fue del 39,8%. La incidencia de eventos cardíacos mayores adversos al año fue del 45,7%.Resultados: La edad, la presencia de bloqueo de rama izquierda o ritmo de marcapasos en el electrocardiograma inicial, el retraso en la demanda de atención médica y el retraso diagnóstico dificultaban la administración de tratamiento en fase aguda. La mortalidad fue 2,7 veces menor en el grupo tratado, a pesar del mayor riesgo de complicaciones hemorrágicas. La ausencia de tratamiento revascularizador, el grado Killip elevado y la baja fracción de eyección fueron predictores independientes de mortalidad. Conclusiones: El IAM en ancianas continua siendo una patología con elevada morbimortalidad. Estas pacientes reciben escaso tratamiento revascularizador en fase aguda a pesar de su aparente beneficio en la reducción de la mortalidad (AU)

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 ¡Ý 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%.Results: 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 (AU)

[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.