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Introduction: Percutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources., Materials and Methods: Prospective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC., Results: 43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean ± SD) 7.29 ± 5 vs 0.42 ± 1.3 ( p  < 0.001); endoscopic procedures were 4.34 ± 2.85 vs 0.27 ± 0.76 ( p  < 0.001); and hospitalizations 2.67 ± 2.14 vs 0.03 ± 0.17 ( p  < 0.001), with a hospital stay of 21.5 ± 17.3 vs 0.09 ± 0.5 days ( p  < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 ± 1.2g/dl to 12.4 ± 2.2g/dl ( p  < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6-65)., Conclusions: LAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources.

Background: Smoking is a challenge in secondary prevention after acute coronary syndrome (ACS). The objective was to assess whether the early anti-smoking intervention (ASI), in the acute hospitalization phase, improves the abstinence rate obtained during a cardiac rehabilitation program (CRP)., Methods: Multicenter clinical trial in which smoker patients admitted for ACS were randomized 1:1 to receive or not ASI from the first day of admission. Upon discharge, both groups were referred to the CRP, performing abstinence controls using co-oximetry. Patients lost were considered smokers., Results: 72 patients were included, 58 men (80.5%), mean age 53 ± 8.1 years. They were admitted for ST elevation myocardial infarction 42 (58%), non-ST elevation myocardial infarction 29 (40%) and unstable angina 1 (1.3%). They smoked an average of 22 ± 11.3 cigarettes/day (pack-year index 37 ± 20). They completed the Richmond test (8.8 ± 1.3) and Fagestrom (5.69 ± 2.1). 36 patients (50%) were randomized to ASI, with no differences in the baseline characteristics of both groups. The dropout rate at the time of inclusion in CRP was higher in the ASI group (69 vs. 44%; p 0.034; OR 2.84), without statistical significance at discharge from the CRP (58 vs. 50%; p 0.478; OR 1.4) or at 12 months (58 vs. 44%; p 0.24; OR 1.75)., Conclusions: The ASI during admission significantly improves the smoking cessation rate at the time of inclusion in the CRP. Part of these beneficial effects are reduced in the follow-up losing statistical significance with respect to the control group., (Copyright © 2022 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

A 78-year-old woman with a history of hypertension, hyperlipidemia, and asthma was referred to her cardiologist for chest pain and dyspnea on exertion. After performing stress echocardiography, it was determined that closure of the fistula with coils was indicated. This case highlights that coronary fistula could be an unusual entity of angina, clinically improving after the occlusion procedure.

Objective: With this case report would like to emphasize the complexity that involves the management of pregnant women with mechanical heart valves. In that sense, an adequate interdisciplinary management of this potentially serious pathology is required for maternal and fetal well-being., Case Report: A 32-year-old primipara, with a mechanical mitral valve replacement, was admitted to our emergency department at 37 +1 weeks of gestation with acute dyspnea and presyncope. The patient was diagnosed with mechanical mitral valve thrombosis and, due to the appearance of hemodynamic instability, the patient underwent an uncomplicated emergency caesarean section and subsequent prosthetic mitral valve replacement. The patient was discharged six days after surgery, without any obstetric complication and with normal valve function., Conclusion: This case report shows that, despite strict control and optimal anticoagulation regimen, pregnant women with mechanical heart valves still have a high risk of developing valve thrombosis., Competing Interests: Declaration of competing interest All authors declare no conflict of interest, not to receive any funding of any organization and their agreement for publication., (Copyright © 2020. Published by Elsevier B.V.)

Aims and Objective: Impact of sex-related differences in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention and treated with new P2Y12 inhibitors is not adequately characterised. We aimed to analyse gender-based differences in dual antiplatelet therapy, and adverse cardiovascular events and bleeding., Materials and Methods: Prospective-observational study of the consecutive ACS patients treated with stent from July 2016 to January 2016, with a follow-up of 1 year., Results: We examined 283 patients, 75 (26.5%) women and 208 (73.5%) men. Women were older than men (71 ± 13 vs. 66,5 ± 13 years). There were 44% of women and 52% of men presenting with ST-elevation ACS (p = 0.21). Women had a higher bleeding risk (CRUSADE), without differences in the ischaemic risk (GRACE and TIMI). More women were treated with drug-eluting stent (88.9 vs. 75.5%, p = 0.04). There was a lower rate of ticagrelor prescription in women (42.6 vs. 50.9%, p = 0.29), in favour of clopidogrel. No differences were observed in prasugrel prescription. No significant differences were observed after a year of follow up, but women had a tendency towards lower mortality (1.4 vs. 6.7%, p = 0.19) and higher bleeding rates (23.3 vs. 17.4%, p = 0.27)., Conclusions: In our study of patients presenting with ACS treated with stent, clopidogrel was preferred in women, whereas ticagrelor was the most frequent prescription in men. No significant differences were noted in clinical outcomes, but women experienced a tendency towards less mortality and more bleeding events., (Copyright: © 2019 Permanyer.)