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Objective To assess the predictive value of four cardiovascular (CV) risk algorithms for identifying high-risk psoriatic arthritis (PsA) patients.Methods Evaluation of patients with PsA enrolled in the Spanish prospective project CARdiovascular in RheuMAtology. Baseline data of 669 PsA patients with no history of CV events at the baseline visit, who were followed in rheumatology outpatient clinics at tertiary centres for 7.5 years, were retrospectively analysed to test the performance of the Systematic Coronary Risk Assessment (SCORE), the modified version (mSCORE) European Alliance of Rheumatology Associations (EULAR) 2015/2016, the SCORE2 algorithm (the updated and improved version of SCORE) and the QRESEARCH risk estimator version 3 (QRISK3).Results Over 4790 years of follow-up, there were 34 CV events, resulting in a linearised rate of 7.10 per 1000 person-years (95% CI 4.92 to 9.92). The four CV risk scales showed strong correlations and all showed significant associations with CV events (p

RESUMEN Introducción y objetivos: La calcificación coronaria es uno de los principales factores que inciden negativamente en la seguridad y la eficacia del intervencionismo coronario percutáneo. Existen varias técnicas de modificación del calcio, pero falta evidencia de estudios aleatorizados sobre la terapia de elección en este escenario. Métodos: El ROLLERCOASTR es un estudio prospectivo, multicéntrico y aleatorizado, diseñado para comparar la seguridad y la eficacia de 3 técnicas de modificación de la placa en el contexto de calcificación coronaria moderada o grave: aterectomía rotacional (AR), aterectomía coronaria con láser láser excimer (ACLE) y litotricia intracoronaria (LIC). El objetivo primario es la expansión del stent evaluada mediante tomografía de coherencia óptica. Su análisis se hará por intención de tratar, con un α de 0,05 entre el grupo de referencia (AR) y cada uno de los otros grupos (ACLE y LIC). Se realizará también un análisis del objetivo primario por protocolo para mantener la coherencia. Si se confirma la hipótesis de no inferioridad, se realizará un análisis bilateral de superioridad. El comité de eventos clínicos y el laboratorio central independiente no conocerán la rama de tratamiento. Asumiendo un error α de 0,05, un error β de 0,2 (80% de potencia), un margen de irrelevancia (ε) del 7% y un 10% de pérdidas por dificultad de medición o imposibilidad de completar la intervención, se estima un tamaño de muestra de 56 casos en cada grupo. Los objetivos secundarios son el éxito del dispositivo, el éxito del procedimiento, la tasa de cruce entre técnicas y la presentación de eventos cardiovasculares adversos importantes al año de seguimiento. Conclusiones: El estudio ROLLERCOASTR evaluará y comparará la seguridad y la eficacia, en pacientes con estenosis coronaria calcificada, de 3 técnicas de modificación de placa: AR, ACLE y LIC. Este ensayo se ha registrado en Clinicaltrials.gov: NCT04181268.

ABSTRACT Introduction and objectives: Coronary calcification is one of the leading factors that affect negatively the safety and effectiveness of percutaneous coronary intervention. Several calcium modification techniques exist. However, there is a lack of randomized evidence on the therapy of choice in this scenario. Methods: The ROLLERCOASTR is a prospective, multicenter, randomized clinical trial designed to compare the safety and efficacy profile of 3 plaque modification techniques in the moderate-to-severe coronary calcification setting: rotational atherectomy (RA), excimer laser coronary angioplasty (ELCA), and intravascular lithotripsy (IVL). The study primary endpoint is stent expansion evaluated by optical coherence tomography. An intention-to-treat analysis will be conducted with an alpha coefficient of 0.05 between the reference group (RA) and the remaining 2 groups (ELCA and IVL). An analysis of the study primary endpoint per protocol will be conducted for consistency purposes. If the non-inferiority hypothesis is confirmed, a superiority 2-sided analysis will be conducted. Both the clinical events committee and the independent core laboratory will be blinded to the treatment arm. Assuming an α error of 0.05, an β error of 0.2 (80% power), a margin of irrelevance (ε) of 7, and losses of 10% due to measurement difficulty or impossibility to complete the intervention, we estimate a sample size of 56 cases per group. The study secondary endpoints are device success, procedural success, crossover rate among the different techniques used, and the occurrence of major adverse cardiovascular events at 1-year follow-up. Conclusions: The ROLLERCOASTR trial will evaluate and compare the safety and effectiveness of 3 plaque modification techniques: RA, ELCA, and IVL in patients with calcified coronary stenosis. This trial was registered at clinicaltrials.gov with identifier NCT04181268.

En torno a la fecha de redacción de esta Página del Editor acabamos de conocer con gran satisfacción que en la última edición del Journal Citation Reports nuestra revista, REC: Interventional Cardiology, ha recibido su primer factor de impacto (FI), siendo este de 1,41. Es sin duda una excepcional noticia, con un valor muy por encima de lo esperado. En anteriores páginas ya hemos manifestado, como otros muchos editores han hecho antes, la excesiva y casi obsesiva dependencia que la publicación médica tiene actualmente con respecto al FI2-6. Todo parece girar en torno a esta métrica tan codiciada y que todas las revistas médicas sin excepción anuncian, sobre todo cuando sube. Los manuscritos publicados en REC: Interventional Cardiology en sus diferentes categorías han tenido de por sí una gran influencia y un notable impacto en la comunidad de cardiología intervencionista de nuestro país y también de otros. De hecho, algunos de los artículos han recibido numerosas citas en las revistas de mayor prestigio internacional. En esta misma línea, los documentos de consenso elaborados por la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) han resultado un éxito en difusión e impacto. No obstante, con todos los aspectos críticos que podamos...

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan su informe anual de actividad hemodinámica en cardiopatías congénitas correspondiente al año 2021. Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos fue telemática y su análisis lo efectuó una empresa externa junto con miembros de la ACI-SEC y el GTH-SECPCC. Resultados: Participaron 16 centros (15 públicos y 1 privado) que acumulan 34 salas de hemodinámica con actividad en cardiopatías congénitas, 7 (20,5%) de ellas con dedicación exclusiva a pacientes pediátricos. Se registraron 1.094 estudios diagnósticos (5,1% más que en 2020) y 1.553 cateterismos intervencionistas (6,4% más que en 2020). Las técnicas más frecuentes fueron el cierre de comunicación interauricular (336 casos), la angioplastia de ramas pulmonares (231 casos) y el cierre de ductus (228 casos). Respecto al año anterior se incrementaron significativamente las técnicas de implantación de válvulas percutáneas (29,3%), cierre de ductus (20,6%) y angioplastia aórtica (12,8%). La tasa de éxito en los procedimientos intervencionistas fue del 95%, con una tasa de complicaciones mayores del 2,7% y una mortalidad intrahospitalaria del 0,2%. Conclusiones: Este trabajo es la segunda publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. Se ha constatado un aumento significativo de los procedimientos diagnósticos y terapéuticos, destacando el incremento en la implantación de válvulas percutáneas, el cierre de ductus y la angioplastia aórtica. La mayoría de las técnicas intervencionistas siguen demostrando excelentes datos de seguridad y eficacia.

ABSTRACT Introduction and objectives: This is the 2021 annual activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC). Methods: All Spanish centers with cath lab capabilities and interventional activity in congenital heart diseases were invited to participate. Data were collected online, analyzed by an external company, and ACI-SEC and GTH-SECPCC members. Results: A total of 16 centers participated—15 public and 1 private—including 34 cath labs with experience in congenital heart diseases, 7 of them (20.5%) exclusively dedicated to pediatric patients. A total of 1094 diagnostic studies (4.5% more than 2020) and 1553 interventional catheterizations (5.8% more than 2020) were registered. The most common procedures were atrial septal defect closure (336 cases), pulmonary branch artery angioplasty (231 cases), and percutaneous closure of the patent ductus arteriosus (228 cases). Interventional procedures were considered successful in 95% of the cases with rates of major procedural complication and in-hospital mortality of 2.7% and 0.2%, respectively. Conclusions: This is the second Spanish Cardiac Catheterization in Congenital Heart Diseases Registry report. A significant increase of diagnostic and interventional procedures was reported with a special increase of percutaneous valve implantation, ductus arteriosus closure, and aortic angioplasty. Most interventional techniques continue to demonstrate excellent safety and efficacy outcomes.

At the time of drafting this Editor’s page, we were thrilled to learn that REC: Interventional Cardiology has received its very first impact factor (IF) of 1.4 in the latest edition of the Journal Citation Reports.1 This is outstanding news and the assigned IF greatly exceeds our expectations. Like many other editors before us, we have previously mentioned on past Editor’s pages the excessive and almost obsessive reliance of the current medical publication world on IF.2-6 Everything seems to revolve around this highly coveted metric, which is made public by all medical journals without exception, especially when it increases. The manuscripts published in the different sections of REC: Interventional Cardiology have significantly impacted the interventional cardiology community in Spain and abroad. Indeed, some of our articles have received numerous citations in top international journals. Likewise, consensus documents drafted by the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) have achieved significant dissemination and impact. However, despite the obvious negative aspects of IF, the truth is that it has become the most widely recognized and accepted metric to estimate the value, visibility, and impact of scientific publications. Therefore, if there is anything we would like to highlight in this Editor’s page, it...

RESUMEN Introducción y objetivos: Las diferencias geográficas y organizativas entre distintas comunidades autónomas (CCAA) pueden generar diferencias en la atención al infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Se han comparado 17 programas de Código Infarto en términos de incidencia, características clínicas, tratamiento de reperfusión, retraso hasta la reperfusión y mortalidad a 30 días. Métodos: Estudio observacional prospectivo nacional (83 centros en 17 redes de infarto). El periodo de selección fue de 3 meses (1 de abril a 30 de junio de 2019), con seguimiento clínico a 30 días. Resultados: Se incluyeron 4.366 pacientes con IAMCEST. La tasa de incidencia fue variable entre las CCAA (p < 0,0001), igual que el sexo (p = 0,003) y la prevalencia de factores de riesgo cardiovascular (p < 0,0001). El tratamiento de reperfusión fue angioplastia primaria (rango 77,5-97,8%), fibrinolisis (rango 0- 12,9%) o ninguno (rango 2,2-13,5%). El análisis del retraso hasta la reperfusión mostró diferencias significativas (p < 0,001) para todos los intervalos analizados. Hubo diferencias significativas en la mortalidad cruda a 30 días que desaparecieron tras ajustar por las características clínicas y dependientes de la red asistencial (primer contacto, tiempo hasta la reperfusión y abordaje de críticos). Conclusiones: Se han detectado diferencias en la atención al IAMCEST entre las distintas CCAA, en términos de incidencia, características clínicas, tratamiento de reperfusión, retraso hasta la reperfusión y mortalidad a 30 días. Las diferencias en mortalidad desaparecen tras ajustar por las características del paciente y de la red asistencial.

ABSTRACT Introduction and objectives: Geographical and organizational differences between different autonomous communities (AC) can generate differences in care for ST-segment elevation myocardial infarction (STEMI). A total of 17 heart attack code programs have been compared in terms of incidence rate, clinical characteristics, reperfusion therapy, delay to reperfusion, and 30-day mortality. Methods: National prospective observational study (83 centers included in 17 infarction networks). The recruitment period was 3 months (April 1 to June 30, 2019) with clinical follow-up at 30 days. Results: 4366 patients with STEMI were included. The incidence rate was variable between different AC (P < .0001), as was gender (P = .003) and the prevalence of cardiovascular risk factors (P < .0001). Reperfusion treatment was primary angioplasty (range 77.5%-97.8%), fibrinolysis (range 0%-12.9%) or no treatment (range 2.2%- 13.5%). The analysis of the delay to reperfusion showed significant differences (P < .001) for all the intervals analyzed. There were significant differences in 30-days mortality that disappeared after adjusting for clinical and healthcare network characteristics. Conclusions: Large differences in STEMI care have been detected between the different AC, in terms of incidence rate, clinical characteristics, reperfusion treatment, delay until reperfusion, and 30-day mortality. The differences in mortality disappeared after adjusting for the characteristics of the patient and the care network.

RESUMEN La calcificación coronaria es probablemente el mayor determinante de un mal resultado de la angioplastia y se asocia a mayores tasas de eventos adversos. En la actualidad existen distintas técnicas de modificación de la placa basadas en balones o en dispositivos específicos. El conocimiento de sus características y su uso adecuado son aspectos clave para el tratamiento óptimo de las lesiones calcificadas. Este artículo de posicionamiento, promovido desde la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC), describe las técnicas de modificación de la placa existentes en la actualidad y propone un algoritmo para el tratamiento de la lesión calcificada.

ABSTRACT Coronary artery calcification is probably the main determinant of the poor outcome of percutaneous coronary interventions and is associated with higher rates of adverse events. There are currently different balloon or specific device-based plaque modification techniques available. Knowing their characteristics and proper use is key for the optimal treatment of calcified lesions. This position paper—promoted by the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC)—describes existing plaque modification techniques currently available and proposes an algorithm for the management of calcified lesions.

