Killip scale reclassification according to lung ultrasound: Killip pLUS.

AIM: The Killip scale remains a fundamental tool for prognostic assessment in ST-segment elevation myocardial infarction (STEMI) due to its simplicity and predictive value. Lung ultrasound (LUS) has emerged as a valuable adjunct for diagnosing and predicting outcomes in heart failure (HF) and STEMI patients, even those with subclinical congestion. We created a new classification (Killip pLUS), which reclassifies Killip I and II patients into an intermediate category (Killip I pLUS) based on LUS results. This category included Killip I patients and ≥1 positive zone (≥3 B-lines) and Killip II with 0 positive zones. We aimed to evaluate this new classification by comparing it with the Killip scale and a previous LUS-based reclassification scale (LUCK scale). METHODS AND RESULTS: LUS was performed within 24 hours of admission in a multicenter cohort of 373 patients admitted for STEMI. In-hospital mortality and major adverse cardiovascular events (MACE) within one year after admission, comprising mortality or readmission for heart failure (HF), acute coronary syndrome, or stroke, were analyzed. When predicting in-hospital mortality, the global comparison of these three classifications was statistically significant: Killip pLUS AUC 0.90 (95% CI 0.85-0.95) vs. Killip AUC 0.85 (95% CI 0.73-0.96) vs. LUCK 0.83 (95% CI 0.70-0.95), p=0.024. To predict events during follow-up, the comparison between scales was also significant: Killip pLUS 0.77 (95% CI 0.71-0.85) vs. Killip 0.72 (95% CI 0.65-0-79) vs. LUCK 0.73 (95% CI 0.66-0.81), p=0.033. CONCLUSIONS: The Killip pLUS scale provides enhanced risk stratification compared to the Killip and LUCK scales while preserving simplicity.

Uninterrupted direct-acting oral anticoagulation in patients undergoing transradial percutaneous coronary procedures: The DOAC-NOSTOP study rationale and design.

BACKGROUND: patients with atrial fibrillation (AF) under treatment with chronic oral anticoagulation (OAC) often require coronary angiography with or without percutaneous coronary intervention (PCI). Deciding the management of OAC during this periprocedural period requires balancing the risks of hemorrhage and thrombotic complications. Guidelines recommend an uninterrupted strategy in patients receiving Vitamin-K Antagonists (VKA). However, for patients undergoing coronary angiography or PCI while on direct oral anticoagulants (DOACs), withdrawal 12-24 h prior to the procedure is still recommended. This is based on expert opinions given the lack of evidence. Therefore, whether DOAC discontinuation prior to trans-radial coronary procedures should be the strategy of choice is a matter of debate and solid evidence is needed to guide clinical decision making. METHODS: The DOAC-NOSTOP study is a prospective, single-arm, open-label study evaluating the safety of DOACs continuation in 200 patients undergoing transradial percutaneous coronary procedures. DOAC treatment will not be interrupted throughout the periprocedural period. Primary outcome will be Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 events, assessed at a 30-day follow-up. CONCLUSIONS: The DOAC-NOSTOP is the first study prospectively assessing the risk of bleeding with uninterrupted DOAC in patients undergoing trans-radial percutaneous coronary procedures.

Consecuencias cardiovasculares del consumo no-recreativo de shabú (clorhidrato de metanfetamina): nueve casos de miocardiopatía dilatada / Cardiovascular consequences of non-recreational use of shabu methamphetamine: 9 cases of dilated cardiomyopathy

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Litoplastia coronaria: experiencia inicial en lesiones calcificadas / Coronary lithoplasty: initial experience in coronary calcified lesions

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Novedades en stents farmacoactivos. Actualización y futuros desarrollos / News in drug-eluting stents. update and future developments

Con el objetivo de mejorar las limitaciones de la primera generación de stents farmacoactivos, las nuevas generaciones se han desarrollado para mejorar su seguridad y su biocompatibilidad optimizando sus tres principales componentes: la plataforma, el polímero y el fármaco. Además de estas, otras líneas de investigación se centran en desarrollar nuevos dispositivos con polímeros biodegradables, sin polímero, entre los que se incluyen los llamados stents bioactivos, que introducen mejoras en la superficie del stent para optimizar la reendotelización arterial, y finalmente prototipos completamente biodegradables. Es impresionante el esfuerzo en investigación básica, estudios de anatomía patológica e ingeniería de diseño que se ha realizado en los últimos años en este campo. Por lo tanto, la información que ha surgido en poco tiempo también es increíble. En esta revisión se hace un análisis de las novedades y los estudios aparecidos en los últimos 3 años en relación con los stents farmacoactivos. Se analizan las mejoras en la segunda generación y se describe la llamada tercera o siguiente generación de stents farmacoactivos (AU)

With the aim of overcoming the limitations of firstgeneration drug-eluting stents, a new generation of stents has been developed to improve safety and biocompatibility by optimizing their three main components: the stent platform, coating and drug. In addition, other lines of research have focused on developing new devices either with biodegradable polymers or without polymers, including so-called bio-active stents, in which the stent surface is modified to optimize arterial endothelialization. Finally, prototypes of fully biodegradable stents are also being developed. The effort put into basic research, studies of anatomy and pathology, and engineering design in recent years in this field has been impressive. As a result, the amount of data that has been produced in a short time has also been remarkable. This review provides an analysis of developments in and studies on drugeluting stents that have taken place in the last 3 years. Improvements in second-generation stents are discussed and the nature of the so-called third or next generation of drug-eluting stents is described (AU)