47 results on '"Salgado-Fernández J"'
Search Results
2. Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI: insights from a cohort of 1391 patients
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Flores-Ríos, X, primary, Couto-Mallón, D, additional, Rodríguez-Garrido, J, additional, García-Guimaraes, M, additional, Gargallo-Fernández, P, additional, Piñón-Esteban, P, additional, Aldama-López, G, additional, Salgado-Fernández, J, additional, Calviño-Santos, R, additional, Vázquez-González, N, additional, and Castro-Beiras, A, additional
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- 2012
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3. 205. Implante de prótesis valvular aórtica por vía transapical. Resultados iniciales
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Pérez López, J., primary, El Diasty, M., additional, Franco Gutiérrez, R., additional, Estévez Cid, F., additional, Velasco García de Sierra, C., additional, Iglesias Gil, C., additional, Fernández Arias, L., additional, Bouzas Mosquera, A., additional, Salgado Fernández, J., additional, Herrera Noreña, J.M.a., additional, and Cuenca Castillo, J.J., additional
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- 2010
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4. Complicaciones vasculares pospunción de la arteria femoral en cateterismos cardíacos
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Hernández-Lahoz, I., primary, Salgado-Fernández, J., additional, Vidal-Insua, J.J., additional, Segura-Iglesias, R.J., additional, Cuesta-Gimeno, C., additional, and Hernàndez-Lahoz, I., additional
- Published
- 2006
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5. Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI: insights from a cohort of 1391 patients
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Flores-Ríos, X, Couto-Mallón, D, Rodríguez-Garrido, J, García-Guimaraes, M, Gargallo-Fernández, P, Piñón-Esteban, P, Aldama-López, G, Salgado-Fernández, J, Calviño-Santos, R, Vázquez-González, N, and Castro-Beiras, A
- Abstract
Aims: To compare the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION risk models in the ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods: We studied all consecutive patients with STEMI who underwent PPCI at our institution between 2006 and 2010 (n=1391). The CRUSADE, ACUITY-HORIZONS, and ACTION risk scores were calculated based on the patients’ clinical characteristics. The occurrence of in-hospital major bleeding (defined as the composite of intracranial or intraocular bleeding, access site haemorrhage requiring intervention, reduction in haemoglobin =4 g/dl without or =3g/dl with overt bleeding source, reoperation for bleeding, or blood transfusion) reached 9.8%. Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow test and the C-statistic, respectively. We compared the predictive accuracy of the risk scores by the DeLong non-parametric test.Results: Calibration of the three risk scores was adequate, given the non-significant results of Hosmer-Lemeshow test for the three risk models. Discrimination of CRUSADE, ACUITY-HORIZONS, and ACTION models was good (C-statistic 0.77, 0.70, and 0.78, respectively). The CRUSADE and ACTION risk scores had a greater predictive accuracy than the ACUITY-HORIZONS risk model (z=3.89, p-value=0.0001 and z=3.51, p-value=0.0004, respectively). There was no significant difference between the CRUSADE and ACTION models (z=0.63, p=0.531).Conclusions: The CRUSADE, ACUITY-HORIZONS, and ACTION scores are useful tools for the risk stratification of bleeding in STEMI treated by PPCI. Our findings favour the CRUSADE and ACTION risk models over the ACUITY-HORIZONS risk score.
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- 2013
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6. Analysis of the appropriate use of β-blockers post-infarction
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Freire Castroseiros, E., Muñiz García, J., Castro Beiras, A., García Pérez, L., Vázquez Rodríguez, J. M., Martínez Ruiz, D., Salgado Fernández, J., Iglesias, L. M., Martínez, J. V., Riesco, C. D., La Peña, M. G., Virgos Lamelas, A., Trillo Nouche, R., Mesias Prego, A., Yañez Wonenburger, J. C., García-García, M., Delgado Martolomé, G., Pérez Rodríguez, M., Sánchez Prieto, A., Platero Vázquez, V., Matinez Sande, J. L., Pose Reino, D. A., Lomban Villanueva, J., Lage Bouzamayor, B., Silva Martínez, M., Pérez Juan Romero, M., Cejudo Díazn, I., Vigil Escalera, P., Casariego Roson, R., Puente Rodero, B., Costa Sánchez, F., Penas Cortes, J., Torrealday Taboada, H., Blanco González, D. N., Santacruz, E. M., Martínez, E. R., Merino Rego, M. D., Pérez Martínez, F., Vázquez Pedreda, M. L., Ménez Fernández, M., Santiago Viqueira, J., Calvo Barros, S., Mira Orro, L., and Masferrer Serra, J.
7. CB18 205. Implante de prótesis valvular aórtica por vía transapical. Resultados iniciales
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Pérez López, J., El Diasty, M., Franco Gutiérrez, R., Estévez Cid, F., Velasco García de Sierra, C., Iglesias Gil, C., Fernández Arias, L., Bouzas Mosquera, A., Salgado Fernández, J., Herrera Noreña, J.M.a., and Cuenca Castillo, J.J.
- Abstract
ObjetivosAnalizamos nuestra experiencia inicial en el implante de una prótesis valvular aórtica por vía transapical en pacientes con estenosis aórtica grave no subsidiarios de cirugía convencional.Material y métodosDe noviembre de 2008 a enero de 2010 fueron intervenidos 22 pacientes (21 con estenosis valvular aórtica nativa y uno con una prótesis biológica degenerada). La mediana de edad era 83 años (RI: 81-86). El 64% presentaba disnea de mínimos esfuerzos o de reposo, y hasta el 50% insuficiencia cardíaca congestiva. La mediana del EuroSCORE logístico fue 11,28% (RI: 9,72-15,08). En cinco casos se observó aorta en porcelana. La media del área valvular aórtica era 0,72 ±0,18 cm2.ResultadosSe logró un anclaje correcto de la prótesis en el 86, 4% de los casos. Un paciente precisó conversión a cirugía convencional tras migración de la prótesis al ventrículo izquierdo.Las principales complicaciones postoperatorias fueron: síndrome de bajo gasto (2 casos, siendo uno exitus), accidente cerebrovascular (2 casos), sangrado diferido a nivel del ápex (1 caso) e implante de marcapasos definitivo por bloqueo auriculoventricular completo (1 caso). La mortalidad a los 30 días de la cirugía fue 4,5%. La media del área valvular aórtica postoperatoria fue 1,8 ± 0,37 cm2, y del gradiente transprotésico medio 11,02 ± 5,6 mmHg. La supervivencia actuarial a los 6 y 12 meses fue 90,2 ± 6,6% y 74,9 ± 11,3%, respectivamente. El 94,4% de los supervivientes se encuentran en clase funcional New York Heart Association (NYHA) I-II (mediana de seguimiento: 9,2 meses).Conclusionesel abordaje transapical se muestra como un tratamiento factible. Los pacientes desarrollaron una mejoría hemodinámica y clínica tras la intervención.
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8. Images in cardiovascular medicine. Percutaneous retrieval of a lost guidewire that caused cardiac tamponade.
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Pérez-Díez D, Salgado-Fernández J, Vázquez-González N, Calviño-Santos R, Vázquez-Rodríguez JM, Aldama-López G, García-Barreiro JJ, Castro-Beiras A, Pérez-Díez, Diego, Salgado-Fernández, Jorge, Vázquez-González, Nicolás, Calviño-Santos, Ramón, Vázquez-Rodríguez, José Manuel, Aldama-López, Guillermo, García-Barreiro, Juan Javier, and Castro-Beiras, Alfonso
- Published
- 2007
9. Acute left main coronary artery occlusion after percutaneous aortic valve replacement.
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Barge-Caballero G, López-Pérez M, Bouzas-Mosquera A, Fábregas-Casal R, Alvarez-García N, Barge-Caballero E, Salgado-Fernández J, Vázquez-González N, and Castro-Beiras A
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- 2012
10. Head-Mounted Display for Clinical Evaluation of Neck Movement Validation with Meta Quest 2.
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Trinidad-Fernández M, Bossavit B, Salgado-Fernández J, Abbate-Chica S, Fernández-Leiva AJ, and Cuesta-Vargas AI
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- Humans, Neck, Range of Motion, Articular, Rotation, Movement, Smart Glasses, Virtual Reality
- Abstract
Neck disorders have a significant impact on people because of their high incidence. The head-mounted display (HMD) systems, such as Meta Quest 2, grant access to immersive virtual reality (iRV) experiences. This study aims to validate the Meta Quest 2 HMD system as an alternative for screening neck movement in healthy people. The device provides data about the position and orientation of the head and, thus, the neck mobility around the three anatomical axes. The authors develop a VR application that solicits participants to perform six neck movements (rotation, flexion, and lateralization on both sides), which allows the collection of corresponding angles. An InertiaCube3 inertial measurement unit (IMU) is also attached to the HMD to compare the criterion to a standard. The mean absolute error (MAE), the percentage of error (%MAE), and the criterion validity and agreement are calculated. The study shows that the average absolute errors do not exceed 1° (average = 0.48 ± 0.09°). The rotational movement's average %MAE is 1.61 ± 0.82%. The head orientations obtain a correlation between 0.70 and 0.96. The Bland-Altman study reveals good agreement between the HMD and IMU systems. Overall, the study shows that the angles provided by the Meta Quest 2 HMD system are valid to calculate the rotational angles of the neck in each of the three axes. The obtained results demonstrate an acceptable error percentage and a very minimal absolute error when measuring the degrees of neck rotation; therefore, the sensor can be used for screening neck disorders in healthy people.
