Publications by authors named "Alfonso F"
Background: Despite fractional flow reserve (FFR)-guided deferral of revascularization, recurrent events in patients with diabetes or after myocardial infarction remain common. This study aimed to assess the association between FFR-negative but high-risk nonculprit lesions and clinical outcomes.
Methods: This is a patient-level pooled analysis of the prospective natural-history COMBINE (OCT-FFR) study (Optical Coherence Tomography Morphologic and Fractional Flow Reserve Assessment in Diabetes Mellitus Patients) and PECTUS-obs study (Identification of Risk Factors for Acute Coronary Events by OCT After STEMI and NSTEMI Patients With Residual Non- Flow Limiting Lesions).
How Can We Optimize the Results of Coronary Bioresorbable Scaffolds?
Circ Cardiovasc Interv
January 2025
Background: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and wall motion abnormalities without culprit coronary artery disease. LV thrombus (LVT) formation during the acute phase is a fearsome complication.
Objectives: To identify factors associated with LVT and its prognostic impact in TTS patients.
Introduction Y Objectives: Tako-tsubo syndrome (TTS) is a cardiac condition that mimics acute coronary syndrome, characterized by transient left ventricular dysfunction in the absence of culprit coronary artery stenosis. Although its etiology remains unknown, reversible microvascular dysfunction secondary to an adrenergic surge is thought to play a role. Treatment is empirical, although most patients receive beta-blockers (BB) in clinical practice.
View Article and Find Full Text PDFSpontaneous coronary artery dissection and concomitant atherosclerotic disease.
Rev Esp Cardiol (Engl Ed)
December 2024
Introduction And Objectives: The Valve Academic Research Consortium (VARC)-3 definition of the early safety (ES) composite endpoint after transcatheter aortic valve replacement (TAVR) lacks clinical validation. The aim of this study was to determine the incidence, predictors, and clinical impact of ES after TAVR as defined by VARC-3 criteria.
Methods: We performed a multicenter study including 10 078 patients with severe aortic stenosis undergoing transarterial TAVR.
Background: Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. This study aimed to determine the rate, factors associated with, and prognostic value of poor functional status (NYHA class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
Methods: This multicenter study included 6,363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I-II vs.
Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in aortic stenosis patients. However, the factors associated with poorer outcomes among AF patients in contemporary TAVR practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown.
Methods: Multicenter study including consecutive patients with a history of AF, evaluating the clinical outcomes and predictors of mortality, and HF-related hospitalization, who underwent TAVR with newer-generation devices using balloon or self-expandable valves.
Background: Drug-coated balloons (DCBs) offer an appealing therapeutic alternative for the treatment of patients with coronary in-stent restenosis (ISR). In-segment late lumen loss, translating into recurrent ISR and the clinical need for target lesion revascularization, represents a well-established and thoroughly investigated limitation of DCB in this setting. However, abrupt vessel occlusion, clinically presenting as ST-segment elevation myocardial infarction (STEMI), has not been previously described after DCB therapy for ISR.
View Article and Find Full Text PDFBackground: Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF METHODS: Our data come from the FRAGIC study ("impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula.
View Article and Find Full Text PDFObjective: To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction (NSTEMI) from the MOSCA-FRAIL clinical trial.
Methods: The MOSCA-FRAIL trial randomized 167 frail patients, defined by a Clinical Frailty Scale (CFS) ≥ 4, with NSTEMI to an invasive or conservative strategy. The primary endpoint was the number of days alive and out of hospital (DAOH) one year after discharge.
Article Synopsis
- Researchers studied 1,729 patients with coronary artery aneurysms (CAAs) to understand their clinical characteristics and predict outcomes, using data from an international registry across 9 countries.
- The majority of patients were male (78.6%) averaging 66 years old, with significant cardiovascular issues such as coronary artery disease (85.8%) and a median of 1 aneurysm per patient, primarily affecting the left anterior descending artery.
- During a median follow-up of about 45 months, 21.9% of patients died, and 37.1% experienced major adverse cardiovascular events; factors like age, diabetes, and kidney disease were linked to worse outcomes.
Article Synopsis
- * The study included 51 patients and found a high safety rate, with 92.2% free from target lesion failure at 180 days and 90.2% at one year.
- * The new DCB showed significantly better results in reducing in-stent late lumen loss compared to standard balloon angioplasty, indicating its superior efficacy for ISR treatment.
Background: The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) has recently introduced a consensus document that outlines risk factors to identify high bleeding risk in patients undergoing transcatheter aortic valve replacement. The objective of the present study was to evaluate the prevalence and predictive value of the VARC-HBR definition in a contemporary, large-scale transcatheter aortic valve replacement population.
Methods: Multicenter study including 10 449 patients undergoing transcatheter aortic valve replacement.
Background: The comparative outcomes with immediate, staged in-hospital, and staged out-of-hospital complete revascularization for patients with ST-segment-elevation myocardial infarction and multivessel disease remain unclear.
Methods And Results: An electronic search of MEDLINE, SCOPUS, and Cochrane databases was performed through August 2023 for randomized trials evaluating immediate, staged in-hospital, and staged out-of-hospital complete revascularization for patients with ST-segment-elevation myocardial infarction and multivessel disease. The primary outcome was major adverse cardiac events (MACEs).
Article Synopsis
- Researchers compared two methods to assess the risk of cardiac events in patients: the Gensini score (which evaluates coronary atherosclerosis burden) and optical coherence tomography (OCT) for plaque morphology.
- Out of 847 patients studied, 56 (6.6%) experienced serious cardiac issues within one year, with higher risks associated with higher Gensini scores and certain OCT features like thin fibrous caps and large lipid arcs.
- Both the Gensini score and specific OCT characteristics were found to be independent predictors of cardiac events, indicating that patients with greater atherosclerosis and vulnerable plaques are at a higher risk for adverse outcomes.
Article Synopsis
- Differentiating tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM) is difficult for patients with heart failure (HF) and left ventricular dysfunction caused by supraventricular tachyarrhythmia (SVT).
- A study analyzed 43 patients admitted for HF due to SVT; those whose left ventricular ejection fraction (LVEF) improved were classified as TIC, while those with persistent low LVEF were classified as DCM.
- Key findings showed that diabetes, late gadolinium enhancement (LGE), low left ventricular peak systolic velocity, and specific right ventricular displacement measurements could help predict LVEF recovery and distinguish between TIC
Article Synopsis
- The DANAMI-3 DEFER study shows that postponing stent implantation in ST-elevation myocardial infarction (STEMI) is safe and may work well when carefully choosing patients.
- The study included 198 patients undergoing primary percutaneous coronary intervention (PCI) and compared those who had deferred stenting with those who received immediate stenting.
- Results indicated that while the deferred stenting group had lower rates of stent use and employed more thrombus aspiration, there were no significant differences in mortality or major adverse events between the two groups, suggesting the need for further research on tailored treatment strategies.