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Most studies, aimed at determining the incidence and transmission of SARS-CoV-2 in children and teenagers, have been developed in school settings. Our study conducted surveillance and inferred attack rates focusing on the practice of sports. Prospective and observational study of those attending the sports facilities of Fútbol Club Barcelona (FCB), in Barcelona, Spain, throughout the 2020–2021 season. Participants were young players (from five different sports) and adult workers, who belonged to stable teams (shared routines and were involved in same quarantine rules). Biweekly health questionnaires and SARS-CoV-2 screening were conducted. From the 234 participants included, 70 (30%) both lived and trained in the FCB facilities (Recruitment Pathway 1;RP1) and 164 (70%) lived at their own household and just came to the facilities to train (RP2). During the study, 38 positive cases were identified; none had severe symptoms or needed hospitalization. The overall weekly incidence in the cohorts did not differ compared to the one expected in the community, except for 2 weeks when an outbreak occurred. The attack rate (AR) was three times higher for the participants from RP1, in comparison to those from RP2 (p Conclusion: Physical activities in stable teams are not related to an increased risk of transmission of SARS-CoV-2, since there were the same observed cases than expected in the community. The risk is higher in indoor sports (Basketball vs. Football), and in closed cohort living settings (RP1 vs. RP2). The fulfilment of preventive measures is essential. What is Known:• Despite the low numerical impact caused in paediatric hospitalizations during COVID-19 pandemic, the social impact has been maximum.• The transmission potential in children and teenagers is limited, and it had been widely demonstrated in school settings. What is New:• Group physical activities in children and teenagers are not also related to an increased risk of transmission of SARS-CoV-2, when preventive measures, such as washing hands, and screening protocols are applied.• Routine and semi-professional sports activities seem safe environments to promote during this pandemic.

Background: Surveillance tools to estimate viral transmission dynamics in young populations are essential to guide recommendations for school opening and management during viral epidemics. Ideally, sensitive techniques are required to detect low viral load exposures among asymptomatic children. We aimed to estimate SARS-CoV-2 infection rates in children and adult populations in a school-like environment during the initial COVID-19 pandemic waves using an antibody-based field-deployable and non-invasive approach. Methods: Saliva antibody conversion defined as ≥ 4-fold increase in IgM, IgA, and/or IgG levels to five SARS-CoV-2 antigens including spike and nucleocapsid constructs was evaluated in 1509 children and 396 adults by high-throughput Luminex assays in samples collected weekly in 22 summer schools and 2 pre-schools in 27 venues in Barcelona, Spain, from June 29th to July 31st, 2020. Results: Saliva antibody conversion between two visits over a 5-week period was 3.22% (49/1518) or 2.36% if accounting for potentially cross-reactive antibodies, six times higher than the cumulative infection rate (0.53%) assessed by weekly saliva RT-PCR screening. IgG conversion was higher in adults (2.94%, 11/374) than children (1.31%, 15/1144) (p=0.035), IgG and IgA levels moderately increased with age, and antibodies were higher in females. Most antibody converters increased both IgG and IgA antibodies but some augmented either IgG or IgA, with a faster decay over time for IgA than IgG. Nucleocapsid rather than spike was the main antigen target. Anti-spike antibodies were significantly higher in individuals not reporting symptoms than symptomatic individuals, suggesting a protective role against COVID-19. Conclusion: Saliva antibody profiling including three isotypes and multiplexing antigens is a useful and user-friendlier tool for screening pediatric populations to detect low viral load exposures among children, particularly while they are not vaccinated and vulnerable to highly contagious variants, and to recommend public health policies during pandemics. This work was supported by the Departament de Salut, Generalitat de Catalunya (grant number SLT006/17/00109). L.I. work was supported by PID2019-110810RB-I00 grant from the Spanish Ministry of Science & Innovation. Development of SARS-CoV-2 reagents was partially supported by the National Institute of Allergy and Infectious Diseases Centers of Excellence for Influenza Research and Surveillance (contract number HHSN272201400008C). ISGlobal receives support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program

Resumen Introduccion y objetivos Los resultados del estudio FREEDOM, fundamento de las guias de practica clinica, concluyen que la cirugia de revascularizacion coronaria es superior a la intervencion coronaria percutanea en pacientes diabeticos multivaso. El objetivo de este trabajo fue evaluar que porcentaje de pacientes de la vida real serian incluibles en dicho estudio y sus implicaciones pronosticas. Metodos Se siguio a 617 diabeticos multivaso, a los que se les habia realizado una coronariografia entre 2012 y 2014. Se clasificaron segun el cumplimiento de criterios para participar en dicho estudio y se analizo su impacto en la mortalidad y en los eventos cardiovasculares mayores. Resultados El 51,2% de los pacientes no cumplia los criterios de inclusion, tenian mas edad (69,3 frente a 66,1 anos; p Conclusiones Mas de la mitad de los diabeticos multivaso de la vida real no serian incluibles en un gran ensayo clinico, presentando 4 veces mas riesgo de muerte en el seguimiento.