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- 2023
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11. Economic evaluation of complete revascularization versus stress echocardiography-guided revascularization in the STEACS with multivessel disease.
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Flores-Ríos X, Calviño-Santos RA, Estévez-Loureiro R, Peteiro-Vázquez J, Salgado-Fernández J, Rodríguez-Vilela A, Franco-Gutiérrez R, Bouzas-Mosquera A, Rodríguez-Fernández JÁ, Marzoa-Rivas R, González-Juanatey C, Aldama-López G, Piñón-Esteban P, Vázquez-González N, Muñiz-García J, and Vázquez-Rodríguez JM
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- Cost-Benefit Analysis, Echocardiography, Stress, Humans, Treatment Outcome, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Myocardial Infarction, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction surgery
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Introduction and Objectives: Economic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial., Methods: We performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography-guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N=306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system., Results: The index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9±6236.8 € vs 14 038.7±4958.5 €; P <.001). There were no differences in the costs of the first year of follow-up rehospitalizations between both groups for (ComR 2423.5±4568.0 vs SelR 2653.9±5709.1; P=.697). Total cost was 22 081.3±7505.6 for the ComR arm and 16 692.6±7669.9 for the SelR group (P <.001)., Conclusions: In the CROSS-AMI trial, the initial extra economic costs of the ComR versus SelR were not offset by significant savings during follow-up. SelR seems to be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease treated by emergent angioplasty. Study registred at ClinicalTrial.gov (Identifier: NCT01179126)., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2021
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12. Balloon-expanding transcatheter aortic valve implantation for degenerated Mitroflow bioprostheses: clinical and echocardiographic long-term outcomes.
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Mosquera VX, Bouzas-Mosquera A, Vilela-González Y, Velasco C, Salgado-Fernández J, Calviño-Santos R, Vázquez-González N, Vázquez-Rodríguez JM, and Herrera-Noreña JM
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- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve surgery, Echocardiography, Female, Fluoroscopy, Humans, Male, Prosthesis Design, Prosthesis Failure, Treatment Outcome, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Objectives: This study aims to analyse the risks associated with valve-in-valve procedures for treating structural valve deterioration in Mitroflow bioprostheses, as well as to determine the impact of the original Mitroflow size on the patients' long-term outcomes., Methods: Between January 2012 and September 2019, 21 patients (61.9% males; mean age 82.4 ± 5.4 years) were treated for Mitroflow deterioration with valve-in-valve procedures (12 transapical and 9 transfemoral)., Results: Mean EuroSCORE I and EuroSCORE II were 28.2% ± 13.6% and 10.5% ± 6.1%, respectively. Six patients presented an indexed aortic root diameter <14 mm/m2 and 7 patients a diameter of sinus of Valsalva <30 mm. Implanted transcatheter valve sizes were 20 mm in 6 cases, 23 mm in 14 cases and 26 mm in 1 patient. A Valve Academic Research Consortium-2 complication occurred in 23.8% of cases, including 3 coronary occlusions. In-hospital mortality was 9.5%. The 20 mm transcatheter valves presented significantly higher postoperative peak and mean aortic gradients than other sizes (54.1 ± 11.3 mmHg vs 29.9 ± 9.6 mmHg, P = 0.003; and 29.3 ± 7.7 mmHg vs 17.4 ± 5.9 mmHg, P = 0.015, respectively). There were 12 cases of patient-prosthesis mismatch (57.1%) and 3 cases (14.3%) of severe patient-prosthesis mismatch. Cumulative survival was 85.7% ± 7.6% at 1 year, 74.3% ± 10% at 2 years and 37.1% ± 14.1% at 5 years., Conclusions: Valve-in-valve procedures with balloon-expandable transcatheter valves associate a high risk of coronary occlusion in patients with indexed aortic root diameter <14 mm/m2 and low coronary ostia <12 mm. Valve-in valve procedures with 20 mm balloon-expandable transcatheter valves in ≤21 mm Mitroflow bioprosthesis leave significant residual transvalvular gradients that might obscure patients' long-term outcomes., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2021
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13. Successful transfemoral management of transcatheter aortic valve embolization into left ventricle.
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Varela-Cancelo A, Salgado-Fernández J, Calviño-Santos R, and Bouzas-Zubeldía B
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- Aortic Valve diagnostic imaging, Aortic Valve surgery, Heart Ventricles diagnostic imaging, Humans, Treatment Outcome, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement
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- 2020
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14. Flow obstruction of continuous-flow ventricular assist devices. Diagnosis and treatment of an uncommon problem.
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Couto Mallón D, Barge Caballero E, Salgado Fernández J, Barge Caballero G, Cuenca Castillo JJ, and Crespo Leiro MG
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- Humans, Ventricular Function, Left, Heart Failure diagnosis, Heart Failure therapy, Heart-Assist Devices
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- 2020
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15. Impact of COVID-19 outbreak and public lockdown on ST-segment elevation myocardial infarction care in Spain.
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Rebollal-Leal F, Aldama-López G, Flores-Ríos X, Piñón-Esteban P, Salgado-Fernández J, Calviño-Santos R, Vázquez-González N, and Vázquez-Rodríguez JM
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- Aged, COVID-19, Elective Surgical Procedures statistics & numerical data, Female, Humans, Male, Middle Aged, Pandemics, Percutaneous Coronary Intervention methods, Prognosis, Risk Assessment, Spain epidemiology, Treatment Outcome, Coronavirus Infections epidemiology, Disease Outbreaks statistics & numerical data, Percutaneous Coronary Intervention statistics & numerical data, Pneumonia, Viral epidemiology, Quarantine organization & administration, ST Elevation Myocardial Infarction epidemiology, ST Elevation Myocardial Infarction surgery
- Published
- 2020
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16. Angiographically Guided Complete Revascularization Versus Selective Stress Echocardiography-Guided Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease: The CROSS-AMI Randomized Clinical Trial.
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Calviño-Santos R, Estévez-Loureiro R, Peteiro-Vázquez J, Salgado-Fernández J, Rodríguez-Vilela A, Franco-Gutiérrez R, Bouzas-Mosquera A, Rodríguez-Fernández JÁ, Mesías-Prego A, González-Juanatey C, Aldama-López G, Piñón-Esteban P, Flores-Ríos X, Soler-Martín R, Seoane-Pillado T, Vázquez-González N, Muñiz J, and Vázquez-Rodríguez JM
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- Aged, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Coronary Artery Disease physiopathology, Coronary Vessels physiopathology, Early Termination of Clinical Trials, Exercise Test, Female, Heart Failure mortality, Heart Failure physiopathology, Heart Failure therapy, Humans, Male, Middle Aged, Patient Readmission, Predictive Value of Tests, Recurrence, Risk Factors, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction physiopathology, Spain, Time Factors, Treatment Outcome, Coronary Angiography, Coronary Artery Disease therapy, Coronary Vessels diagnostic imaging, Echocardiography, Stress, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, ST Elevation Myocardial Infarction therapy
- Abstract
Background: Recent trials suggest that complete revascularization in patients with acute ST-segment-elevation myocardial infarction and multivessel disease is associated with better outcomes than infarct-related artery (IRA)-only revascularization. There are different methods to select non-IRA lesions for revascularization procedures. We assessed the clinical outcomes of complete angiographically guided revascularization versus stress echocardiography-guided revascularization in patients with ST-segment-elevation myocardial infarction., Methods: We performed a randomized clinical trial in patients with multivessel disease who underwent a successful percutaneous coronary intervention of the IRA to test differences in prognosis (composite end point included cardiovascular mortality, nonfatal reinfarction, coronary revascularization, and readmission for heart failure after 12 months of follow-up) between complete angiographically guided revascularization (n=154) or stress echocardiography-guided revascularization (n=152) of the non-IRA lesions in an elective procedure before hospital discharge., Results: The trial was prematurely stopped after the inclusion of 77% of the planned study population. As many as 152 (99%) patients in the complete revascularization group and 44 (29%) patients in the selective revascularization group required a percutaneous coronary intervention procedure of a non-IRA lesion before discharge. The primary end point occurred in 21 (14%) patients of the stress echocardiography-guided revascularization group and 22 (14%) patients of the complete angiographically guided revascularization group (hazard ratio, 0.95; 95% CI, 0.52-1.72; P =0.85)., Conclusions: In patients with ST-segment-elevation myocardial infarction and multivessel disease, stress echocardiography-guided revascularization may not be significantly different to complete angiographically guided revascularization, thereby reducing the need for elective revascularization before hospital discharge., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01179126.
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- 2019
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17. Efficacy and safety of transcatheter valve-in-valve replacement for Mitroflow bioprosthetic valve dysfunction.
