[Subacute myocardial perforation related to a pacemaker lead. Case report and literature review].

Myocardial perforation related to cardiac electronic devices leads is a rare, but unfortunate complication, since its clinical implications are potentially lethal. The fluoroscopic outcome of case of subacute right ventricular perforation is presented, together with an analysis based on a literature review.

Atherothrombotic disease, traditional risk factors, and 4-year mortality in a Latin American population: the REACH Registry.

Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk.

Attained educational level and incident atherothrombotic events in low- and middle-income compared with high-income countries.

Background: Studies report a protective effect of higher attained educational level (AEL) on cardiovascular outcomes. However, most of these studies have been conducted in high-income countries (HICs) and lack representation from low- and middle-income countries (LMICs), which bear >80% of the global burden of cardiovascular disease.

Methods And Results: The Reduction of Atherothrombosis for Continued Health (REACH) Registry is a prospective study of 67 888 subjects with either established atherothrombotic (coronary, cerebrovascular, and/or peripheral arterial) disease or multiple atherothrombotic risk factors enrolled from 5587 physician practices in 44 countries.

Coronary revascularization strategy and outcomes according to blood pressure (from the International Verapamil SR-Trandolapril Study [INVEST]).

The optimal blood pressure (BP) to prevent major adverse outcomes (death, myocardial infarction, and stroke) for patients with hypertension and coronary artery disease who have undergone previous revascularization is unknown but might be influenced by the type of revascularization procedure. We analyzed data from the INternational VErapamil SR-Trandolapril STudy, focusing on the relation between BP and the outcomes of 6,166 previously revascularized patients, using the 16,410 nonrevascularized patients as a reference group. The previous revascularization strategy consisted of coronary artery bypass grafting (CABG, 45.

Assessment of atherothrombosis and its treatment in Mexico: first-year data of the REACH Registry.

Background: Atherothrombosis, a generalized and progressive process, is currently a major healthcare problem in Mexico.

Methods: The worldwide Reduction of Atherothrombosis for Continued Health (REACH) registry aimed to evaluate risk factors for atherosclerosis, long-term cardiovascular (CV) event rates, and current management of either patients with established symptomatic atherosclerotic disease or asymptomatic subjects with multiple risk factors for atherothrombotic disease. One-year follow-up of the global REACH database was available for 64 977 outpatients.

Characteristics and outcomes of revascularized patients with hypertension: an international verapamil SR-trandolapril substudy.

Our understanding of the growing population of revascularized patients with hypertension is limited. We retrospectively analyzed the International Verapamil SR-Trandolapril Study, which randomized coronary artery disease patients with hypertension to either verapamil SR- or atenolol-based treatment strategies, focusing on characteristics and outcomes of 6166 previously revascularized patients compared with 16 410 nonrevascularized patients. Revascularized patients had a history of coronary artery bypass grafting (45.

[Detection and treatment of vulnerable plaque].

Advances in the understanding of the role of vulnerable plaque coupled with novel diagnostic and therapeutic approaches create a unique opportunity for cardiovascular events prevention due to rupture of vulnerable plaques. Currently, non-invasive methods do not have enough resolution to identify vulnerable plaques, on the other hand, some invasive methods can define the morphological and anatomic characteristics of vulnerable plaques. These invasive methods include intravascular ultrasound and three dimensional intravascular ultrasound, virtual histology, optical coherence tomography, intravascular magnetic resonance and intracoronary angioscopy.

Influence of Hispanic ethnicity on blood pressure control and cardiovascular outcomes in women with CAD and hypertension: findings from INVEST.

Background: Prospective data regarding blood pressure (BP) control and cardiovascular (CV) outcomes in Hispanic women are lacking.

Methods: We analyzed 5017 Hispanic and 4710 non-Hispanic white hypertensive women with coronary artery disease (CAD) in the INternational VErapamil SR/Trandolapril STudy (INVEST) to determine the impact of baseline characteristics and BP control on CV outcomes.

Results: At baseline, Hispanic women were younger and a had lower prevalence of most established CV risk factors than non-Hispanic white women.

Twelve-month outcomes with a paclitaxel-eluting stent transitioning from controlled trials to clinical practice (the WISDOM Registry).

The WISDOM Registry tracked clinical outcomes in patients receiving a slow-release, polymer-based, paclitaxel-eluting stent during the transition from randomized trials to commercial use in everyday interventional cardiology practice. Although randomized trials of drug-eluting stents have demonstrated the safety and effectiveness of these devices in less complicated, de novo lesions, observation of long-term clinical outcomes is required to monitor safety as use of this revolutionary technology expands to broader patient populations. In total, 778 patients were enrolled at 22 sites in 9 countries where the TAXUS paclitaxel-eluting stent first received market approval.

[Cardiogenic shock: treatment of the near future].

The mortality rate for cardiogenic shock has decreased over the past decade. These improvements are presumed to reflect increased use of intraaortic ballon counterpulsation and coronary reperfusion strategies which, by restoring patency to the infarct-related artery, can limit infarct size. Despite these therapeutic measures, mortality rates remain elevated.

Blood pressure control and cardiovascular outcomes in high-risk Hispanic patients--findings from the International Verapamil SR/Trandolapril Study (INVEST).

Background: People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities which increase the risk associated with coronary artery disease (CAD).

Methods And Results: An analysis of the 8045 Hispanic patients enrolled in INVEST was conducted, and comparisons were made to the 14,531 non-Hispanic patients. INVEST was a prospective, randomized, open, blinded end point study in CAD patients with hypertension.

Predictors of adverse outcome among patients with hypertension and coronary artery disease.

Objectives: We sought to determine predictors for adverse outcomes in hypertensive patients with coronary artery disease (CAD).

Background: Factors leading to adverse outcomes in hypertensive patients with CAD are poorly understood. The INternational VErapamil-trandolapril STudy (INVEST) compared outcomes in hypertensive patients with CAD that were assigned randomly to either a verapamil sustained-release (SR)- or an atenolol-based strategy for blood pressure (BP) control.

Characteristics of contemporary patients with hypertension and coronary artery disease.

Background: Despite a high prevalence of hypertension in the population with CAD, there are limited data describing the clinical characteristics and treatments, as well as their interrelations in these patients. This is particularly true for black and Hispanic patients who have been underrepresented in randomized CAD trials.

Hypothesis: There exist racial and ethnic differences that define the characteristics of patients with both coronary artery disease (CAD) and hypertension.

Clinical outcomes in the diabetes cohort of the INternational VErapamil SR-Trandolapril study.

The INternational VErapamil SR-Trandolapril study (INVEST) had 6400 of 22,576 (28.3%) participants with diabetes at entry. The objectives of this prespecified analysis were to compare antihypertensive treatment strategies in the diabetes cohort (verapamil SR-based [n=3169] versus atenolol-based [n=3231]) and identify predictors for the primary outcome (a composite of first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke).

Comparison of reperfusion regimens with or without tirofiban in ST-elevation acute myocardial infarction.

There is continued debate as to whether a combined reperfusion regimen with platelet glycoprotein IIb/IIIa inhibitors provides additional benefit in optimal myocardial reperfusion of patients with a ST-elevation acute myocardial infarction (AMI). In addition, the best angiographic method to evaluate optimal myocardial reperfusion is still controversial. Patients (n = 144) with a first AMI presenting <6 hours from onset of symptoms were randomized to receive a conjunctive strategy (n = 72) with low-dose alteplase (50 mg) and tirofiban (0.

Left ventricular volume reduction by radiofrequency heating of chronic myocardial infarction in patients with congestive heart failure.

Background: Myocardial infarct expansion and left ventricular (LV) remodeling are integral components in the evolution of chronic heart failure and predict morbidity and mortality. Radiofrequency (RF) heating and patch placement of chronic LV aneurysms caused a sustained reduction in LV infarct area and volume in an ovine infarct model. This study evaluated the effect of RF heating and epicardial patch as an adjunct to coronary artery bypass graft on LV volumes in patients with prior myocardial infarction, evidence of akinetic/dyskinetic scar, and LV ejection fraction < or =40%.

Aortic Stenosis in the Elderly: A Decade of Changing Concepts.

The last 10 years have been a time of dynamic evolution in the diagnosis and treatment of aortic stenosis in elderly patients. The pathology of diseased aortic valves has been better defined. Improvements in cardiac catheterization and Doppler echocardiographic assessment have been introduced.