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Resumen Introduccion y objetivos El lactato y su evolucion se asocian con el pronostico de los pacientes en shock, si bien es escasa la evidencia en aquellos asistidos con oxigenador extracorporeo de membrana venoarterial (ECMO-VA). Nuestro objetivo es evaluar su valor pronostico en shock cardiogenico asistido con ECMO-VA. Metodos Estudio de pacientes tratados con ECMO-VA por shock cardiogenico de indicacion medica entre julio de 2013 y abril de 2021. Se calculo el aclaramiento de lactato: (lactato inicial − lactato 6 h) / lactato inicial × tiempo exacto entre ambas determinaciones. Resultados De 121 pacientes, 44 (36,4%) tenian infarto agudo de miocardio; 42 (34,7%), implante intraparada; 14 (11,6%), tromboembolia pulmonar, 14 (11,6%), tormenta arritmica y 6 (5,0%), miocarditis fulminante. A los 30 dias habian fallecido 60 pacientes (49,6%); la mortalidad fue mayor con el implante intraparada que con el implante en circulacion espontanea (30 [71,4%] de 42 frente a 30 [38,0%] de 79; p = 0,030). Se asociaron de manera independiente con la mortalidad a 30 dias la alanina aminotransferasa (ALT) antes del implante y el lactato (tanto basal como a las 6 h y el aclaramiento). Los modelos de regresion que incluian el lactato presentaron mejor capacidad predictiva de la supervivencia que las puntuaciones ENCOURAGE y ECMO-ACCEPTS, con mayor area bajo la curva ROC en el modelo con lactato a las 6 h. Conclusiones El lactato (basal y a las 6 h y el aclaramiento) es un predictor independiente para el pronostico de los pacientes en shock cardiogenico asistidos con ECMO-VA que facilita una mejor estratificacion del riesgo y tiene una capacidad predictiva superior.

Introducción y objetivos Los datos respecto a la utilización del oxigenador extracorpóreo de membrana venoarterial (ECMO-VA) en adultos con shock cardiogénico (SC) son escasos. El objetivo del presente estudio fue describir los datos de un registro multicéntrico español, y analizar qué factores tuvieron un impacto en la mortalidad intrahospitalaria. Métodos Registro retrospectivo multicéntrico español de pacientes en situación de SC profundo que recibieron soporte circulatorio con ECMO-VA. Resultados Desde enero de 2012 hasta octubre de 2018, se asistieron 233 pacientes con ECMO-VA. La edad media fue 56,3 ± 12,18 años y 50 eran mujeres (21,5%). Recibieron el alta hospitalaria 109 pacientes (46,8%). Las complicaciones más frecuentes observadas fueron: insuficiencia renal aguda en 131 (59,0%), hemorragia en 70 (31,7%), hipoxemia en 86 (36,9%) e infección en 99 (43,4%). Los predictores independientes de mortalidad intrahospitalaria fueron lactato al implante (OR = 1,05; IC95%, 1,05-1,19), edad (OR = 2,19; IC95%, 1,05-4,58) y canulación intraparada cardiaca (OR = 1,04; IC95%, 1,01-1,06). Un total de 45 pacientes tenían edad > 60 años y lactato al implante > 8 mmol/l, su mortalidad intrahospitalaria fue de 77,8% y llegó al 91,7% en 12 de ellos en los que la canulación fue intraparada cardiaca. Conclusiones La terapia con ECMO-VA es factible en pacientes con SC profundo. La selección adecuada parece fundamental para evitar la futilidad del implante en pacientes con escasas posibilidades de éxito. Introduction and objectives The data regarding the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults in with cardiogenic shock (CS) are scarce. The aim of this study was to describe the data of a Spanish multicenter registry, and to analyze which factors had an impact on in-hospital mortality. Methods Retrospective Spanish multicenter registry of patients with deep CS treated with VA-ECMO circulatory support. Results From January 2012 to October 2018, 233 patients were treated with VA-ECMO. Mean age was 56.3 ± 12.18 years and 50 were female (21.5%). A total of 109 patients were successfully discharged (46.8%). The most frequent complications were acute kidney injury in 131 (59.0%), hypoxemia in 86 (36.9%) major bleeding in 70 (31.7%), and infection in 99 (43.4%). The independent in-hospital mortality risk factors were lactate before implant (OR, 1.05; 95%CI, 1.05-1.19), age (OR, 2.19; 95%CI, 1.05-4.58), and cannulation during cardiac arrest (OR, 1.04; 95%CI, 1.01-1.06). A total of 45 patients > 60 years with lactate before implant > 8 mmol/l had an in-hospital mortality rate of 77.8%, in-hospital mortality and reached 91.7% in 12 of them with cannulation during cardiac arrest. Conclusions VA-ECMO therapy for patients with deep cardiogenic shock is feasibly. Appropriate selection seems critical in order to avoid the futility of using ECMO in those patients with low survival chances. Sin financiación No data JCR (2021) 0.130 SJR (2021) Q4, 317/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Sin financiación 6.975 JCR (2021) Q1, 33/143 Cardiac & Cardiovascular Systems 0.407 SJR (2021) Q3, 205/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Introducción y objetivos Se presentan las características clínicas y los resultados de los trasplantes cardiacos realizados en España con la actualización correspondiente a 2019. Métodos Se describen las características clínicas y los resultados de los trasplantes cardiacos realizados en 2019, así como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a años previos, los cambios más llamativos son el descenso hasta el 38% de los trasplantes realizados en código urgente, y la consolidación en el cambio de asistencia circulatoria pretrasplante, con la práctica desaparición del balón de contrapulsación (0, 7%), la estabilización del uso del oxigenador extracorpóreo de membrana (9, 6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0, 34), y ambas mejores que la del trienio 2010-2012 (p = 0, 002 y p = 0, 01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en España como los resultados en supervivencia en los últimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoría con dispositivos de asistencia ventricular. Introduction and objectives: The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods: We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results: In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P = .34). Survival in both these periods was better than that from 2010 to 2012 (P = .002 and P = .01, respectively). Conclusions: Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.

