Belen Alvarez

RETRACTED ARTICLE: Long-term mortality prediction of CHA2DS2VASc and HATCH scores in a cohort of patients with typical atrial flutter

The Editors-in-Chief retract the above-mentioned article per the Committee on Publication Ethics (COPE) guidelines on redundant publication. The editors have examined and discussed this case of redundant publication and followed the guidelines from the Committee on Publication Ethics (COPE) to address this issue. The overlap between the above-mentioned article and International Journal of Cardiology 199 (2015) 426–428 was deemed substantial, and the editors decided that the publication of two separate articles of this study is redundant and unnecessary. The Editors-in-Chief take issues of research and publication misconduct seriously in order to preserve the integrity of the academic record. The online version of this article contains the full text of the retracted article as electronic supplementary material.

Cardiac resynchronization therapy response in heart failure patients with different subtypes of true left bundle branch block

PurposeLeft bundle branch block (LBBB) configuration has been described as a predictor of response to cardiac resynchronization therapy (CRT). We investigated whether different subtypes of true LBBB configuration could help select patients with better response and clinical outcome.MethodsThis retrospective study included 198 consecutive LBBB patients implanted with a CRT. True LBBB was defined using the Strauss and the Predict study criteria. Echocardiographic response was evaluated by the reduction in left ventricular end-systolic volume (LVESV) and the increase in left ventricular ejection fraction (LVEF). Clinical response was defined as an improvement in one category of the NYHA functional class.ResultsPatients with true LBBB had a greater improvement in both LVESV reduction (median = − 27.6%, interquartile range = [− 4.9, − 50.1]) and LVEF increase (median 10.8 ± 10) than those with non-true LBBB (− 19.7%, [16.7, − 48.0]) p = 0.04 and 5.1 ± 10, p = 0.03, respectively. No differences were exhibited between true LBBB Strauss group (− 26.7%, [− 11.0, − 46.9]) and true LBBB Predict group (− 26.6%, [− 15.9, − 39.4]). There were no statistically significant differences in the percentage of patients with clinical response, assessed by NYHA improvement, among all groups. In the Cox model for death, age, ischemic etiology, and ΔLVESV were independent predictors of mortality. True LBBB (Strauss + Predict) patients had a trend towards lower mortality than non-true LBBB [HR = 0.55, 95% CI = (0.22–1.15)], p = 0.08. In the Cox model for HF hospitalization, age, sex male, prior LVEF, and ΔLVESV were independent predictors. True LBBB (Strauss + Predict) patients had a significantly lower risk of developing HF hospitalization than those with non-true LBBB [0.45 (0.21–0.90)], p = 0.029.ConclusionsPatients with true LBBB, either Strauss or Predict criteria, had greater echocardiographic response and lower incidence of HF hospitalization than non-true LBBB when implanted with CRT.

Prevalence, long-term prognosis and medical alternatives for patients admitted for acute coronary syndromes and prasugrel contraindication

BACKGROUND Prasugrel is a potent antiplatelet therapy that has demonstrated to be superior to clopidogrel for patients with acute coronary syndromes (ACS) but has three main contraindications. METHODS Prospective study of all patients admitted for ACS in two hospitals. Prasugrel contraindication group was defined by the presence of age >75 years, weight <60 kg or previous stroke. We also performed a propensity score matching to obtain a well-balanced subset of patients with the same probability of receiving ticagrelor. RESULTS We included 8207 patients and 2538 (30.9%) had any contraindication for prasugrel, being age >75 years the most frequent (29.0%). Hospital mortality was 4.4% and it was >2-fold higher in patients with any contraindication for prasugrel (7.9% vs. 2.8%; p < 0.01). Postdischarge follow-up (median 59.9 months) revealed that patients with prasugrel contraindication had higher cardiovascular and all-cause mortality as well as a first major cardiovascular event (MACE). No differences in bleeding rates were found in patients with vs. without prasugrel contraindication. Prasugrel contraindication was independently associated to higher cardiovascular (HR: 1.42) and all-cause mortality (HR: 1.47), as well as higher MACE (HR: 1.25). In the sub-cohort of 482 pairs of patients, obtained by a propensity score matching, ticagrelor treatment was associated with lower cardiovascular death (HR: 0.22), all-cause mortality (HR: 0.30) and first MACE (HR: 0.58) in patients with prasugrel contraindication. CONCLUSIONS Almost one third of ACS patients have prasugrel contraindications and they have worst in in-hospital and post-discharge prognosis. Ticagrelor improved postdischarge outcomes in patients with prasugrel contraindications.