CASE RESOLUTION The heart team decision was to percutaneously treat both the coronary artery disease and the partial anomalous pulmonary venous connection (PAPVC). Percutaneous coronary intervention was successfully performed in the first place. Treatment of the PAPVC was performed 3 months later. Since it is recommended that the diameter of the device should be 30% to 50% larger than the vessel diameter, a 22 mm Amplatzer Vascular Plug II device (AVP-II) (Abbott, United States) was selected based on the VV computed tomography measurements. The procedure was performed under local anesthesia and with fluoroscopic control. A 7-Fr introducer sheath was inserted into the right femoral vein. A 6-Fr multipurpose diagnostic catheter was advanced using a 0.035 in exchange guidewire to reach the VV through the left innominate vein (figure 1A). Angiography confirmed the presence of a left upper pulmonary vein (LUPV) with dual drainage and significant contrast flow from the LUPV to the innominate vein that filled the right chambers (left-to-right shunt) (figure 1, video 1 of the supplementary data). Using a femoral 7-Fr 90 cm Destination Guiding Sheath (Terumo, United States) the AVP-II device was placed and delivered into the VV (figure 2A, video 2 of the supplementary data). The correct position,...

RESOLUCIÓN DEL CASO La decisión del equipo multidisciplinar fue tratar percutáneamente tanto la enfermedad coronaria como el drenaje venoso pulmonar anómalo parcial (DVPAP). En primer lugar, se realizó, con éxito, una intervención coronaria percutánea. El tratamiento de la DVPAP se llevó a cabo 3 meses después. Como se recomienda que los dispositivos tengan un diámetro entre un 30 y un 50% más grande que el diámetro del vaso, se optó por emplear un dispositivo Amplatzer Vascular Plug II (AVP-II) (Abbott, Estados Unidos) de 22 mm de acuerdo con las mediciones obtenidas en la tomografía computarizada de la VV. La intervención se realizó con anestesia local y bajo control fluoroscópico. Se insertó una vaina introductora de 7 Fr en la vena femoral derecha. Posteriormente, se avanzó un catéter diagnóstico multipropósito de 6 Fr empleando una guía de intercambio de 0,035 pulgadas para llegar a la VV a través de la vena innominada izquierda (figura 1A). La angiografía confirmó la presencia de una vena pulmonar superior izquierda (VPSI) con drenaje doble y un importante flujo de contraste desde la VPSI hasta la vena innominada que rellenaba las cámaras derechas (shunt izquierda-derecha) (figura 1, vídeo 1 del material adicional). Empleando una vaina guía Destination de...

BackgroundA steep rise in the use of transcatheter aortic valve implantation (TAVI) for the management of symptomatic severe aortic stenosis occurred. Minimalist TAVI procedures and streamlined patient pathways within experienced Heart Valve Centres are designed to overcome the challenges of ever-increasing procedural volume.AimsThe 2022 European TAVI Pathway Survey aims to describe contemporary TAVI practice across Europe.Materials and methodsBetween October and December 2022, TAVI operators from 32 European countries were invited to complete an online questionnaire regarding their current practice.ResultsResponses were available from 147 TAVI centres in 26 countries. In 2021, the participating centres performed a total number of 27,223 TAVI procedures, with a mean of 185 TAVI cases per centre (median 138; IQR 77–194). Treatment strategies are usually (87%) discussed at a dedicated Heart Team meeting. Transfemoral TAVI is performed with local anaesthesia only (33%), with associated conscious sedation (60%), or under general anaesthesia (7%). Primary vascular access is percutaneous transfemoral (99%) with secondary radial access (52%). After uncomplicated TAVI, patients are transferred to a high-, medium-, or low-care unit in 28%, 52%, and 20% of cases, respectively. Time to discharge is day 1 (12%), day 2 (31%), day 3 (29%), or day 4 or more (28%).ConclusionReported adoption of minimalist TAVI techniques is common among European TAVI centres, but rates of next-day discharge remain low. This survey highlights the significant progress made in refining TAVI treatment and pathways in recent years and identifies possible areas for further improvement.

En el momento de escribir esta página se cumplen 4 años desde el inicio de REC: Interventional Cardiology. Han sido años muy intensos en general debido a la pandemia de la COVID-19 y, en particular, por las incertidumbres y los retos que supone arrancar una nueva publicación médica en el entorno actual, tan competitivo en todos los aspectos. Con todo ello, creemos firmemente que estos 4 años han resultado muy satisfactorios para nuestra joven revista, más incluso de lo que habríamos aventurado en sus orígenes. Podemos decir que se ha logrado su consolidación y se la ha dotado de un contenido de calidad de forma estable, y eso a pesar de las limitaciones inherentes a una publicación que todavía carece de algunas de las indexaciones y métricas de impacto, que tan atractivas son para los autores. En este sentido hemos de reseñar, como se detallará más adelante, que son ya varias las indexaciones logradas y estamos muy cerca de alcanzar las más relevantes. Esta revista es el órgano oficial de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC), y por ello es, debe ser, su principal medio de expresión. En esta línea, la publicación de varios documentos de...

At the time of writing, 4 years have gone by since REC: Interventional Cardiology made its publishing appearance for the first time. Overall, these have been very intense years due to the COVID-19 pandemic. In particular due to the uncertainty surrounding the birth of a new medical journal in today’s competitive setting. Still, we strongly believe that these 4 years have been more profitable for our young journal than we could have ever anticipated. Although we still are in the process of being included in certain citation indices, which will give us the impact metrics so attractive to authors, our journal has become established and publishes quality content on a regular basis. In this sense, and as we will be seeing next, REC: Interventional Cardiology has already been included in some citation indices and we are very close to being accepted in the most relevant ones. REC: Interventional Cardiology is the official journal of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and stands tall as its official true means of expression. We can see that the decision to publish several consensus documents was correct as the thousands of visits received demonstrate.1,2 A couple more documents are in...

Complete blood count-derived ratios have been described as inflammatory biomarkers in several diseases. These hematological scores include the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index ([SIRI]; neutrophils × monocytes/lymphocytes). Our aim was to study how these biomarkers are related to disease expression in a large and well-characterized series of patients with systemic lupus erythematosus (SLE). A total of 284 SLE patients and 181 age- and sex-matched healthy controls were recruited. The NLR, MLR, PLR, and SIRI were calculated, and activity (SLEDAI-2K), severity (Katz), and damage index (SLICC-DI) scores were assessed in patients with SLE. Multivariable linear regression analysis was performed to study whether these scores differ between patients and controls and how they are related to clinical and laboratory features of the disease. Crude cell counts of neutrophils, monocytes, lymphocytes, and platelets were lower in SLE patients compared to controls. Despite this, NLR, MLR, and PRL, but not SIRI, were higher in SLE patients than in controls after multivariable analysis. However, the relationship between the different scores and disease characteristics was limited. Only the Katz severity index revealed a significant positive relationship with SIRI, NLR, and MLR after adjustment for covariates. Similarly, alternative complement cascade activation and low C3 were significantly associated with higher NLR, MLR, and PLR. In conclusion, although cytopenias are a common feature of patients with SLE, hematologic composite scores are independently higher in this population compared to controls. However, the relationship of these scores with the characteristics of the disease is scarce, with the relationship with the complement system being the most consistent.

