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Introduction and objectives: The COVID-19 epidemic and the declaration of the state of alarm have led to a decrease in healthcare activity in interventional cardiology units. The objective of this study is to quantify these changes in activity, with special interest in the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Methods: A telematic survey of 81 centers involved in STEMI networks in the 17 autonomous communities of Spain. Information was collected on diagnostic activity, percutaneous coronary intervention (PCI), structural interventions, and PCI in STEMI on changes in the organization of STEMI networks, and on the prevalence of COVID-19 among interventional cardiologists. Data was compared for the week of February 24 through March 1 (before the outbreak) and for the week of March 16 through March 22 (during the outbreak). Results: Response has been obtained from 73 centers (90%). A very significant decrease in the number of diagnostic procedures (─56%), PCI (─48%), structural interventions (─81%) and PCI in STEMI (─40%) has been observed. A slight increase in the use of pharmacological thrombolysis has been reported, although primary angioplasty remains the leading reperfusion strategy. Up to 5% of interventional cardiologists (17) had COVID-19. Conclusions: An important reduction in the activity in interventional cardiology has been observed during the COVID-19 epidemic. Likewise, a great decrease has been detected in the number of patients treated in the STEMI networks, with the risk of increased morbidity and mortality that this represents. Scientific societies and health authorities have to promote that patients presenting STEMI compatible symptoms proceed with no delay to access the health system to receive reperfusion treatment in an appropriate way.

There are insufficient data regarding risk scores validation in patients with diabetes mellitus and non-ST elevation acute coronary syndrome (NSTEACS). We performed a diabetes mellitus-specific analysis of cardiovascular outcomes after NSTEACS. We tested the predictive power of the Global Registry of Acute Coronary Events (GRACE) and PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy (PRECISE-DAPT) scores.This work is a retrospective analysis that included 7,415 consecutive NSTEACS patients from two Spanish Universitarian hospitals between the years 2003 and 2017. The area under the ROC curve among with and without diabetes mellitus patients was calculated, to evaluate the predictive power of both scores. RESULTS: Among the study participants, 2124 patients (28.0%) were diabetic. The median follow-up was 54,3 months (IQR 24,7-80,0 months). Diabetic patients were more women (30.5% vs. 25.7%) and older (70.0 ± 10.8 vs. 65.3 ± 13.2 years old); they had higher GRACE (146 ± 36 vs. 137 ± 36), PRECISE-DAPT (15 ± 7 vs. 18 ± 9) at admission. Early invasive coronary angiography (≤ 24 h after admission) was performed more frequently in non-diabetic. We tested the predictive power of the GRACE and PRECISE-DAPT risk scores among diabetic and non-diabetic. PRECISE-DAPT risk score showed a good predictive power for all-cause mortality, cardiovascular mortality and MACE in diabetic admitted with NSTEACS, without differences compared to non-diabetic.PRECISE-DAPT risk score has an appropriate predictive power in diabetic patients admitted with NSTEACS compared to non-diabetic NSTEACS. However, GRACE would be predictive worse in diabetic during long-term follow-up in a large contemporary registry.

The benefit of complete revascularization in elderly patients with non-ST elevation myocardial infarction (NSTEMI), and multivessel disease remains debated (MVD). The aim of our study was to determine the current long-term prognostic benefit of complete revascularization in this population. A retrospective cohort study of 1722 consecutive elderly NSTEMI patients was performed. Among the study participants 30.4% (n = 524) were completed revascularizated and in 69.6% (n = 1198) culprit vessel only revascularization was performed. A propensity score analysis was performed and we divided the study population into two groups: complete revascularization (n = 500) and culprit vessel only revascularization (n = 500). The median follow-up was 45.7 months, the all cause mortality (44.5% vs 30.5%, p < 0.001) (HR 0.74 (0.57–0.97); p = 0.035) and cardiovascular mortality (32.6% vs 17.4%, p < 0.001) (HR = 0.67 (0.47–0.94); p = 0.021) were significantly lower in patients with complete revascularization. In our study, we observed a long-term benefit of complete revascularization in elderly NSTEMI and MVD patients. Elderly patients should also be managed according to current guidelines to improve their long-term prognosis.

