Fernando Lozano

Bladder Cancer in Spain 2011: Population Based Study

PURPOSEnWe estimate the annual incidence of bladder cancer in Spain and describe the clinical profile of patients with bladder cancer enrolled in a population based study.nnnMATERIALS AND METHODSnUsing the structure of the Spanish National Health System as a basis, in 2011 the AEU (Spanish Association of Urology) conducted this study with a representative sample from 26 public hospitals and a reference population of 10,146,534 inhabitants, comprising 21.5% of the Spanish population.nnnRESULTSnA total of 4,285 episodes of bladder cancer were diagnosed, of which 2,476 (57.8%) were new cases and 1,809 (42.2%) were cases of recurrence, representing an estimated 11,539 new diagnoses annually in Spain. The incidence of bladder cancer in Spain, age adjusted to the standard European population, was 20.08 cases per 100,000 inhabitants (95% CI 13.9, 26.3). Of patients diagnosed with a first episode of bladder cancer 84.3% were male, generally older than 59 years (81.7%) with a mean ± SD age of 70.5 ± 11.4 years. Of these patients 87.5% presented with some type of clinical symptom, with macroscopic hematuria (90.8%) being the most commonly detected. The majority of primary tumors were nonmuscle invasive (76.7%) but included a high proportion of high grade tumors (43.7%). According to the ISUP (International Society of Urologic Pathology)/WHO (2004) classification 51.1% was papillary high grade carcinoma. Carcinoma in situ was found in 2.2% of primary and 5.8% of recurrent cases.nnnCONCLUSIONSnThe incidence of bladder cancer in Spain, age adjusted to the standard European population, confirms that Spain has one of the highest incidences in Europe. Most primary nonmuscle invasive bladder cancer corresponded to high risk patients but with a low detected incidence of carcinoma in situ.

Interferencias electromagnéticas entre los desfibriladores automáticos y los teléfonos móviles digitales y analógicos

Introduccion y objetivos La interferencia funcional de los marcapasos por la telefonia movil ha sido descrita con los sistemas analogicos y con mayor incidencia con los sistemas digitales, incluyendo inhibicion y estimulacion inadecuada. La influencia de ambos sistemas sobre el desfibrilador automatico no ha sido aun completamente estudiada. Pacientes y metodos Estudiamos la influencia de los telefonos moviles tanto de la red analogica como digital en pacientes con desfibrilador automatico: en un modelo in vivo en un total de 72 pacientes, 50 con telefono analogico y 22 con telefono digital e in vitro con un simulador de arritmias conectado al propio desfibrilador de forma directa e indirecta con las sondas en un medio salino de impedancia similar a la del medio corporal (300-350 Ohmios). Analizamos diferentes modelos de desfibriladores, en un test estandarizado disenado para lograr una gran sensibilidad del dispositivo con distintos modelos de telefonos moviles y diferente energia de transmision. Resultados Se documentaron interferencias en 14 pacientes, en 8 con telefonos analogicos y en 6 con telefono digital. En 11 de ellos, la interferencia se produjo exclusivamente en el canal del electrocardiograma de superficies obtenido desde el programador externo del desfibrilador. En 5 pacientes se constataron alteraciones en el canal de registro intracavitario, con perdida intermitente de telemetria (con el programador externo en conexion al desfibrilador). En el modelo experimental, tambien se observo la perdida ocasional de telemetria. Con el simulador de arritmias se introdujo un ritmo sinusal normal en el medio salino (y tambien en conexion directa) y fue sensado de forma correcta por el desfibrilador (sin interferencias). Posteriormente se introdujeron diferentes arritmias ventri ventriculares sostenidas, que fueron correctamente diagnosticadas por el generador (con y sin la presencia del telefono movil, situado en multiples posiciones). Se comprobo que la perdida de telemetria observada previamente no habia producido ninguna alteracion en el generador, ya que contenia los intervalos RR de cada episodio y los electrogramas almacenados de forma correcta. Por tanto, no se documentaron alteraciones reales de sobresensado, ni infrasensado en ningun desfibrilador in vivo ni in vitro. No se observaron terapias inapropiadas. El posible efecto iman de estos telefonos no se objetivo durante ninguna prueba, lo que hubiera podido inhibir la deteccion del episodio. Conclusiones a) no hemos observado en nuestra serie ninguna interferencia clinicamente significativa entre los desfibriladores y los telefonos moviles de la red analogica ni digital, tanto en el paciente portador como en el modelo experimental, ya que las alteraciones observadas correspondieron exclusivamente a la telemetria entre el generador y el programador, sin afectar a la funcion intrinseca del dispositivo; b) el modelo in vitro empleado nos permite asegurar el funcionamiento correcto del dispositivo en caso de presentar arritmias ventriculares simultaneamente al uso del telefono; c) por tanto, el uso de los telefonos moviles no se ha demostrado que sea perjudicial en estos pacientes, y d) sin embargo, pueden ser aconsejables algunas normas sencillas, como mantener una distancia superior a 15 cm entre el desfibrilador y el telefono movil.