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Mosquera VX, González-Barbeito M, Bouzas-Mosquera A, Herrera-Noreña JM, Velasco C, Salgado-Fernández J, Calviño-Santos R, Vázquez-González N, Vázquez-Rodríguez JM, and Cuenca-Castillo JJ
- Subjects
- Aged, Aged, 80 and over, Female, Follow-Up Studies, Heart Valve Diseases physiopathology, Hemodynamics, Humans, Male, Safety, Stents, Treatment Outcome, Aortic Valve surgery, Bioprosthesis adverse effects, Heart Valve Diseases surgery, Heart Valve Prosthesis adverse effects, Prosthesis Failure adverse effects, Transcatheter Aortic Valve Replacement methods
- Abstract
Objectives: Bioprostheses with pericardial leaflets mounted externally on the stent pose a high risk for valve-in-valve (ViV) procedures. This study analyzed the efficacy and safety of ViV procedures for treating structural valve deterioration (SVD) in Mitroflow bioprostheses., Methods: Between January 2012 and August 2017, 11 patients (mean age 80.3 ± 5.6 years) were treated for SVD of Mitroflow bioprostheses with transcatheter ViV procedures (six transapical [TA] and five transfemoral [TF]) using balloon expandable bioprostheses., Results: All patients but one were in NYHA class III-IV. Mean STS PROM, euroSCORE I, and euroSCORE II were 8 ± 6.5%, 27.8 ± 11.5%, and 12 ± 5.9%, respectively. Two patients had a "porcelain aorta." The size of implanted valves were 23 mm in 10 cases and 26 mm in one case. One patient suffered a coronary occlusion during a TF approach. The mean volume of contrast used in TF implants was 163 ± 69.8 mL. No contrast media were used in TA procedures. There was one in-hospital death (10%). At 1 year of follow-up, peak and mean aortic gradients were 25.5 ± 5.8 mmHg and 15.5 ± 5.7 mmHg, respectively. One patient had mild paravalvular regurgitation. Cumulative survival was 90.9% at 1 year, 70.7% at 2 years, and 53% at 3 years., Conclusions: ViV procedures with balloon-expandable aortic valves provide good hemodynamic and clinical mid-term results for treating patients with a degenerated Mitroflow aortic bioprosthesis. Special care must be taken in small aortic roots, when the stented valve is in the supra-annular position to avoid coronary ostial obstruction., (© 2018 Wiley Periodicals, Inc.)
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- 2018
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18. Post-introduction observation of transcatheter aortic valve implantation in Galicia (Spain).
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Varela-Lema L, Queiro-Verdes T, Baz-Alonso JA, Cuenca-Castillo JJ, Durán-Muñoz D, Gónzalez-Juanatey JR, Herrera Noreña JM, Iñiguez-Romo A, López-Otero D, Pradas-Montilla G, Rubio-Álvarez J, Salgado-Fernández J, Trillo Nouche R, Vázquez-González N, and López-García M
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- Aged, Aged, 80 and over, Electrocardiography, Female, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Complications, Spain, Time Factors, Aortic Valve Stenosis surgery, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement statistics & numerical data
- Abstract
Rationale, Aims and Objectives: Transcatheter aortic valve implantation constitutes an example of a technology introduced into the Galician Health Care System basket and subjected to a post-introduction observational study after coverage. This paper aims to describe the process and results of this experience, illustrating the main challenges and opportunities in using these studies for supporting decision making., Methods: The study protocol was developed by a multidisciplinary team consisting of experts from the Galician HTA Agency (avalia-t), interventional cardiologists and cardiac surgeons. Together they agreed on the information that was relevant and feasible for collection, and planned the study design, data collection and analysis of results., Results: During the 1-year recruitment period, 94 patients underwent percutaneous aortic valve replacement in the three authorized centres. Implantation rate and prosthesis models differed substantially across the centres. Overall, procedural success rate was 96.8% and hospital mortality was 7.4%. Complications during post-surgical admission were recorded in 40.4% of patients. Moderate residual aortic regurgitation was observed in 10% of patients, and the procedure was associated with a stroke rate of 3.3% at 30 days and 5.3% at 1 year., Conclusions: Post-introduction observation has made it feasible to determine the use of this procedure within the SERGAS context and has enabled the assessment of performance in real-life conditions. The proposed strategic actions and interventions have been drawn up based upon the collective judgement of a group of experienced professionals, and have served to establish recommendations on further research that would be required to optimize health benefits., (© 2014 John Wiley & Sons, Ltd.)
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- 2015
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19. Timely reperfusion for ST-segment elevation myocardial infarction: Effect of direct transfer to primary angioplasty on time delays and clinical outcomes.
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Estévez-Loureiro R, López-Sainz A, Pérez de Prado A, Cuellas C, Calviño Santos R, Alonso-Orcajo N, Salgado Fernández J, Vázquez-Rodríguez JM, López-Benito M, and Fernández-Vázquez F
- Abstract
Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) when it can be performed expeditiously and by experienced operators. In spite of excellent clinical results this technique is associated with longer delays than thrombolysis and this fact may nullify the benefit of selecting this therapeutic option. Several strategies have been proposed to decrease the temporal delays to deliver PPCI. Among them, prehospital diagnosis and direct transfer to the cath lab, by-passing the emergency department of hospitals, has emerged as an attractive way of diminishing delays. The purpose of this review is to address the effect of direct transfer on time delays and clinical events of patients with STEMI treated by PPCI.
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- 2014
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20. Long-term prognostic value of mitral regurgitation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.
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López-Pérez M, Estévez-Loureiro R, López-Sainz A, Couto-Mallón D, Soler-Martin MR, Bouzas-Mosquera A, Peteiro J, Barge-Caballero G, Prada-Delgado O, Barge-Caballero E, Salgado-Fernández J, Calviño-Santos R, Vázquez-Rodríguez JM, Piñón-Esteban P, Aldama-López G, Vázquez-González N, and Castro-Beiras A
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- Aged, Cause of Death trends, Coronary Angiography, Echocardiography, Doppler, Color, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency epidemiology, Myocardial Infarction complications, Myocardial Infarction diagnosis, Prognosis, Prospective Studies, Spain epidemiology, Survival Rate trends, Time Factors, Electrocardiography, Mitral Valve Insufficiency etiology, Myocardial Infarction surgery, Percutaneous Coronary Intervention methods
- Abstract
The presence of mitral regurgitation (MR) is associated with an impaired prognosis in patients with ischemic heart disease. However, data with regard to the impact of this condition in patients with ST-segment elevation myocardial infarction (STEMI) treated by means of primary percutaneous coronary intervention (PPCI) are lacking. Our aim was to assess the effect of MR in the long-term prognosis of patients with STEMI after PPCI. We analyzed a prospective registry of 1,868 patients (mean age 62 ± 13 years, 79.9% men) with STEMI treated by PPCI in our center from January 2006 to December 2010. Our primary outcome was the composite end point of all-cause mortality or admission due to heart failure during follow-up. After exclusions, 1,036 patients remained for the final analysis. Moderate or severe MR was detected in 119 patients (11.5%). Those with more severe MR were more frequently women (p <0.001), older (p <0.001), and with lower ejection fraction (p <0.001). After a median follow-up of 2.8 years (1.7 to 4.3), a total of 139 patients (13.4%) experienced our primary end point. There was an association between the unfavorable combined event and the degree of MR (p <0.001). After adjustment for relevant confounders, moderate or severe MR remained as an independent predictor of the combined primary end point (adjusted hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.57 to 6.27) and each event separately (adjusted HR death 3.1, 95% CI 1.34 to 7.2; adjusted HR heart failure 3.3, 95% CI 1.16 to 9.4). In conclusion, moderate or severe MR detected early with echocardiography was independently associated with a worse long-term prognosis in patients with STEMI treated with PPCI., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
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21. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry.
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Ribeiro HB, Webb JG, Makkar RR, Cohen MG, Kapadia SR, Kodali S, Tamburino C, Barbanti M, Chakravarty T, Jilaihawi H, Paradis JM, de Brito FS Jr, Cánovas SJ, Cheema AN, de Jaegere PP, del Valle R, Chiam PT, Moreno R, Pradas G, Ruel M, Salgado-Fernández J, Sarmento-Leite R, Toeg HD, Velianou JL, Zajarias A, Babaliaros V, Cura F, Dager AE, Manoharan G, Lerakis S, Pichard AD, Radhakrishnan S, Perin MA, Dumont E, Larose E, Pasian SG, Nombela-Franco L, Urena M, Tuzcu EM, Leon MB, Amat-Santos IJ, Leipsic J, and Rodés-Cabau J
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- Aged, Aged, 80 and over, Aortic Valve surgery, Bicuspid Aortic Valve Disease, Cohort Studies, Coronary Occlusion mortality, Coronary Occlusion therapy, Disease Management, Female, Heart Defects, Congenital mortality, Heart Valve Diseases mortality, Humans, Male, Postoperative Complications mortality, Postoperative Complications therapy, Predictive Value of Tests, Retrospective Studies, Treatment Outcome, Cardiac Catheterization adverse effects, Coronary Occlusion diagnosis, Heart Defects, Congenital surgery, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation adverse effects, Postoperative Complications diagnosis, Registries
- Abstract
Objectives: This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO)., Background: Very little data exist on CO following TAVI., Methods: This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size)., Results: Baseline and procedural variables associated with CO were older age (p < 0.001), female sex (p < 0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower in patients with obstruction than in control subjects (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001; 28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention., Conclusions: Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2013
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22. Long-term prognostic benefit of field triage and direct transfer of patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.