Clinical impact of mineralocorticoid receptor antagonists treatment after acute coronary syndrome in the real world: A propensity score matching analysis

Background: Recent studies suggest that the benefit of mineralocorticoid receptor antagonists in the acute coronary syndrome setting is controversial. The aim of this study was to examine the current long-term prognostic benefit of mineralocorticoid receptor antagonists in patients with acute coronary syndrome. Material and methods: We conducted a retrospective cohort study of 8318 consecutive acute coronary syndrome patients. Baseline patient characteristics were examined and a follow-up period was established for registry of death, major cardiovascular adverse events and heart failure re-hospitalization. We performed a propensity-matching analysis to draw up two groups of patients paired according to whether or not they had been treated with mineralocorticoid receptor antagonists. The prognostic value of mineralocorticoid receptor antagonists to predict events during follow-up was analysed using Cox regression. Results: Among the study participants, only 524 patients (6.3%) were discharged on mineralocorticoid receptor antagonists. Patients on mineralocorticoid receptor antagonists had a different clinical and pharmacological profile. These differences disappeared after the propensity score analysis. The median follow-up was 40.7 months. After the propensity score analysis, the cardiovascular mortality and heart failure readmission rates were similar between patients who were discharged on mineralocorticoid receptor antagonists and those whose not. The use of mineralocorticoid receptor antagonists was only associated with a reduction in major cardiovascular adverse events (hazard ratio=0.83, 95% confidence interval 0.69–0.97, p=0.001). Conclusions: Our results do not corroborate the long-term benefit of mineralocorticoid receptor antagonists to improve survival after acute coronary syndrome in a large cohort of patients with heart failure or reduced left ventricular ejection fraction and diabetes. Their prescription was associated with a significantly lower incidence of major cardiovascular adverse events during the long-term follow-up without effect on heart failure development.

TCT-149 Impact of Chronic Total Occlusion in a Non-Infarct-related Artery on clinical outcomes in patients undergoing Primary Percutanous Coronary Intervention: analysis of a 8 year-all-comers prospective registry.

In the setting of primary percutaneous coronary intervention (PPCI), encountering with chronic total oclussion (CTO) in a noninfarct-related artery (IRA) is not a rare situation. The impact of CTO on clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients is not well defined.

Is HATCH score a reliable predictor of atrial fibrillation after cavotricuspid isthmus ablation for typical atrial flutter

Objective We determined the effectiveness of the HATCH score in patients with typical atrial flutter (AFl) undergoing cavotricuspid isthmus (CTI) ablation to predict long-term atrial fibrillation (AF). Methods We conducted an observational retrospective single-center cohort study including all patients admitted to our hospital for a CTI ablation between 1998 and 2010. The patients were divided into four categories: 1) new-onset AF (no prior AF and AF during follow-up (FU)); 2) old AF (prior AF and no AF during FU); 3) prior and post AF (AF prior and post CTI ablation); and 4) no AF. Results Four hundred and eight patients were included. In patients without prior AF, the hazard ratio (HR) for new-onset AF during FU was 0.98 (CI 95%: 0.65–1.50; p = 0.95) and 1.00 (CI 95%: 0.57–1.77; p = 0.98) for HATCH ≥ 2 and HATCH ≥ 3, respectively. In patients with prior AF, the HR for AF was 1.41 (CI 95%: 0.87–2.28; p = 0.17) and 1.79 (CI 95%: 0.96–3.35; p = 0.06), for HATCH ≥ 2 and HATCH ≥ 3, respectively. Left atrial enlargement was positively correlated with the occurrence of AF during FU, especially in the subgroup without prior AF, which had a HR of 2.44 (CI 95%: 1.35–4.40; p = 0.003), a HR of 2.88 (CI 95%: 1.36–6.10; p = 0.006) and a HR of 3.68 (CI 95%: 1.71–7.94; p = 0.001), for slight, moderate and severely dilated left atrial dimension, respectively, compared with a normal value. Conclusions HATCH score did not predict AF in patients with typical AFl who underwent CTI ablation. Basal left atrium dimension could help predict new-onset AF.