Tomás Ripoll

Comentarios a la guía de práctica clínica de la ESC para el manejo del infarto agudo de miocardio en pacientes con elevación del segmento ST

The European Society of Cardiology (ESC) guidelines are endorsed by the Spanish Society of Cardiology (SEC) and translated into Spanish for their publication in the Revista Española de Cardiología. Under the policy introduced in 2011, each new guideline is accompanied by an article that formulates comments in accordance with the objectives and methodology recommended in the article that established the Guidelines Committee of the SEC.1 In the present article, we discuss the new European guidelines for ST-segment elevation acute myocardial infarction (STEMI).2 The Guidelines Committee established a work group composed of members proposed by the Ischemic Heart Disease, Hemodynamics, Clinical Cardiology, Heart Failure, and Geriatric Cardiology work groups. As a general comment, we consider that the present guidelines introduce highly interesting developments and that the topics are dealt with clearly and in detail. However, we should also point out that it contains 157 recommendations, 69 (44%) of which are accompanied by level C evidence (expert consensus), predominantly in the sections on in-hospital management, heart failure, and complications, fields in which there thus remains ample room for individualization and progress in clinical research. In applying them, we should not forget that the guidelines themselves remind us that the level A and B recommendations are based on clinical trials, and that even these results are open to interpretation. The different therapeutic options could be influenced by the available resources. Thus, it will be increasingly necessary to perform cost-efficiency studies that aid us in choosing among the different strategies. For the purpose of making the article more readable and to highlight the most relevant or novel aspects, as well as those that are not made clear or are not addressed, we have summarized them in Tables 1 and 2, respectively.

Nuevas evidencias, nuevas controversias: análisis crítico de la guía de práctica clínica sobre fibrilación auricular 2010 de la Sociedad Europea de Cardiología

Manuel Anguita,* Fernando Worner, Pere Domenech, Francisco Marı́n, Javier Ortigosa, Julián Pérez-Villacastı́n, Antonio Fernández-Ortiz, Angel Alonso, Angel Cequier, Josep Comı́n, Magda Heras, Manuel Pan, Javier Alzueta, Angel Arenal, Gonzalo Barón, Xavier Borrás, Ramón Bover, Mariano de la Figuera, Carlos Escobar, Miguel Fiol, Benito Herreros, José L. Merino, Lluis Mont, Nekane Murga, Alonso Pedrote, Aurelio Quesada, Tomás Ripoll, José Rodrı́guez, Martı́n Ruiz, and Ricardo Ruiz Coordinadores del Grupo de Trabajo sobre Guı́as de Fibrilación Auricular de la Sociedad Española de Cardiologı́a, Madrid, Spain Grupo de Trabajo sobre Guı́as de Fibrilación Auricular de la Sociedad Española de Cardiologı́a, Madrid, Spain Comité de Guı́as de Práctica Clı́nica de la Sociedad Española de Cardiologı́a, Madrid, Spain Grupo de expertos revisores del documento sobre Guı́as de Fibrilación Auricular de la Sociedad Española de Cardiologı́a, Madrid, Spain

Comentarios a las guías de práctica clínica sobre manejo de las dislipemias de la Sociedad Europea de Cardiología y la Sociedad Europea de Aterosclerosis 2011. Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología

In line with the new philosophy on clinical practice guidelines adopted by the executive committee of the Sociedad Española de Cardiología (SEC: Spanish Society of Cardiology), which was explained and justifi ed in a recent document published in the Revista Española de Cardiología (REC),1 this article has the objective of discussing the most important and novel aspects of the guidelines on the management of dyslipidemias but without attempting to replace them. A joint effort by the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS),2 these guidelines updated the old protocols for treating dyslipidemias developed by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III) and published in 2001 (summary) and 2002 (complete text),3 with a minor update in 2004.4 In Spain, recommendations from the Comité Español Interdisciplinario para la Prevención Cardiovascular (CEIPC) have been used more recently,5 with the approval of the Spain’s Health Ministry and the participation of the SEC, although in this Spanish guideline dyslipidemia is just one section of the general recommendations on cardiovascular prevention.

2013 Update on Congenital Heart Disease, Clinical Cardiology, Heart Failure, and Heart Transplant

This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices.