Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias

Introduction

The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking.

Materials and methods

A random group of 1,353 subjects aged between 40 and 70 years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV₁/FVC ratio was less than 0.70.

Results

The prevalence of COPD was 7.3% (95% CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P = .134). The incidence of smoking was 29.4% (95% CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P < .001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in group i, 69.9% in group ii, 10.4% in group iii and 3.3% in group iv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated.

Conclusions

Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.     

Valor predictivo de la hipoalbuminemia pre-tratamiento sobre el pronóstico del cáncer colorrectal resecado

Introduction

Albuminemia is part of the antitumoral systemic inflammatory response. We therefore analyzed its possible value in establishing the preoperative prognosis of colorectal carcinoma (CRC).

Patients and methods

We conducted a retrospective, observational study of a series of consecutive patients who underwent CRC resection. Univariate and multivariate analyses of survival curves were performed in patients with and without pre-treatment hypoalbuminemia (< 3.5 g/dl), both in the overall group of patients and in the subgroup of those with pTNM stage ii tumors. In addition, we compared the 5-year tumor-related mortality in patients with and without hypoalbuminemia.

Results

A total of 207 patients were reviewed (median follow-up: 81 months). In the overall multivariate analysis, survival curves were better in patients with normal albumin levels than in those with hypoalbuminemia (HR = 2.82; CI 95% = [1.54-5.19]; P = .001). This better prognostic value of normal albumin levels was also significant in pTNM stage ii tumors: (HR = 3.76; CI 95% = [1.40-10.08]; P = .009). The 5-year mortality index was lower in patients with normal albumin levels: overall series = 18.8% vs 42.9% (OR = 3.24; CI 95% = [1.48-7.12]; p = 0.001); pTNM stage ii = 13.3% vs 44.4% (OR = 5.2; CI 95% = [1.36-20.34]; P = 0.004).

Conclusions

Pre-treatment hypoalbuminemia (< 3.5 g/dl) was independently related to shorter survival after tumor resection, both in the overall series of patients and in pTNM stage ii CRC. If these results are confirmed, hypoalbuminemia would be a simple and significant marker of poor prognosis, available at the initial diagnosis.     

Factores asociados y análisis descriptivo de la endocarditis infecciosa adquirida en el entorno hospitalario de un centro terciario de referencia

Introduction and objectives

The primary aim of this study was to evaluate associated factors, clinical features and prognosis of healthcare-related infective endocarditis cases compared with community-acquired and intravenous drug user-related episodes. Changes in the distribution of healthcare-related infective endocarditis were also analysed over time in our setting.

Methods

A prospective, observational, comparative study was performed. We included all the cases of infective endocarditis from January 2003 to June 2010, which were then classified into 2 groups: group 1: community-acquired and intravenous drug user origin, and group 2: nosocomial and non-nosocomial healthcare-related cases. The episodes were classified into 2 periods: period I: January/2003-June/2006 and period II: July/2006-June 2010. Univariate and multivariate analyses were performed.

Results

A total of 212 cases were included (group 1: 138, group 2: 74). The variables of age (risk ratio 1.026; 95% CI, 1.003 to 1.049), Charlson index (risk radio 1.242; 95% CI, 1.067 to 1.445), and previous heart surgery (risk ratio 2.522; 95% CI, 1.353 to 4.701) were independently associated with healthcare-related infective endocarditis on multivariate analysis. A non-significant increase was observed in healthcare-related cases of infective endocarditis in period II (40/104; 38.4% vs. 34/108; 31.4%).

Conclusions

The recent increase in healthcare-related infective endocarditis seems to be associated with the use of invasive procedures in elderly patients with prosthetic cardiac valve, and those with a greater number of underlying diseases, especially patients with chronic renal failure on haemodialysis.     