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan el informe de actividad hemodinámica en cardiopatías congénitas de 2020, año de inicio de la pandemia de la enfermedad coronavírica de 2019 (COVID-19). Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos se realizó telemáticamente; una empresa externa, junto con miembros de la ACI-SEC y el GTH-SECPCC, los analizó. Resultados: Participaron 16 centros (todos públicos), que acumulan 30 salas de hemodinámica con actividad en cardiopatías congénitas, 7 (23,3%) de ellas con dedicación exclusiva a pacientes pediátricos. Se registraron 1.046 estudios diagnósticos y 1.468 cateterismos intervencionistas. Los procedimientos terapéuticos fueron exitosos en el 94,9%, con una tasa de complicaciones mayores del 2% y una mortalidad del 0,1%. Las técnicas más frecuentes fueron el cierre de comunicación interauricular (377 casos), la angioplastia pulmonar (244 casos) y el cierre de ductus arterioso (199 casos). Conclusiones: El presente trabajo representa la primera publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. La casuística registrada está condicionada por la pandemia de la COVID-19. Los cateterismos diagnósticos siguen teniendo un papel relevante en esta actividad. Para la mayoría de las técnicas intervencionistas se han reportado excelentes datos de seguridad y eficacia.

ABSTRACT Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and the Spanish Society of Pediatric Cardiology Working Group on Interventional Cardiology (GTH-SECPCC) introduce their annual activity report for 2020, the starting year of the pandemic of coronavirus disease (COVID-19). Methods: All Spanish centers with cath labs and interventional activity in congenital heart diseases were invited to participate. Data were collected online, and analyzed by an external company together with members from the ACI-SEC and the GTH-SECPCC. Results: A total of 16 centers participated (all of them public) including 30 cath labs experienced in the management of congenital heart diseases, 7 of them (23.3%) dedicated exclusively to pediatric patients. A total of 1046 diagnostic studies, and 1468 interventional cardiac catheterizations were registered. The interventional procedures were considered successful in 93.4% of the cases with rates of major procedural complications and mortality of 2%, and 0.1%, respectively. The most frequent procedures were atrial septal defect closure (377 cases), pulmonary angioplasty (244 cases), and the percutaneous closure of the patent ductus arteriosus (199 cases). Conclusions: This report is the first publication from the Spanish Cardiac Catheterization in Congenital Heart Diseases Registry. The data recorded are conditioned by the COVID-19 pandemic. Diagnostic cardiac catheterization still plays a key role in this field. Most interventional techniques have reported excellent security and efficacy rates.

Abstract Long-term adherence to antiosteoporosis medication (AOM) in the setting of a fracture liaison service (FLS) are not well known. Patients ≥ 50 with hip fracture seen in an FLS and recommended for treatment to prevent new fractures were analyzed. Baseline data included demographics, identification mode, previous treatment and FRAX items. Patient records were reviewed 3–8 years later, and these data were collected: (1) survival; (2) major refracture; (3) initiation of treatment, proportion of days covered (PDC) and persistence with AOM. 372 patients (mean age, 79 years; 76% women) were included. Mean follow-up was 47 months, 52 patients (14%) had a refracture (22 hip) and 129 (34.5%) died. AOM was started in 283 patients (76.0%). Factors associated with initiation of AOM were previous use of bisphosphonate (OR 9.94; 95% CI 1.29–76.32) and a lower T-score lumbar (OR 0.80; 95% CI 0.65–0.99). Persistence decreased to 72.6%, 60% and 47% at 12, 36 and 60 months. A PDC > 80% was confirmed in 208 patients (55.7%) and associated with previous use of bisphosphonate (OR 3.38; 95% CI 1.34–8.53), treatment with denosumab (OR 2.69; 95% CI:1.37–5.27), and inpatient identification (OR 2.26; 95% CI 1.18–4.34). Long-term persistence with AOM was optimal in patients with hip fracture seen at an FLS. A PDC > 80% was associated with inpatient identification and prescription of denosumab.

ABSTRACT Introduction and objectives: Coronary artery disease and mental health disorders are often coexistent. Selective serotonin reuptake inhibitors (SSRIs) are often used in this context but have been associated with an increased risk of bleeding due to platelet dysfunction. Previous studies have assessed this risk in patients treated with clopidogrel-based dual antiplatelet therapy (DAPT) with contradictory results. However, there is no data regarding the use of SSRIs and potent P2Y12 inhibitors or triple antithrombotic therapy after percutaneous coronary intervention (PCI). The purpose of this study was to assess the impact of SSRIs on bleeding outcomes after PCI in patients treated with clopidogrel, prasugrel or ticagrelor-based DAPT or triple antithrombotic therapy. Methods: Retrospective study including all patients undergoing PCI at a high-volume center during 2018. Patients on SSRIs were propensity-score-matched on a 1:1 ratio with patients naive to SSRIs adjusting for the baseline differences. The primary endpoint was major bleeding (BARC type 3 or 5 bleeding) at the 1-year follow-up. Secondary endpoints were a composite of major/non-major clinically relevant bleeding (BARC type 2, 3 or 5 bleeding), and a composite of major adverse cardiovascular events. Results: Out of a total of 1063 patients treated with PCI during the study period, 1002 met the selection criteria, and 139 (13.9%) were on SSRIs. The latter had a higher bleeding risk before matching [PRECISE-DAPT, 16 [10-24] vs 13 [9-21]; P = .040]. No differences were reported in major bleeding (2.9% vs 2.9%, P = .991), major/non-major clinically relevant bleeding (2.9% vs 7.2%, P = .120) or in major adverse cardiovascular events (7.9% vs 7.9%, P = .979) in patients treated with SSRIs. Conclusions: The use of SSRIs was frequent in patients treated with PCI, and although it was a marker of a higher bleeding risk at baseline, this was not associated with an additional bleeding liability.

