José Antonio Acevedo Díaz

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

Aims The aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA2DS2-VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. Methods LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6u2005months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24u2005months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during follow-up was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2u2005years (annual event rates, 290 patients/year) were less frequent than expected from CHADS2 (2.4% vs 9.6%), CHA2DS2-VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores (p<0.001, p=0.003, p=0.047, respectively). Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

A Five-Year Report on Experience in the Detection of Pheochromocytoma

OBJECTIVEnThe purpose of the study is to identify biochemical tests that are good predictors for the diagnosis of pheochromocytoma in patients at hypertension.nnnSETTINGnReview of data from of 3826 patients studied over a 5-year period, between 1994 and 1998, at the University Hospital Virgen de la Arrixaca, Murcia, Spain.nnnDESIGN AND METHODSnA retrospective study for the diagnosis of pheochromocytoma of 24-h urinary free catecholamines (norepinephrine, epinephrine, and dopamine) measured by high-performance liquid chromatography (HPLC)-electrochemical detector (ECD), total metanephrines (MNt), and vanillylmandelic acid measured by spectrophotometric methods.nnnRESULTSnDuring this period, 57 patients were found to have pheochromocytoma, being 47 sporadic, 9 with multiple endocrine neoplasia type 2A, and 1 with neurofibromatosis. In all patients multiple endocrine neoplasia type 2A the tumor were bilateral but only in four of the sporadic tumor group (p < 0.0001, Fishers exact test). MNt was determined to be the best discriminator of hypertension and pheochromocytoma. It scored a sensitivity of 94.7% (95% confidence interval, 88.3-99.9%), a specificity of 95.3% (89.5-99.9%), and thus had the best negative predictive value of 99.9% (99.8-99.9%), and this biochemical test also had the best positive predictive value of 23.3% (10.8-59.9%). When combining both MNt and norephinephrine, the positive predictive value to increases to 85.6% (65.3-95.6%).nnnCONCLUSIONnUrinary 24-h MNt excretion level is the best single biochemical test for screening and, in combination with norephinephrine, is diagnostic of the presence of pheochromocytoma.

Percutaneous Mitral Valve Repair for Acute Mitral Regurgitation After an Acute Myocardial Infarction.

Data from real-world registries have shown that inxa0axa0high-risk population, the transcatheter mitral valve repair technique is associated with a persistent reduction in mitral regurgitation (MR) severity and relevant improvement in New York Heart Association (NYHA) functional class [(1)][1]. Acute

The EXTREME registry: Titanium-nitride-oxide coated stents in small coronary arteries†

Objectives: We sought to explore the immediate results of Titan2® stent implantation in small coronary arteries, as well as the incidence of major adverse cardiac events (MACE) at six months follow‐up. Background: The safety of Titan2® stent has been confirmed in several studies in real‐life unselected populations. Methods: We enrolled 311 consecutive patients admitted for percutaneous intervention for at least one significant (50%) de novo lesion in a native small coronary artery (2.0–2.75 mm). All lesions were treated with Titan2® stent implantation. Patients were prospectively followed up for at least six months. The primary endpoint was MACE at six months follow‐up [death, myocardial infarction (MI), or target vessel revascularization (TVR)]. Secondary endpoints included angiographic and clinical procedural success, in‐hospital MACE, target lesion revascularization (TLR) during follow‐up, and stent thrombosis. Results: The mean age was 67.3 ± 10.9 years (65.9% males). A total of 356 Titan2® stents were implanted in 353 lesions. Angiographic and clinical procedural success was achieved in 344 (97.5%) patients. No case of in‐hospital MACE or acute stent thrombosis was reported. Clinical follow‐up was completed for an average of 8 ± 2 months. Two patients (0.7%) died, and 6 (2.1%) developed MI. TLR was performed in 12 (4.2%) and TVR in 16 (5.5%) patients, all were clinically driven. Cumulative MACE occurred in 20 (6.9%) patients. One patient suffered subacute stent thrombosis, but no late stent thrombosis. Conclusions: Titan2® stent implantation in small coronary arteries achieves excellent immediate outcome, with a low incidence of MACE at mid‐term follow‐up.

Spain: coronary and structural heart interventions from 2010 to 2015

Since 1990 The Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology has presented a yearly report on the data collected in the National Registry, with online support since 2010. The Steering Committee has analysed all data provided voluntarily by institutions, which consisted of a total of anywhere between 105 and 113 hospitals. Medical care was provided to a population of 46.8 million inhabitants in 2015. During this period, diagnostic procedures increased progressively from 2010, reaching a maximum of 145,836 in 2015, 86% (125,484) corresponding to coronary angiograms. This means a ratio of 3,127 diagnostic studies per million inhabitants and 2,746 coronary angiograms per million inhabitants. Total percutaneous coronary interventions have increased to 67,671 procedures, with a ratio of 1,466 per million inhabitants where 18,418 were carried out during the acute phase of myocardial infarction (21.7%). Radial access has been successfully implemented in up to 73.8% of diagnostic procedures and 76.1% of percutaneous interventions. Concerning structural interventions such as septal defects, valve interventions and closure of left atrial appendage, these have had a marked evolution over time, with a total of 1,586 TAVI and 334 LAA closure procedures performed in 2015.