Resumen Han sido numerosos los estudios publicados en el campo de la cardiopatia isquemica y de los cuidados criticos cardiovasculares en este ultimo ano. Por este motivo, esta revision no pretende abarcar todos ellos, sino mas bien una seleccion de algunas publicaciones que a criterio subjetivo de los autores se consideran de interes.

Background. The “weekend effect” has been associated with worse clinical outcomes. Our aim was to compare off-hours vs. regular-hours peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic shock patients. Methods. We analyzed in-hospital and 90-day mortality among 147 consecutive patients treated with percutaneous VA-ECMO for medical reasons between July 1, 2013, and September 30, 2022, during regular-hours (weekdays 8:00 a.m.–10:00 p.m.) and off-hours (weekdays 10:01 p.m.–7:59 a.m., weekends, and holidays). Results. The median patient age was 56 years (interquartile range [IQR] 49–64 years) and 112 (72.6%) were men. The median lactate level was 9.6 mmol/L (IQR 6.2–14.8 mmol/L) and 136 patients (92.5%) had a Society for Cardiovascular Angiography and Interventions (SCAI) stage D or E. Cannulation was performed off-hours in 67 patients (45.6%). In-hospital mortality was similar in off-hours and regular hours (55.2% vs. 56.3%, p = 0.901), as was the 90-day mortality (58.2% vs. 57.5%, p = 0.963), length of hospital stay (31 days [IQR 16–65.8 days] vs. 32 days [IQR 18–63 days], p = 0.979), and VA-ECMO related complications (77.6% vs. 70.0%, p = 0.305). Conclusions. Off-hours and regular-hours percutaneous VA-ECMO implantation in cardiogenic shock of medical cause have similar results. Our results support well-designed 24/7 VA-ECMO implantation programs for cardiogenic shock patients.

Our aim was to describe the clinical profile of patients presenting sustained ventricular arrhythmias after sacubitril/valsartan (SV) initiation. All cases of sustained ventricular arrhythmias in patients receiving SV were consecutively recorded in two centers. Nineteen patients had sustained ventricular arrhythmias after SV. All were men and were previously receiving angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers before SV initiation. Fifteen patients (78.9%) had electrical stability in the previous 6 months. Nine patients (47.4%) initiated SV at the lowest available dose (24/26 mg). Globally, in all but five patients alive at discharge, SV was discontinued after the event. Six patients presented new arrhythmic events after discontinuation of SV. Two deaths and three heart transplants occurred (one due to heart failure and the other two due to persistent ventricular arrhythmias). All patients had a high arrhythmic risk, and 17 (89.5%) had an implanted cardioverter defibrillator. No specific triggers for the arrhythmic event were found. Male sex and previous episodes of ventricular arrhythmias could be associated with an increased risk of sustained ventricular tachycardia after SV initiation. Discontinuation of the drug might be an additional approach to enable a better control of ventricular arrhythmias in some patients. Sin financiación 2.037 JCR (2020) Q3, 106/142 Cardiac & Cardiovascular Disease 0.624 SJR (2020) Q2, 157/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

