Publications by authors named "Elizaga J"
Objective: 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
- The article reviews the 2023 activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology, highlighting key trends in interventional cardiology practices in Spain.
- A survey involving 119 hospitals revealed a slight decrease in diagnostic studies but an increase in percutaneous coronary interventions (PCI), with a notable rise in the use of drug-coated balloons and techniques for plaque modification.
- The findings indicate a stabilization in coronary interventions while showcasing a growth in complex procedures, particularly for valvular and nonvalvular structural heart diseases, with primary PCI becoming the leading treatment for myocardial infarction.
Article Synopsis
- The MOSCA-FRAIL trial examined the effects of invasive versus conservative treatment strategies in frail patients aged 70 and older with non-ST-segment elevation myocardial infarction (NSTEMI).
- The study included 167 participants and focused on various geriatric conditions, finding that invasive management had a notable survival benefit primarily for those with lower frailty levels (CFS=4).
- Results suggested that frailty, as indicated by the Clinical Frailty Scale (CFS), is an important factor in determining the risks and benefits of treatment, with a CFS score greater than 4 potentially signaling a need for more cautious decision-making.
Background: Longitudinal changes in gut microbiome and inflammation may be involved in the evolution of atherosclerosis after an acute coronary syndrome (ACS). We aimed to characterize repeated profiles of gut microbiota and peripheral CD4+ T lymphocytes during the first year after an ACS, and to address their relationship with atherosclerotic plaque changes.
Methods: Over one year we measured the microbiome, peripheral counts of CD4+ T populations and cytokines in 67 patients shortly after a first ACS.
Article Synopsis
- The MOSCA-FRAIL trial investigated treatment approaches for frail patients (aged ≥70) with non-ST-segment elevation myocardial infarction (NSTEMI) and found no significant difference in health outcomes after one year between invasive and conservative strategies.
- Following extended follow-up until January 2023, the analysis of 167 patients indicated similar survival times and readmission rates, revealing that neither treatment significantly outperformed the other.
- Overall, while initial outcomes suggested that invasive treatment might lead to shorter survival in the first year, the long-term results demonstrated inconclusive differences, highlighting the need for personalized treatment decisions in frail older adults.
Background: Twitch-independent tension has been demonstrated in cardiomyocytes, but its role in heart failure (HF) is unclear. We aimed to address twitch-independent tension as a source of diastolic dysfunction by isolating the effects of chamber resting tone (RT) from impaired relaxation and stiffness.
Methods: We invasively monitored pressure-volume data during cardiopulmonary exercise in 20 patients with hypertrophic cardiomyopathy, 17 control subjects, and 35 patients with HF with preserved ejection fraction.
Article Synopsis
- This article reports on the annual activities of the Interventional Cardiology Association of the Spanish Society of Cardiology for 2022.
- A total of 111 centers participated, revealing a 4.8% increase in diagnostic studies and a significant 22% rise in PCIs on the left main coronary artery, while the overall PCI numbers remained stable.
- Key trends included a preference for the radial approach in 94.9% of cases, increased use of drug-eluting balloons and intracoronary imaging, and a continuous rise in noncoronary procedures, especially those related to heart valve and structural heart issues.
Background: Coronary obstruction (CO) following transcatheter aortic valve replacement (TAVR) is a life-threatening complication, scarcely studied.
Objectives: The authors analyzed the incidence of CO after TAVR, presentation, management, and in-hospital and 1-year clinical outcomes in a large series of patients undergoing TAVR.
Methods: Patients from the Spanish TAVI (Transcatheter Aortic Valve Implantation) registry who presented with CO in the procedure, during hospitalization or at follow-up were included.
Background: The "weekend effect" has been associated with worse clinical outcomes. Our aim was to compare off-hours vs. regular-hours peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic shock patients.
View Article and Find Full Text PDFArticle Synopsis
- This study is the first randomized clinical trial to compare invasive versus conservative treatment strategies for frail, older patients (≥70 years) with non-ST-segment elevation acute myocardial infarction (NSTEMI).