RESUMEN En las últimas dos décadas han tenido lugar grandes avances en el campo de la cardiología intervencionista. Estos incluyen no solo nuevas técnicas y tratamientos, sino también cambios en la organización, como la atención continuada al infarto agudo de miocardio y la aparición de salas tuteladas. Todos estos avances hacen necesaria una actualización de los requisitos y del equipamiento necesarios en una unidad de hemodinámica y cardiología intervencionista. En este documento de consenso de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología, la Asociación de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares de la Sociedad Española de Cardiología, y la Asociación Española de Enfermería en Cardiología, se establecen las recomendaciones que deberían cumplir los centros hospitalarios donde esté instalada o se pretenda instalar una unidad de hemodinámica y cardiología intervencionista, los requisitos de dotación y cualificación de profesionales, las dotaciones tecnológicas y los materiales necesarios, y aspectos relacionados con las salas tuteladas y los programas de tratamiento de la cardiopatía estructural.

The objective of our work is to evaluate the prognostic benefit of an early invasive strategy in patients with high-risk NSTACS according to the recommendations of the 2020 clinical practice guidelines during long-term follow-up.This retrospective observational study included 6454 consecutive NSTEACS patients. We analyze the effects of early coronary angiography ( 24 h) in patients with: (a) GRACE risk score 140 and (b) patients with "established NSTEMI" (non ST-segment elevation myocardial infarction defined by an increase in troponins) or dynamic ST-T-segment changes with a GRACE risk score 140.From 2003 to 2017, 6454 patients with "new high-risk NSTEACS" were admitted, and 6031 (93.45%) of these underwent coronary angiography. After inverse probability of treatment weighting, the long-term cumulative probability of being free of all-cause mortality, cardiovascular mortality and MACE differed significantly due to an early coronary intervention in patients with NSTEACS and GRACE 140 [HR 0.62 (IC 95% 0.57-0.67), HR 0.62 (IC 95% 0.56-0.68), HR 0.57 (IC 95% 0.53-0.61), respectively]. In patients with NSTEACS and GRACE 140 with established NSTEMI or ST/T-segment changes, the benefit of the early invasive strategy is only observed in the reduction of MACE [HR 0.62 (IC 95% 0.56-0.68)], but not for total mortality [HR 0.96 (IC 95% 0.78-1.2)] and cardiovascular mortality [HR 0.96 (IC 95% 0.75-1.24)].An early invasive management is associated with reduced all-cause mortality, cardiovascular mortality and MACE in NSTEACS with high GRACE risk score. However, this benefit is less evident in the subgroup of patients with a GRACE score 140 with established NSTEMI or ST/T-segment changes.

Over the last two decades, several key advances have been made in the field of interventional cardiology including new techniques and treatments, organizational changes such as the management of acute myocardial infarction, and the arrival of satellite catheterization laboratories. All these advances require the updating of the requirements and equipment that are needed in an interventional cardiology unit. This consensus document by the Interventional Cardiology Association of the Spanish Society of Cardiology, the Ischemic Heart Disease and Acute Cardiac Care Association of the Spanish Society of Cardiology and the Spanish Association of Nursing in Cardiology which describes the recommendations that should be followed by percutaneous coronary intervention capable hospitals or centers intend to build interventional cardiology units. It also describes the requirements for provision, qualification of professionals, technological and material resource allocation, and aspects related to supervised catheterization laboratories and structural heart disease programs.