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Estévez-Loureiro R, Calviño-Santos R, López-Sainz A, Vázquez-Rodríguez JM, Soler-Martín MR, Prada-Delgado O, Barge-Caballero E, Salgado-Fernández J, Aldama-López G, Piñón-Esteban P, Flores-Ríos X, Barreiro-Díaz M, Varela-Portas J, Freire-Tellado M, García-Guimaraes M, Vázquez-González N, and Castro-Beiras A
- Subjects
- Aged, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Prognosis, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary, Heart Conduction System physiopathology, Myocardial Infarction therapy, Patient Transfer statistics & numerical data, Triage statistics & numerical data
- Abstract
Direct transfer (DT) to the catheterization laboratory has been demonstrated to reduce delays in primary percutaneous coronary intervention (PPCI). However, data with regard to its effect on long-term mortality are sparse. The aim of this study was to investigate the effect of DT on long-term mortality in patients with ST-segment elevation myocardial infarctions treated with PPCI. A cohort study was conducted of 1,859 patients (mean age 63.1 ± 13 years, 80.2% men) who underwent PPCI from May 2005 to December 2010. From the whole series, 425 patients (23%) were admitted by DT and 1,434 (77%) by emergency departments. DT patients were younger (mean age 61 ± 12 vs 64 ± 12 years, p = 0.017), were more frequently men (86% vs 76%, p = 0.001), and had a higher proportion of abciximab use (77% vs 64%, p <0.0001). The DT group had a shorter median contact-to-balloon time (105 vs 122 minutes, p <0.0001) and a shorter time to treatment (185 vs 255 minutes, p <0.0001) compared with the emergency department group. Thirty-day and long-term mortality (median follow-up 2.4 years, interquartile range 1.6 to 3.2) were lower in the DT group (3% vs 6%, p = 0.049, and 9.4% vs 14.4%, p = 0.008, respectively). An adjusted Cox regression analysis proved that the DT group had an improved prognosis during follow-up (hazard ratio 0.71, 95% confidence interval 0.50 to 0.99). In conclusion, DT of patients with ST-segment elevation myocardial infarctions for PPCI was associated with fewer delays and improved survival. This benefit was maintained after long follow-up. This strategy should be emphasized in all networks of ST-segment elevation myocardial infarction care., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
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23. Acute coronary artery occlusions complicating a valve-in-valve-in-valve procedure.
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Barge-Caballero G, Salgado-Fernández J, and Vázquez-González N
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- Acute Disease, Aged, 80 and over, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency physiopathology, Cardiac Catheterization instrumentation, Coronary Angiography, Coronary Occlusion diagnosis, Coronary Occlusion therapy, Echocardiography, Transesophageal, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation methods, Humans, Percutaneous Coronary Intervention instrumentation, Prosthesis Design, Prosthesis Failure, Severity of Illness Index, Stents, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Aortic Valve surgery, Aortic Valve Insufficiency therapy, Cardiac Catheterization adverse effects, Coronary Occlusion etiology, Heart Valve Prosthesis Implantation adverse effects
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- 2013
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24. Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI: insights from a cohort of 1391 patients.
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Flores-Ríos X, Couto-Mallón D, Rodríguez-Garrido J, García-Guimaraes M, Gargallo-Fernández P, Piñón-Esteban P, Aldama-López G, Salgado-Fernández J, Calviño-Santos R, Vázquez-González N, and Castro-Beiras A
- Abstract
Aims: To compare the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION risk models in the ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI)., Methods: We studied all consecutive patients with STEMI who underwent PPCI at our institution between 2006 and 2010 (n=1391). The CRUSADE, ACUITY-HORIZONS, and ACTION risk scores were calculated based on the patients' clinical characteristics. The occurrence of in-hospital major bleeding (defined as the composite of intracranial or intraocular bleeding, access site haemorrhage requiring intervention, reduction in haemoglobin ≥4 g/dl without or ≥3g/dl with overt bleeding source, reoperation for bleeding, or blood transfusion) reached 9.8%. Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow test and the C-statistic, respectively. We compared the predictive accuracy of the risk scores by the DeLong non-parametric test., Results: Calibration of the three risk scores was adequate, given the non-significant results of Hosmer-Lemeshow test for the three risk models. Discrimination of CRUSADE, ACUITY-HORIZONS, and ACTION models was good (C-statistic 0.77, 0.70, and 0.78, respectively). The CRUSADE and ACTION risk scores had a greater predictive accuracy than the ACUITY-HORIZONS risk model (z=3.89, p-value=0.0001 and z=3.51, p-value=0.0004, respectively). There was no significant difference between the CRUSADE and ACTION models (z=0.63, p=0.531)., Conclusions: The CRUSADE, ACUITY-HORIZONS, and ACTION scores are useful tools for the risk stratification of bleeding in STEMI treated by PPCI. Our findings favour the CRUSADE and ACTION risk models over the ACUITY-HORIZONS risk score.
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- 2013
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25. Image of a chronic recanalized thrombus by intracoronary imaging: intravascular ultrasound and optical coherence tomography analysis.
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Estévez-Loureiro R, Calviño-Santos R, Salgado-Fernández J, López-Sainz A, García-Guimaraes M, Piñón-Esteban P, Aldama-López G, Vazquez-Gonzalez N, and Castro-Beiras A
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- Aged, Chronic Disease, Humans, Male, Coronary Artery Disease diagnosis, Thrombosis diagnosis, Tomography, Optical Coherence, Ultrasonography, Interventional
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- 2012
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26. Percutaneous closure of an aorto-atrial fistula after surgery for infective endocarditis.
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Estévez-Loureiro R, Salgado Fernández J, Vázquez-González N, Piñeiro-Portela M, López-Sainz Á, Bouzas-Mosquera A, Pombo F, and Castro-Beiras A
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- Adult, Aortic Diseases diagnosis, Aortic Diseases etiology, Echocardiography, Doppler, Color, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Endocarditis, Bacterial complications, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial microbiology, Fistula diagnosis, Fistula etiology, Heart Atria, Heart Diseases diagnosis, Heart Diseases etiology, Humans, Male, Multidetector Computed Tomography, Streptococcal Infections complications, Streptococcal Infections diagnosis, Streptococcal Infections microbiology, Treatment Outcome, Aortic Diseases therapy, Cardiac Catheterization, Cardiac Surgical Procedures, Endocarditis, Bacterial surgery, Fistula therapy, Heart Diseases therapy, Streptococcal Infections surgery, Viridans Streptococci isolation & purification
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- 2012
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27. Primary angioplasty in Northern Galicia: care changes and results following implementation of the PROGALIAM protocol.
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Barge-Caballero E, Vázquez-Rodríguez JM, Estévez-Loureiro R, Calviño-Santos R, Salgado-Fernández J, Aldama-López G, Piñón-Esteban P, Flores-Ríos X, Campo-Pérez R, Rodríguez-Fernández JÁ, Lombán-Villanueva JA, Mesías-Prego A, Gutiérrez-Cortés JM, González-Juanatey C, Portela C, Iglesias-Vázquez A, Varela-Portas Mariño J, Vázquez-González N, and Castro-Beiras A
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- Abciximab, Aged, Angioplasty, Balloon, Coronary mortality, Antibodies, Monoclonal therapeutic use, Delivery of Health Care, Female, Hospitals, University, Humans, Immunoglobulin Fab Fragments therapeutic use, Length of Stay, Logistic Models, Male, Middle Aged, Myocardial Infarction epidemiology, Patient Transfer, Platelet Aggregation Inhibitors therapeutic use, Prognosis, Spain epidemiology, Treatment Outcome, Angioplasty, Balloon, Coronary statistics & numerical data, Myocardial Infarction therapy
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Introduction and Objectives: To analyze changes in healthcare delivery and results for primary angioplasty at Centro Hospitalario Universitario A Coruña following implementation of the PROGALIAM protocol., Methods: Observational registry of 1434 patients referred for primary angioplasty between 2003 and 2007. Results under PROGALIAM (May 2005 - December 2007; n=963) were compared with those from the preceding period (January 2003 - April 2005; n=388)., Results: After implementing PROGALIAM, there were increases in the number of primary angioplasty procedures (preceding period, 14.4 cases/month; PROGALIAM, 32.2 cases/month), mean patient age (preceding period, 61.3 (11.9) years; PROGALIAM, 64.2 (11.7) years; P<.001), and the percentage of patients referred from peripheral hospitals and treated after normal working hours. Overall median first medical contact-to-balloon time increased (previous period, 106 min; PROGALIAM, 113 min; P=.02), but decreased significantly among patients referred from noninterventional centers (previous period, 171 min; PROGALIAM, 146 min; P<.001). Percentage of cases with an first medical contact-to-balloon time <120 min remained unchanged among interventional-center patients (preceding period, 69%; PROGALIAM, 71%; P=.56) and increased among patients at noninterventional centers, although it remained low in this subgroup (preceding period, 17%; PROGALIAM, 30%; P=.04). Thirty-day mortality (preceding period, 5.2%; PROGALIAM, 6.2%; P=.85) and 1-year mortality (preceding period, 9.5%; PROGALIAM, 10.2%; P=.96) remained unchanged., Conclusions: Implementation of PROGALIAM allowed us to increase the percentage of patients receiving primary angioplasty without jeopardizing the clinical results of this treatment., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)
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- 2012
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28. Renal insufficiency and vascular complications after primary angioplasty via femoral route. Impact of vascular closure devices use.