COVID-19 affects children to a lesser extent than adults but they can still get infected and transmit SARS-CoV-2 to their contacts. Field deployable non-invasive sensitive diagnostic techniques are needed to evaluate the infectivity dynamics of the coronavirus in pediatric populations and guide public health interventions.We evaluated the utility of high-throughput Luminex-based assays applied to saliva samples to quantify IgM, IgA and IgG antibodies against five SARS-CoV-2 spike (S) and nucleocapsid (N) antigens in the context of a contacts and infectivity longitudinal study. We compared the antibody levels obtained in saliva versus serum/plasma samples from a group of children and adults tested weekly by RT-PCR over 35 days and diagnosed as positive (n=58), and a group of children and adults who consistently tested negative over the follow up period (n=61), in the Summer of 2020 in Barcelona, Spain.Antibody levels in saliva samples from individuals with confirmed RT-PCR diagnosis of SARS-CoV-2 infection were significantly higher than in negative individuals and correlated with those measured in sera/plasmas. Higher levels of anti-S IgG were found in asymptomatic individuals that could indicate protection against disease in infected individuals. Higher anti-S IgG and IgM levels in serum/plasma and saliva, respectively, in infected children compared to infected adults could also be related to stronger clinical immunity in them. Among infected children, males had higher levels of saliva IgG to N and RBD than females. Despite overall correlation, individual clustering analysis suggested that responses that may not be detected in blood could be patent in saliva, and vice versa, and therefore that both measurements are complementary.In addition to serum/plasma, measurement of SARS-CoV-2-specific saliva antibodies should be considered as a complementary non-invasive assay to better estimate the percentage of individuals who have experienced coronavirus infection. Saliva antibody detection could allow determining COVID-19 prevalence in pediatric populations, alternative to bleeding or nasal swab, and serological diagnosis following vaccination.

Background Understanding the role of children in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is critical to guide decision-making for schools in the pandemic. We aimed to describe the transmission of SARS-CoV-2 among children and adult staff in summer schools. Methods During July 2020, we prospectively recruited children and adult staff attending summer schools in Barcelona who had SARS-CoV-2 infection. Primary SARS-CoV-2 infections were identified through (1) a surveillance program in 22 summer schools of 1905 participants, involving weekly saliva sampling for SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) during 2–5 weeks; and (2) cases identified through the Catalonian Health Surveillance System of children diagnosed with SARS-CoV-2 infection by nasopharyngeal RT-PCR. All centers followed prevention protocols: bubble groups, handwashing, face masks, and conducting activities mostly outdoors. Contacts of a primary case within the same bubble were evaluated by nasopharyngeal RT-PCR. Secondary attack rates and the effective reproduction number in summer schools (Re*) were calculated. Results Among the >2000 repeatedly screened participants, 30 children and 9 adults were identified as primary cases. A total of 253 close contacts of these primary cases were studied (median, 9 [interquartile range, 5–10] for each primary case), among which 12 new cases (4.7%) were positive for SARS-CoV-2. The Re* was 0.3, whereas the contemporary rate in the general population from the same areas in Barcelona was 1.9. Conclusions The transmission rate of SARS-CoV-2 infection among children attending school-like facilities under strict prevention measures was lower than that reported for the general population. This suggests that under preventive measures schools are unlikely amplifiers of SARS-CoV-2 transmission, supporting current recommendations for school opening.

[EN] The university population is a particularly vulnerable group from the point of view of nutrition and physical condition, which increases the risk of obesity and cardiovascular disease. It has been seen that ICTs and TACs improve the learning of university students, so the aim is to carry out strategies based on the use of ICTs and TACs for comprehensive training, leading to the implementation of healthy habits and improved health indicators in the university population. The development of the educational innovation action was carried out in the academic year 2019-2020, in which a total of 42 students participated. The results obtained show that those students who have participated in the IIEACSA innovation action present better values in relation to body composition and physical condition, although no changes in eating habits were observed. It is concluded that the strategies carried out based on the use of ICTs and CTs for the integral and competent training of the student, has led to an adequate implementation of healthy habits and improvement of health indicators in the university population., [ES] La población universitaria es un grupo especialmente vulnerable desde el punto de vista nutricional y de condición física, lo que aumenta el riesgo para la salud en etapas posteriores. Las Tecnologías de: la Información y la Comunicación (TIC), o del Aprendizaje y la Comunicación (TAC), podrían ayudar a mejorar el aprendizaje del alumnado universitario al respecto. Por ello, el objetivo fue realizar una acción de innovación educativa en hábitos saludables y estudiar los cambios en los indicadores de salud en estudiantes universitarios. El desarrollo de la acción de innovación educativa fue la implementación de la investigación en la enseñanza y aprendizaje de las ciencias de la salud (IIEACSA) en el grado de nutrición humana y dietética utilizando metodologías TIC y las TAC para la formación integral. Se evaluaron los hábitos alimentarios, la composición corporal y la condición física de los estudiantes de siguieron la acción educativa y en otros estudiantes sin intervención (control). Los resultados mostraron que los estudiantes IIEACSA presentaron mejores resultados en la composición corporal y la condición física frente al grupo control, pero no hubo diferencias en la alimentación. Cabe concluir que la acción IIEACSA puede presentar mejorías en determinados indicadores de la salud de estudiantes universitarios.