espanolIntroduccion y objetivos: La epidemia de COVID-19 y la declaracion del estado de alarma han propiciado una disminucion en la actividad en la cardiologia intervencionista. El objetivo de este estudio es cuantificar esta disminucion, con especial interes en el funcionamiento del codigo infarto. Metodos: Se realizo una encuesta telematica a 81 centros de las 17 comunidades autonomas espanolas con procedimientos de codigo infarto. Se recogio informacion sobre la actividad diagnostica, el intervencionismo coronario, el intervencionismo estructural y el intervencionismo en el seno del infarto agudo de miocardio con elevacion del segmento ST (IAMCEST) sobre cambios en la organizacion de las redes del infarto y sobre la afeccion por COVID-19 de las plantillas de cardiologia intervencionista. Se compararon 2 periodos: uno entre el 24 de febrero y el 1 de marzo (antes del inicio de la pandemia en Espana) y el otro entre el 16 y el 22 de marzo (durante la pandemia). Resultados: Se obtuvo respuesta de 73 centros (90%) que evidencio una disminucion significativa en el numero de procedimientos diagnosticos (─56%), terapeuticos coronarios (─48%), terapeuticos estructurales (─81%) y en el seno del IAMCEST (─40%). Se indico un leve incremento en el uso de trombolisis. Se diagnostico infeccion por COVID-19 en 17 cardiologos intervencionistas (5%). Conclusiones: Se observo una reduccion importante de la actividad asistencial durante la epidemia de COVID-19 y una gran disminucion en el numero de pacientes tratados con IAMCEST, con el riesgo de incremento de morbimortalidad que esto supone. Las sociedades cientificas y autoridades sanitarias deberian promover que los pacientes con sintomas compatibles con IAMCEST demanden asistencia al sistema sanitario para poder recibir el tratamiento de reperfusion de forma adecuada. EnglishIntroduction and objectives: The COVID-19 epidemic and the declaration of the state of alarm have led to a decrease in healthcare activity in interventional cardiology units. The objective of this study is to quantify these changes in activity, with special interest in the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Methods: A telematic survey of 81 centers involved in STEMI networks in the 17 autonomous communities of Spain. Information was collected on diagnostic activity, percutaneous coronary intervention (PCI), structural interventions, and PCI in STEMI on changes in the organization of STEMI networks, and on the prevalence of COVID-19 among interventional cardiologists. Data was compared for the week of February 24 through March 1 (before the outbreak) and for the week of March 16 through March 22 (during the outbreak). Results: Response has been obtained from 73 centers (90%). A very significant decrease in the number of diagnostic procedures (─56%), PCI (─48%), structural interventions (─81%) and PCI in STEMI (─40%) has been observed. A slight increase in the use of pharmacological thrombolysis has been reported, although primary angioplasty remains the leading reperfusion strategy. Up to 5% of interventional cardiologists (17) had COVID-19. Conclusions: An important reduction in the activity in interventional cardiology has been observed during the COVID-19 epidemic. Likewise, a great decrease has been detected in the number of patients treated in the STEMI networks, with the risk of increased morbidity and mortality that this represents. Scientific societies and health authorities have to promote that patients presenting STEMI compatible symptoms proceed with no delay to access the health system to receive reperfusion treatment in an appropriate way.

Resumen Introduccion y objetivos El objetivo es analizar la incidencia, los predictores y el impacto pronostico de la insuficiencia cardiaca (IC) aguda tras el implante percutaneo de una valvula aortica (TAVI) con una protesis autoexpandible. Metodos Desde 2008, se incluye prospectivamente en nuestro registro de TAVI a todos los pacientes sometidos a TAVI en nuestro centro. Se analizan los factores pronosticos determinantes de IC aguda, y la relacion con la mortalidad mediante modelos de regresion de Cox. Resultados Se sometieron a TAVI 399 pacientes, con una media de edad de 82,4 ± 5,8 anos, de los que 213 (53,4%) eran mujeres. Durante el seguimiento (27,0 ± 24,1 meses), el 29,8% de los pacientes (n = 119) ingresaron en el hospital con el diagnostico de IC aguda, lo que representa una incidencia anual del 13,2% (IC95%, 11,1-15,8%). Al final del seguimiento, habian fallecido 150 pacientes (37,59%). En el grupo de IC aguda se evidencio una tasa de mortalidad significativamente mayor (el 52,1 frente al 31,4%; HR = 1,84; IC95%, 1,14-2,97; p Conclusiones El TAVI se asocia con una alta incidencia de eventos de IC aguda, lo que supone un gran impacto en la mortalidad. La IC aguda previa al implante y la puntuacion de la Society of Thoracic Surgeons fueron los unicos predictores de IC aguda hallados. Un indice de riesgo nutricional bajo y la enfermedad pulmonar obstructiva cronica son potentes determinantes de mortalidad en el grupo de IC aguda.