Primary Angioplasty in Patients Older Than 75 Years. Profile of Patients and Procedures, Outcomes, and Predictors of Prognosis in the ESTROFA IM + 75 Registry

INTRODUCTION AND OBJECTIVESnThe proportion of elderly patients undergoing primary angioplasty is growing. The present study describes the clinical profile, procedural characteristics, outcomes, and predictors of outcome.nnnMETHODSnA 31-center registry of consecutive patients older than 75 years treated with primary angioplasty. Clinical and procedural data were collected, and the patients underwent clinical follow-up.nnnRESULTSnThe study included 3576 patients (39.3% women, 48.5% with renal failure, 11.5% in Killip III or IV, and 29.8% with>6hours of chest pain). Multivessel disease was present in 55.4% and nonculprit lesions were additionally treated in 24.8%. Radial access was used in 56.4%, bivalirudin in 11.8%, thromboaspiration in 55.9%, and drug-eluting stents in 26.6%. The 1-month and 2-year incidences of cardiovascular death were 10.1% and 14.7%, respectively. The 2-year rates of definite or probable thrombosis, repeat revascularization, and BARC bleeding>2 were 3.1%, 2.3%, and 4.2%, respectively. Predictive factors were diabetes mellitus, renal failure, atrial fibrillation, delay to reperfusion>6hours, ejection fraction<45%, Killip class III-IV, radial access, bivalirudin, drug-eluting stents, final TIMI flow of III, and incomplete revascularization at discharge.nnnCONCLUSIONSnNotable registry findings include frequently delayed presentation and a high prevalence of adverse factors such as renal failure and multivessel disease. Positive procedure-related predictors include shorter delay, use of radial access, bivalirudin, drug-eluting stents, and complete revascularization before discharge.

Modelo de intervención coronaria percutánea primaria en la Comunidad de Castilla-La Mancha

A B S T R A C T Coronary heart disease, and acute myocardial infarction in particular, is the primary cause of death in Spain, resulting in more deaths than cancer. Where available, primary percutaneous coronary intervention is the treatment of choice in the first 12 hours after an acute myocardial infarction. The universalization of percutaneous revascularization to all patients with myocardial infarctions necessitates the creation of wellorganized networks. The participation of health-care professionals and coordination with local health-care authorities are essential. This article describes the CORECAM protocol of the primary percutaneous coronary intervention program in Castile-La Mancha, Spain, thereby providing a summary of the treatment initiative for patients with acute myocardial infarction.