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Prada-Delgado O, Estévez-Loureiro R, Calviño-Santos R, Barge-Caballero E, Salgado-Fernández J, Piñón-Esteban P, Vázquez-Rodríguez JM, Aldama-López G, Flores-Ríos X, Soler-Martín MR, Vázquez-González N, and Castro-Beiras A
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- Aged, Creatinine blood, Endpoint Determination, Female, Humans, Logistic Models, Male, Middle Aged, Renal Insufficiency epidemiology, Risk Factors, Spain epidemiology, Vascular Diseases epidemiology, Angioplasty adverse effects, Femoral Artery surgery, Hemostatic Techniques adverse effects, Hemostatic Techniques instrumentation, Postoperative Complications epidemiology, Renal Insufficiency etiology, Vascular Diseases etiology
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Introduction and Objectives: We sought to determine the incidence of vascular complications in patients with chronic kidney disease undergoing primary angioplasty via the femoral route; we also evaluated the safety and efficacy of the use of vascular closure devices in this setting., Methods: Registry of 527 patients undergoing primary angioplasty via the femoral route from January 2003 to December 2008. Chronic kidney disease was defined as creatinine clearance less than 60 mL/min. The primary endpoint was the presence of major vascular complications., Results: Baseline chronic kidney disease was observed in 166 (31.5%) patients. Patients with chronic kidney disease experienced higher rates of major vascular complications compared to those without worsening of renal function (8.4% vs 4.2%; P=.045), especially those requiring transfusion (6.6% vs 1.9%; P=.006). Among patients with chronic kidney disease, 129 (77.7%) received a vascular closure device and manual compression was used in 37 patients (22.3%). The risk of major vascular complications was significantly lower with vascular closure device use compared to manual compression (4.7% vs 21.6%; P=.003). Multivariable logistic regression analysis showed that the use of a vascular closure device was independently associated with a decreased risk of major vascular complications in patients with chronic kidney disease undergoing primary angioplasty (odds ratio=0.11; 95% confidence interval, 0.03-0.41; P=.001)., Conclusions: Patients with chronic kidney disease undergoing primary angioplasty via the femoral route experience higher rates of major vascular complications. The use of vascular closure devices in this group of patients is safe and is associated with lower rates of major vascular complications compared to manual compression., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)
- Published
- 2012
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29. Comparison of the prognostic predictive value of the TIMI, PAMI, CADILLAC, and GRACE risk scores in STEACS undergoing primary or rescue PCI.
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Méndez-Eirín E, Flores-Ríos X, García-López F, Pérez-Pérez AJ, Estévez-Loureiro R, Piñón-Esteban P, Aldama-López G, Salgado-Fernández J, Calviño-Santos RA, Vázquez Rodríguez JM, Vázquez-González N, and Castro-Beiras A
- Subjects
- Abciximab, Acute Coronary Syndrome surgery, Aged, Cohort Studies, Coronary Disease complications, Coronary Disease mortality, Female, Humans, Logistic Models, Male, Middle Aged, Myocardial Revascularization, Postoperative Complications mortality, Predictive Value of Tests, Prognosis, ROC Curve, Recurrence, Registries, Retrospective Studies, Risk Assessment, Treatment Outcome, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal therapeutic use, Coronary Disease surgery, Immunoglobulin Fab Fragments therapeutic use, Myocardial Infarction drug therapy, Myocardial Infarction surgery, Platelet Aggregation Inhibitors therapeutic use, Postoperative Complications drug therapy, Thrombolytic Therapy
- Abstract
Introduction and Objectives: We sought to compare the predictive value of the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) scores for the outcome of ST-segment elevation acute coronary syndrome undergoing urgent percutaneous coronary intervention., Methods: We performed a retrospective analysis of a cohort composed of all consecutive patients with ST-segment elevation acute coronary syndrome treated by urgent percutaneous coronary intervention between 2006 and 2010 (n=1503). TIMI, PAMI, CADILLAC, and GRACE risk scores were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for death, reinfarction, and target-vessel revascularization at 30 days and 1 year, using the C statistic, which was obtained by means of logistic regression and ROC curves., Results: The TIMI, PAMI, CADILLAC and GRACE showed an excellent predictive value for 30-day and 1-year mortality (C statistic range, 0.8-0.9), with superiority of the TIMI, CADILLAC, and GRACE risk models. The performance of these 4 scores was poor for both reinfarction and target-vessel revascularization (C statistic, 0.5-0.6)., Conclusions: The TIMI, PAMI, CADILLAC, and GRACE scores provide excellent information to stratify the risk of mortality in patients treated by percutaneous coronary intervention. The TIMI, CADILLAC, and GRACE models have higher predictive accuracy. The usefulness of these models for reinfarction and target-vessel revascularization prediction is questionable., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)
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- 2012
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30. Safety and efficacy of femoral vascular closure devices in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction.
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Prada-Delgado Ó, Estévez-Loureiro R, Calviño-Santos R, Barge-Caballero E, Salgado-Fernández J, Piñón-Esteban P, Vázquez-Rodríguez JM, Aldama-López G, Flores-Ríos X, Soler-Martín MR, Vázquez-González N, and Castro-Beiras A
- Subjects
- Aged, Cardiac Catheterization, Female, Femoral Artery surgery, Hemorrhage epidemiology, Hemorrhage prevention & control, Hemostasis, Surgical, Humans, Length of Stay, Logistic Models, Male, Middle Aged, Multivariate Analysis, Platelet Aggregation Inhibitors therapeutic use, Prognosis, Wound Closure Techniques adverse effects, Angioplasty, Balloon, Coronary, Myocardial Infarction therapy, Wound Closure Techniques instrumentation
- Abstract
Background: The use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A lack of information exists regarding the use of VCDs in this group of patients because they have been routinely excluded from randomized trials. This study sought to evaluate the safety and efficacy of the routine use of VCDs after primary PCI., Methods: A total of 558 consecutive patients undergoing primary PCI for STEMI via femoral route were studied for in-hospital outcomes through a prospective registry from January 2003 to December 2008. The primary end point was the presence of major vascular complication (MVC) defined as a composite of fatal access site bleeding, access site complication requiring interventional or surgical correction, or access site bleeding with ≥3 g/dL drop in hemoglobin or requiring blood transfusion., Results: Of the total patients, 464 (83.2%) received a VCD; and manual compression was used in 94 patients (16.8%). Major vascular complication occurred in 5.2% of patients. The risk of MVC was significantly lower with VCDs compared with manual compression (4.3% vs 9.6%, P = .036). Multivariable logistic regression analysis determined that VCD use remained an independent predictor of lower rate of MVC (odds ratio 0.38, 95% CI 0.17-0.91)., Conclusions: The use of VCDs in patients undergoing primary PCI for STEMI is safe and is associated with lower rates of MVC compared with manual compression., (Copyright © 2011 Mosby, Inc. All rights reserved.)
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- 2011
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31. Direct transfer of ST-elevation myocardial infarction patients for primary percutaneous coronary intervention from short and long transfer distances decreases temporal delays and improves short-term prognosis: the PROGALIAM Registry.
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Estévez-Loureiro R, Calviño-Santos R, Vázquez-Rodríguez JM, Marzoa-Rivas R, Barge-Caballero E, Salgado-Fernández J, Aldama-López G, Barreiro-Díaz M, Varela-Portas J, Freire-Tellado M, Vázquez-González N, and Castro-Beiras A
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- Disease Progression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Prognosis, Retrospective Studies, Spain epidemiology, Survival Rate trends, Time Factors, Transportation of Patients standards, Treatment Outcome, Angioplasty, Balloon, Coronary, Electrocardiography, Myocardial Infarction therapy, Registries, Transportation of Patients methods
- Abstract
Aims: This study sought to evaluate the impact of a direct transfer strategy on treatment times and prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI)., Methods and Results: We conducted a cohort study of 1,194 patients who underwent PPCI in our centre between May 2005 and December 2008. We studied the role of direct transfer on time to treatment and door-to-balloon delays and its effect on 30-day mortality adjusted by risk profile on admission. During this period, 255 patients (21%) experienced direct transfer (DT) from the field to the catheterisation laboratory. Patients referred directly for PPCI experienced lower median door-to-balloon delay (102 minutes vs. 125 minutes, p<0.0001) and lower time to treatment (median 189 minutes vs. 259 minutes, p<0.0001) when compared with those referred from emergency departments (ED). These differences were consistent, with respect to door-to-balloon delay and time to treatment interval, in patients from our catchment area: median 88 vs. 98 minutes, (p=0.003) and 174 vs. 219 minutes (p<0.0001) respectively, and from long-distance transfer: 110 vs. 169 minutes (p<0.0001) and 197 minutes vs. 342 minutes (p<0.0001) respectively. Patients in the DT group experienced lower 30-day mortality than patients transferred from the ED (2.7% vs. 6.8%, p=0.017). In a multivariable analysis, DT strategy was independently associated with better short-term prognosis (OR 0.33, CI95% 0.12 - 0.92)., Conclusions: Direct transfer reduces time delays and improves prognosis of patients with STEMI undergoing PPCI.
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- 2010
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32. Prevalence, etiology and outcome of catheterization laboratory false alarms in patients with suspected ST-elevation myocardial infarction.