Background: Beach handball (BH) is a sport in which sporting performance is influenced, together with team interaction, by individual performance in terms of strength. Body composition is one of the main factors for sports performance and eating habits can condition this variable. The Mediterranean diet (MD) can significantly reduce the risk of mortality or cardiovascular disease. In addition, the Spanish Ministry of Agriculture, Food and Environment carries out different campaigns to promote it among young athletes, establishing it as a suitable diet for sports. Objectives: The main aims of the study are to assess body composition, physical activity and adherence to the MD of beach handball players. It also aims to evaluate age group differences in male and female players, as well as studying the possible relationship between MD, body composition and performance variables. Methods: A total of 59 Spanish BH players were recruited in the national championship of BH in the province of Alicante. Thirty-eight male (14 junior, 17.0 ± 0.1 years and 24 seniors, 25.5 ± 4.7 years) and twenty-one female (7 junior, 16.1 ± 1.46 years and 14 seniors, 23.2 ± 2.0 years) BH players participated in this study. The questionnaire to evaluate eating habits was Mediterranean diet adherence (KIDMED). Body composition was measured with electrical bioimpedance. Strength was evaluated by means of a maximum isometric handgrip test of the dominant hand with handgrip and height of jump by counter-jump on contact platform. In the statistical analysis, descriptions and correlations between the study variables were made. Results: In females, when the adherence to the MD is lower, the weight is higher, the lean body mass is lower and worse results are observed in performance tests. As for males, there are differences in weight and lean body mass according to category. Conclusions: Adequate eating habits are related to the weight of beach handball athletes. In addition, specifically with junior players, it has been observed that adherence to the MD correlates with weight.

BACKGROUND: Ageing is associated with changes of physical and physiological parameters, but there is evidence that regular physical activity could minimize these effects. Additionally, the older population presents a great risk of suboptimal nutrition. Therefore, the purpose of this study was to review the evidence of nutritional strategies and endurance exercises in the older population. METHODS: A systematic review was performed based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. The search was carried out in three different databases: PubMed, Web of Science, and SPORTDiscus. RESULTS: Eight studies were included in the present review. The use of caffeine and beta-alanine supplementation with proteins have been found to be beneficial in both sexes. In older women, a balanced diet, an increase in protein, supplementation with beta hydroxy methyl butyrate, and supplementation with sodium bicarbonate have been favorable. However, no benefit has been seen in older men with sodium bicarbonate or ubiquinone supplementation. Nevertheless, the use of supplements should be prescribed according to individual characteristics and physical activity. CONCLUSIONS: Caffeine and high protein supplement with beta-alanine may provide positive effects in the older population. In addition, in older women, bicarbonate supplementation and beta-hydroxyethyl butyrate (HMB), lysine, and arginine supplementation have shown positive effects on exercise performance.

Resumen Introduccion La regurgitacion mitral es la segunda valvulopatia en frecuencia, y pese a su mal pronostico casi la mitad de los pacientes no son considerados candidatos a cirugia. Para este perfil de pacientes se ha empleado MitraClip® con resultados prometedores en regurgitacion mitral funcional y degenerativa. Material y metodos Analisis retrospectivo de las caracteristicas y resultados de 72 pacientes tratados con MitraClip® entre noviembre de 2011 y octubre de 2016. Resultados La etiologia de la regurgitacion fue funcional en el 61,1%, degenerativa o mixta en el 38,9%. La etiologia funcional se asocio a menor edad (67,9 ± 8,74 vs 74,6 ± 13,06 anos, p = 0,21) y fraccion de eyeccion (34 ± 8,5% vs 57 ± 15%; p Conclusion El tratamiento con MitraClip® es seguro y efectivo en etiologia funcional y degenerativa, aunque esta ultima podria asociarse a menor mortalidad tardia.