Introduction and objectives: Lactate and its evolution are associated with the prognosis of patients in shock, although there is little evidence in those assisted with an extracorporeal venoarterial oxygenation membrane (VA-ECMO). Our objective was to evaluate its prognostic value in cardiogenic shock assisted with VA-ECMO. Methods: Study of patients with cardiogenic shock treated with VA-ECMO for medical indication between July 2013 and April 2021. Lactate clearance was calculated: [(initial lactate - 6 h lactate) / initial lactate × exact time between both determinations]. Results: From 121 patients, 44 had acute myocardial infarction (36.4%), 42 implant during cardiopulmonary resuscitation (34.7%), 14 pulmonary embolism (11.6%), 14 arrhythmic storm (11.6%), and 6 fulminant myocarditis (5.0%). After 30 days, 60 patients (49.6%) died, mortality was higher for implant during cardiopulmonary resuscitation than for implant in spontaneous circulation (30 of 42 [71.4%] vs 30 of 79 [38.0%], P=.030). Preimplantation GPT and lactate (both baseline, at 6hours, and clearance) were independently associated with 30-day mortality. The regression models that included lactate clearance had a better predictive capacity for survival than the ENCOURAGE and ECMO-ACCEPTS scores, with the area under the ROC curve being greater in the model with lactate at 6 h. Conclusions: Lactate (at baseline, 6h, and clearance) is an independent predictor of prognosis in patients in cardiogenic shock supported by VA-ECMO, allowing better risk stratification and predictive capacity. Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM

Despite improvements in device design and hemocompatibility, intracranial hemorrhage and stroke remain the most feared and devastating complications in patients under mechanical circulatory support. We present the case of a 48 year old man with advanced heart failure (INTERMACS 3) and severe biventricular dysfunction who underwent biventricular pulsatile paracorporeal device implantation (Berlin Heart Excor) as a bridge to candidacy. Although on the heart transplantation waiting list, the patient experienced an intracranial hemorrhage, which was successfully managed by switching to a less thrombogenic biventricular assist device (Levitronix Centrimag) using the Excor cannulae, thus enabling temporary withdrawal of antithrombotic therapy. Heart transplant was performed successfully with no significant complications.

Valganciclovir (VGCV) and ganciclovir (GCV) doses must be adjusted according to indication, renal function and weight. No specific therapeutic exposure values have been established. We aimed to evaluate the adequacy of VGCV/GCV doses, to assess the interpatient variability in GCV serum levels, to identify predictive factors for this variability and to assess the clinical impact. This is a prospective study at a tertiary institution including hospitalized patients receiving VGCV/GCV prophylaxis or treatment. Adequacy of the antiviral dose was defined according to cytomegalovirus guidelines. Serum levels were determined using High-Performance Liquid Chromatography. Blood samples were drawn at least 3 days after antiviral initiation. Outcome was considered favorable if there was no evidence of cytomegalovirus infection during prophylaxis or when a clinical and microbiological resolution was attained within 21 days of treatment and no need for drug discontinuation due to toxicity. Seventy consecutive patients [74.3% male/median age: 59.2 years] were included. VGCV was used in 25 patients (35.7%) and GCV in 45 (64.3%). VGCV/GCV initial dosage was deemed adequate in 47/70 cases (67.1%), lower than recommended in 7/70 (10%) and higher in 16/70 (22.9%). Large inter-individual variability of serum levels was observed, with median trough levels of 2.3 mg/L and median peak levels of 7.8 mg/L. Inadequate dosing of VGCV/GCV and peak levels lower than 8.37 or greater than 11.86 mg/L were related to poor outcome. Further studies must be performed to confirm these results and to conclusively establish if VGCV/GCV therapeutic drug monitoring could be useful to improve outcomes in specific clinical situations.