Intervención domiciliaria y variables predictoras para reingreso hospitalario en la enfermedad pulmonar obstructiva crónica agudizada

Background

Chronic obstructive pulmonary disease (COPD) exacerbation increases mortality and resources used associated with hospitalization. We studied whether early home monitoring reduces the rate of readmission and if there are any predictor variables.

Patients and methods

We performed a prospective, controlled, parallel-group study in patients who were hospitalized for COPD. Patients whose residence was within less than 15 km from the hospital were assigned to an interventional group (home visits by nurses about 48-72 hours after discharge), the remainder were assigned to a conventional care group. The rate of rehospitalization within the first month was compared between the two groups, as well as those variables that showed a predictive capability.

Results

Seventy one patients were included: 35 in the conventional care group and 36 in the interventional group. In the latter, the treatment was modified in 13 patients (36%). The hospital readmission rate was 17%, which was similar in both groups (P = .50). For every 5-year increase in age, the risk for readmission was 2.54 (95% CI, 1.06-5.07) and for each increase of 10 mmHg in PaCO₂, the risk of readmission was 8.34 (95% CI, 2.43-18.55).

Conclusions

Early home monitoring did not decrease the readmission rate during the first month. Older age and high PaCO₂ are factors that identify the group with a high risk for rehospitalization.     

Enfermedades inflamatorias mediadas por inmunidad en pacientes con enfermedad inflamatoria intestinal. Datos basales del estudio Aquiles

Objective

To determine the prevalence of immune-mediated inflammatory diseases (IMID) in a cohort of patients with inflammatory bowel disease (IBD) enrolled in hospital gastroenterology outpatients units for the AQUILES study, a prospective 2-year follow-up study.

Material and methods

We included patients ≥ 18 years old with a prior or new diagnosis of IBD (Crohn disease [CD], ulcerative colitis [UC] or indeterminate colitis). Diagnoses were collected in a cross-sectional manner from the clinical records at enrollment of a new patient in the study.

Results

We included 526 patients (mean age 40.2 years; 47.3% men, 52.7% women), 300 with CD (57.0%), 218 with UC (41.4%) and 8 with indeterminate colitis. Other types of IMID were present in 71 patients (prevalence: 13.5%, 95% CI: 10.8-16.7): 47 were spondyloarthropathies (prevalence: 8.9%); 18 psoriasis (3.4%); 5 pyoderma gangrenosum (1.0%), and 11 uveitis (2.1%). The prevalence of IMID was higher in patients with CD than in those with UC (17.0% [95% CI: 13.2-21.7] vs 9.2% [95% CI: 6.0-13.8], p = 0.011). In the multivariate analysis, the variables associated with the presence of IMID were diagnosis of CD (OR = 1.8 [95% CI: 1.1-3.2]) and duration of IBD ≥ 4 years (OR = 2.1 [95% CI: 1.1-4.1] in those with disease duration 4-8 years, and OR = 2.1 [95% CI: 1.2-3.9] in those with ≥ 8 years vs. < 4 years).

Conclusions

In the cohort of patients with IBD in the AQUILES study, 13.5% had another IMID, with a higher prevalence in patients with CD and > 4 years since disease onset.     

Elaboración de un score predictivo preoperatorio de coledocolitiasis

Introduction

Choledocholithiasis is the most common cause of obstructive jaundice and occurs in 5-10% of patients with cholelithiasis.

Objectives

To design a preoperative predictive score for choledocholithiasis.