Objectives The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). Background TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. Methods A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients’ clinical characteristics and outcomes were evaluated according to the presence of a PMV. Results The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was Conclusions TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV–to–aortic annulus distances

Background and objectives: Pregnancy is a stage associated with various biopsychosocial changes. These changes, along with concerns about keeping an adequate weight, can modulate an individual’s risk for psychological disorders, especially eating disorders (EDs). The aim of this review was to investigate the prevalence, associated risks, and consequences of eating disorders in pregnancy and in breastfeeding mothers. Materials and Methods: A systematic review was carried out following the PRISMA guidelines in the scientific databases: PubMed, Web of Science, Scopus, and PsycINFO. Search terms related to EDs, pregnancy, and breastfeeding were used. The evaluation of the methodological quality of the studies was carried out using different scales; CASP (Checklist for Cohort Study), NICE (Methodology Checklist for Cohort Study), ARHQ (Methodology Checklist for Cross-Sectional), and NOS (Newcastle-Ottawa Scale for Cohort). Results: From 2920 studies, 16 were selected to study EDs in pregnant women and 2 studies in nursing mothers. Most of the studies used questionnaires and scales as tools for the diagnosis of EDs. Binge eating, anxiety, and depression were the most common comorbidities of EDs, accompanied in most cases by excessive concern about weight gain. The consequences of EDs are diverse. The prevalence of EDs in this population is estimated to be 1 out of 20. Conclusions: Eating disorders are related to anxiety and depression and have negative consequences for both mothers and fetuses (cesarean, miscarriages, premature births). More research on the field to determine the risk factors for EDs in the population of pregnant and lactating women is needed.

Unintentional injuries are the leading cause of child morbidity and mortality, Emergency Services can be a good place to influence their prevention, guiding and anticipating risk situations. The objective of this work was to determine the knowledge and attitude of parents-caregivers of children from one to four years old about child safety. We evaluate if there are differences according the consultation was for unintentional injury or not.Study of cross-sectional surveys performed in an Emergency Health Service during 44 days randomly chosen between two periods (10 / 2015 - 01 / 2016 and 10 / 2016 - 01 / 2017). The parents-caregivers of children between one and four years old were surveyed. For each child with unintentional injury (GROUP1) two other children were included with another reason of consultation (GROUP2). The Framingham Security Survey was used. It was considered that the knowledge and attitude of the parents-caregivers was adequate if the proportion of correct answers was ≥75%. The data was analyzed with the statistical program SPSS v 22.0 for Windows.499 parents-caregivers responded to the survey; 170 belonged to GROUP1 and 329 belonged to GROUP2. The median of correct answers was 27/39 (69.2%) in both groups. The variables where more incorrect answers were detected were: lack of security in front of a fire (409, 82%) and absence of window bars (402, 80.6%). Forty-five (26.5%) parents-caregivers of GROUP1 and 94 (28.6%) of GROUP2 answered correctly≥75% of the questions (p = 0.620); According to the age of children, 34.8% of parents- caregivers of children aged one year, 26.9% of the one aged two years, 26.8% of the ones aged three years and 17.9% of the ones aged four years (p = 0.007) answered correctly the questions.The knowledge of families to prevent unintentional injuries was low, whether or not it was the reason for consultation. A relaxation in the security measures was detected when increasing the autonomy of the children.Las lesiones no intencionadas son la primera causa de morbimortalidad infantil, los Servicios de Urgencias pueden ser un buen lugar para incidir en su prevención, orientando y anticipando situaciones de riesgo. El objetivo de este trabajo fue evaluar en Urgencias el conocimiento y la actitud de los padres-cuidadores de los niños de uno a cuatro años en seguridad infantil y valorar si existen diferencias en función de si el niño ha sufrido una lesión no intencionada (LNI) o no.Estudio descriptivo transversal a través de encuestas realizado en un Servicio de Urgencias durante 44 días escogidos aleatoriamente entre dos periodos (10/2015-01/2016 y 10/2016-01/2017). Se encuestó a los padres-cuidadores de los niños entre uno y cuatro años. Por cada niño con LNI (GRUPO1) se incluyeron dos con otro motivo de consulta (GRUPO2). Se utilizó la encuesta de Seguridad de Framingham. Se consideró que el conocimiento y actitud de los padres-cuidadores era adecuado si la proporción de respuestas correctas fue≥75%. Se analizaron los datos con el programa estadístico SPSS v 22.0 para Windows.Respondieron a la encuesta 499 padres-cuidadores; 170 pertenecían al GRUPO1 y 329 al GRUPO2. La mediana de respuestas correctas fue de 27/39(69,2%) en ambos grupos. Las variables donde se detectaron más respuestas incorrectas fueron: falta de seguridad frente a un incendio (409;82%) y ausencia de rejas en las ventanas (402;80,6%). Cuarenta y cinco (26,5%) padres-cuidadores del GRUPO1 y 94(28,6%) del GRUPO2 contestaron correctamente≥75% a las preguntas (p=0,620); por edad de los niños, el 34,8% de los padres-cuidadores de los de un año, el 26,9% de los de dos, el 26,8% de los de tres y el 17,9% de los de cuatro (p=0,007).El conocimiento de las familias para prevenir LNI fue bajo, tanto si éste era o no, el motivo de consulta. Se detectó una relajación en las medidas de seguridad al aumentar la autonomía de los niños.