Resumen: Introducción: Las terapias respiratorias no invasivas (TRNI) fueron ampliamente utilizadas en la primera ola de la pandemia de COVID-19, en escenarios distintos según los medios disponibles. El objetivo fue presentar la supervivencia a 90 días y los factores asociados a esta de los pacientes tratados con TRNI en un centro de tercer nivel sin Unidad de Cuidados Respiratorios Intermedios. Como objetivo secundario comparar los resultados obtenidos de las distintas terapias. Métodos: Estudio observacional de pacientes tratados con TRNI fuera de un ambiente de Cuidados Intensivos o Unidad de Cuidados Respiratorios Intermedios, diagnosticados de COVID-19 y con síndrome de distrés respiratorio agudo por criterios radiológicos y de ratio SpO2/FiO2. Se desarrolló un modelo multivariante de regresión logística para determinar las variables independientemente asociadas, y se compararon los resultados de la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea. Resultados: Se trataron 107 pacientes y sobrevivieron 85 (79,4%) a los 90 días. Antes de iniciar la TRNI el ratio medio de SpO2/FiO2 fue de 119,8 ± 59,4. Un mayor score de SOFA se asoció significativamente a la mortalidad (OR 2,09; IC95% 1,34 – 3,27), mientras que la autopronación fue un factor protector (OR 0,23; IC95% 0,06 – 0,91). La terapia de alto flujo con cánula nasal fue utilizada en 63 sujetos (58,9%), y la presión positiva continua en la vía aérea en 41 (38,3%). No se encontraron diferencias entre ellas. Conclusión: Aproximadamente cuatro de cada cinco pacientes tratados con TRNI sobrevivieron a los 90 días, y no se encontraron diferencias significativas entre la terapia de alto flujo con cánula nasal y la presión positiva continua en la vía aérea. Abstract: Introduction: Non-invasive respiratory therapies (NRT) were widely used in the first wave of the COVID-19 pandemic in different settings, depending on availability. The objective of our study was to present 90-day survival and associated factors in patients treated with NRT in a tertiary hospital without an Intermediate Respiratory Care Unit. The secondary objective was to compare the outcomes of the different therapies. Methods: Observational study of patients treated with NRT outside of an intensive care or intermediate respiratory care unit setting, diagnosed with COVID-19 and acute respiratory distress syndrome by radiological criteria and SpO2/FiO2 ratio. A multivariate logistic regression model was developed to determine independently associated variables, and the outcomes of high flow nasal cannula and continuous positive airway pressure were compared. Results: In total, 107 patients were treated and 85 (79.4%) survived at 90 days. Before starting NRT, the mean SpO2/FiO2 ratio was 119.8 ± 59.4. A higher SOFA score was significantly associated with mortality (OR 2,09; 95% CI 1.34-3.27), while self-pronation was a protective factor (OR 0.23; 95% CI 0.06-0.91). High flow nasal cannula was used in 63 subjects (58.9%), and continuous positive airway pressure in 41 (38.3%), with no differences between them. Conclusion: Approximately 4 out of 5 patients treated with NRT survived to 90 days, and no significant differences were found between high flow nasal cannula and continuous positive airway pressure.

Background: Ticagrelor has a bactericidal effect in vitro, and clinical studies suggest a beneficial effect in infections. Our aim was to determine the incidence of infections in patients treated with 3 different P2Y12 receptor inhibitors. Methods: Retrospective registry in a cardiology department. Patients with coronary artery disease discharged on ticagrelor, prasugrel, or clopidogrel from March 2017 to June 2019 were included. The risk of infection was analyzed during the period of P2Y12 inhibitor treatment (12.4 ± 6.7 months). Results: A total of 250 patients were included (ticagrelor 91 [36.4%], prasugrel 89 [35.6%], clopidogrel 70 [28.0%]). Mean age was 61.0 ± 13.1 years, and 63 (25.2%) were women. The most common reason to use these drugs was ST-segment elevation acute myocardial infarction (STEMI) (152 patients – 60.8%). STEMI was the reason to use prasugrel in 84 patients (94.4%), ticagrelor in 44 (48.4%), and clopidogrel in 24 (34.3%), p < 0.001. An infection during follow-up was seen in 87 patients (34.8%), 23 treated with ticagrelor (25.3%), 30 with prasugrel (33.7%) and 34 with clopidogrel (48.6%), p = 0.009. Ticagrelor was independently associated with a lower likelihood of infection (Hazard Ratio [HR] 0.52, 95% confidence interval [CI] 0.28–0.95; p = 0.035) compared to prasugrel (HR 0.96, 95% CI 0.54–1.73; p = 0.909) and clopidogrel (HR = 1). Conclusions: In patients admitted with coronary artery disease patients treated with ticagrelor had a lower frequency of infections during follow-up than those treated with other P2Y12 inhibitors. Further studies are necessary to clarify the bactericidal effect of ticagrelor in this context.

Sin financiación 6.333 JCR (2021) Q1, 14/66 Respiratory System 0.262 SJR (2021) Q3, 102/144 Pulmonary and Respiratory Medicine No data IDR 2021 UEM