TCT-403 Bioresorbable Coronary Devices in Bifurcations: Immediate and 6-month Results of the REPARA Registry

TCT-403 Bioresorbable Coronary Devices in Bifurcations: Immediate and 6-month Results of the REPARA Registry Felipe Hernandez, Jose M. de la Torre Hernandez, Bruno Garcia, Jose Rumoroso, Ramiro Trillo, Armando Perez de Prado, eduardo molina, Raul Moreno, Jose Diaz, Ivan Gomez Blazquez, Hipolito Gutierrez, Pedro Canas da Silva, Vasco Gama Ribeiro Hospital 12 de Octubre, Madrid, Spain; Hospital Universitario Marques de Valdecilla, Santander, Spain; Hospital Universitari Vall D’Hebron, Barcelona, Spain; Hospital Galdakao-Usansolo, Galdakao, Spain; Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Fundación Investigación Sanitaria en León, Leon, Spain; Unknown, granada, Spain; University Hospital La Paz, Madrid, Spain; Unknown, huelva, Spain; Hospital Meixoeiro, Vigo, Spain; H Valladolid; Hospital Santa Maria, Lisboa, Portugal; Centro Hospitalar de Vila Nova de Gaia, Gaia, Portugal

TCT-428 Bioresorbable Coronary Devices in Clinical Practice: 6-month Results of the Prospective REPARA Registry

Regular use of bioresorbable coronary devices in daily clinical practice is not fully established yet. Few data exist about clinical outcomes in specific lesions or clinical scenarios.nnREPARA is a multicentre, prospective registry, designed to evaluate the efficacy and safety of the bioresorbable

Vascular response at proximal and distal edges between polymer-free and polymer-based paclitaxel-eluting stents: intravascular ultrasound analysis

Aim: Polymer-based paclitaxel eluting stent (PB-PES) has shown to have a positive vascular remodeling at the distal edge compared to bare metal stent (BMS), probably due to higher downstream concentrations of the drug in comparison to proximal edge. The AXXION stent is a polymer-free paclitaxel eluting stent (PF-PES), whose dosage of drug is approximately 2.7 μg/cm2 compared to 1.0 μg/cm2 of the PB-PES. The purpose of this study was to compare vascular responses in adjacent segments between PF-PES and PB-PES.nnMethods and results: Consecutive 164 patients undergoing percutaneous coronary intervention were prospectively randomized 1:1 to receive either PF-PES or PB-PES (Clinicaltraials.gov [NCT01375855][1]). All patients provided written informed consent for their inclusion into IVUS examination at post-procedure and 9-month follow-up. Paired serial IVUS data were available in 76 patients with 84 lesions (38 patients with 41 lesions for PB-PES and 38 patients with 43 lesions for PF-PES). Baseline patient and lesion characteristics were similar between 2 groups. No significant differences were observed between PB-PES and PF-PES in terms of change in vessel area either at proximal (16.77±5.20% vs. 15.97±4.27%; p=0.450) or at distal segment (11.59±4.91% vs. 11.03±4.74%; p=0.546). No differences were also found in the percentage of change in plaque area (-5.73±42.81% for PB-PES vs. 9.81±32.91% for PF-PES; p=0.122) and in lumen area (0.43±19.42% for PB-PES vs. -5.70±17.87% for PF-PES; p=0.178) at proximal edge. Conversely at distal edge, a significant increase in plaque area was observed with PF-PES compared to PB-PES. (plaque area: 2.23±18.54% for PB-PES vs. 12.59±28.62% for PF-PES; p=0.038) with subsequent reduction in lumen area (5.82±21.18% for PB-PES vs. -4.98±17.59% for PF-PES; p=0.024).nnConclusion: PF-PES did not seem to have a different edge response as compared to PB-PES. In particular they seem to increase plaque area with lumen reduction at the distal edge, probably due to differences in polymer-base drug release between the two platforms.nn [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01375855&atom=%2Fehj%2F34%2Fsuppl_1%2FP3945.atom

Thrombolytic fibrin specificity influences activated partial thromboplastin time prolongation

Despite limited comparative data, guidelines suggest the same concomitant unfractionated heparin (UFH) dose for all fibrin-specific thrombolytic agents in acute myocardial infarction. Since a supratherapeutic activated partial thromboplastin time (aPTT) correlates with adverse outcomes, clarifying effects of various agents on aPTT are needed. The present in vitro study evaluated the influence of alteplase (rt-PA), reteplase (r-PA), and tenecteplase (TNK) on aPTT prolongation. Blood samples from healthy volunteers (n = 12) were treated with equipotent concentrations of rt-PA, r-PA, and TNK, with and without UFH. Samples of each treatment group were incubated at 37°C; aPTT and fibrinogen activity were measured after 4 h. Mean aPTT values for rt-PA alone and r-PA alone were prolonged versus those of TNK alone (P = 0.001 for both). Combined with UFH, rt-PA and r-PA increased the aPTT versus UFH alone (P < 0.05 for both). Interestingly, TNK + UFH reduced the aPTT versus UFH alone (P < 0.001). A negative correlation existed between fibrinogen activity and aPTT for all treatments, except TNK alone. The present investigation illustrates that an agent with maximal fibrin specificity (TNK) has minimal effect on the aPTT, while agents with less fibrin specificity are more likely to prolong the aPTT, with and without UFH present.