Infarto agudo de miocardio por oclusión trombótica en paciente con elevación del factor VIII de la coagulación

Sı́ndrome de ratchet: retracción y dislocación de electrodos ocasionada por el desplazamiento progresivo de los electrodos por sus piezas fijadoras o sus protecciones, facilitado por los Miguel A. Arias*, Marta Pachón, Alberto Puchol, Jesús Jiménez-López, Blanca Rodrı́guez-Picón y Luis Rodrı́guez-Padial movimientos del brazo homolateral y debido a una fijación no completa del electrodo con el protector, pero sin que haya rotación del generador sobre alguno de sus ejes. En este caso, podrı́an afectarse todos los electrodos de un sistema en un paciente o, lo que puede resultar más frecuente, que sólo se afecte alguno de los electrodos con posición absolutamente normal de otros, algo que puede resultar clave a la hora de identificar el sı́ndrome de ratchet y su diferenciación de los otros dos sı́ndromes de macrodislocación de electrodos. Antes de la revisión quirúrgica del sistema en caso de dislocación de electrodos, la simple visualización del electrodo o los electrodos, junto con la visualización radiológica de la posición del generador y su comparación con la del implante, nos permitirá una aproximación a la identificación del mecanismo operativo. Para casos en que las evidencias no sean definitivas, bien porque hay un solo electrodo en el sistema y no presenta signos de un mecanismo (p. ej., su giro sobre su eje largo en forma de trenza), bien porque se observa posición normal del generador sin alteraciones del electrodo, serı́a preferible denominar el proceso macrodislocación de electrodos, sin más. Pensamos que la clasificación y ordenación de definiciones propuesta puede ser de ayuda al clı́nico y al médico implantador y permitirı́a una mejor caracterización de esta no excepcional complicación en pacientes portadores de dispositivos cardiacos electrónicos implantables.

Multivessel disease in patients over 75 years old with ST elevated myocardial infarction. Current management strategies and related clinical outcomes in the ESTROFA MI + 75 nation-wide registry

BACKGROUNDnIn elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known.nnnMETHODSnSubgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes.nnnRESULTSnOf 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results.nnnCONCLUSIONSnIn elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence.nnnSUMMARYnWe sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.

Baseline Risk Stratification of Patients Older Than 75 Years With Infarction and Cardiogenic Shock Undergoing Primary Angioplasty

BACKGROUND AND OBJECTIVESnPatients older than 75 years with ST-segment elevation myocardial infarction undergoing primary angioplasty in cardiogenic shock have high mortality. Identification of preprocedural predictors of short- and long-term mortality could be useful to guide decision-making and further interventions.nnnMETHODSnWe analyzed a nationwide registry of primary angioplasty in the elderly (ESTROFA MI+75) comprising 3576 patients. The characteristics and outcomes of the subgroup of patients in cardiogenic shock were analyzed to identify associated factors and prognostic predictors in order to derive a baseline risk prediction score for 1-year mortality. The score was validated in an independent cohort.nnnRESULTSnA total of 332 patients were included. Baseline independent predictors of mortality were anterior myocardial infarction (HR 2.8, 95%CI, 1.4-6.0 P=.005), ejection fraction<40% (HR 2.3, 95%CI, 1.14-4.50 P=.018), and time from symptom onset to angioplasty >6hours (HR 3.2, 95%CI, 1.6-7.5; P=.001). A score was designed that included these predictive factors (score 6-ANT-40). Survival at 1 year was 54.5% for patients with score 0, 32.3% for score 1, 27.4% for score 2 and 17% for score 3 (P=.004, c-statistic 0.70). The score was validated in an independent cohort of 124 patients, showing 1-year survival rates of 64.5%, 40.0%, 28.9%, and 22.2%, respectively (P=.008, c-statistic 0.68).nnnCONCLUSIONSnA preprocedural score based on 3 simple clinical variables (anterior location, ejection fraction<40%, and delay time >6 hours) may be used to estimate survival after primary angioplasty in elderly patients with cardiogenic shock and to guide preinterventional decision-making.