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Barge-Caballero E, Vázquez-Rodríguez JM, Estévez-Loureiro R, Barge-Caballero G, Rodríguez-Vilela A, Calviño-Santos R, Salgado-Fernández J, Aldama-López G, Piñón-Esteban P, Campo-Pérez R, Rodríguez-Fernández JA, Vázquez-González N, Muñiz-García J, and Castro-Beiras A
- Subjects
- Aged, Angioplasty, Angioplasty, Balloon, Coronary, Cardiac Surgical Procedures, Coronary Angiography, False Positive Reactions, Female, Humans, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction diagnosis, Cardiac Catheterization adverse effects, Electrocardiography, Myocardial Infarction epidemiology, Myocardial Infarction etiology
- Abstract
Introduction and Objectives: To investigate the prevalence, causes and outcome of catheterization laboratory false alarms (CLFAs) in a regional primary angioplasty network., Methods: A prospective registry of 1,662 patients referred for primary angioplasty between January 2003 and August 2008 was reviewed to identify CLFAs (i.e. when no culprit coronary lesion could be found)., Results: No culprit coronary lesion could be identified in 120 patients (7.2%; 95% confidence interval [CI], 5.9-8.5%). Of these, 104 (6.3%, 95% CI, 5.1-7.4%) had a discharge diagnosis other than ST-elevation myocardial infarction, 91 (5.5%; 95% CI, 4.3-6.6%) had no significant coronary disease, and 64 (3.8%; 95% CI, 2.9-4.8%) tested negative for cardiac biomarkers. The most frequent alternative diagnoses were: previous Q-wave myocardial infarction (18 cases), nonspecific ST-segment abnormalities (11), pericarditis (10) and transient apical dyskinesia (10). The 30-day mortality rate was similar in patients with and without culprit lesions (5.8% vs. 5.8%; P=.99). The prevalence of CLFAs was slightly higher in patients not previously evaluated by a cardiologist and referred from emergency departments in hospitals without catheterization laboratories than in those referred by cardiologists from emergency departments at hospitals with such facilities (9.5% vs. 6.1%; P=.02; odds ratio=1.64; 95% CI, 1.08-2.5). The prevalence of CLFAs was not significantly higher in patients referred by physicians with out-of-hospital emergency medical services (7.2%; P=.51; odds ratio=1.37; 95% CI, 0.79-2.37)., Conclusions: The prevalence of CLFAs was 7.2%, with the criterion of no culprit coronary lesion. Our findings suggest that different patterns of referral to catheterization laboratories could account for small variations in the prevalence of CLFAs.
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- 2010
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33. Effect of stent thrombosis on the risk-benefit balance of drug-eluting stents and bare metal stents.
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Flores-Ríos X, Abugattás-de Torres JP, Campo-Pérez R, Piñón-Esteban P, Aldama-López G, Salgado-Fernández J, Calviño-Santos R, Vázquez-Rodríguez JM, Vázquez-González N, and Castro-Beiras A
- Subjects
- Aged, Antineoplastic Agents, Phytogenic administration & dosage, Antineoplastic Agents, Phytogenic therapeutic use, Cohort Studies, Coronary Thrombosis etiology, Coronary Thrombosis mortality, Female, Follow-Up Studies, Graft Occlusion, Vascular prevention & control, Humans, Male, Middle Aged, Paclitaxel administration & dosage, Paclitaxel therapeutic use, Retrospective Studies, Risk Assessment, Coronary Thrombosis epidemiology, Drug-Eluting Stents adverse effects, Stents adverse effects
- Abstract
Introduction and Objectives: To determine the difference in the risk of stent thrombosis between drug-eluting stents (DES) and bare-metal stents (BMS) and to assess the clinical implications., Methods: A retrospective analysis of two cohorts of patients treated at our center with either > or =1 paclitaxeleluting stents (PES) (n=430) or > or =1 BMSs (n=1230) during 2003-2004 was carried out using propensity score methods to compare the adjusted risks of stent thrombosis, instent restenosis, cardiovascular death, acute myocardial infarction (AMI), and target-lesion revascularization with the two stent types., Results: After a median follow-up of 46 months, there was a higher risk of stent thrombosis in PESs (hazard ratio [HR]=3; 95% confidence interval [CI], 1.2-7.1] though the risk of in-stent restenosis was lower (HR=0.3; 95% CI, 0.2-0.7]. There was no difference in the risk of cardiovascular death, AMI or target-lesion revascularization. With PESs, the risks of target-lesion revascularization (HR=0.33; 95% CI, 0.2-0.7) and in-stent restenosis (HR=0.32; 95% CI, 0.2-0.7) were reduced during the first year of follow-up. After this time, the risks of target-lesion revascularization (HR=1.8; 95% CI, 1-3.2) and very late stent thrombosis (HR=12.8; 95% CI, 3-55.1) both increased., Conclusions: Our findings indicate that the balance of risks and benefits of PESs compared with BMSs is different in the early and late periods after stent implantation. The greatly increased risk of very late stent thrombosis in PESs could cancel out the clinical benefits associated with the reduction in in-stent restenosis observed in PESs relative to BMSs.
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- 2010
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34. [Cobra-like deformation of amplatzer devices used for closing atrial septal defects: can it be avoided?].
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Estévez-Loureiro R, Martínez-Bendayan I, Salgado-Fernández J, and Rueda-Núñez F
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- Aged, Female, Humans, Heart Septal Defects, Atrial therapy, Prosthesis Failure, Septal Occluder Device
- Published
- 2010
35. Safety and feasibility of returning patients early to their originating centers after transfer for primary percutaneous coronary intervention.
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Estévez-Loureiro R, Calviño-Santos R, Vázquez JM, Barge-Caballero E, Salgado-Fernández J, Piñeiro M, Freire-Tellado M, Varela-Portas J, Martínez L, Gómez S, Rodríguez JA, Vázquez N, and Castro-Beiras A
- Subjects
- Cohort Studies, Feasibility Studies, Female, Hospitals, Humans, Male, Middle Aged, Prospective Studies, Safety, Time Factors, Angioplasty, Balloon, Coronary, Myocardial Infarction therapy, Patient Transfer
- Abstract
Introduction and Objectives: At present, little information is available on returning patients with ST-elevation myocardial infarction (STEMI) to their originating centers after transfer for primary percutaneous coronary intervention (PPCI). The objective of this study was to evaluate the safety and feasibility of the early return of these patients to their originating centers., Methods: The cohort study involved 200 consecutive STEMI patients (age 62+/-13 years, 83% male) who were returned to their originating centers after PPCI. They were compared with a group of 297 patients with similar characteristics from our healthcare catchment area. The length of stay in the intervention hospital and major adverse cardiovascular events occurring within 30 days were recorded., Results: The median length of stay in the intervention hospital was 8 hours. No adverse events occurred during transport in the group who returned to their originating centers. At 30-day follow-up, no significant difference was observed between patients who returned and the control group in either mortality (1.0% vs. 3.7%; P=.064), readmission (5.0% vs. 4.5%; P=.657), ischemic complications (2.5% vs. 2.0%; P=.721), re-catheterization (5.0% vs. 2.5%; P=.112), stroke (1% vs. 1%; P=.936) or the composite end-point (11% vs. 9.2%; P=.540). Multivariate analysis showed that returning patients after PPCI was not associated with a significantly greater number of major adverse cardiovascular events (odds ratio=1.32; 95% confidence interval, 0.62-2.80)., Conclusions: The early return of patients with low-risk STEMI to their originating centers after PPCI was safe and feasible.
- Published
- 2009
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36. Mean platelet volume predicts patency of the infarct-related artery before mechanical reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
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Estévez-Loureiro R, Salgado-Fernández J, Marzoa-Rivas R, Barge-Caballero E, Pérez-Pérez A, Noriega-Concepción V, Calviño-Santos R, Vázquez-Rodríguez JM, Vázquez-González N, Castro-Beiras A, and Kaski JC
- Subjects
- Abciximab, Aged, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal therapeutic use, Female, Follow-Up Studies, Humans, Immunoglobulin Fab Fragments therapeutic use, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction drug therapy, Myocardial Infarction surgery, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Prognosis, Survival Analysis, Vascular Patency, Blood Platelets pathology, Myocardial Infarction blood, Myocardial Infarction therapy
- Abstract
Background and Aims: Patency of infarct-related artery (IRA) before mechanical reperfusion with primary percutaneous coronary intervention (PPCI) has been associated with better prognosis in patients with ST-Elevation myocardial infarction (STEMI). Mean platelet volume (MPV) increases in STEMI patients and may be associated with increased thrombotic potential. In STEMI patients scheduled for PPCI we sought to assess whether mean platelet volume (MPV), as measured at admission, correlates with "spontaneous" reperfusion of the IRA and short-term clinical outcome., Methods: Blood samples were obtained on hospital admission in 617 consecutive patients (82% men; age 64 + or - 12 years) with STEMI, before PPCI. 372 (61%) patients were treated with the GP IIb/IIIa blocker abciximab. The main study endpoint was mortality at 30 days., Results: MPV was significantly lower in patients with basal TIMI flow grade 2 -3 compared to patients with TIMI grade 0-1 (median, 9 vs. 8.5 fL, p<0.0001). After adjustment, MPV remained an independent predictor of the patency of the IRA (OR 0.63, CI 95% 0.51 - 0.78). A cut off value of 8.95 fL had a predictive negative value of 82% to identify patients with patent IRA. Using this cut point, and after adjusting for confounders, MPV was an independent predictor of 30-day mortality (HR 2.92, CI 95% 1.36 - 6.29). When patients were subdivided according to abciximab use, MPV was a marker of worse outcome but only in patients who did not receive abciximab (HR 3.67, CI 95% 1.13 - 11.49)., Conclusion: An increased MPV is an independent predictor of both a patent IRA (TIMI flow 2 or 3 before PPCI) and 30-day mortality. This marker may be able to identify patients requiring more aggressive antiplatelet therapy.