BackgroundThe optimal pulmonary revascularisation strategy in high-risk pulmonary embolism (PE) requiring implantation of extracorporeal membrane oxygenation (ECMO) remains controversial.MethodsWe conducted a systematic review and meta-analysis of evidence comparing mechanical embolectomy and other strategies, including systemic thrombolysis, catheter-directed thrombolysis or ECMO as stand-alone therapy, with regard to mortality and bleeding outcomes.ResultsWe identified 835 studies, 17 of which were included, comprising 327 PE patients. Overall, 32.4% were treated with mechanical pulmonary reperfusion (of whom 85.9% had surgical embolectomy), while 67.6% received other strategies. The mortality rate was 22.6% in the mechanical reperfusion group and 42.8% in the “other strategies” group. The pooled odds ratio for mortality with mechanical reperfusion was 0.439 (95% CI 0.237–0.816) (p=0.009; I2=35.2%)versusother reperfusion strategies and 0.368 (95% CI 0.185–0.733) (p=0.004; I2=32.9%) for surgical embolectomyversusthrombolysis. The rate of bleeding in patients under ECMO was 22.2% in the mechanical reperfusion group and 19.1% in the “other strategies” group (OR 1.27, 95% CI 0.54–2.96; I2=7.7%). The meta-regression model did not identify any relationship between the covariates “more than one pulmonary reperfusion therapy”, “ECMO implantation before pulmonary reperfusion therapy”, “clinical presentation of PE” or “cancer-associated PE” and the associated outcomes.ConclusionsThe results of the present meta-analysis and meta-regression suggest that mechanical reperfusion, notably by surgical embolectomy, may yield favourable results regardless of the timing of ECMO implantation in the reperfusion timeline, independent of thrombolysis administration or cardiac arrest presentation.

Sin financiación 6.333 JCR (2021) Q1, 14/66 Respiratory System 0.262 SJR (2021) Q3, 102/144 Pulmonary and Respiratory Medicine No data IDR 2021 UEM

Introduction and objectives The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P=.34). Survival in both these periods was better than that from 2010 to 2012 (P=.002 and P=.01, respectively). Conclusions Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.

Background: Previous studies have described a circadian pattern of death from cardiovascular causes with a morning peak. Our aim is to describe the daytime oscillations in mortality in hospitalized patients with cardiovascular diseases. Methods: Our retrospective registry including all patients who died in the Cardiology Department, including the cardiac intensive care unit, Madrid, Spain. Results: From a total of 500 patients, time of death was registered in 373 (74.6%), which are the focus of our study; 354 (70.8%) died in the cardiac intensive care unit and 146 (29.2%) in the conventional ward. Mean age was 74.2 ± 13.1 years, and 239 (64.1%) were male. Cardiovascular causes were the leading cause of death (308 patients; 82.6%). Mortality followed a circadian biphasic pattern with a peak at dawn (00.00–05.59 a.m.: 104 patients [27.9%]) and in the afternoon (12.00–17.59 p.m.: 135 patients [36.2%]), irrespective of the cause of death. The peak of mortality occurred in the afternoon (12.00–17.59 p.m.) in the case of cardiovascular mortality (119 deaths [38.6%]) and in the evening (18.00–23.59 p.m.) for non-cardiovascular deaths (21 deaths [32.3%], p = 0.03). This pattern was present regardless from the place of death (conventional ward or cardiac intensive care unit) and also throughout the four seasons. Conclusions: Mortality in hospitalized patients with cardiovascular diseases follows a circadian biphasic pattern.

Introducción y objetivos: El uso del oxigenador extracorpóreo de membrana venoarterial (ECMO-VA) ha experimentado un auge en los últimos años para el tratamiento de diferentes enfermedades en el ámbito de la cardiología. El objetivo del presente estudio fue describir los resultados de la puesta en marcha de un programa de ECMO-VA en un servicio de cardiología, destinado a pacientes con enfermedad médica. Métodos: Estudio observacional. Se incluyó de manera consecutiva a los pacientes tratados con ECMO-VA debido a enfermedad médica en los primeros 5 años del programa. Se analizaron las características de los pacientes y los resultados obtenidos a corto y largo plazo. Resultados: Se incluyó a 83 pacientes tratados con ECMO-VA durante el periodo de estudio. La supervivencia a 30 días fue del 55,4% y la supervivencia al alta hospitalaria fue del 50,6%. Resultaron predictores independientes de mortalidad a 30 días la edad (odds ratio [OR] por cada 10 años = 1,83; intervalo de confianza del 95% [IC95%], 1,08-2,33; p = 0,03), el lactato previo (OR por cada mmol/l 1,27; IC95%, 1,12-1,45; p < 0,001) y el tiempo decisión-implante (OR por cada 15 min = 1,99; IC95%, 1,12-3,56; p = 0,02). La supervivencia a un año de los pacientes que recibieron el alta fue del 100%. Conclusiones: La aplicación de un programa de ECMO-VA en un servicio de cardiología es factible y aplicable a pacientes con enfermedad cardiológica aguda, con unos resultados favorables en cuanto a supervivencia a corto y largo plazo. El retraso en el tiempo de implante parece jugar un papel importante en el resultado de la terapia, junto con la edad y el lactato previo. Introduction and objectives: Use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) has expanded in the last few years due to its applicability in different cardiac conditions. The aim of this study is to describe the outcomes of developing a VA-ECMO program in a cardiology department. Methods: Observational study. We consecutively collected the patients treated with VA-ECMO due to medical pathology during the first 5 years of the program. We analyzed the characteristics and short and long term outcomes of these cases. Results: Eighty-three patients were supported with VA-ECMO during the study period. Thirty-day survival was 55.4% and survival to hospital discharge was 50.6%. On multivariate logistic regression analysis age (10 years old odds ratio [OR], 1.83; 95% confidence interval [95%CI], 1.08-2.33; P = .03), previous lactate (mmol/L OR, 1.27; 95%CI, 1.12-1.45; P < .001) and time from decision to support (15 min OR, 1.99; 95%CI, 1.12-3.56; P = .02). One-year survival of patients who were discharged was 100%. Conclusions: The developing of a VA-ECMO program in the cardiology departments is feasible and applicable to patients with medical acute cardiovascular failure. Time from decision to support appears to play an important role in the outcomes, as do lactate and age. Sin financiación No data JCR 2020 0.114 SJR (2020) Q4, 316/349 Cardiology and Cardiovascular Medicine No data IDR 2020 UEM