TCT-265 Comparison of long-term outcomes of percutaneous coronary intervention with Sequent Please® versus In-Pact Falcon® paclitaxel eluting balloon catheter.

Paclitaxel coated balloons (PCB) currently constitute one of the therapeutic tools used in percutaneous coronary interventions (PCI). Sequent Please® (SPB) and In-Pact Falcon® (IFB) are PCB widely used that differ in several features such as the drug carrier. Their results at a long-term follow-up

TCT-137 Influence of non-culprit lesions management on outcomes in patients over 75 years old with ST elevated myocardial infarction. Results from the ESTROFA MI+75 nation-wide registry

nos: 137 201 TCT-137 Influence of non-culprit lesions management on outcomes in patients over 75 years old with ST elevated myocardial infarction. Results from the ESTROFA MI+75 nation-wide registry Jose M. de la Torre Hernandez, Joan Antoni Gomez Hospital, Salvatore Brugaletta, jose antonio baz, Armando Perez de Prado, Ramon Lopez Palop, Ana Belen Cid Alvarez, Tamara Garcia Camarero, Alejandro Diego Nieto, Federico Gimeno, Jose Antonio Fernandez Diaz, Juan Sanchis Fores, Fernando Alfonso, Roberto Blanco, Javier Botas, Javier Navarro Cuartero, Jose Moreu Burgos, Francisco Bosa, Jose Miguel Vegas, Jaime Elizaga, Antonio Luis Arrebola Moreno, Joseantonio Linares Vicente, Felipe Hernandez, Neus Salvatella Giralt, Marta Monteagudo, Alfredo Gomez Jaume, Xavier Carrillo, Roberto Martin-Reyes, Fernando Lozano, Jose Rumoroso, leire andraka, Antonio J. Dominguez Hospital Universitario Marques de Valdecilla, Santander, Spain; HU Bellvitge, Barcelona, Spain; Hospital Clinic, Barcelona, Spain; Unknown, Vigo, Spain; Fundación Investigación Sanitaria en León, Leon, Spain; Hospital San Juan, Alicante, Spain; HCU Santiago de Compostela, Santiago de compostela, Spain; H M de Valdecilla; Hospital Universitario de Salamanca, Pozuelo de Alarcon, Spain; Hospital de Valladolid; Hosp. Puerta de Hierro, Madrid, Spain; Hospital Clinico De Valencia, Valencia, Spain; Hospital Universitario de la Princesa, Madrid, Spain; Hospital de Cruces, Etxebarri, Spain; Fundacion Hospital Alcorcon, Alcorcon, Spain; Hospital de Albacete; Complejo Hospitalario de Toledo, Toledo, Spain; Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Oviedo, Spain; H.U. Gregorio Maranon, Madrid, Spain; H.U. Virgen de las Nieves, Granada, Spain; Lozano Blesa Hospital, Zaragoza, Spain; Hospital 12 de Octubre, Madrid, Spain; Clinical Cardiologist, Barcelona, Spain; Hospital Dr Peset; HU Son Espases, Palma de Mallorca, Spain; Hospital Germans Trias i Pujol; Hospital Universitario Fundacion Jimenez Diaz, MADRID, Spain; Madrid, Spain; Hospital Galdakao-Usansolo, Galdakao, Spain; hospital de basurto, Bilbao, Spain; Hospital Virgen de la Victoria de Malaga BACKGROUND Presence of multivessel disease and non-culprit lesions is not infrequent in patients undergoing primary angioplasty. However in patients over 75 years old the prognostic implications of angiographically significant non-culprit lesions management is not well known. METHODS A subanalysis of the nation-wide database of primary angioplasty in the elderly (ESTROFA MI+75) with 3,576 patients included in 31 centers. Angiographically significant non-culprit lesion was defined as any stenosis > 50% with reference vessel diameter > 2 mm. RESULTS In 2,155 (60.2%) patients angiographically significant nonculprit lesions were observed. In 891 patients (41.3%) complete revascularization was attempted, in 475 cases within the primary angioplasty procedure and in 416 in a staged procedure during admission. Finally, at discharge 1,264 (58.7%) patients had incomplete revascularization. A multivariant analysis was conducted with all clinical, angiographic and procedural variables in order to establish predictors