espanolIntroduccion y objetivos: Las lesiones coronarias calcificadas pueden impedir una correcta expansion del stent que en ocasiones conduce a eventos adversos. La litotricia intracoronaria es una nueva herramienta de modificacion de la placa, cuyas seguridad y viabilidad en pacientes con enfermedad coronaria estable han sido evaluadas en el ensayo Disrupt CAD II. Aunque su uso ha aumentado rapidamente, hasta el momento solo se han comunicado casos aislados en escenarios concretos. Se presentan los resultados en pacientes clinicamente complejos de la vida real con calcificacion coronaria grave. Metodos: Entre octubre de 2018 y marzo de 2019 se trato a 25 pacientes (37 lesiones) en 2 centros espanoles, lo que representa el 2,7% de los pacientes tratados con intervencion coronaria percutanea. Resultados: Las tasas de exito clinico y del dispositivo fueron del 84 y el 95%, y no se observaron complicaciones relacionadas con el procedimiento. En todos los casos se consiguio cruzar la lesion con el balon de litotricia intracoronaria, si bien en el 8% de los casos se rompio el balon durante el inflado. Se trataron con exito lesiones complejas, como oclusiones coronarias totales y estenosis del tronco comun. En comparacion con el estudio Disrupt CAD II, nuestros pacientes eran mas jovenes, pero tenian peor escenario clinico, con mayor prevalencia de diabetes (68%) e insuficiencia renal (22%), y hasta el 76% se presento como sindrome coronario agudo. En 3 de 4 pacientes con infraexpansion de stent tratados con litotricia intracoronaria no se consiguio una expansion adecuada tras el procedimiento. No hubo complicaciones ni mortalidad hospitalaria. Un paciente fallecio por causa no cardiaca a los 30 dias de seguimiento. Conclusiones: La litotricia intracoronaria se ha demostrado efectiva y segura en una cohorte de pacientes complejos de la vida real con lesiones calcificadas. EnglishIntroduction and objectives: Complex calcified lesions can affect stent expansion and lead to stent failure and adverse outcomes. Intracoronary lithotripsy (ICL) has emerged as a new tool that enables calcium modification. The Disrupt CAD II clinical trial has recently evaluated the safety and feasibility of ICL in patients with stable coronary disease and calcified coronary lesions. Although its use has increased rapidly, the experience already reported with this new device is limited. We report the results in real-life complex patients with heavy coronary calcification. Methods: From October 2018 to March 2019, 25 patients (37 calcified lesions) were treated in 2 Spanish centers, which accounted for 2.7% of the patients treated with percutaneous coronary intervention. Results: The device and clinical success rates were 84% and 95%, respectively. No procedure-related complications were seen. The crossing rate of the ICL balloon was 100% and balloon rupture during inflation occurred in 8%. The ICL was performed in a subset of highly complex lesions like left main coronary artery lesions and chronic total coronary occlusions. Compared to the Disrupt CAD II trial, our patients were younger but their clinical scenario was worse with a higher prevalence of diabetes (68%), renal failure (22%), and up to 76% suffered from acute coronary syndrome. The ICL failed to reach proper expansion in 3 out of 4 cases of stent underexpansion. The procedure was performed safely, and clinical and device success were high with no in-hospital mortality. One patient died of non-cardiac causes at the 30-day follow-up. Conclusions: The ICL-assisted percutaneous coronary intervention was performed safely and effectively in a real-life cohort of patients with calcified and highly complex lesions.

Introduction and objectives: Complex calcified lesions can affect stent expansion and lead to stent failure and adverse outcomes. Intracoronary lithotripsy (ICL) has emerged as a new tool that enables calcium modification. The Disrupt CAD II clinical trial has recently evaluated the safety and feasibility of ICL in patients with stable coronary disease and calcified coronary lesions. Although its use has increased rapidly, the experience already reported with this new device is limited. We report the results in real-life complex patients with heavy coronary calcification. Methods: From October 2018 to March 2019, 25 patients (37 calcified lesions) were treated in 2 Spanish centers, which accounted for 2.7% of the patients treated with percutaneous coronary intervention. Results: The device and clinical success rates were 84% and 95%, respectively. No procedure-related complications were seen. The crossing rate of the ICL balloon was 100% and balloon rupture during inflation occurred in 8%. The ICL was performed in a subset of highly complex lesions like left main coronary artery lesions and chronic total coronary occlusions. Compared to the Disrupt CAD II trial, our patients were younger but their clinical scenario was worse with a higher prevalence of diabetes (68%), renal failure (22%), and up to 76% suffered from acute coronary syndrome. The ICL failed to reach proper expansion in 3 out of 4 cases of stent underexpansion. The procedure was performed safely, and clinical and device success were high with no in-hospital mortality. One patient died of non-cardiac causes at the 30-day follow-up. Conclusions: The ICL-assisted percutaneous coronary intervention was performed safely and effectively in a real-life cohort of patients with calcified and highly complex lesions.

