Roberto Martín Asenjo

Frailty is a short-term prognostic marker in acute coronary syndrome of elderly patients:

Background: Frailty is a biological condition that reflects a state of decreased physiological reserve and vulnerability to stressors. The role of frailty in acute coronary syndrome patients has not been fully explored. Our study aims to assess the prevalence of frailty and its impact on in-hospital adverse outcomes of patients aged ⩾75 years admitted for acute coronary syndrome. Methods: This prospective, observational study included patients aged ⩾75 years admitted due to type 1 myocardial infarction in four tertiary hospitals. Frailty was assessed by the SHARE-FI index. The primary endpoint was the combination of in-hospital death or non-fatal myocardial (re)infarction. Secondary endpoints included the assessment of individual rates of (re)infarction, mortality, stroke, major bleeding and the combination of in-hospital death, (re)infarction and mortality. Results: A total of 202 patients were analysed. Frail patients (n=71, 35.1%) were older, more often women, had higher rates of comorbidities, and a higher risk profile according to GRACE, TIMI and CRUSADE scores at admission. The primary endpoint was significantly more frequent among frail patients (9.9% vs. 1.5%; P=0.006), as well as the combination of death, myocardial infarction and stroke (11.3% vs. 1.5%; P=0.002), driven mainly by a higher mortality rate (8.5% vs 0.8%; P=0.004). On multivariate analysis, frailty phenotype was an independent predictor of major adverse cardiac events (odds ratio 7.13; 95% confidence interval 1.43–35.42). Conclusions: Over one third of elderly patients with high-risk acute coronary syndrome are frail. Frailty phenotype is an important and independent prognostic marker in these patients.

Isquemia miocárdica aguda y trombosis ventricular asociadas a feocromocitoma

Comunicamos el caso de un paciente con un feocromocitoma suprarrenal que curso con una evolucion clinica compleja, alteraciones electrocardiograficas propias de afeccion miocardica difusa, con coronariografia normal y un trombo intraventricular izquierdo complicado con un ictus embolico.

Long-term Cardiovascular Risk After Acute Coronary Syndrome, An Ongoing Challenge

Los avances en la prevencion de eventos cardiovasculares recurrentes en los pacientes que han sufrido un sindrome coronario agudo (SCA) —prevencion secundaria— han sido espectaculares en las ultimas dos decadas. El descubrimiento de sus efectos beneficiosos y el uso generalizado de antiagregantes plaquetarios, bloqueadores beta, estatinas e inhibidores de la enzima de conversion de la angiotensina, asi como el empleo mas selectivo de la rehabilitacion cardiaca, los inhibidores de los receptores de aldosterona y los desfibriladores automaticos implantables, principalmente en pacientes con disfuncion sistolica ventricular izquierda significativa, han reducido sustancialmente la mortalidad y la tasa de eventos cardiovasculares en los pacientes que ya han sufrido un SCA. Pese a ello, el pronostico de los pacientes que sobreviven a un SCA dista de ser benigno. De hecho, es ya bien conocido el hecho de que algunos pacientes con SCA con una mortalidad inicial menor, como aquellos sin elevacion del ST en el ECG, acaban presentando una mortalidad a largo plazo similar a la de aquellos con SCA con elevacion de ST, lo que se produce a expensas del mayor riesgo de recurrencia de eventos coronarios, que aumenta el riesgo de mortalidad tardia. Tradicionalmente se ha hecho enfasis en el riesgo posinfarto de los 12 meses siguientes al episodio agudo. Esto se debe, en primer lugar, a que la tasa de eventos recurrentes es mayor en los primeros meses y la duracion de la doble antiagregacion se recomienda durante 12 meses tras el SCA. Sin embargo, el riesgo persiste posteriormente y, aunque a un ritmo menor, los eventos vasculares y, con menor frecuencia, la muerte de origen cardiovascular siguen produciendose. En el articulo publicado en REVISTA ESPANOLA DE CARDIOLOGIA se presenta el analisis de la recurrencia de eventos cardiovasculares —infarto, ictus o muerte cardiovascular— en una cohorte de 4.858 pacientes tratados en el Complejo Hospitalario Universitario de Santiago de Compostela. En el se encontro una incidencia de 329 eventos durante el primer ano y 616 en los aproximadamente 4 anos de seguimiento posterior, lo que supone

Comments on the 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

In accordance with the policy on clinical practice guidelines established by the Executive Committee of the Spanish Society of Cardiology, the current article discusses the most notable and novel aspects of the European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure (HF). The aim of the guidelines is to update our knowledge of the diagnosis and treatment of HF based on the best clinical evidence available.

Acute Myocardial Ischemia and Ventricular Thrombus Associated With Pheochromocytoma

We describe a patient with a suprarenal pheochromocytoma that had a complex course with electrocardiographic findings characteristic of diffuse myocardial damage, normal findings on coronary angiography, and left intraventricular thrombus complicated by embolic stroke.

Anomalous bilateral pulmonary veins with normal drainage into the left atrium.

A healthy 42-year-old female was referred for further investigation following an incidental discovery on plain chest radiograph. The chest radiograph showed a tortuos tubular structure running across the mediastinum and the right pulmonary hilum ( Panel A ). A contrast-enhanced CT demonstrated that a large anomalous …