Material and methods

A prospective study was carried out in 556 patients admitted to our department for biliary disease. Preoperative clinical, laboratory, and ultrasound variables were compared between patients without choledocholithiasis and 65 patients with this diagnosis. A multivariate logistic analysis was performed to obtain a predictive model of choledocholithiasis, determining sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results

Predictors of choledocholithiasis were the presence of a prior history of biliary disease (history of biliary colic, acute cholecystitis, choledocholithiasis or acute biliary pancreatitis) (p = 0.021, OR = 2.225, 95% CI: 1.130-4.381), total bilirubin values > 4 mg/dl (p = 0.046, OR = 2.403, 95% CI: 1.106-5.685), alkaline phosphatase values > 150 mg/dl (p = 0.022 income, OR = 2.631, 95%: 1.386-6.231), gamma-glutamyltransferase (GGT) values > 100 mg/dl (p = 0.035, OR = 2.10, 95% CI: 1.345-5.850), and an ultrasound finding of biliary duct > 8 mm (p = 0.034, OR = 3.063 95% CI: 1086-8649). A score superior to 5 had a specificity and PPV of 100% for detecting choledocholithiasis and a score less than 3 had a sensitivity and NPV of 100% for excluding this diagnosis.

Conclusions

The preoperative score can exclude or confirm the presence of choledocholithiasis and allows patients to directly benefit from laparoscopic cholecystectomy (LC) or prior endoscopic retrograde cholangiopancreatography (ERCP).     

Factores predictores de recanalización arterial en pacientes con hemoptisis amenazante que requieren embolización arterial

Introduction

Artery embolization (AE) is a safe and useful procedure in the management of massive hemoptysis. The objective of our study was to describe the experience of AE in a tertiary referral center, to characterize angiographic findings at the time of recurrence, and to analyze factors associated with these findings.

Material and methods

Observational retrospective study of patients presenting with life-threatening hemoptysis. All consecutive patients with at least one episode of hemoptysis that required AE during a 13-year period were included. The effects of i) time to recurrence; ii) use of coils, and iii) number of arteries embolized on the likelihood that the recurrence was secondary to recanalization were assessed.

Results

One hundred seventy-six patients were included in the study. Twenty-two patients (12.5%) died due to hemoptysis. Probability of recurrence-free survival at one month was 0.91 (95% CI: 0.87 to 0.95), at 12 months was 0.85 (95% CI: 0.79 to 0.91), and after 3 years was 0.75 (95% CI: 0.66 to 0.83). A longer time to recurrence was associated with a higher probability that the hemorrhage affected the same artery (estimate = 0.0157, z-value = 2.41, p-value = 0.016).

Conclusion

AE is a safe and useful technique in the management of massive and recurrent hemoptysis. Nevertheless, recurrence after embolization is not uncommon. Recurring hemoptysis due to recanalization is related to time to recurrence, but not to the use of coils or number of arteries embolized.     

Evolución del uso de la ventilación mecánica no invasiva en enfermedad pulmonar obstructiva crónica en una región española, 1997-2010

Introduction

Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).

Subjects and methods

A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.

Results

We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.

Conclusions

The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay.     

Factores asociados al abandono de tratamiento antituberculoso convencional en Perú

Background

The non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru.

Patients and methods

An unmatched case-control study in patients diagnosed with tuberculosis from 2004-2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI).

Results

We studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR = 1.62; CI: 1.07-2.44), having felt discomfort during treatment (OR = 1.76; CI: 1.19-2.62), a prior history of non-compliance (OR = 7.95; CI: 4.76-13.27) and illegal drug use (OR = 3.74; CI: 1.25-11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR = 11.24; CI: 4-31.62). Conversely, having been properly informed about the disease (OR = 0.25; CI: 0.07-0.94) and being able to access health-care services within office hours (8 am-8 pm) (OR = 0.52; CI: 0.31-0.87) were associated with better adherence.

Conclusions

The non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be priorities.     

Estudio de la repetición del pentanucleótido CCTTT en el gen de la sintasa inducible del óxido nítrico en pacientes con hipertensión arterial pulmonar

Introduction

One of the pathways involved in pulmonary arterial hypertension (PAH) is the nitric oxide (NO) pathway. A polymorphism in the inducible NO synthase (NOS2) gene has been described, consisting of the CCTTT pentanucleotide repeat, which causes a reduction in NO production. The aim of this study was to determine if this polymorphism increases susceptibility to developing PAH.