RESUMEN Introducción y objetivos: La cardiopatía isquémica y la enfermedad mental coexisten a menudo. Los inhibidores selectivos de la recaptación de serotonina (ISRS) se utilizan con frecuencia en este contexto, pero se han asociado con un incremento en el riesgo hemorrágico. Los estudios previos han evaluado este fenómeno en pacientes tratados con clopidogrel, con resultados contradictorios. No hay datos sobre el uso de ISRS e inhibidores del P2Y12 potentes o triple terapia antitrombótica. El objetivo de este estudio fue examinar el impacto de los ISRS en los eventos hemorrágicos en pacientes tratados con doble (incluyendo clopidogrel, prasugrel o ticagrelor) o triple terapia antitrombótica tras una intervención coronaria percutánea (ICP). Métodos: Estudio retrospectivo en el que se incluyeron todos los pacientes tratados con ICP en un centro de alto volumen durante 2018. Los pacientes en tratamiento con ISRS fueron emparejados mediante puntaje de propensión con pacientes sin ISRS. El objetivo primario fue el sangrado mayor al año de seguimiento (BARC 3 o 5). Los objetivos secundarios fueron un combinado de sangrado mayor o menor clínicamente relevante (BARC 2, 3 o 5) y un combinado de eventos cardiovasculares adversos mayores. Resultados: De los 1.063 pacientes tratados con ICP durante el periodo del estudio, 1.002 cumplieron los criterios de selección y 139 (13,9%) recibían ISRS. Los pacientes con ISRS tenían un mayor riesgo de sangrado antes del emparejamiento (PRECISE-DAPT: 16 [10-24] frente a 13 [9-21]; p = 0,040). No hubo diferencias en el objetivo primario (2,9% frente a 2,9%; p = 0,991) ni en los objetivos secundarios de sangrado mayor o menor clínicamente relevante (2,9 frente a 7,2%; p = 0,120) y eventos cardiovasculares adversos mayores (7,9 frente a 7,9%; p = 0,979). Conclusiones: El uso de ISRS fue frecuente en los pacientes tratados con ICP, y aunque fue un marcador de riesgo hemorrágico basal, no se asoció con un mayor riesgo de sangrado en el seguimiento.

RESUMEN Introducción y objetivos: Los pacientes con estenosis en el tronco coronario izquierdo (TCI) han sido excluidos de los ensayos que apoyan la no inferioridad del cociente de presiones en el índice diastólico instantáneo sin ondas (iFR) respecto a la reserva fraccional de flujo (RFF) en la toma de decisiones sobre revascularización coronaria. El presente estudio propone valorar de manera prospectiva la concordancia entre los dos índices en lesiones del TCI y validar el valor de corte del iFR de 0,89 para su uso clínico. Métodos: Registro multicéntrico nacional, prospectivo, observacional, con la inclusión de 300 pacientes consecutivos con lesiones intermedias (estenosis angiográfica 25-60%) en el TCI. Se realizará un estudio con guía de presión y determinación de RFF e iFR. En caso de resultado concordante negativo (RFF > 0,80 / iFR > 0,89), no se realizará tratamiento; en caso de resultado concordante positivo (RFF ≤ 0,80 / iFR ≤ 0,89), se realizará revascularización; en caso de resultado discordante (RFF > 0,80 / iFR ≤ 0,89 o RFF ≤ 0,80 / iFR > 0,89), se realizará estudio con ecocardiografía intravascular y se considerará diferir la revascularización si el área luminal mínima es > 6 mm2. El criterio de valoración clínico primario será la incidencia del combinado de muerte cardiovascular, infarto no mortal relacionado con la lesión del TCI o necesidad de revascularización de la lesión del TCI a los 12 meses. Conclusiones: La demostración de la seguridad clínica en la toma de decisiones del iFR en pacientes con lesiones intermedias en el TCI tendría un impacto clínico importante y justificaría su uso sistemático para la decisión del tratamiento en estos pacientes de potencial alto riesgo. Registrado en ClinicalTrials.gov (identificador: NCT03767621).

ABSTRACT Introduction and objectives: Patients with left main coronary artery (LMCA) stenosis have been excluded from the trials that support the non-inferiority of the instantaneous wave-free ratio (iFR) compared to the fractional flow reserve (FFR) in the decision-making process of coronary revascularization. This study proposes to prospectively assess the concordance between the two indices in LMCA lesions and to validate the iFR cut-off value of 0.89 for clinical use. Methods: National, prospective, and observational multicenter registry of 300 consecutive patients with intermediate lesions in the LMCA (angiographic stenosis, 25% to 60%. A pressure gudiewire study and determination of the RFF and the iFR will be performed: in the event of a negative concordant result (FFR > 0.80/iFR > 0.89), no treatment will be performed; in case of a positive concordant result (FFR ≤ 0.80/iFR ≤ 0.89), revascularization will be performed; In the event of a discordant result (FFR> 0.80/iFR ≤ 0.89 or FFR ≤ 0.80/iFR> 0.89), an intravascular echocardiography will be performed and revascularization will be delayed if the minimum lumen area is > 6 mm2. The primary clinical endpoint will be a composite of cardiovascular death, LMCA lesion-related non-fatal infarction or need for revascularization of the LMCA lesion at 12 months. Conclusions: Confirm that an iFR-guided decision-making process in patients with intermediate LMCA stenosis is clinically safe and would have a significant clinical impact. Also, justify its systematic use when prescribing treatment in these potentially high-risk patients. Registered at ClinicalTrials.gov ( Identifier: NCT03767621).

RESUMEN Las pruebas de vasorreactividad coronaria con infusión de acetilcolina son una prueba diagnóstica fundamental para pacientes con sospecha de enfermedad cardiaca secundaria a vasoespasmo y en procedimientos de investigación en los que se valora la función endotelial coronaria. Se calcula que más del 40% de los pacientes con angina y ausencia de lesiones coronarias presentan vasoespasmo como causa fundamental de los síntomas, y su tratamiento específico ha demostrado mejorar la calidad de vida en estos pacientes. El Grupo de Trabajo de Técnicas de Diagnóstico Intracoronario de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) ha elaborado el presente documento técnico que expone de manera práctica las indicaciones, la preparación, la realización y la interpretación de dichas pruebas. Palabras clave: Prueba de provocacion de vasoespasmo. Funcion endotelial coronaria. Abstract Coronary vasoreactivity testing is a key diagnostic procedure in patients with suspected coronary spasm and research procedures intended to assess the coronary endothelial function. We should mention that coronary spasm has been observed in > 40% of the patients with angina and non-obstructive coronary stenosis. Also, that its dedicated treatment has proven to reduce ischemic symptoms and improve these patients’ quality of life. This technical report elaborated by the Working Group on Intracoronary...

ABSTRACT Coronary vasoreactivity testing is a key diagnostic procedure in patients with suspected coronary spasm and research procedures intended to assess the coronary endothelial function. We should mention that coronary spasm has been observed in > 40% of the patients with angina and non-obstructive coronary stenosis. Also, that its dedicated treatment has proven to reduce ischemic symptoms and improve these patients’ quality of life. This technical report elaborated by the Working Group on Intracoronary Diagnostic Techniques of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) summarizes the indications, preparation, performance, and interpretation of the vasoreactivity testing performed by intracoronary infusion of acetylcholine.