- Published
- 2009
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- View/download PDF
37. Coronary-subclavian steal syndrome.
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Bouzas-Mosquera A, Salgado-Fernández J, Calviño-Santos R, Aldama G, Vázquez-Rodríguez JM, Vázquez-González N, and Castro-Beiras A
- Subjects
- Angiography methods, Angioplasty, Balloon methods, Diagnosis, Differential, Follow-Up Studies, Humans, Male, Middle Aged, Subclavian Steal Syndrome therapy, Subclavian Artery diagnostic imaging, Subclavian Steal Syndrome diagnostic imaging
- Published
- 2009
- Full Text
- View/download PDF
38. [Long-term results with the off-label use of paclitaxel-eluting stents].
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Flores Ríos X, Marzoa Rivas R, Abugattás de Torres JP, Piñón Esteban P, Aldama López G, Salgado Fernández J, Calviño Santos R, Vázquez Rodríguez JM, Vázquez González N, and Castro Beiras A
- Subjects
- Device Approval, Drug Approval, Female, Follow-Up Studies, Humans, Male, Middle Aged, Time Factors, Drug-Eluting Stents adverse effects, Paclitaxel therapeutic use
- Abstract
Introduction and Objectives: Little information is available about the results obtained with the off-label use of drug-eluting stents. Our aim was to investigate clinical findings on long-term follow-up., Methods: The study included 604 consecutive patients who received > or = 1 paclitaxel-eluting stents (PES) at our catherization laboratory between June 2003 and February 2005. Patients were divided into two groups according to whether stent use was on-label or off-label as defined by current practice. The primary study endpoints were the combination of death and non-fatal acute myocardial infarction (AMI) and the combination of death, AMI and target-vessel revascularization (TVR). Secondary endpoints were these events individually and late stent thrombosis (ST)., Results: During the median follow-up period of 34.3 months (interquartile range 8.6 months), PESs had been used off-label in the majority of patients (i.e., 464, 76.8% of the sample) and their use was associated with an increased risk of death or AMI (hazard ratio [HR]=2.2; 95% confidence interval [CI], 1.2-4) and of death, AMI or TVR (HR=1.8; 95% CI, 1.1-3). There was no significant difference in individual events (i.e., death, AMI or TVR). The group who used stents off-label had poorer clinical characteristics (i.e., older age, and higher likelihoods of previous AMI or previous revascularization and multivessel disease), as well as a higher incidence of ST (5% vs. 0; log-rank test, P=.015)., Conclusions: The off-label use of PESs was associated with an increased risk of a combined clinical endpoint during long-term follow-up. Further studies are needed to determine the efficacy and safety of these devices in these settings.
- Published
- 2008
39. Late thrombosis of paclitaxel-eluting stents: long-term incidence, clinical consequences, and risk factors in a cohort of 604 patients.
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Flores-Ríos X, Marzoa-Rivas R, Abugattás-de Torres JP, Piñón-Esteban P, Aldama-López G, Salgado-Fernández J, Calviño-Santos R, Vázquez-Rodríguez JM, Vázquez-González N, and Castro-Beiras A
- Subjects
- Aged, Coronary Disease mortality, Coronary Restenosis epidemiology, Drug Administration Schedule, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction epidemiology, Platelet Aggregation Inhibitors therapeutic use, Risk Factors, Statistics, Nonparametric, Coronary Disease therapy, Coronary Thrombosis epidemiology, Drug-Eluting Stents adverse effects, Paclitaxel administration & dosage
- Abstract
Background: Late thrombosis is the major safety concern of drug-eluting stents, but its incidence in common clinical practice remains controversial to date, especially beyond the first year after stent implantation. We sought to investigate the incidence, clinical consequences, and risk factors of late thrombosis after drug-eluting stent implantation., Methods: Consecutive patients (N = 604) who received > or = 1 paclitaxel-eluting stent(s) (PES) between June 2003 and February 2005 at our institution were enrolled. Clinical characteristics and major outcomes were reviewed to detect cases and predictors of late and very late definite PES thrombosis (LDT) of PES, as currently defined by the Academic Research Council., Results: During long-term follow-up (median 34.3 months, IQR 8.6), 17 cases of LDT were noted (cumulative incidence 2.8%, 95% CI 1.7%-4.5%). Most of LDT were very late thromboses (14 cases, 82%). Late and very late definite PES thrombosis appeared at a steady rate (incidence density 1.1% patient-years). Late and very late definite PES thrombosis was related to a high risk of all-cause death (HR 3.2, 95% CI 1.3-7.9) and cardiac death (HR 6.0, 95% CI 2.3-15.6). Withdrawal of antiplatelet therapy, left ventricular ejection fraction, and average stent diameter per patient were independent predictors of LDT in multivariate analysis., Conclusions: Late and very late definite PES thrombosis may be more frequent in a real setting than anticipated by initial experimental and observational studies but is keeping with more recent scientific evidence. It seems to occur at a constant rate during long-term follow-up and is associated with a high risk of overall and cardiac death.
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- 2008
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40. [Transient cortical blindness following cardiac catheterization: an alarming but infrequent complication with a good prognosis].
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García de Lara J, Vázquez-Rodríguez JM, Salgado-Fernández J, Calviño-Santos R, Vázquez-González N, and Castro-Beiras A
- Subjects
- Aged, Humans, Male, Middle Aged, Prognosis, Blindness, Cortical etiology, Cardiac Catheterization adverse effects
- Abstract
Transient cortical blindness is a rare complication of using an angiographic contrast agent. Its incidence following cardiac catheterization is low and has been studied scarcely. This article describes our experience with this condition and compares it with the findings of a review of published reports. Although the clinical characteristics of the onset and development of the condition are well-defined, its occurrence usually causes great alarm, in both patients and interventional cardiologists. It occurs more frequently in patients with an internal mammary artery graft and in those undergoing extended procedures. Etiologically, it appears to be related to the direct toxic effects of an accumulation of contrast in lower body areas during prolonged supination. Contrast can leak through the vertebral arteries during internal mammary artery catheterization. The condition resolves completely within a few days. Further investigations using contrast are not contraindicated.
- Published
- 2008
41. [Contrast-induced nephropathy and acute renal failure following emergent cardiac catheterization: incidence, risk factors and prognosis].
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Bouzas-Mosquera A, Vázquez-Rodríguez JM, Calviño-Santos R, Peteiro-Vázquez J, Flores-Ríos X, Marzoa-Rivas R, Piñón-Esteban P, Aldama-López G, Salgado-Fernández J, Vázquez-González N, and Castro-Beiras A
- Subjects
- Acute Kidney Injury epidemiology, Acute Kidney Injury therapy, Cohort Studies, Creatinine blood, Emergencies, Female, Humans, Incidence, Male, Middle Aged, Prognosis, Regression Analysis, Retrospective Studies, Risk Assessment, Risk Factors, Shock, Cardiogenic chemically induced, Urea blood, Acute Coronary Syndrome therapy, Acute Kidney Injury chemically induced, Cardiac Catheterization adverse effects, Contrast Media adverse effects, Iohexol adverse effects
- Abstract
Introduction and Objectives: The aim was to investigate the incidence and prognosis of, and predictive factors for, acute renal failure following emergent cardiac catheterization., Methods: The study involved 602 consecutive patients who underwent emergent cardiac catheterization. Acute renal failure (ARF) was defined as an increase in serum creatinine level > or =0.5 mg/dL within 72 hours following the procedure. Predictive factors for and the prognosis of ARF were evaluated in an initial cohort of 315 patients, and a risk score was derived. The risk score was validated in a second cohort of 287 patients. The median (interquartile) follow-up time was 1.3 years (0.8-2.0 years)., Results: Seventy-two of the 602 patients (12.0%) developed ARF. In the initial cohort of 315 patients, the following factors were predictors of ARF: cardiogenic shock at admission (odds ratio [OR] 4.56), diabetes mellitus (OR 2.98), time to reperfusion >6 hours (OR 3.18), anterior myocardial infarction (OR 2.61), baseline serum creatinine level > or =1.5 mg/dL (OR 3.51), and baseline serum urea level > or =50 mg/dL (OR 3.00). A risk score based on these variables was constructed in which cardiogenic shock = 3 points and each of the remaining variables = 2 points. Patients in the validation cohort were divided into five risk categories: in those with 0 points, the incidence of ARF was 1.2%; with 2-3 points, 8.7%; with 4-5 points, 12.5%; with 6-7 points, 46.2%; and with > or =8 points, 66.7% (P< .0001). Cox regression analysis showed that ARF was a powerful predictor of total mortality (hazard ratio [HR] 5.97, 95% confidence interval [CI] 2.54-14.03; P< .0001) and of a major cardiovascular event (HR 3.29, 95% CI 1.61-6.75; P=.001)., Conclusions: The incidence of ARF after emergent cardiac catheterization is high. Cardiogenic shock, diabetes mellitus, myocardial infarction location, time to reperfusion, and serum creatinine and urea levels are predictors of ARF. Patients who developed this complication had higher mortality and major cardiovascular events rates.