Methods

Sixty four patients with a diagnosis of PAH groups i and iv and 50 healthy controls were compared. DNA genotyping of the samples for this polymorphism was performed using PCR. The distribution between both groups was compared and correlated with clinical and haemodynamic parameters and therapeutic response.

Results

A significantly different distribution was observed in the number of repeats between patients and controls (P < .0001). When the samples were categorised by short forms (both alleles with less than 12 repeats) and long forms (≥ 12 repeats), it was observed that the former had an almost 4-fold risk of developing PAH (odds ratio: 3.83; 95% CI: 1.19-12.32, P = .024). There were no differences between the most common types of PAH, either in therapeutic response or survival. There was no correlation between haemodynamic parameters and the number of repeats in the patients, and only a weak correlation with systolic PAH.

Conclusions

There are significant differences in the distribution of the NOS2 promotor CCTTT polymorphism between patients with PAH and the healthy population. A minor CCTTT pentanucleotide repeat in the NOS2 gene may increase the risk of developing PAH.     

Erradicación de un brote nosocomial de infecciones por Acinetobacter baumannii multirresistente tras el ajuste de cargas de trabajo y refuerzo de precauciones específicas

Introduction

During 2009, an outbreak of multidrug-resistant Acinetobacter baumannii (MDR A. baumannii) infections was detected in a 27-bed intensive care unit, resulting in 25 cases being infected.

Methods

A matched case-control study was conducted to identify risk factors for infection. The colonization pressure, or the proportion of other patients colonized by MDR A. baumannii, was estimated. TISS-28 and Omega scores of each patient were calculated to evaluate nursing work requirements. Conditional logistic regression analyses were carried out.

Results

Breakdowns in hand washing and glove use were observed. Infected patients (cases) were more likely than paired controls to have had longer exposure to invasive devices and antimicrobial treatment. The independent risk factors identified by the multivariate analysis were, mechanical ventilation [odds ratio (OR) = 1.03; 95% confidence interval (CI), 1.01-1.05; P = .01], and exposure to an infected or colonized patient [OR = 1.7; 95% CI, 1.1-2.6; P = .02). A combined infection control strategy was implemented, including strict compliance with isolation precautions, grouping of patients, reinforcing cleaning and disinfection of surfaces, and a decrease in work load. Subsequently, a sharp reduction in the incidence MDR A. baumannii infections was shown. Therapeutic activity scores were significantly higher for cases than for controls.

Conclusion

The results suggest patient-to-patient transmission of MDR A. baumannii. Reinforcement of specific procedures and work load adjustment were essential to eradicate this outbreak.     

Poder diagnóstico y pronóstico de los biomarcadores para mejorar el manejo de la neumonía adquirida en la comunidad en los servicios de urgencias

Objectives

To analyse the usefulness and performance of several biomarkers [C-reactive protein (CRP), mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT)] and lactate in predicting short- and medium-term mortality compared with the prognostic severity scales (PSS) usually employed for community-acquired pneumonia (CAP) and in assessing the aetiological suspicion of infection by Streptococcus pneumoniae and bacteraemia.

Methods

Observational, prospective and analytical study was conducted on patients who were diagnosed with CAP in our emergency department (ED). The data collected included socio-demographic and comorbidity variables, Charlson index, priority level according to the Spanish Triage System (STS), stage in the Pneumonia Severity Index (PSI) and in the CURB-65 (confusion, urea, respiratory rate, blood pressure and age ≥ 65 years), criteria of severe CAP, microbiological studies, and biomarkers determinations. The patients were followed-up for 180 days to calculate the prognostic power and the diagnostic performance for bacteraemia and aetiology.