RESUMEN Introducción y objetivos: Los pacientes con lesiones coronarias largas, secuenciales o difusas tratadas percutáneamente continúan presentando un riesgo alto de eventos cardiovasculares a pesar de la mejoría de la seguridad y de la eficacia de los nuevos stents liberadores de fármacos. El objetivo de este estudio es analizar la utilidad del software SyncVision /iFR (SyncVision versión 4.1.0.5, Philips Volcano, Bélgica) para guiar la revascularización en este tipo de lesiones. Métodos: Estudio aleatorizado, multicéntrico, controlado y abierto para comparar la revascularización guiada por SyncVision /iFR respecto a la revascularización guiada por angiografía en pacientes con lesiones coronarias largas, secuenciales o difusas (identificador de ClinicalTrials.gov: NCT04283734). Se incluirá a 100 pacientes (aleatorización 1:1 no estratificada). El objetivo primario es la longitud total del stent implantado. Como objetivo secundario se ha establecido un combinado de muerte cardiaca, infarto de miocardio, trombosis definitiva o probable del stent, nueva revascularización de la lesión tratada en el procedimiento basal o nueva revascularización de la lesión analizada en el procedimiento basal, y la presencia de isquemia residual evaluada por tomografía computarizada por emisión de fotón simple a los 6 meses de seguimiento. El tiempo de seguimiento será de 12 meses tras el procedimiento índice. Resultados: El estudio se encuentra actualmente en fase de reclutamiento, con los primeros 7 pacientes ya incluidos. Esperamos completar el reclutamiento en febrero de 2021 y el seguimiento en febrero de 2022. Conclusiones: El estudio iLARDI es el primer estudio aleatorizado para la evaluación de la potencial utilidad de la revascularización guiada por Syncvision en lesiones coronarias largas, secuenciales y difusas.

RESUMEN Introducción y objetivos: El propósito del estudio fue describir nuestra experiencia con el uso del índice diastólico instantáneo sin ondas (iFR) para la evaluación fisiológica coronaria o el uso del software Syncvision/iFR (Syncvision versión 4.1.0.5, Philips Volcano, Bélgica) en todo tipo de pacientes. Métodos: Se incluyeron todos los pacientes consecutivos a quienes, entre enero de 2017 y diciembre de 2019, se realizó en nuestro centro una evaluación fisiológica coronaria con iFR o con Syncvision/iFR. El valor de corte establecido para el iFR fue 0,89. El objetivo primario fue un compuesto de muerte cardiaca, infarto de miocardio, trombosis de stent probable o definitiva y nueva revascularización de la lesión evaluada. Resultados: Se incluyeron 277 pacientes con 433 lesiones evaluadas. La edad media fue de 65 ± 10 años y el 74% eran varones. El 41% tenía antecedente de diabetes mellitus. La presentación clínica fue angina estable en 160 pacientes (58%) y síndrome coronario agudo en 117 pacientes (42%). Se obtuvo un iFR > 0,89 en 266 lesiones (61,4%), en las cuales la intervención coronaria percutánea fue diferida. Las lesiones restantes se revascularizaron. El software Syncvision/iFR se usó en 155 lesiones (36%) para guiar la toma de decisiones, principalmente lesiones largas, difusas o secuenciales (91 lesiones, 58,7%) y lesiones intermedias (52 lesiones, 33,5%). Tras un periodo de seguimiento de 18 meses, el objetivo primario se observó en 17 pacientes (6,1%), sin diferencias en función del iFR basal (≤ 0,89 o > 0,89) (4,2 frente a 3,8%; p = 0,9) ni de la presentación clínica (angina estable o síndrome coronario agudo) (4,4 frente a 8,5%; p = 0,1). Conclusiones: La evaluación fisiológica coronaria con iFR y el software Syncvision/iFR en la práctica diaria y en todo tipo de pacientes parece ser segura, con un bajo porcentaje de eventos cardiacos adversos mayores a medio plazo.

ABSTRACT Introduction and objectives: The objective of this study was to describe our experience with coronary physiology assessment using the instantaneous wave-free ratio (iFR) and/or a Syncvision-guided iFR-pullback study [Syncvision version 4.1.0.5, Philips Volcano, Belgium] in all-comer patients. Methods: Consecutive patients undergoing coronary physiology assessment with the iFR (and/or a Syncvision-guided iFR-pullback study) at our center between January 2017 and December 2019 were included. The iFR cut-off value was 0.89. The primary endpoint was a composite of cardiac death, myocardial infarction, probable or definitive stent thrombosis, and target lesion revascularization. Results: A total of 277 patients with 433 lesions evaluated were included. The mean age was 65 ± 10 years and 74% were men. Personal history of diabetes mellitus was present in 41% of patients. Clinical presentation was stable angina in 160 patients (58%), and acute coronary syndrome in 117 patients (42%). iFRs > 0.89 were obtained in 266 lesions (61.4%) on which the PCI was postponed. The remaining lesions were revascularized. The Syncvision software was used to guide the iFR-pullback study in 155 lesions (36%) and the decision-making process, mainly in long, diffuse or sequential lesions (91 lesions, 58.7%), and intermediate lesions (52 lesions, 33.5%). After a median follow-up of 18 months, the primary endpoint occurred in 17 patients (6.1%) without differences regarding the baseline iFR (≤ 0.89 or > 0.89) (4.2% vs 3.8%; P = .9) or the clinical presentation (stable angina or acute coronary syndrome) (4.4% vs 8.5%; P = .1) Conclusions: The use of coronary physiology assessment with the iFR and the Syncvision-guided iFR-pullback study in the routine daily practice and in all-comer patients seems safe with a low percentage of major adverse cardiovascular events at the mid-term follow-up.

ABSTRACT Introduction and objectives: patients with long, sequential and diffuse coronary lesions who undergo a percutaneous coronary intervention remain at a high risk of suffering cardiovascular events despite the improved safety and efficacy of the new drug-eluting stents. The objective of this study was to analyze the utility of SyncVision/iFR-guided revascularization (SyncVision version 4.1.0.5, Philips Volcano, Belgium) in this type of lesions. Methods: Randomized, multicenter, controlled, and open-label trial designed to compare SyncVision/iFR-guided and angiography-guided revascularizations in patients with long, sequential or diffuse significant angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). A total of 100 patients will be randomized (1:1, no stratification). The primary endpoint is the average length of the stent implanted. The secondary endpoint is a composite of cardiac death, myocardial infarction, definitive or probable stent thrombosis, new target lesion revascularization or new target lesion failure; and the presence of residual ischemia as seen on single-photon emission computed tomography at the 6-month follow-up. Patients will be followed for 12 months after the procedure. Results: The trial is currently in the recruitment phase, and it has already recruited the first 7 patients. We expect to complete the recruitment phase by February 2021 and the follow-up by February 2022. Conclusions: The iLARDI study is the first randomized trial to assess the potential utility of SyncVision-guided revascularization in long, sequential and diffuse coronary lesions.

