Juan Sanchis Fores

Amplitud de distribución eritrocitaria y riesgo de mortalidad en pacientes con insuficiencia cardiaca aguda

BACKGROUND AND OBJECTIVE Red cell distribution width (RDW) is a quantitative measure of the variability in size of erythrocytes, and it is used for the differential diagnosis of anemia. Recent reports have suggested that high RDW could play a role for risk stratification in patients with chronic heart failure. However, the prognostic role of RDW in unselected population with acute heart failure (AHF), after a thoroughly multivariate adjustment, has not been well established. The aim of this study was to establish the association between RDW and long-term mortality in patients admitted for AHF. PATIENTS AND METHOD We analyzed 1,190 consecutive patients admitted for AHF in our center. RDW measurement was performed on admission. RDW values were stratified into quartiles (Q) and the association of RDW with total mortality was assessed using Cox regression. RESULTS After a median follow-up of 15 months (interquartile range 3-33 months) 458 (38%) deaths were identified. There was a progressive increase in mortality rates from Q1 to Q4: 1.34, 1.82, 2.56 and 3.53 per 10 patients-year of follow-up (for Q1, Q2, Q3 and Q4 respectively, P for trend <.001). In the multivariate analysis, this association remained independent for patients in Q3 (15-16%) and Q4 (>16%) versus Q1 (≤14%), hazard ratio (HR): 1.66, 95% confidence interval (95% CI) 1.24-2.22, P<.01, HR: 1.80, 95% CI 1.33-2.43, p<.01, respectively, in a model adjusted for established prognostic markers in AHF. CONCLUSION In patients with AHF, higher RDW values were associated with increased long-term mortality.

Comments on the 2016 ESC/EAS Guidelines for the Management of Dyslipidemias☆

In the present article, we discuss the recently published guidelines for the treatment of dyslipidemia developed by the European Society of Cardiology (ESC) in conjunction with the European Atherosclerosis Society and with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation.1 To comment on these guidelines, the Guidelines Committee formed a task force composed of members of the Spanish Society of Cardiology (SEC). Thus, following the same order as the guidelines, the current article reviews the most important aspects of the various sections.

The Scope of Cardiological Competence in New Clinical Settings. Spanish Society of Cardiology Consensus Document

Cardiology is the medical discipline or specialty responsible for the prevention, diagnosis, and treatment of cardiovascular disease. As this is the major cause of morbidity and mortality in Spain and the European Union,1 cardiology professionals have, with respect to other medical specialists, an additional moral authority and responsibility derived from the relevance for society of an excellent performance in combating cardiovascular disease. Hence the importance of keeping up with the rapid transitions that are currently taking place at the social, administrative, educational, health care, and professional levels, transitions that necessarily generate novel contexts for the practice of cardiology and for its professionals. At the end of 2005, the Spanish Society of Cardiology (SSC), by virtue of its leadership role in combating cardiovascular disease, decided to undertake a project, applying a synthetic approach to the process matrix, involving the professionals in cardiology and in other medical specialties, the health care administrations, the pharmaceutical industry, and biotechnology companies, the institutions, the patients and the general population; these processes will ultimately play a role in the development of the field of cardiology, in the work of The Scope of Cardiological Competence in New Clinical Settings

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-120 Primary angioplasty for patients over 75 years old in cardiogenic shock: contemporary results and prognostic predictors from the ESTROFA MI+75 nationwide registry.

TCT-119 A New Risk Score to Predict Long-Term Cardiac Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock and Treated with Primary Percutaneous Intervention Ruben Vergara, Renato Valenti, Angela Migliorini, Guido Parodl, Maria Grazia De gregorio, Maria Raffaella Aicale, Elena De Vito, Eleonora Gabrielli, David Antoniucci DivCardiology-Careggi Hospital, Florence, Italy; Careggi Hospital, Florence, Italy; careggi Hospital, Florence, Florence, Italy; Division of Cardiology Careggi Hospital; Division of Cardiology Careggi Hospital; Division of Cardiology Careggi Hospital; Division of Cardiology Careggi Hospital; Division of Cardiology Careggi Hospital; Careggi Hospital, Florence, Italy

The Scope of Cardiological Competence in New Clinical Settings

Cardiology is the medical discipline or specialty responsible for the prevention, diagnosis, and treatment of cardiovascular disease. As this is the major cause of morbidity and mortality in Spain and the European Union,1 cardiology professionals have, with respect to other medical specialists, an additional moral authority and responsibility derived from the relevance for society of an excellent performance in combating cardiovascular disease. Hence the importance of keeping up with the rapid transitions that are currently taking place at the social, administrative, educational, health care, and professional levels, transitions that necessarily generate novel contexts for the practice of cardiology and for its professionals. At the end of 2005, the Spanish Society of Cardiology (SSC), by virtue of its leadership role in combating cardiovascular disease, decided to undertake a project, applying a synthetic approach to the process matrix, involving the professionals in cardiology and in other medical specialties, the health care administrations, the pharmaceutical industry, and biotechnology companies, the institutions, the patients and the general population; these processes will ultimately play a role in the development of the field of cardiology, in the work of The Scope of Cardiological Competence in New Clinical Settings

The Scope of Cardiological Competence in New Clinical Settings: A Consensus Document of the Spanish Society of Cardiology

Cardiology is the medical discipline or specialty responsible for the prevention, diagnosis, and treatment of cardiovascular disease. As this is the major cause of morbidity and mortality in Spain and the European Union,1 cardiology professionals have, with respect to other medical specialists, an additional moral authority and responsibility derived from the relevance for society of an excellent performance in combating cardiovascular disease. Hence the importance of keeping up with the rapid transitions that are currently taking place at the social, administrative, educational, health care, and professional levels, transitions that necessarily generate novel contexts for the practice of cardiology and for its professionals. At the end of 2005, the Spanish Society of Cardiology (SSC), by virtue of its leadership role in combating cardiovascular disease, decided to undertake a project, applying a synthetic approach to the process matrix, involving the professionals in cardiology and in other medical specialties, the health care administrations, the pharmaceutical industry, and biotechnology companies, the institutions, the patients and the general population; these processes will ultimately play a role in the development of the field of cardiology, in the work of The Scope of Cardiological Competence in New Clinical Settings