Results

A total of 127 patients were finally enrolled in the study. The 30-day mortality was 10.3% (13), and 22.6% (28) at 180 days. Blood cultures were positive in 29 patients (23%) and S. pneumoniae was identified as the responsible pathogen in 28 cases (22.2%). The area under the ROC curve (AUC-ROC) for lactate and MR-proADM to predict 30-day mortality was 0.898 (95% CI: 0.824-0.973; P < .0001) and 0.892 (95% CI: 0.811-0.974; P < .0001), respectively, and for MR-proADM at 180 days it was 0.921 (95% CI: 0.874-0.968; P < .0001). The AUC-ROC for PCT to predict bacteraemia was 0.952 (95% CI: 0.898-1.000; P < .0001) and, considering a cut-off value ≥ 0.95 ng/ml, the negative predictive value (NPV) and the likelihood ratio (LR+) were 97.8% and 9.03, respectively. Using a PCT cut-off value > 0.85 ng/ml, the NPV and the LR+ were 96.6% and 5.89%, respectively, to predict a S. pneumoniae infection.

Conclusions

MR-proADM and lactate showed a similar or even better performance for 30-day intra-hospital mortality than PSI, CURB-65, STS and CAP severity criteria in patients diagnosed with CAP (P > .05). Furthermore, the MR-proADM capacity to predict 180-day mortality was higher than PSS and the rest of biomarkers (P > .05), and its AUC-ROC increased if it was used in combination with PSI, CURB65 and STS. The determination of PCT has a remarkable diagnostic performance to rule out bacteraemia and to orientate the aetiology towards a S. pneumoniae infection.     

Influencia del fenómeno migratorio sobre la tuberculosis en una zona semiurbana

Aims

To describe the epidemiology of tuberculosis and analyzing the differences among native and immigrant patients in Area III of the Region of Murcia.

Methods

Cohort study of tuberculosis cases reported to the Epidemiological Surveillance Service from 2004 to 2009. Data collection was performed through the System of Notification Diseases, reviewing clinical files and epidemiological surveys.

Results

One hundred sixty two cases were detected; 110 (67.9%) were immigrants, whose incidence rates ranged from 43.4 to 101.2 cases per 100,000 inhabitants. Ecuador (42.7%), Bolivia (30%) and Morocco (18.2%) were the main nationalities.Immigrants were younger than Spanish population (P < .001). The overall diagnostic delay was 50.5 days: 59.5 in Spanish and 47 in foreigners. Moroccans had higher proportions of extrapulmonary TB (P = .02). Mainly, immigrant population took treatment with four drugs (P < .001). Natives had better treatment adherence (P = .04). Spanish cases tuberculosis were associated with smoking (P < .001), the same as alcohol consumption (P = .01) and injection drug use (P < .001), nevertheless in the foreign-born population the most relevant risk factor was overcrowding (P < .001).

Conclusions

The incidence tuberculosis rates are higher among immigrant population, whose the main risk factor is overcrowding. In contrast, Spanish cases are associated with toxic substances consumption and increasing age.     

Experiencia y desarrollo de la técnica de lobectomía por cirugía torácica videoasistida: estudio comparativo con cirugía convencional en estadio i de cáncer de pulmón no microcítico

Background

Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to compare long and short-term results of conventional surgery (CS) vs. VATS lobectomy in the treatment of stage I NSCLC.

Materials and methods

We performed a retrospective, analytical study of patients undergoing surgery for stage I NSCLC during the period January 1993 to December 2005. The variables analyzed were overall survival, recurrence, distant metastasis, morbidity, mortality and hospital stay. During this period, 256 anatomic lung resections were performed: 141 by CS and 115 by VATS.

Results

There were statistically significant differences in: (i) mean hospital stay in patients with no complications (VATS group: 4.3 days vs. CS group: 8.7 days, P = .0001); (ii) mean hospital stay in patients with complications (VATS: 7.2 days vs. CS: 13.7 days, P = .0001), and (iii) morbidity (VATS: 15.6% vs. CS: 36.52%, P = .0001). No statistically significant differences were found in: (i) mortality (VATS: 2.17% vs. CS: 1.7%, P = .88); (ii) 5-year overall survival (VATS: 68.1% vs. CS: 63.8%), and (iii) local recurrence and distant metastasis (P = .82).