Objectives The aim of this landmark exploratory analysis, ATLANTIC-H 24 , was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. Background The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). Methods The ATLANTIC-H 24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. Results Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. Conclusions The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580 ])

Resumen Introduccion y objetivos En el intervencionismo percutaneo sobre el tronco comun izquierdo el caracter urgente del procedimiento y el shock cardiogenico constituyen los principales predictores de eventos. Para procedimientos electivos, el pronostico y la identificacion de predictores estan menos establecidos. El objetivo de este estudio es valorar el pronostico a corto y medio plazo del intervencionismo percutaneo sobre el tronco comun izquierdo no protegido cuando este se efectua de forma electiva. Metodos y resultados Serie multicentrica de 250 pacientes consecutivos incluidos entre enero del 2004 y marzo del 2008. El 49,6% de los pacientes presentaba EuroScore de alto riesgo. La mortalidad cardiaca intrahospitalaria fue del 0,4%, y tras un seguimiento medio de 19,6 meses, la incidencia de eventos cardiacos adversos mayores fue del 18,4% (infarto no fatal, 2,0%; revascularizacion del vaso diana, 6,8%; mortalidad cardiaca, 9,6%). Los predictores independientes de eventos cardiacos adversos mayores en el seguimiento fueron el EuroScore de alto riesgo (HR; 2,59, IC del 95%, 1,35-5,00; p = 0,004) y el uso de 2 stents para la lesion del tronco comun (HR 2,05; IC del 95%, 1,05-4,00; p = 0,035). Conclusiones En nuestro estudio el intervencionismo percutaneo electivo sobre el tronco comun no protegido de la coronaria izquierda se efectua principalmente en pacientes de alto riesgo quirurgico, resultando un procedimiento factible y con un porcentaje de eventos adversos en el seguimiento aceptable. Los predictores de eventos en el seguimiento son el EuroScore de alto riesgo y el uso de 2 stents para la lesion en el tronco comun.

Background Drug-eluting stents (DES) have been shown in randomized trials to reduce clinical events in diabetic patients. Our aim was to determine whether these clinical results are applicable in an unselected population of patients with non-insulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM). Methods We studied 440 consecutive patients (271 NIDDM and 169 IDDM) who underwent percutaneous coronary intervention, divided into 2 cohorts: Group A (1998–2000): 220 patients with bare metal stents, and Group B (2002–2004): 220 patients with drug-eluting stents. We analyzed major coronary adverse events (death, nonfatal acute myocardial infarction, and target lesion revascularization) over a mean follow-up of 18 ± 15 months. Results Group B had more patients who were insulin-dependent (44.5 versus 32.3% p

Introduccion y objetivos La diabetes mellitus modifica la historia natural de los pacientes con cardiopatia isquemica. El objetivo de nuestro trabajo ha sido describir las caracteristicas y resultados de los diabeticos sometidos a revascularizacion coronaria percutanea y determinar los factores pronosticos de complicaciones tras la misma. Metodos Hemos analizado de manera retrospectiva una poblacion no seleccionada de 198 diabeticos a los que se les realizo revascularizacion coronaria percutanea entre septiembre de 1996 y enero de 2000 en nuestro hospital, y como grupo control a 198 pacientes no diabeticos consecutivos a los primeros. La muerte, el infarto no mortal, el ingreso hospitalario por angina inestable y la necesidad de nueva revascularizacion miocardica se consideraron acontecimientos adversos en un ano de seguimiento. Resultados La frecuencia global de acontecimientos adversos en un ano de seguimiento fue mayor en los diabeticos (37%) que en los no diabeticos (24%) (p = 0,03). Los diabeticos presentaban un peor perfil clinico y angiografico, incluyendo un mayor porcentaje de revascularizacion incompleta (43 frente al 30%). Los diabeticos con revascularizacion incompleta tenian una mayor edad (66,5 frente a 63,2), mas revascularizacion previa, lesiones mas desfavorables anatomicamente (70% lesiones tipo B2-C frente a 51%) y una menor fraccion de eyeccion (54,7 frente a 59,4%). Los diabeticos presentaron mas complicaciones en el seguimiento medio de un ano (37 frente al 24%; p = 0,03), debido fundamentalmente a una mayor mortalidad cardiovascular en los diabeticos con revascularizacion incompleta (12 frente al 2%). La revascularizacion incompleta, pero no la diabetes, fue el unico factor predictor de complicaciones en el seguimiento. Conclusiones Los diabeticos sometidos a revascularizacion coronaria percutanea presentan unas peores caracteristicas clinicas y anatomicas que los no diabeticos. La revascularizacion incompleta empeora el pronostico durante el seguimiento.