INTRODUCTION AND OBJECTIVES The present report updates the characteristics and results of heart transplantation in Spain, mainly focused in the 2008-2017 period. METHODS We describe the recipient and donor characteristics, surgical procedures, and outcomes of heart transplants performed in 2017. The 2017 data were compared with those obtained from 2008 to 2016. RESULTS A total of 304 cardiac transplants were performed in 2017. Between 1984 and 2017, 8173 procedures were performed, 2689 of them after 2008. Significant temporal trends were observed in recipient characteristics (lower pulmonary vascular resistance, lower use of mechanical ventilation, and a higher percentage of diabetic patients and those with previous cardiac surgery), donor characteristics (older donor age and a higher percentage of female donors and those with a prior cardiac arrest) and procedures (lower ischemia time). In 2017, 27% of patients were transplanted after undergoing mechanical ventricular assistance (P

Sin financiación 4.642 JCR (2019) Q1, 30/138 Cardiac & Cardiovascular Systems 0.473 SJR (2019) Q3, 196/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Resumen Introduccion y objetivos El presente articulo presenta las caracteristicas y resultados del trasplante cardiaco en Espana, desde que empezo su actividad en mayo de 1984. Metodos Se realiza un analisis descriptivo de las caracteristicas de los receptores, donantes, procedimiento quirurgico y resultados de los trasplantes cardiacos realizados en Espana hasta el 31 de diciembre de 2016. Resultados Durante 2016 se han realizado 281 procedimientos, con lo que la serie historica consta de 7.869 trasplantes. Las caracteristicas generales del procedimiento son similares a las observadas en los ultimos anos y destacan el alto porcentaje de procedimientos realizados en codigo urgente y, sobre todo, la extension del uso de dispositivos de asistencia circulatoria, particularmente de asistencia ventricular de flujo continuo (el 19,1% del total de trasplantes). La supervivencia ha aumentado significativamente en la ultima decada con respecto a periodos anteriores. Conclusiones La actividad de trasplante cardiaco en Espana permanece estable en los ultimos anos, con alrededor de 250-300 procedimientos al ano. A pesar de la mayor complejidad del contexto clinico, se observa una mejoria de la supervivencia en los ultimos anos.

Background/Introduction: Outcome after ST segment elevation myocardial infarction (STEMI), has improved but patients with high Killip class still have a poor prognosis, and those ≥ II need a closer monitoring in a specialized cardiac care unit. Purpose: We aimed to determine the predictors of Killip class in a group of patients admitted for acute STEMI. Methods: Non-interventional registry in a Cardiac Intensive Care Unit. Patients were consecutively included from January 2010 to April 2015, and multivariate analysis was performed to determine independent predictors of high Killip Class. Results: We included 1111 patients, mean age was 64.0 ± 14.0 years and 258 (23.2%) were female. Primary percutaneous coronary intervention was performed in 991 (89.2%), and 120 (10.8%) only received thrombolysis as acute reperfusion therapy. A total of 230 (20.7%) were in class II or higher. The independent predictors of Killip ≥ II were (odds ratio [95% confidence interval]): older age (2.1 [1.4–3.0]), female sex (1.6 [1.1–2.2]), diabetes (1.4 [1.0–2.1]), prior heart failure (3.2 [1.4–7.2]), chronic kidney disease (2.0 [1.1–3.6]), anaemia (3.0 [2.0–4.5]), multivessel disease (1.6 [1.1–2.2]), anterior location (2.4 [1.8–3.4]), time of evolution > 2 h (1.6 [1.1–2.4]), and TIMI flow-grade < 3 (1.8 [1.2–2.7]). In-hospital mortality increased with Killip class (I 1.5%, II 3.7%, III 16.7%, IV 36.7%). Conclusion: In patients with STEMI Killip class can be predicted with variables available when primary percutaneous coronary intervention is performed and is strongly associated with in-hospital prognosis. Sin financiación 4.034 JCR (2017) Q2, 41/128 Cardiac and Cardiovascular Systems UEM