of 2 years outcomes. Incomplete revascularization resulted independent predictor of cardiac death, infarction and revascularization (HR 1.39; 95% CI 1.02-1.63: p1⁄40.034), but PCI of non-culprit lesions in the same procedure of primary angioplasty was independent predictor of stent thrombosis (HR 2.55; 95% CI 1.10-5.92: p1⁄40.029). CONCLUSION Presence of significant non-culprit lesions is common in patients over 75 years undergoing primary angioplasty. Complete revascularization is attempted in less than half of cases. Incomplete revascularization is predictor of 2 years outcomes but complete revascularization in the primary PCI procedure is associated with steht thrombosis suggesting the recommendation of a staged approach. CATEGORIES CORONARY: Acute Myocardial Infarction TCT-138 Multivessel versus culprit-only percutaneous coronary intervention in ST-segment elevation myocardial infarction: analysis of a 8 yearall-comers registry Ana Belen Cid Alvarez, Carlos Galvao Braga, Alfredo Redondo Dieguez, Ramiro Trillo, Diego Lopez Otero, Raymundo Ocaranza-Sanchez, Belen Alvarez Alvarez, Kieran Docherty, Jose Ramon González-Juanatey HCU Santiago de Compostela, Santiago de compostela, Spain; Cleveland Clinic Foundation Weston Fl; Christus Health; Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Unknown, Santiago De Composte, Spain; Unknown, Spain, Spain; Au;tman Hospital; Golden Jubilee National Hospital; Philippine Heart Center BACKGROUND The optimal treatment of patients with multivessel coronary artery disease and ST-segment elevation acute myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is controversial. The aim of this study was to access the prognostic impact of multivessel PCI versus culprit vessel-only PCI in real-world patients with STEMI and multivessel disease. METHODS This was a retrospective cohort study of 1499 patients with STEMI diagnosis who underwent primary-PCI between January 2008 and December 2015. We performed a propensity score-matched analysis to draw up two groups of 225 patients paired according to whether or not they had undergone multivessel PCI or culprit vesselonly PCI. RESULTS During follow-up (median 2.36 years), after propensity score matching, patients who underwent multivessel PCI had lower rates of mortality (7.6% versus 11.6%, log rank p1⁄40.022), unplanned repeated revascularization (9.4% versus 14.7%, log rank p1⁄40.010) and MACE (29.7% versus 33.8%, log rank p1⁄40.016). These patients had also a trend to lower incidence of myocardial infarction (8.0% vs. 4.9%, log rank p1⁄40.093). CONCLUSION In real-world patients presenting with STEMI and multivessel coronary artery disease, multivessel PCI strategy was associated with lower rates of mortality, unplanned repeated revascularization and MACE. CATEGORIES CORONARY: Acute Myocardial Infarction TCT-139 A randomized trial of complete versus culprit-only revascularization during primary percutaneous coronary intervention in diabetic patients with acute ST elevation myocardial infarction and multi vessel disease Mohamed Hamza, Islam Elgendy Ain Shams University, Cairo, Egypt; University of Florida, Gainesville, Florida, United States BACKGROUND Recent randomized trials and meta-analyses demonstrated that a complete revascularization of significant non culprit lesions in patients with ST elevation myocardial infarction (STEMI) is J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 8 , N O . 