Introduction and objectives. It is known that the outcome of percutaneous coronary intervention is worse in diabetics than in non-diabetics. The aim of our study was to determine whether abciximab therapy could improve clinical outcome in an unselected diabetic population that underwent percutaneous coronary interventions.

Background: In the context of established cardiovascular disease, obesity is protective factor (obesity paradox). The aim of our study is to determine if the body mass index (BMI) is a prognostic factor in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: A retrospective

Introduccion y objetivos La revascularizacion percutanea ha producido en los ultimos anos un cambio importante en el manejo de los pacientes con cardiopatia isquemica. Existe una gran controversia sobre la incidencia y el significado pronostico de pequenas elevaciones de la creatincinasa despues del procedimiento. El objetivo de este trabajo ha sido determinar la incidencia de estas elevaciones y los factores relacionados y observar los acontecimientos cardiovasculares en el grupo de pacientes en los que se produjo elevacion de la creatincinasa y en los que no se produjo. Metodos Hemos estudiado a los 447 pacientes sometidos a procedimientos de revascularizacion percutanea realizada en nuestro servicio desde enero de 1997 hasta junio de 1998, excluyendose los 138 casos que presentaron un infarto agudo de miocardio en los 4 dias previos o angioplastias fallidas. En todos los pacientes se determino la creatincinasa basal y a las 4, 8 y 24 h tras la angioplastia. Estudiamos la incidencia de estas elevaciones en nuestro medio, asi como las caracteristicas de los pacientes en los que se produjeron elevacion de la creatincinasa respecto a un grupo control constituido por aquellos enfermos en los que no se evidenciaron estas elevaciones en los que se habia realizado un similar procedimiento revascularizador percutaneo atendiendo a diversas variables como la arteria, tipo y caracteristica de la lesion, funcion ventricular y periodo de tiempo. Se considero como acontecimiento cardiovascular en el seguimiento la muerte, infarto de miocardio no fatal, necesidad de nueva revascularizacion o reingreso hospitalario por angina inestable. Resultados De los 309 pacientes que cumplian los criterios de inclusion, solo se aprecio elevacion de la creatincinasa posprocedimiento en 24 pacientes (7,7%). En el 50% de los pacientes que presentaron elevaciones, estas pudieron relacionarse con complicaciones menores durante el procedimiento, fundamentalmente perdidas de ramas laterales. No se apreciaron diferencias en cuanto a las caracteristicas demograficas de los pacientes ni respecto a las caracteristicas anatomicas de las lesiones en los grupos estudiados. Durante el periodo de seguimiento de 9,5 meses apreciamos un 37,5% de complicaciones en el grupo con elevacion enzimatica, frente a un 20% en el grupo control, aunque la diferencia no alcanzo significacion estadistica. Conclusiones Las elevaciones de creatincinasa postintervencionismo coronario se producen en el 7,7% de los pacientes a los que se les realiza en nuestro medio. Solo el 50% de dichas elevaciones estan objetivamente relacionadas con complicaciones menores del procedimiento, preferentemente perdida de ramas laterales, sin que se evidenciaran hallazgos en los restantes. La determinacion seriada de creatincinasa tras revascularizacion percutanea presenta una baja sensibilidad metodica para la deteccion de complicaciones en el seguimiento. Otros marcadores mas sensibles y especificos de dano miocardico, como las troponinas, podrian definir a este grupo de pacientes.