Advanced age and low hemoglobin levels have been associated with a poor prognosis in ST-segment elevation myocardial infarction (STEMI). We studied 1,111 patients with STEMI who received reperfusion treatment (1,032 [92.9%] primary angioplasty and 79 [7.1%] fibrinolysis without rescue percutaneous coronary intervention). Mean age was 64.1 ± 14.0 years, and 23.2% were women. Patients in the last age quartile (>76 years) were more frequently women, presented more risk factors (except smoking), received thrombolysis less frequently, had less complete revascularization, and presented more complications and higher mortality. Hemoglobin level at admission was associated with age and ranged from 14.8 ± 1.5 g/dl in the first quartile to 13.2 ± 1.8 g/dl in the last, p

BACKGROUND: Several studies have shown that, after an acute myocardial infarction, women have worse prognosis than males. However, it is not clear if female sex is an independent predictor of mortality risk. Our aim was to analyse sex influence on the prognosis of these patients. METHODS: Retrospective registry of patients with ST segment elevation myocardial infarction (STEMI) from January 2010 to April 2015. RESULTS: From 1111 patients, 258 (23.2%) were women. Compared with men, they presented higher risk profiles with older age (70.1±14.4years vs. 62.3±13.4, P

Early discharge protocols have been proposed for ST-segment elevation myocardial infarction (STEMI) low risk patients despite the existence of few but significant cardiovascular events during mid-term follow-up. We aimed to identify a subgroup of patients among those considered low-risk in which prognosis would be particularly good. We analyzed 30-day outcomes and long-term follow-up among 1.111 STEMI patients treated with reperfusion therapy. Multivariate analysis identified seven variables as predictors of 30-day outcomes: Femoral approach; age > 65; systolic dysfunction; postprocedural TIMI flow < 3; elevated creatinine level > 1.5 mg/dL; stenosis of left-main coronary artery; and two or higher Killip class (FASTEST). A total of 228 patients (20.5%), defined as very low-risk (VLR), had none of these variables on admission. VLR group of patients compared to non-VLR patients had lower in-hospital (0% vs. 5.9%; p < 0.001) and 30-day mortality (0% vs. 6.25%: p < 0.001). They also presented fewer in-hospital complications (6.6% vs. 39.7%; p < 0.001) and 30-day major adverse events (0.9% vs. 4.5%; p = 0.01). Significant mortality differences during a mean follow-up of 23.8 ± 19.4 months were also observed (2.2% vs. 15.2%; p < 0.001). The first VLR subject died 11 months after hospital discharge. No cardiovascular deaths were identified in this subgroup of patients during follow-up. About a fifth of STEMI patients have VLR and can be easily identified. They have an excellent prognosis suggesting that 24–48 h in-hospital stay could be a feasible alternative in these patients. Sin financiación 4.034 JCR (2017) Q2, 41/128 Cardiac and Cardiovascular Systems UEM

Introduction and objectives The present report updates the clinical characteristics and outcomes of heart transplant in Spain to 2018. Methods Prospective registry of all the heart transplants performed between 1984 and 2018 in Spain. Specifically, temporal trends in clinical characteristics and outcomes are described for the period from 2009 to 2017. Results In 2018, 321 transplants were performed (8494 since 1984; 2719 between 2009 and 2018). Compared with the previous year, the number of transplants performed in 2018 rose by 52% in recipients younger than 16 years and by 42% in those older than 60 years. In the last decade, significant temporal trends were observed in recipient characteristics (better pretransplant renal function, higher rates of diabetes, more urgent transplants, and greater use of pretrasplant circulatory support, particularly ventricular assist devices), donor characteristics (higher donor age, more female donors, and higher frequencies of cerebrovascular cause of death and predonation cardiac arrest and lower ischemia time). Survival significantly improved in the last decade, mainly due to lower mortality due to primary graft failure. Conclusions The number of heart transplants is increasing in Spain, with a progressive improvement in survival.