Introduction and objectives: ST-segment elevation myocardial infarction (STEMI) regional networks pose great organizational differences that may compromise their results. The Working Group on Hemodynamics and Interventional Cardiology has carried out a survey among its members on the level of satisfaction and the state of primary angioplasty programs in Spain. Methods: On-line, open and anonymous survey, among the Hemodynamics and Interventional Cardiology Working Group members conducted between May 22 and June 5, 2018 on the necessities of the aforementioned programs and the degree of satisfaction of the professionals involved. Results: Answers were obtained from 172 professionals with representation from 75 centers and 17 autonomous communities. The number of angioplasties performed in the STEMI setting per year and per center was 259 ± 110. The degree of satisfaction of the professionals with the application of the Infarction Code and the degree of personal satisfaction scored 7.2 ± 2.2 and 7.2 ± 2.4 points out of 10, respectively, although with significant regional differences. The main areas of concern detected were logistics issues, insufficient paycheck compensations and lack of rest. The 55% were inclined to leave their on-call duties when possible. Conclusions: The survey has revealed a high degree of satisfaction by the professionals involved in STEMI treatment, although with notable differences among different autonomous communities and has allowed detecting logistical, structural and paycheck disturbances that can put primary angioplasty programs in situations of vulnerability.

espanolIntroduccion y objetivos: Las redes regionales de atencion al infarto agudo de miocardio con elevacion del segmento ST presentan grandes diferencias en terminos de organizacion que puede llegar a comprometer sus resultados. La Seccion de Hemodinamica y Cardiologia Intervencionista ha realizado una encuesta entre sus miembros sobre el grado de satisfaccion y la situacion de los programas de angioplastia primaria en Espana. Metodos: Se realizo una encuesta online, abierta y anonima, entre los miembros de la Seccion de Hemodinamica y Cardiologia Intervencionista entre los dias 22 de mayo y 5 de junio de 2018, sobre las necesidades de los programas y el grado de satisfaccion de los profesionales. Resultados: Se obtuvieron 172 respuestas de profesionales, con representacion de 75 centros y 17 comunidades autonomas. El numero de angioplastias en el infarto agudo de miocardio con elevacion del segmento ST por ano y por centro fue de 259 ± 110. El grado de satisfaccion de los profesionales con la aplicacion del Codigo Infarto, asi como el grado de satisfaccion personal, obtuvieron una puntuacion de 7,2 ± 2,2 y 7,2 ± 2,4 puntos sobre 10, respectivamente, aunque con diferencias regionales significativas. Las principales areas de preocupacion detectadas fueron las limitaciones logisticas, la retribucion insuficiente y la falta de descanso. Si fuera posible, un 55% estaria dispuesto a dejar las guardias. Conclusiones: La encuesta ha puesto de manifiesto un alto grado de valoracion del sistema por parte de los profesionales, aunque con diferencias notables entre las comunidades autonomas, y ha permitido detectar disfunciones logisticas, estructurales y retributivas que pueden poner a los programas de angioplastia primaria en situacion de vulnerabilidad. EnglishIntroduction and objectives: ST-segment elevation myocardial infarction (STEMI) regional networks pose great organizational differences that may compromise their results. The Working Group on Hemodynamics and Interventional Cardiology has carried out a survey among its members on the level of satisfaction and the state of primary angioplasty programs in Spain. Methods: On-line, open and anonymous survey, among the Hemodynamics and Interventional Cardiology Working Group members conducted between May 22 and June 5, 2018 on the necessities of the aforementioned programs and the degree of satisfaction of the professionals involved. Results: Answers were obtained from 172 professionals with representation from 75 centers and 17 autonomous communities. The number of angioplasties performed in the STEMI setting per year and per center was 259 ± 110. The degree of satisfaction of the professionals with the application of the Infarction Code and the degree of personal satisfaction scored 7.2 ± 2.2 and 7.2 ± 2.4 points out of 10, respectively, although with significant regional differences. The main areas of concern detected were logistics issues, insufficient paycheck compensations and lack of rest. The 55% were inclined to leave their on-call duties when possible. Conclusions: The survey has revealed a high degree of satisfaction by the professionals involved in STEMI treatment, although with notable differences among different autonomous communities and has allowed detecting logistical, structural and paycheck disturbances that can put primary angioplasty programs in situations of vulnerability.

Renal dysfunction in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) indicates a poor long-term prognosis. However, the prognostic value of the improvement or stabilisation of renal function during follow-up has not yet been assessed. This study aimed to investigate the long-term predictive impact of the improvement or stabilisation of renal function after one year of follow-up in patients with STEMI undergoing pPCI with renal dysfunction at discharge.This prospective, single-centre cohort study included 2170 consecutive patients with STEMI who underwent pPCI. The glomerular filtration rate (GFR) was determined at hospital discharge and one-year follow-up. The median clinical follow-up was 72 months.Among the 2004 patients, 393 (19.6%) had a GFR60 ml/min, and 1611 (80.4%) had a GFR ≥ 60 ml/min at discharge. Among patients with GFR60 ml/min, data at one-year follow-up were available for 342. Of these patients, 127 (32%) showed improvement in renal function (defined as improvement in the Kidney Disease Improving Global Outcomes (KDIGO) chronic kidney disease (CKD) classification), 47 (12%) showed worsening of renal function (defined as worsening of the KDIGO CKD classification), and 168 (43%) showed no category changes. Improvement or stabilisation of GFR at one year of follow-up was associated with a reduction of major adverse cardiovascular events (MACE) [HR 0.51, 95% CI: 0.35-0.75, p = 0.001] and all-cause mortality [HR 0.54, 95% CI: 0.34-0.84, p = 0.007] during follow-up.The improvement or stabilisation of renal function at one-year follow-up in patients with STEMI and renal dysfunction is associated with a better long-term prognosis.

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p &lt, 0.001) and more often had a history of hypertension (77% vs. 83.1%, p &lt, 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p &lt, 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78, p &lt, 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14, p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

HOW WOULD I APPROACH IT? The authors hereby present the clinical case of a 61-year-old male who suffered a seizure in his home, was assessed by the EMT, and then transferred to his reference center where one primary angioplasty was performed with a diagnosis of inferior-lateral ST-segment elevation acute myocardial infarction in a situation of cardiogenic shock (CS) and further treatment with vasoactive amines and orotracheal intubation. Upon arrival to the cath. lab and since the CS was persistent, as a first-line therapy, it was decided to implant the circulatory mechanical assist Impella CP device (AbioMed, Danvers, Massachusetts, United States). Then a coronary angiography confirmed the embolic occlusion of the circumflex and right coronary arteries that resolved partially after thrombus aspiration and simple angioplasty. However, since hemodynamic instability was persistent and a left intracavitary mass was found on the echocardiography after the interventional procedure, it was decided to remove the Impella CP device and proceed to use extracorporeal membrane oxygenation (ECMO).

ST-segment elevation myocardial infarction (STEMI) networks should guarantee STEMI care with good clinical results and within the recommended time parameters. There is no contemporary information on the performance of these networks in Spain. The objective of this study was to analyze the clinical characteristics of patients, times to reperfusion, characteristics of the intervention performed, and 30-day mortality.Prospective, observational, multicenter registry of consecutive patients treated in 17 STEMI networks in Spain (83 centers with the Infarction Code), between April 1 and June 30, 2019.A total of 5401 patients were attended (mean age, 64±13 years; 76.9% male), of which 4366 (80.8%) had confirmed STEMI. Of these, 87.5% were treated with primary angioplasty, 4.4% with fibrinolysis, and 8.1% did not receive reperfusion. In patients treated with primary angioplasty, the time between symptom onset and reperfusion was 193 [135-315] minutes and the time between first medical contact and reperfusion was 107 [80-146] minutes. Overall 30-day mortality due to STEMI was 7.9%, while mortality in patients treated with primary angioplasty was 6.8%.Most patients with STEMI were treated with primary angioplasty. In more than half of the patients, the time from first medical contact to reperfusion was120 minutes. Mortality at 30 days was relatively low.