Introduccion y objetivos El objetivo del estudio es analizar el seguimiento de pacientes a los que se practico valvulotomia mitral percutanea y los factores predictores de supervivencia libre de eventos. Metodos Analizamos 220 valvulotomias mitrales percutaneas consecutivas realizadas entre 1988 y 1996 para establecer la incidencia de eventos (muerte, reestenosis, cirugia mitral, clase funcional IV de la New York Heart Association, nueva valvulotomia mitral percutanea y embolia sistemica) y las caracteristicas pre y posvalvulotomia predictoras de aquellos, en un seguimiento entre 1 y 96 meses (mediana 42 meses). Resultados La supervivencia global fue del 94,7% y la supervivencia libre de eventos del 59,2% a 96 meses. Analizando las variables del perfil basal (metodo actuarial de Kaplan-Meier), la fibrilacion auricular (p 2 era predictora de estar libre de eventos: el 72,9 frente al 10,5% (test log-rank p Conclusiones Los eventos a medio plazo tras valvulotomia mitral percutanea se pueden predecir en funcion de caracteristicas pre y posvalvulotomia. La edad 3 56 anos, una puntuacion ecocardiografica 3 9 y la fibrilacion auricular fueron factores preprocedimiento relacionados con eventos adversos. Los pacientes con ningun o un factor adverso en el perfil clinico basal no tienen diferencias significati vas en la evolucion a medio plazo, mientras que los que presentan dos, y sobre todo, tres caracteristicas adversas tienen una menor supervivencia libre de eventos. Un area mitral 3 1,5 cm 2 es la unica variable posprocedimiento predictora independiente de la evolucion libre de eventos.

Introduccion y objetivos La indicacion de coronariografia en pacientes valvulares es recomendada de forma rutinaria previa a la realizacion de cirugia. La seleccion se hace en funcion de la edad, sexo y presencia de angina pero no suele estar basada en los factores de riesgo. El objetivo de este estudio es valorar marcadores que permitan predecir la probabilidad de lesion coronaria en este grupo de pacientes. Pacientes y metodos Se estudio retrospectivamente una poblacion de 541 pacientes con enfermedad valvular a los que se realizo coronariografia durante el periodo 1989-1994. De ellos, 301 eran varones y 240 mujeres con una edad media de 61,8 anos (rango, 34-82). Se relaciono la presencia de lesion coronaria con las variables edad, sexo, angina, hipertension, diabetes, hipercolesterolemia, tabaco, antecedentes familiares y la presencia de angina mediante analisis de regresion logistica. Resultados En 73 pacientes existia lesion coronaria superior al 50% (13,4%). La presencia de angina se aprecio en el 34,6% de los casos. El riesgo de lesion coronaria fue definido como odds ratio: angina 3,3, tabaco 2,6, diabetes 2,2, hipertension 1,8 y edad 1,4. El resto de variables no fueron predictoras de enfermedad coronaria. La probabilidad de lesion coronaria en pacientes sin angina y ausencia de los factores de riesgo descritos como predictores es del 4%. Si ademas analizamos la edad la probabilidad de enfermedad coronaria en pacientes menores de 65 anos era del 3% para los pacientes sin angina ni factores de riesgo, en cambio la probabilidad en el mismo grupo de pacientes > 65 anos fue del 6%. Conclusiones La ausencia de angina y de al menos los tres factores de riesgo descritos como predictores (tabaquismo, hipertension y diabetes) en pacientes menores de 65 anos permite descartar la enfermedad coronaria asociada en pacientes valvulares que van a ser intervenidos quirurgicamente lo que permite obviar la coronariografia en este grupo de pacientes.

It is known that the outcome of percutaneous coronary intervention is worse in diabetics than in non-diabetics. The aim of our study was to determine whether abciximab therapy could improve clinical outcome in an unselected diabetic population that underwent percutaneous coronary interventions.We analyzed retrospectively 198 diabetic patients who underwent PTCA from January 1997 to January 2000. Seventy-three patients (36.7%) were treated with abciximab and the remaining 125 patients (63.3%) did not receive abciximab. The mean follow-up was 12.6 months. The events considered were death, non-fatal myocardial infarction, any revascularization procedure (including the target vessel), and hospital admission for unstable angina.Patients who received abciximab had more frequent previous myocardial infarction (67.1 vs. 52.8%; p = 0.04), worse left ventricular function (0.53 vs. 0.59%; p = 0.02), more frequent angiographic thrombus (67.1 vs. 36.8%; p0.001), more complex lesions (B2/C) (76.4 vs. 55.8%; p = 0.004), and less frequent location in left anterior descending artery (34.2 vs. 60.8%; p = 0.002). The indication for PTCA in patients who received abciximab was most often related to myocardial infarction. There were no differences between the groups in sex, age and distribution of diabetes treatment. Events were more frequent in diabetics not treated with abciximab than in those who were treated with abciximab (38 vs. 22%; p0.037). The patients not treated with abciximab suffered more frequently target vessel revascularization (22.7 vs. 7.2%; p0.007). There were no significant differences in the frequency of death or non-fatal myocardial infarction, but hospital readmissions for unstable angina were significantly more frequent in diabetics not treated with abciximab (29.1 vs. 15.9%; p = 0.045). Multivariate analysis identified abciximab as a predictor of the absence of complications during follow-up (OR: 0.45; p = 0.03).Abciximab treatment seems to reduce events in unselected diabetic patients undergoing percutaneous coronary intervention, particularly target vessel revascularization.