Conclusions

VATS lobectomy is a safe and effective approach, with a shorter hospital stay and lower morbidity than CS; no statistically significant differences were observed in survival in patients undergoing surgery for stage I NSCLC.     

Ancho de distribución eritrocitaria y predicción adicional del riesgo de hemorragia mayor en el síndrome coronario agudo sin elevación del ST

Introduction and objectives

Red cell distribution width has been linked to an increased risk for in-hospital bleeding in patients with non–ST-segment elevation acute coronary syndrome. However, its usefulness for predicting bleeding complications beyond the hospitalization period remains unknown. Our aim was to evaluate the complementary value of red cell distribution width and the CRUSADE scale to predict long-term bleeding risk in these patients.

Methods

Red cell distribution width was measured at admission in 293 patients with non–ST-segment elevation acute coronary syndrome. All patients were clinically followed up and major bleeding events were recorded (defined according to Bleeding Academic Research Consortium Definition criteria).

Results

During a follow-up of 782 days [interquartile range, 510-1112 days], events occurred in 30 (10.2%) patients. Quartile analyses showed an abrupt increase in major bleedings at the fourth red cell distribution width quartile (> 14.9%; P = .001). After multivariate adjustment, red cell distribution width > 14.9% was associated with higher risk of events (hazard ratio = 2.67; 95% confidence interval, 1.17-6.10; P = .02). Patients with values ≤ 14.9% and a CRUSADE score ≤ 40 had the lowest events rate, while patients with values > 14.9% and a CRUSADE score > 40 points (high and very high risk) had the highest rate of bleeding (log rank test, P < .001). Further, the addition of red cell distribution width to the CRUSADE score for the prediction of major bleeding had a significant integrated discrimination improvement of 5.2% (P < .001) and a net reclassification improvement of 10% (P = .001).

Conclusions

In non–ST-segment elevation acute coronary syndrome patients, elevated red cell distribution width is predictive of increased major bleeding risk and provides additional information to the CRUSADE scale.Full English text available from: www.revespcardiol.org/en     

Análisis combinado de dos ensayos aleatorizados de comparación de stents con recubrimiento de titanio-óxido nítrico con stents liberadores de fármacos en el IAMCEST

Introduction and objectives

We performed a pooled analysis based on patient-level data from the TITAX-AMI and BASE-ACS trials to evaluate the outcome of titanium-nitride-oxide-coated bioactive stents vs drug-eluting stents in patients with ST-segment elevation myocardial infarction at 2-year follow-up.

Methods

The TITAX-AMI trial compared bioactive stents with paclitaxel-eluting stents in 425 patients with acute myocardial infarction. The BASE-ACS trial compared bioactive stents with everolimus-eluting stents in 827 patients with acute coronary syndrome. The primary endpoint for the pooled analysis was major adverse cardiac events: a composite of cardiac death, recurrent myocardial infarction, or ischemia-driven target lesion revascularization at 2-year follow-up.

Results

The pooled analysis included 501 patients; 245 received bioactive stents, and 256 received drug-eluting stents. The pooled bioactive stent group was associated with a risk ratio of 0.85 for major adverse cardiac events (95% confidence interval, 0.53-1.35; P = .49) compared to the pooled drug-eluting stent group. Similarly, the pooled bioactive stent group was associated with a risk ratio of 0.71 for cardiac death (95% confidence interval, 0.26-1.95; P = .51), 0.44 for recurrent myocardial infarction (95% confidence interval, 0.20-0.97; P = .04), and 1.39 for ischemia-driven target lesion revascularization (95% confidence interval, 0.74-2.59; P = .30), compared to the pooled drug-eluting stent group. These results were confirmed by propensity-score adjusted analysis of the combined datasets.