Objectives: Our goal was to determine the presentation and prognosis of influenza in an intensive cardiac care unit and to analyze the impact of an active surveillance program in the diagnosis. Methods: We performed a prospective registry during the flu season in a coronary unit. In the first phase, no systematic screening was performed. Systematic influenza A and B detection was performed in a second phase for all patients admitted. Results: From 227 patients, we identified 17 (7.5%) with influenza. Influenza patients were more likely to have a non-ischemic cause of admission (14 patients [82.4%] vs. 48 patients [40.3%], p = 0.002), fever (8 patients [47.1%] vs. 3 patients [2.6%], p < 0.001), and respiratory failure (7 patients [41.2%] vs. 8 patients [7%], p = 0.001). Influenza infection was an independent predictor of mortality (odds ratio 12.0, 95% confidence interval 1.9–13.6, p < 0.001). The incidence of influenza was 6.6% (6 patients) when no active screening was performed and 7.9% (11 patients) when systematic detection was performed (p = 0.005). The time to diagnosis was shorter in the systematic screening phase (0.92 ± 1.6 vs. 5.2 ± 3.8 days, p = 0.01). Conclusions: Influenza affects approximately 8% of patients admitted to an intensive cardiac care unit during the flu season, with a high mortality rate. An active surveillance program improves early detection.

Sin financiación 1.791 JCR (2019) Q3, 93/138 Cardiac & Cardiovascular Systems 0.559 SJR (2019) Q2, 166/362 Cardiology and Cardiovascular Medicine, 125/263 Pharmacology (medical) No data IDR 2019 UEM

Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

Background: Previous studies have indicated that cardiovascular mortality follows a seasonal trend. The aim of this work was to determine the evolution of mortality throughout the year in a cardiology department. Methods: All admissions and deaths occurring in our Cardiology Department over a 5-year period (2013–2017) were recorded retrospectively. Results: From a total of 17,829 hospital admissions, 500 patients died (2.8%, 0.3 patients/day). The mean age of deceased patients was 74.2 ± 13.1 years, and 186 (37.2%) were women. Mortality ranged from 0.17 deaths/day in August to 0.40 deaths/day in February (p = 0.03), and from 0.20 deaths/day in summer to 0.36 deaths/day in winter (p = 0.001). There was also a trend towards a variation in hospitalizations, with a peak in January (10.5 admissions/day) and the lowest figure in August (7.0 admissions/day), p = 0.047. We found no significant seasonal trend regarding mortality rate with respect to the number of hospital admissions (p = 0.89). The most common cause of death was refractory heart failure (267 patients [65.8%]). A noncardiac cause of death was observed in 134 patients (26.8%). Conclusions: In a cardiology department, there are twice as many deaths in winter as in summer. Hospitalizations also tend to be more frequent in winter than in summer.

Objectives: Sacubitril/valsartan was approved recently for the treatment of patients with heart failure and reduced ejection fraction. We present 6 cases of ventricular arrhythmia, that occurred shortly after sacubitril/valsartan initiation, that required drug withdrawal. Other potential triggering factors of electrical storm were ruled out and, from the arrhythmic perspective, all of the patients were stable in the previous year. Our aim is to describe the possible association of sacubitril/valsartan with arrhythmic storm. Methods: This was an observational monocentric study performed in the first 7 months of sacubitril/valsartan commercialization in Spain (October 2016). All patients were included in the SUMA (Sacubitril/Varsartan Usado Ambulatoriamente en Madrid [Sacubitril/Valsartan Used in Outpatients in Madrid]) registry. Patients were consecutively enrolled on the day they started the drug. Ventricular arrhythmic storm was defined as ≥2 episodes of sustained ventricular arrhythmia or defibrillator therapy application in 24 h. Results: From 108 patients who received the drug, 6 presented with ventricular arrhythmic storm (5.6%). Baseline characteristics were similar in the patients with and without ventricular arrhythmic storm. The total number of days that sacubitril/valsartan was administered to each patient was 5, 6, 44 (8 since titration), 84, 93, and 136 (105 since titration), respectively. Conclusions: Our data are not enough to infer a cause-and-effect relationship. Further investigations regarding a potential proarrhythmic effect of sacubitril/valsartan are probably needed. Sin financiación 1.561 JCR (2018) Q4, 103/136 Cardiac & Cardiovascular Systems 0.837 SJR (2018) Q2, 109/365 Cardiology and Cardiovascular Medicine, 92/268 Pharmacology (medical) No data IDR 2018 UEM

Sin financiación 3.542 JCR (2018) Q1, 7/31 Anesthesiology 0.735 SJR (2018) Q2, 33/130 Anesthesiology and Pain Medicine No data IDR 2018 UEM

Sin financiación 4.642 JCR (2019) Q1, 30/138 Cardiac & Cardiovascular Systems 0.473 SJR (2019) Q3, 196/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Sin financiación 4.642 JCR (2019) Q1, 30/138 Cardiac & Cardiovascular Systems 0.473 SJR (2019) Q3,196/362 Cardiology and Cardiovascular Medicine No data IDR 2019 UEM

Sin financiación 6.189 JCR (2016) Q1, 16/126 Cardiac and Cardiovascular Systems UEM