BACKGROUND New techniques to evaluate coronary artery disease, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to determine the correlation between FFR and dobutamine stress echocardiography in patients with moderately severe coronary stenosis in order to judge the usefulness of FFR for commonly encountered clinical problems. METHODS AND RESULTS We studied 21 patients with 23 moderately severe coronary artery stenoses on angiography. The FFR was calculated and dobutamine stress echocardiography was performed to detect ischemia. Of the 16 stenoses with a negative FFR (> or = 0.75), dobutamine echocardiography also was negative. In the seven stenoses with a positive FFR (< 0.75), dobutamine echocardiography was positive in three. The efficacy of FFR in detecting ischemia that was confirmed with stress echocardiography was sensitivity 100%, specificity 80%, positive and negative predictive value 42.8%, and 100%, respectively, with a global predictive value 82.6%. A moderate degree of correlation was found between the two diagnostic tests (kappa [kappa] = 0.51). CONCLUSIONS FFR correlates moderately well with dobutamine stress echocardiography in the assessment of moderately severe lesions in patients for whom coronary arteriography is usually indicated. However, its high negative predictive value makes FFR a useful aid in reaching clinical decisions promptly in the hemodynamics laboratory.

AIMS New interventional techniques to diagnose coronary artery stenosis, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to investigate the occurrence of cardiac events in patients with coronary syndromes and negative FFR findings in moderately severe coronary stenosis in order to determine the usefulness of this technique in predicting coronary events during follow-up for problems commonly encountered in clinical practice. A further objective was to evaluate the safety of deferring angioplasty in patients with a negative FFR result. METHODS We studied 43 patients with 44 moderately severe coronary artery stenoses on angiography and FFR > or = 0.75. Mean age of the patients was 58 +/- 11.4 years. The indications for coronary angiography included recent unstable angina in 24 (55.8%) patients, recent acute myocardial infarction in 10 (23.2%) patients, 5 (11.6%) patients with a coronary stent who had symptoms of uncertain cause, and stable angina in 4 (9.3%) patients. RESULTS During a mean follow-up period of 10.7 +/- 5.9 months, clinical events (unstable angina) occurred in five patients. In three patients, the initially investigated artery was involved, and in the two patients who required coronary revascularization, unstable angina was related with an artery different from the one studied initially. CONCLUSIONS Patients with recent coronary syndromes and negative FFR findings in moderately severe coronary stenosis were unlikely to have cardiac events during a 10-month follow-up period. Our findings suggest that FFR is a potentially useful indicator of the likelihood of cardiac events and thus represents a useful aid in clinical decision-making in the hemodynamics laboratory. This diagnostic technique also is potentially useful in identifying patients for whom angioplasty can be safely deferred.

Diabetes mellitus modifies the natural history of patients with coronary artery disease. The aim of this study was to assess the clinical outcome of diabetic patients with successful coronary angioplasty in our environment and to identify the factors predictive of complications during follow-up.A retrospective analysis was made of a series of 198 diabetics and who underwent angioplasty from September 1996 to January 2000 in our hospital. A group of 198 nondiabetic patients who subsequently underwent the same procedure was used as the control group. Death, non-fatal myocardial infarction, unstable angina resulting in hospitalization and coronary revascularization were considered adverse events during a 1 year follow-up period.The overall frequency of coronary adverse events in a 1-year follow-up was higher in diabetics (37%) than in non-diabetics (24%; p = 0.03). Diabetics had a less favorable clinical and angiographic profile and more frequent incomplete revascularization (43 vs 30%). Diabetics with incomplete revascularization were older (66.5 vs 53.2 years), had previous angioplasty more often, anatomically more unfavorable lesions (70 vs 51% type B2-C), and a smaller ejection fraction (54.7 vs 59.4%). Diabetics had more complications at 1 year of follow-up (37 vs 24%; p = 0.03), mainly due to increased cardiovascular mortality in diabetics with incomplete revascularization (12 vs 2%). Multivariate analysis identified incomplete revascularization as the only correlate of clinical outcome. Diabetes per se was not predictive of complications during follow-up.Diabetics who undergo successful coronary revascularization have a less favorable clinical outcome than non-diabetic patients undergoing the same procedure at 1 year of follow up. Incomplete revascularization is associated with a less favorable outcome.

Mortality rates for coronary artery disease are greater in elderly patients. Although prodromal angina occurring shortly before an acute myocardial infarction (MI) has protective effects against ischemia, this effect has not been well documented in older patients. This study investigated whether angina 1 week before a first MI provides protection in this group of patients. A total of 290 consecutive elderly (>64 years old, n = 143) and adult patients (