¿CÓMO LO HARÍA? Los autores presentan el caso clínico de un varón de 61 años que, tras sufrir un episodio sincopal en su domicilio, fue valorado por los servicios de emergencias y trasladado al centro de referencia, donde se realizó una angioplastia primaria con el diagnóstico de infarto con elevación del segmento ST inferolateral, en situación de shock cardiogénico (SC), bajo tratamiento con aminas vasoactivas e intubación orotraqueal. A su llegada al laboratorio de hemodinámica, ante la persistencia en SC, se decidió como primera medida implantar un sistema de soporte mecánico circulatorio tipo Impella CP (AbioMed, Danvers, Massachusetts, Estados Unidos). Posteriormente se realizó una coronariografía que mostró una oclusión embólica de las arterias circunfleja y coronaria derecha, que se resolvió parcialmente con tromboaspiración y angioplastia simple. Sin embargo, ante la persistencia de la inestabilidad hemodinámica y el hallazgo por ecocardiografía tras el intervencionismo de una masa intracavitaria izquierda, se decidió retirar el Impella CP y se implantó un oxigenador extracorpóreo de membrana (ECMO).

Percutaneous coronary intervention (PCI) is establishing as the last remaining revascularization option in an increasing number of patients affected by complex coronary artery disease not suitable for surgery. Over the past decade, percutaneous left ventricular assist device (pLVAD) has increasingly replaced intra-aortic balloon pump to provide hemodynamic support during such non-emergent complex high-risk indicated procedures (CHIP) averting the risk of circulatory collapse and of adverse events in long lasting and/or complicated procedures. This review article aims to report the key factors to define CHIP, to summarize the available pLVAD which have CE mark for temporary mechanical LV support and to discuss the rationale of their use in this subset of patients. Based on the expertise of the Italian Society of Interventional Cardiology working group, with the endorsement from Spanish and Portuguese Society of Interventional Cardiology working groups, it will provide several practical suggestions in regards to the use of pLVAD in different clinical CHIP scenarios.

Resumen La hipertension arterial (HTA) es un factor de riesgo cardiovascular altamente prevalente y de dificil control a pesar de la evolucion del tratamiento farmacologico. La denervacion renal percutanea (DRP) es una intervencion cuyo objetivo es la modulacion del sistema nervioso simpatico, directamente implicado en la fisiopatologia de la HTA. A pesar de los resultados iniciales, el estudio SYMPLICITY HTN-3 no demostro la eficacia de la DRP en el tratamiento de la HTA resistente al tratamiento farmacologico. Analisis a posteriori de los resultados revelaron potenciales factores de confusion que podrian explicar parte de los inesperados resultados del estudio. Estudios recientes con un numero limitado de pacientes han demostrado la eficacia de la DRP en el tratamiento de la HTA moderada y en ausencia de tratamiento farmacologico. Aunque el papel de la DRP en el tratamiento de la HTA esta por determinar, los resultados de los ultimos estudios abren un campo de aplicaciones que habra que explorar en los proximos anos.

Coronary artery disease (CAD) is a common co-morbidity in transcatheter aortic valve implantation (TAVI) patients, but the prognostic value of coronary revascularization before TAVI is currently unknown. The aim of the present study was to assess the impact of coronary revascularization in patients who underwent TAVI. Patients underwent TAVI from 2008 to 2016 were included in the study. Baseline SYNTAX score and residual SYNTAX score (rSS) after percutaneous coronary intervention were calculated. Based on rSS, patients were classified as complete revascularization (rSS = 0), reasonably incomplete revascularization (rSS0 and8), and incomplete revascularization (rSS ≥8). The primary objective was to evaluate the impact of CAD and rSS on major cardiovascular adverse events (MACEs). The secondary objective was to assess the impact of rSS on hospitalization for heart failure. A total of 349 patients (mean age 82.4 ± 5.7 years, 53% women) were included in the study. A total of 187 patients (53.6%) had CAD (mean baseline SYNTAX score 9.2 ± 8.1). Percutaneous coronary intervention was performed in 29.9% of patients, achieving reasonably incomplete revascularization in 45.4%, and incomplete revascularization in 24.5%. The mean follow-up was 35.2 ± 25.3 months. No differences were observed in MACE rate between the CAD and non-CAD groups, or between the different degrees of revascularization. Differences were also not seen in the different levels of revascularization and hospitalization due to heart failure. In patients who underwent TAVI in this study, no association was found between the presence of CAD or the degree of revascularization in a long-term follow-up.