Conclusions

In patients with ST-segment elevation myocardial infarction, bioactive stents were associated with lower rates of recurrent myocardial infarction compared to drug-eluting stents at 2-year follow-up; yet, the rates of cardiac death and ischemia-driven target lesion revascularization were similar.Full English text available from: www.revespcardiol.org/en     

Usefulness of endothelin-1 assessment in acute myocardial infarction

Introduction and objectives

High endothelin-1 (ET-1) levels have been linked to poor clinical outcomes after ST-segment elevation myocardial infarction (STEMI). Vasoconstriction of the coronary microcirculation seems to be the underlying mechanism. The aim of the study was to assess the effect of ET-1 on microvascular integrity, infarct size, left ventricular ejection fraction (LVEF) and myocardial salvage in evolving myocardial infarction (MI).

Methods

We measured ET-1 levels acutely (6-24 h) in 127 patients presenting with their first STEMI. Contrast-enhanced cardiac magnetic resonance (ce-CMR) was performed in 94 patients within 1 week to assess microvascular obstruction (MO), infarct size and LVEF. A myocardial salvage index (MSI) was defined as the percentage of at-risk angiographic area without necrosis on the ce-CMR.

Results

Mean age was 60.9 ± 11.8 years and 98 (77%) were males. Median ET-1 level within the first 24 h was 6.8 pg/mL (25^th -75^th percentile range: 5.4-8.5 pg/mL). Patients with ET-1 concentrations over the median presented higher percentage of MO (77.7% for ET-1 > 6.8 pg/mL vs. 16.6% for ET-1 ≤ 6.8 pg/mL, P < .001) and lower MSI values (13.8 ± 26% for ET-1 > 6.8 pg/mL vs. 37.4 (26%) for ET-1 ≤ 6.8 pg/mL, P = .02). ET-1 levels did not show a significant association with infarct size (P = .11) and LVEF (P = .16). Multivariate analysis found ET-1 to be a significant predictor of MO (OR = 2.78; CI 95% 1.16-6.66; P = .021) and MSI ≤ Percentile 25 (OR = 1.69, CI 95% 1.01-2.81; P = .04).

Conclusions

High ET-1 levels after myocardial infarction are associated with the presence of microvascular obstruction and lower myocardial salvage index.Full English text available from: www.revespcardiol.org     

Distribución de fenotipos clínicos en pacientes con enfermedad pulmonar obstructiva crónica por humo de biomasa y por tabaco

Introduction

Exposure to biomass smoke is a risk factor for chronic obstructive pulmonary disease (COPD). It is unknown whether COPD caused by biomass smoke has different characteristics to COPD caused by tobacco smoke.

Objective

To determine clinical differences between these two types of the disease.

Methods

Retrospective observational study of 499 patients with a diagnosis of COPD due to biomass or tobacco smoke. The clinical variables of both groups were compared.

Results

There were 122 subjects (24.4%) in the biomass smoke group and 377 (75.5%) in the tobacco smoke group. In the tobacco group, the percentage of males was higher (91.2% vs 41.8%, P < .0001) and the age was lower (70.6 vs 76.2 years, P < .0001). Body mass index and FEV₁% values were higher in the biomass group (29.4 ± 5.7 vs 28.0 ± 5.1, P = .01, and 55.6 ± 15.6 vs 47.1 ± 17.1, P < .0001, respectively). The mixed COPD-asthma phenotype was more common in the biomass group (21.3% vs 5%, P < .0001), although this difference disappeared when corrected for gender. The emphysema phenotype was more common in the tobacco group (45.9% vs 31.9%, P = .009). The prevalence of the chronic bronchitis and exacerbator phenotypes, the comorbidity burden and the rate of hospital admissions were the same in both groups.

Conclusion

Differences were observed between COPD caused by biomass and COPD caused by tobacco smoke, although these may be attributed in part to uneven gender distribution between the groups.