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Resumen Durante este ultimo ano se han publicado multiples estudios en el campo de la cardiopatia isquemica y de los cuidados criticos cardiovasculares. Hemos seleccionado las publicaciones mas destacadas segun el criterio de los autores, ordenandolas por bloques tematicos, para hacer mas sencilla su lectura.

Introduction and objectives Temporary pacemaker (TP) is used in patients with high-degree atrioventricular block (HAVB) and ST-segment elevation myocardial infarction (STEMI) to maintain cardiac output and prevent the onset of malignant arrhythmias. Our aim was to characterize the outcomes of patients with STEMI who require TP implantation in the primary angioplasty era. Methods We enrolled all consecutive patients with STEMI who underwent primary angioplasty from 2004 to 2017 in a tertiary care referral center. Patients with STEMI and HAVB who required TP implantation were analyzed. Patients with anterior and inferior STEMI were compared and a multivariate analysis was performed to identify mortality risk factors. All patients completed 30-day and 1-year follow-up. Results Of the 3063 patients in the study cohort, 180 (5.9%) had HAVB at the time of cardiac catheterization, and 114 (3.7%) underwent TP implantation. Thirty-day and 1-year mortality were 25.6% and 31.5%, respectively. Low left ventricle ejection fraction and impaired renal function showed independent association with mortality in this patient population. Patients with anterior STEMI who required TP had a ∼4-fold higher 30-day mortality than those with inferior STEMI (71% vs 18%; P ≤ .001). Only in 7% of patients a definitive pacemaker was finally implanted. Conclusions Patients with STEMI and HAVB who require TP implantation, particularly those with anterior STEMI, are at high risk of adverse outcome. Low left ventricle ejection fraction and impaired renal function are independently associated with mortality. A definitive pacemaker implant is finally required in a small proportion of this patient population.

Introduction and objectives Despite evidence of a reduction in the incidence and mortality of acute coronary syndrome (ACS), some studies have highlighted differences in outcomes between men and women. We aimed to explore sex differences in the management and treatment of patients with ACS in Spain. Methods This ecological cross-sectional study combined ACS data from 10 Spanish registries (54 centres). Meta-regression analysis was performed using aggregated data of baseline characteristics, interventional procedures, treatments, and events that occurred during hospitalization and one-year follow-up. Results Aggregated data from 34 605 patients (75.1% men) was included. ST-segment elevation myocardial infarction was the most frequent diagnosis (58.9%) and almost 80% of patients were Killip Class I. Compared to men, women were older (mean age: 71.0 vs 63.3 years) and presented higher rates of hypertension (68.1% vs 51.7%) and diabetes (37.7% vs 26.5%). Women were also less likely to undergo percutaneous coronary interventions, revascularization surgery, and to receive drug-eluting stents during hospitalization. Regarding to antiplatelet therapy, even though indicated, 23.1% of women were not treated with P2Y12 inhibitors (vs 14.2% of men; P 60%). Significantly higher in-hospital (5.4% vs 3.7%) and 1-year (8.2% vs 4.9%) mortality was observed among women compared to men, which was mainly attributed to cardiovascular causes. Conclusions Despite older age and unfavourable risk profile, female ACS patients seem to be suboptimally treated with P2Y12 inhibitors. To reduce mortality associated with ACS, improved prevention and optimized therapeutic approaches are needed.

Introduction and objectives Severe pericardial effusion (PE) is a potentially severe clinical entity. Idiopathic PE accounts for one-third of patients with severe PE. However, evidence-based treatments are scarce. The aim of the study was to investigate whether pericardial drainage is associated with prognostic improvement, and to evaluate the influence of anti-inflammatory treatment on prognosis. Methods All severe PE diagnosed between 2003 and 2017 were retrospectively collected. Of them, those classified as idiopathic were selected (N = 153). Patients were divided in 2 groups: those who underwent pericardial drainage (N = 105) and patients who did not (N = 48). In addition, the study population was divided according to the anti-inflammatory drug (AD) administration. Median follow-up was 47.7 months. Results There were no significant differences in 2-year mortality between patients who underwent pericardial drainage and those who did not. There were also no significant differences in the number of hospitalizations for heart failure between the 2 study groups. However, mortality was significantly lower among patients who received AD compared to those who did not receive these agents. Only treatment with AD (HR, 0.24; P = .002) remained independently associated with lower mortality in the multivariate analysis. AD treatment was associated with a 70% reduction in mortality (HR, 0.30; 95%CI, 0.10–0.90; P Conclusions Pericardial drainage was not associated with a better prognosis of patients with severe idiopathic PE, in terms of 2-year mortality, heart failure admissions, or the combined endpoint. AD treatment was found to be an independent protective factor for mortality in this patient population.

Resumen Durante el ultimo ano se han publicado multiples estudios en el campo de la cardiopatia isquemica y de los cuidados criticos cardiovasculares. Hemos seleccionado las publicaciones mas destacadas segun el criterio de los autores.