Abstract Background During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. Objectives The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. Methods We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. Results Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p

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

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

RESUMEN Introducción y objetivos: La epidemia de COVID-19 y la declaración del estado de alarma han propiciado una disminución en la actividad en la cardiología intervencionista. El objetivo de este estudio es cuantificar esta disminución, con especial interés en el funcionamiento del código infarto. Métodos: Se realizó una encuesta telemática a 81 centros de las 17 comunidades autónomas españolas con procedimientos de código infarto. Se recogió información sobre la actividad diagnóstica, el intervencionismo coronario, el intervencionismo estructural y el intervencionismo en el seno del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) sobre cambios en la organización de las redes del infarto y sobre la afección por COVID-19 de las plantillas de cardiología intervencionista. Se compararon 2 periodos: uno entre el 24 de febrero y el 1 de marzo (antes del inicio de la pandemia en España) y el otro entre el 16 y el 22 de marzo (durante la pandemia). Resultados: Se obtuvo respuesta de 73 centros (90%) que evidenció una disminución significativa en el número de procedimientos diagnósticos (─56%), terapéuticos coronarios (─48%), terapéuticos estructurales (─81%) y en el seno del IAMCEST (─40%). Se indicó un leve incremento en el uso de trombolisis. Se diagnosticó infección por COVID-19 en 17 cardiólogos intervencionistas (5%). Conclusiones: Se observó una reducción importante de la actividad asistencial durante la epidemia de COVID-19 y una gran disminución en el número de pacientes tratados con IAMCEST, con el riesgo de incremento de morbimortalidad que esto supone. Las sociedades científicas y autoridades sanitarias deberían promover que los pacientes con síntomas compatibles con IAMCEST demanden asistencia al sistema sanitario para poder recibir el tratamiento de reperfusión de forma adecuada.

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

RESUMEN Durante marzo de 2020, el virus SARS-CoV-2 se ha extendido por toda Europa, con especial intensidad en Italia y España. Ante la emergencia creada por el brote de COVID-19, la inmensa mayoría de las salas de hemodinámica y electrofisiología han visto alterada su actividad habitual. Además se enfrentan a la realización de procedimientos en pacientes con diagnóstico confirmado de COVID-19 o con la incertidumbre en casos no confirmados. El presente texto es un documento de consenso de la Asociación de Cardiología Intervencionista y la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología que pretende dar información al personal sanitario de estas instalaciones de cardiología invasiva (hemodinámica y electrofisiología y marcapasos) para garantizar una atención de calidad a los pacientes así como unos niveles los niveles adecuados de prevención de la infección.

ABSTRACT During March 2020, the SARS-CoV-2 virus spread throughout Europe, with the spread being especially intense in Italy and Spain. Given the emergency created by the COVID-19 outbreak, routine activity has been altered in most cardiac catheterization and electrophysiology labs. Health staff working in these areas are faced with performing procedures in patients with a confirmed diagnosis of COVID-19 or with uncertainty in unconfirmed cases. This article is a consensus document of the Interventional Cardiology Association and Heart Rhythm Association of the Spanish Society of Cardiology and aims to provide information to health care professionals working in these invasive cardiology facilities (cardiac catheterization and electrophysiology labs, pacemaker implantation) in order to guarantee quality patient care and adequate levels of infection prevention.

ABSTRACT The current COVID-19 outbreak is forcing healthcare workers to continuously reconsider the proper indications for cardiac catheterization. Human and material resources optimization, infection prevention for patients and healthcare workers, and transfer times force a rethink of the previously established protocols. This article is a consensus statement of the Interventional Cardiology Association and the Ischemic Heart Disease Association of the Spanish Society of Cardiology, and aims to provide information to healthcare workers on the indications of diagnostic or therapeutic cardiac catheterization during the current COVID-19 pandemic.

El brote actual de COVID-19 está obligando a los profesionales sanitarios a replantear de forma continua las indicaciones de cateterismo cardiaco. La optimización de recursos materiales y humanos, la prevención de contagios a profesionales y pacientes, así como la gestión de los tiempos de traslado, hace totalmente necesario reformular los protocolos previamente establecidos. El presente texto es un documento de consenso de la Asociación de Cardiología Intervencionista y la Asociación de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares de la Sociedad Española de Cardiología que pretende dar información al personal sanitario sobre las indicaciones de cateterismo diagnóstico o terapéutico durante la pandemia actual de COVID-19.

RESUMEN En este artículo se revisan los cambios acaecidos durante los últimos 20 años en el tratamiento percutáneo de las lesiones en bifurcación bajo la perspectiva de nuestra experiencia. También se analizan los estudios más relevantes en este campo, así como las estrategias y las recomendaciones actuales. Los aspectos técnicos son fundamentales en el tratamiento de las lesiones en bifurcación, por lo que parte de la revisión se dedica a ellos. Las mejoras técnicas aparecidas en los últimos años han sido determinantes en el aumento de la tasa de éxito del tratamiento de este tipo de lesiones complejas. Al mismo tiempo, la estrategia terapéutica ha sido reglada y estandarizada, de modo que actualmente podemos abordar con seguridad todo tipo de lesiones en bifurcación, incluida la enfermedad del tronco común de la arteria coronaria izquierda.

ABSTRACT In this article, we analyse the changes occurred over the last 20 years in the percutaneous treatment of bifurcation lesions based on our own experience. We also analyse the more relevant papers recently published, as well as the strategies and guidelines recommended for the percutaneous management of bifurcation lesions. Technical aspects are relevant in this field and, for this reason, a significant section of this manuscript is dedicated to the technique used together with some tips and tricks also provided here. The technical advances made over the last years have significantly increased the success rate in the management of these complex lesions. At the same time, the technique of treatment has been standardized allowing the management of all type of bifurcations including distal left main disease.

The use of transcatheter edge-to-edge repair for the treatment of mitral regurgitation has markedly increased in the last few years. The rate of adverse events related to the procedure is low; however, some of the complications that may occur are potentially dangerous. Due to the growing popularity of the technique, which is no longer limited to high-volume centers, knowledge of the complications related to the procedure is fundamental. Transesophageal echocardiography has a key role in the guidance of the intervention while allowing for the avoidance of most of these adverse events, as well as enabling us to diagnose them early. In this article, we review the main complications that might present during a transcatheter mitral edge-to-edge repair procedure (tamponade, thromboembolic events, single leaflet device attachment, device embolization, vascular injury…) while highlighting key aspects of transesophageal echocardiographic monitoring in the prevention and prompt diagnosis of these complications.