- Published
- 2007
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42. Hepatic rupture after Heimlich maneuver.
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Otero Palleiro MM, Barbagelata López C, Fernández Pretel MC, and Salgado Fernández J
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- Aged, Aged, 80 and over, Humans, Liver diagnostic imaging, Male, Rupture diagnostic imaging, Tomography, X-Ray Computed, Airway Obstruction therapy, First Aid adverse effects, Liver injuries
- Published
- 2007
- Full Text
- View/download PDF
43. Deep vein thrombosis after transfemoral endomyocardial biopsy in cardiac transplant recipients.
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Calviño-Santos RA, Crespo-Leiro MG, Vázquez-Rodríguez JM, Salgado-Fernández J, Vázquez-González N, Paniagua-Martín MJ, and Castro-Beiras A
- Subjects
- Biopsy adverse effects, Biopsy methods, Femoral Vein, Humans, Endocardium pathology, Heart Transplantation, Myocardium pathology, Venous Thrombosis etiology
- Published
- 2005
- Full Text
- View/download PDF
44. Management of iatrogenic radial artery perforation.
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Calviño-Santos RA, Vázquez-Rodríguez JM, Salgado-Fernández J, Vázquez-González N, Pérez-Fernández R, Vázquez-Rey E, and Castro-Beiras A
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Treatment Outcome, Coronary Angiography methods, Iatrogenic Disease, Needlestick Injuries therapy, Prosthesis Implantation methods, Radial Artery
- Abstract
The aim of this study was to evaluate a new protocol allowing coronary angiography to be performed transradially in spite of the occurrence of iatrogenic radial artery perforation during catheterization. Nine patients with iatrogenic radial artery perforation were managed conservatively by inserting a long arterial sheath in the damaged radial artery up to the brachial artery, after which the diagnostic and/or interventional procedures that had motivated transradial catheterization were completed via the protected radial artery. Radial angiography performed immediately thereafter showed no extravasation, and no major vascular complications developed during follow-up. The day after the procedure, two patients had asymptomatic radial occlusion, but the other seven patients had normal radial pulses and reversed Allen test responses showing normal perfusion. A conservative management technique, installation of a long arterial sheath not only promotes resolution of iatrogenic radial artery perforation but also allows the procedures motivating catheterization to be completed transradially., (Copyright 2004 Wiley-Liss, Inc.)
- Published
- 2004
- Full Text
- View/download PDF
45. [Transradial approach to coronary angiography and angioplasty: initial experience and learning curve].
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Salgado Fernández J, Calviño Santos R, Vázquez Rodríguez JM, Vázquez González N, Vázquez Rey E, Pérez Fernández R, Bouzas Zubeldía B, and Castro Beiras A
- Subjects
- Angioplasty, Balloon, Coronary education, Cardiac Catheterization methods, Catheters, Indwelling statistics & numerical data, Female, Femoral Artery, Humans, Learning, Male, Middle Aged, Postoperative Complications, Angioplasty, Balloon, Coronary methods, Coronary Angiography methods, Radial Artery
- Abstract
Introduction: The transradial approach has emerged as an attractive alternative to the femoral approach for coronary angiography and interventions. We describe our experience with the transradial approach and analyze the influence of the learning curve., Patients and Methods: The transradial approach was attempted in patients with a good radial pulse and normal Allen test. When feasible and clinically indicated, we attempted ad hoc intervention. We divided the study population into two groups: Group A (the first 200 cases) and B (all other patients). We compared the radial group with a matched femoral control group., Results: We attempted the transradial approach in 526 patients (77.6% male; age 63.5 +/- 11.51), and obtained a success rate of 93.7%. We found differences between group A and B in the success rate (91.0 vs 95.4%, p = 0,04), duration of procedure [23 (16-29) vs. 19 (15-24) minutes; p < 0.001], and fluoroscopy time [6.4 (4.2-10) vs. 5.0 (3.0-7.7) minutes; p < 0,001]. At 24 h of follow-up, we found small hematomas in 9.4%, bleeding in 4.9%, and radial artery obstruction in 2.8%, with no cases of arteriovenous fistula, pseudoaneurysm, or need for vascular surgery. We attempted intervention in 169 patients with 258 lesions, achieving angiographic success in 96.1%. We found no differences in the characteristics of the lesions and patients, or in the angiographic success rate of the radial and femoral PTCA groups., Conclusions: The transradial approach is a safe and effective alternative to femoral catheterization. There is a significant learning curve associated with the successful performance of transradial procedures.
- Published
- 2003
- Full Text
- View/download PDF
46. [Exercise echocardiography to differentiate dilated cardiomyopathy from ischemic left ventricular dysfunction].
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Peteiro Vázquez J, Monserrat Iglesias L, Vázquez Rey E, Calviño Santos R, Vázquez Rodríguez JM, Fabregas Casal R, Salgado Fernández J, Rodríguez-Fernández JA, and Castro Beiras A
- Subjects
- Aged, Coronary Angiography, Echocardiography, Doppler, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Cardiomyopathy, Dilated diagnostic imaging, Exercise Test methods, Myocardial Ischemia diagnostic imaging, Ventricular Dysfunction, Left diagnostic imaging
- Abstract
Objectives: Previous studies have shown the usefulness of dobutamine echocardiography to differentiate dilated cardiomyopathy (DC) from ischemic left ventricular dysfunction (ILVD), but no studies have been made using exercise echocardiography (EE). We hypothesized that most patients with DC have some contractile reserve and experience an increase in left ventricular ejection fraction (LVEF) during exercise, as opposed to patients with ILVD. Differences in response to EE may be useful to clinically differentiate between these two entities., Patients and Method: Between 1 March 1995 and 1 March 2001, we performed 4,133 EE studies on 3,830 patients. Of 289 patients (8%) with moderate or severe LV dysfunction (biplane LVEF < 41% and left ventricular end-diastolic diameter > 5.2 cm), 207 were excluded: 111 for a history of myocardial infarction; 28 for scarring on echocardiography (regional akinesia/dyskinesia with thinning and/or increased brightness); 13 for previous revascularization procedures; 9 for aortic valve disease; 11 for a known cause of cardiomyopathy; and 35 for not undergoing angiography. The study group was therefore composed of 82 patients who were encouraged to perform maximal treadmill EE. EE criteria for ILVD were either impaired regional wall motion (RWM) or a decrease/no change in LVEF from baseline to peak exercise, while criteria for DC were RWM improvement/no change and LVEF increase. The ILVD group was formed by 39 patients with stenosis >/= 70% diameter stenosis of a major epicardial coronary artery or major branch vessel. The remaining 43 patients constituted the DC group., Results: The number of coronary risk factors (ILVD 2.0 1.1; DC 1.9 1.1), baseline LVEF (ILVD 30 7; DC 30 8), and exercise-induced angina (ILVD 23%; DC 14%) did not differ between groups (p = NS). ILVD patients achieved less Mets (6.6 3.1 vs 8.3 2.8; p < 0.05), had a lower heart rate x systolic blood pressure product (22 5 vs 27 7; p < 0.001), and developed regional and/or global LV dysfunction more frequently (79 vs 28%; p < 0.001). Sensitivity, specificity, positive and negative predictive values and global accuracy for ILVD detection were 79% (95% CI: 70-88), 72% (95% CI: 63-81), 72% (95% CI: 63-81), 79% (95% CI: 67-85), and 76% (95% CI: 69-83), respectively., Conclusion: Global and/or regional LV function impairment with exercise is accurate in identifying patients with ILVD. This method could reduce the need for invasive procedures.
- Published
- 2003
- Full Text
- View/download PDF
47. [Acute myocardial infarction after anaphylactic reaction to amoxicillin].
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Salgado Fernández J, Penas Lado M, Vázquez González N, López Rico MR, Alemparte Pardavila E, and Castro Beiras A
- Subjects
- Anaphylaxis diagnosis, Drug Hypersensitivity diagnosis, Electrocardiography, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Amoxicillin adverse effects, Anaphylaxis chemically induced, Drug Hypersensitivity physiopathology, Myocardial Infarction chemically induced, Penicillins adverse effects
- Abstract
A 62-year-old man was admitted to the hospital in a state of shock with electrocardiographic signs of inferior-wall acute myocardial infarction. He was initially diagnosed of cardiogenic shock. An urgent coronary angiography showed an irregular stenosis of 90% in the right coronary artery. Coronary angioplasty was performed, and a stent was placed in this lesion. In-depth questioning of the family revealed that the patient had taken an oral dose of amoxicillin 15 minutes before the onset of the symptoms. Further tests proved that he was allergic to amoxicillin, and was diagnosed of anaphylactic shock, complicated with acute myocardial infarction. There are several reports of myocardial infarction as a complication of anaphylactic reaction. We have found very few cases related to antibiotics, and none associated with amoxicillin. The most frequently quoted mechanism in these cases is coronary artery spasm due to the mediators of anaphylaxis. In the case reported herein, the irregular lesion suggests that disruption of an atherosclerotic plaque and platelet aggregation have occurred.
- Published
- 1999
- Full Text
- View/download PDF
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