1 8 , S U P P L B , 2 0 1 6 B57 superior to a culprit only revascularization approach in reducing major adverse cardiac events (MACE), however the proportion of diabetic patients was low in these trials. METHODS One hundred diabetic patients with acute STEMI with at least one non-culprit lesion were randomized to either complete revascularization (n1⁄450) or culprit-only treatment (n1⁄450). Complete revascularization was performed either at the time of primary percutaneous coronary intervention (PCI) or within 72 hours during hospitalization. The primary endpoint was the composite of all-cause mortality, recurrent MI, and ischemia-driven revascularization at 6 months. RESULTS A complete revascularization approach was significantly associated with a reduction in the primary outcome (6% versus 24%, p1⁄40.01), primarily due to reduction in ischemia driven revascularization in the complete revascularization group (2% versus 12%; p 1⁄4 0.047). There was no significant reduction in death or MI (2% vs. 8%; p 1⁄4 0.17) and (2% vs. 4%; p 1⁄4 0.56) respectively, or in the safety endpoints of major or minor bleeding, contrast-induced nephropathy, or stroke between the groups. CONCLUSION In diabetic patients with multi-vessel coronary artery disease undergoing PPCI, complete revascularization is associated with significantly reduced risk of adverse cardiovascular events, as compared with culprit vessel only PCI. CATEGORIES CORONARY: Acute Myocardial Infarction TCT-140 Explore trial (additional early CTO PCI in STEMI patients with a concurrent CTO) and SYNTAX score. What are lessons learned? Ivo van Dongen, Joelle Elias, Loes Hoebers, Dagmar Ouweneel, Bimmer Claessen, Jose Henriques Academic Medical Center University of Amsterdam, Amsterdam, Netherlands; Academic Medical Centre (AMC) University of Amsterdam, Amsterdam, Netherlands; Academic Medical Center, Amsterdam, Netherlands; Academic Medical Center, Amsterdam, Netherlands; Academic Medical Center University of Amsterdam, Amsterdam, Netherlands; Academic Medical Center University of Amsterdam, Amsterdam, Netherlands BACKGROUND The EXPLORE trial studied the impact on Left Ventricular Function (LVF) of additional early PCI of a concurrent chronic total occlusion in post STEMI patients, compared to no early PCI. No difference was observed between both arms. However, previous observational data consistently showed an improvement in LVF after elective CTO-PCI. Explorative subanalyses may yet reveal which patients may benefit from an early PCI CTO approach. The SYNTAX score enables high level quantification of the extent of coronary artery disease. We therefore analyzed the value of SYNTAX score on LV MRI data in the EXPLORE trial. METHODS Corelab adjudicated (Cardialysis) syntax score calculations were divided in tertiles. Cardiac MRI at baseline and 4 months were also analyzed by a corelab. In patients with paired MRI (baseline and 4 months), delta ejection fraction, enddiastolic volume, culprit scar, CTO scar and total scar were related to the SYNTAX score tertiles. RESULTS The Syntax tertiles for the entire study population were: Low <25, Intermediate 25-32.5 and High >32.5. In the group of patients with MRI at 4 months the median (IQR) total scar was 4.8 (2.8 – 7.7) for the low, 5.7 (3.4 – 9.5) for

TCT-350 Clinical Results At A Long-Term Follow-Up Of Percutaneous Coronary Intervention In Left Main Coronary Artery Disease

TCT-350 Clinical Results At A Long-Term Follow-Up Of Percutaneous Coronary Intervention In Left Main Coronary Artery Disease Jesus Piqueras-Flores, Ignacio Sanchez-Perez, Alfonso Jurado, María Thiscal López Lluva, Natalia Pinilla-Echeverri, Andrea Moreno-Arciniegas, Manuel Marina-Breysse, Fernando Lozano Medical University of Silesia; University General Hoispital of Ciudad Real, Ciudad Real, Spain; University General Hospital of Ciudad Real, Ciudad Real, Spain; Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; Hamilton General Hospital / Mc Master University, Hamilton, Ontario, Canada; Montefiore Medical Center; Medical University of Silesia; Hospital General Universitario de Ciudad Real., Ciudad Real, Spain