- Conducted across 13 hospitals in Spain from 2017 to 2021, it included 167 patients and measured primary outcomes like days alive and out of the hospital (DAOH) and the rates of cardiac-related complications.
- Results showed that while conservatively managed patients had slightly more DAOH (312 days) compared to those managed invasively (284 days), the difference was not statistically significant, and no major differences in mortality were found between the two groups. *
Endothelial dysfunction in patients with angina and non-obstructed coronary arteries is associated with an increased risk of mayor cardiovascular events. Results of the Spanish ENDOCOR registry.
Int J Cardiol
January 2023
Background: Coronary endothelial dysfunction and vasospasm are potential causes of ischemia in patients without obstructive coronary stenoses (INOCA).
Objective: To evaluate the prevalence of endothelial dysfunction and the clinical profile of patients with INOCA in Spain, as well as to identify the predictors and the prognostic impact of endothelial dysfunction in this scenario.
Methods: A total of 438 consecutive patients with INOCA in whom the acetylcholine test was performed were prospectively enrolled.
We systematically categorized the longer-term (≥3 years) structural and functional characteristics of the ABSORB bioresorbable vascular scaffold (BVS) using optical coherence tomography imaging and coronary vasomotor reactivity testing and further compared the functional characteristics of BVS stented versus remote coronary segments. A total of 92 patients (mean age 56.4 ± 9.
View Article and Find Full Text PDFIntroduction And Objectives: Transaxillary access (TXA) has become the most widely used alternative to transfemoral access (TFA) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to compare total in-hospital and 30-day mortality in patients included in the Spanish TAVI registry who were treated by TXA or TFA access.
Methods: We analyzed data from patients treated with TXA or TFA and who were included in the TAVI Spanish registry.
Effect of COMBinAtion therapy with remote ischemic conditioning and exenatide on the Myocardial Infarct size: a two-by-two factorial randomized trial (COMBAT-MI).
Basic Res Cardiol
January 2021
Remote ischemic conditioning (RIC) and the GLP-1 analog exenatide activate different cardioprotective pathways and may have additive effects on infarct size (IS). Here, we aimed to assess the efficacy of RIC as compared with sham procedure, and of exenatide, as compared with placebo, and the interaction between both, to reduce IS in humans. We designed a two-by-two factorial, randomized controlled, blinded, multicenter, clinical trial.
View Article and Find Full Text PDFBackground The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial.
View Article and Find Full Text PDFIntroduction And Objectives: The development of complete AV block and the need for pacemaker implantation (PM) is the most frequent complication after Transaortic valve replacement (TAVR). In other PM clinical contexts, a higher percentage of ventricular stimulation has been associated with worse prognosis. The objective was to study the existence of predictors of PM dependence.
View Article and Find Full Text PDFAims: We determined the incidence and type of arrhythmias at 2-year follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR).
Methods And Results: Multicentre prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR (SAPIEN XT/3: 53; CoreValve/Evolut R: 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted before hospital discharge and patients had continuous monitoring for up to 2 years.
Article Synopsis
- The study examines how the COVID-19 outbreak affected the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) in Spain, focusing on changes in patient care before and after the pandemic.
- Results showed a 27.6% decrease in STEMI patient treatments and a significant rise in in-hospital mortality during COVID-19 (7.5% vs 5.1%) despite consistent use of primary percutaneous coronary intervention as a treatment strategy.
- The findings indicate that COVID-19 led to longer ischemic times for patients and a notable incidence of confirmed SARS-CoV-2 infections during hospitalization, highlighting the challenges faced in managing STEMI cases during the pandemic.
Article Synopsis
- The study evaluated the impact of the COVID-19 outbreak on the treatment and outcomes of patients with STEMI in Spain, comparing cohorts treated before and after the pandemic began.
- It found a significant decrease in both suspected and confirmed STEMI patients, along with a longer ischemic time for those treated during COVID-19; however, the reperfusion strategy remained largely unchanged.
- In-hospital mortality increased during the COVID-19 period, with a reported rate rising from 5.1% to 7.5%, highlighting a concerning trend in patient outcomes despite consistent treatment methods.