Abstract Background Cellular therapies have been increasingly applied to diverse human diseases. Intracoronary infusion of bone marrow-derived mononuclear cells (BMMNC) has demonstrated to improve ventricular function after acute myocardial infarction. However, less information is available about the role of BMMNC therapy for the treatment of dilated myocardiopathies (DCs) of non-ischemic origin. This article presents the methodological description of a study aimed at investigating the efficacy of intracoronary injection of autologous BMMNCs in the improvement of the ventricular function of patients with DC. Methods This randomised, placebo-controlled, double-blinded phase IIb clinical trial compares the improvement on ventricular function (measured by the changes on the ejection fraction) of patients receiving the conventional treatment for DC in combination with a single dose of an intracoronary infusion of BMMNCs, with the functional recovery of patients receiving placebo plus conventional treatment. Patients assigned to both treatment groups are monitored for 24 months. This clinical trial is powered enough to detect a change in Left Ventricular Ejection Fraction (LVEF) equal to or greater than 9%, although an interim analysis is planned to re-calculate sample size. Discussion The study protocol was approved by the Andalusian Coordinating Ethics Committee for Biomedical Research (Comité Coordinador de Ética en Investigación Biomédica de Andalucia), the Spanish Medicines and Medical Devices Agency (Agencia Española de Medicamentos y Productos Sanitarios), and is registered at the EU Clinical Trials Register (EudraCT: 2013–002015-98). The publication of the trial results in scientific journals will be performed in accordance with the applicable regulations and guidelines to clinical trials. Trial registration ClinicalTrials.gov Identifier NCT02033278 (First Posted January 10, 2014): https://clinicaltrials.gov/ct2/show/NCT02033278; EudraCT number: 2013–002015-98, EU CT Register: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-002015-98. Trial results will also be published according to the CONSORT statement at conferences and reported peer-reviewed journals.

Sr. Editor: La pandemia de COVID-19 ha producido un cambio drástico en nuestro sistema de salud. La necesidad de tener recursos disponibles para atender el alto volumen de pacientes afectados, la sobrecarga asistencial y la necesidad de limitar la exposición al virus han llevado a implantar medidas extraordinarias, tales como el retraso en la atención de los pacientes con patología crónica y la suspensión, prácticamente total, de procedimientos electivos, como el implante percutáneo de válvula aórtica (TAVI)1. Desde la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) se ha realizado una encuesta a los centros del registro español de TAVI con los siguientes objetivos: cuantificar la afectación temporal en el implante de TAVI en nuestro país por la pandemia de COVID-19, analizar la evolución de los pacientes no tratados debido a dicha pandemia, estudiar la incidencia y las consecuencias de la infección en los tratados durante este periodo de tiempo, y valorar los contagios de COVID-19 en la plantilla médica de las unidades de cardiología intervencionista. De los 46 centros integrantes del registro nacional, participaron en el estudio 40 (86,9%). Los parámetros recogidos en dicha encuesta quedan reflejados en la figura 1. Figure 1. Encuesta realizada a los...

To the Editor, The current COVID-19 pandemic has changed our health system dramatically. The need to have resources available to assist the high volume of patients affected, the healthcare overload, and the need to limit exposure to the virus have led to the implementation of extraordinary measures like delaying the healthcare provided to patients with chronic conditions and the almost total suspension of elective procedures such as the transcatheter aortic valve implantation (TAVI).1 The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) sent a survey to the hospitals included in the Spanish TAVI registry with the following objectives: quantify the temporal damage caused by the COVID-19 pandemic to TAVI procedures in our country, analyze the disease progression of patients not treated because of the pandemic, study the rate and consequences of the infection in patients treated during this period of time, and ultimately assess the number of COVID-19 infections within the medical staff of the cath labs. Forty out of the 46 centers included in the national registry participated in the study (86.9%)....

There is limited evidence that supports the use of the global longitudinal strain (GLS) in long-term cardiac monitoring of childhood acute lymphoblastic leukemia survivors (CLSs). Our aim was to assess the utility of automated GLS to detect left ventricular systolic dysfunction (LVSD) in long-term CLSs. Asymptomatic and subclinical LVSD were defined as LVEF < 50% and GLS < 18.5%, respectively. Echocardiographic measurements and biomarkers were compared with a control group. Inverse probability weighting was used to reduce confounding. Regression models were used to identify factors associated with LVEF and GLS in the survivors. Ninety survivors with a median follow-up of 18 (11–26) years were included. The prevalence of LVSD was higher using GLS than with LVEF (26.6% vs. 12.2%). The measurements were both reduced as compared with the controls (p < 0.001). There were no differences in diastolic parameters and NT-ProBNP. Survivors were more likely to have Hs-cTnI levels above the detection limit (40% vs. 17.2%, p = 0.006). The dose of anthracycline was associated with LVEF but not with GLS in the survivors. Biomarkers were not associated with GLS or LVEF. In conclusion, LVSD detection using automated GLS was higher than with LVEF in long-term CLSs. Its incorporation into clinical routine practice may improve the surveillance of these patients.

BackgroundWe aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures.MethodsScores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared.ResultsMean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, pConclusionProcedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

Sr. Editor: Durante los primeros meses de 2020, se alertó en todo el mundo de la presencia de un brote de coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) El 11 de marzo de 2020 la Organización Mundial de la Salud (OMS) declaraba el estado de pandemia mundial. Después de Estados Unidos, España es uno de los países del mundo con mayor número de pacientes infectados. Aparte de las consecuencias directas que provoca la enfermedad coronavírica de 2019 (COVID-19), la sobrecarga del sistema sanitario está afectando negativamente al manejo efectivo de otras patologías graves cuyo tratamiento no debe demorarse. Durante la actual pandemia de COVID-19, los pacientes con cardiopatías están sufriendo retrasos diagnósticos y de tratamiento que muy probablemente se estarán reflejando en la mortalidad cardiovascular1. Las sociedades científicas ya han avisado reiteradamente de los riesgos que se corren en patologías tales como el síndrome coronario agudo y el infarto de miocardio con elevación del segmento ST2. La estenosis aórtica grave (EAG) sintomática tiene mal pronóstico clínico a corto plazo si no se trata. Como el implante percutáneo de válvula aórtica (TAVI) se ha establecido como la opción de tratamiento más habitual para el manejo de la EAG sintomática3, las recomendaciones sobre esta terapia durante la actual pandemia son relevantes a nivel clínico para los médicos que tratan a estos pacientes.

To the Editor, During the first few months of 2020, a severe acute respiratory syndrome outbreak due to coronavirus 2 (SARS-CoV-2) was an- nounced worldwide. The WHO (World Health Organization) declared the global pandemic in March 11, 2020. After the United States, to this day Spain remains as the second country with the highest number of patients infected. Apart from the direct consequences of the coronavirus disease 2019 (COVID-19), the healthcare system overload is negatively impacting the effective management of other severe conditions whose treatment can’t wait. During the current COVID-19 pandemic, patients with cardiovascular diseases are suffering diagnostic and treatment delays that are probably impacting cardiovascular mortality.1 Scientific societies have issued several warnings on the management of the acute coronary syndrome and ST-segment elevation myocardial infarction.2