Publications by authors named "Jose Moreu"
Background And Aim: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic.
Methods And Results: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020.
Background: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.
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- 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
- Intravascular lithotripsy (IVL) is effective for treating calcified coronary lesions in patients with stable coronary disease, as shown in a study involving 426 patients across 26 centers in Spain.
- The study found that IVL was successfully delivered in 99% of cases, achieving procedural success in 66% of patients and similar outcomes for both acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) groups.
- The safety analysis showed a relatively low rate of major adverse cardiovascular events (MACE) at 30 days, with 3% overall (1% for CCS and 5% for ACS), indicating that IVL is both safe and effective in real-life clinical settings.
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.
Article Synopsis
- Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, with patients presenting reduced left ventricular ejection fraction (LVEF) displaying different clinical features and outcomes compared to those with preserved LVEF.
- In a study of 389 patients, those with reduced LVEF (15% of participants) more often experienced severe presentations like ST-segment elevation myocardial infarction (STEMI) and had more extensive coronary artery involvement.
- Despite receiving specific medications, patients with reduced LVEF had significantly higher mortality rates (9% vs. 0.7%) and readmission for heart failure (4% vs. 0.3%) during a median follow-up of
Article Synopsis
- * A study involving over 16,600 STEMI patients found a 16% reduction in PPCI procedures in 2020 compared to 2019, with the elderly experiencing the most significant delays.
- * Consequently, there was a notable increase in 30-day mortality rates during the pandemic, particularly among older patients, attributed to longer ischemia times and treatment delays.
Changes in the Treatment Strategy Following Intracoronary Pressure Wire in a Contemporaneous Real-Life Cohort of Patients With Intermediate Coronary Stenosis. Results From a Nationwide Registry.
Cardiovasc Revasc Med
June 2023
Article Synopsis
- The study focused on the use of intracoronary pressure wires in guiding treatment for patients with coronary artery disease, aiming to assess changes in diagnosis, treatment strategies, and clinical outcomes.
- Involving 1,414 patients and observing 1,781 lesions, the study found significant changes in the extent of coronary disease and treatment plans, with over half of the patients experiencing adjustments after using the pressure wire.
- The findings indicated that using the pressure wire was generally safe and led to a lower incidence of major adverse cardiovascular events (MACE), particularly when percutaneous coronary intervention (PCI) was the initial treatment strategy.
Article Synopsis
- The COVID-19 pandemic significantly reduced the number of primary percutaneous coronary interventions (PPCIs) for ST-segment elevation myocardial infarction (STEMI) patients by 16% in 2020 compared to 2019.
- Despite this reduction affecting both genders equally, 30-day mortality rates increased notably for female patients during the pandemic, while male patients did not show a significant change.
- The analysis highlights the importance of addressing gender-specific outcomes in cardiac care during public health crises.
Article Synopsis
- The "smoking paradox" refers to lower mortality rates in smokers among STEMI patients, particularly in the context of modern primary PCI protocols during the COVID-19 pandemic.
- A large retrospective study revealed that among 16,083 STEMI patients, active smokers had better postprocedural blood flow and lower mortality rates compared to both non-smokers and previous smokers.
- The findings suggest that despite initial challenges in treatment, active smoking was linked to improved heart health outcomes in this patient population, indicating the need for further investigation into this unexpected relationship.
Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute myocardial infarction. Coronary angiography remains the best diagnostic tool; however, clinical suspicion and experience is required to interpret angiographic findings. This study sought to assess the clinical implications of the "broken line" (BKL) angiographic pattern in a large, nationwide, cohort of patients with SCAD.
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- - The study examined how SARS-CoV-2 positivity affects outcomes for patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), using data from the ISACS-STEMI COVID-19 registry.
- - Results showed that SARS-CoV-2 positive patients were older, more likely to experience cardiogenic shock, and had worse post-procedural outcomes, including lower blood flow and increased need for thrombectomy.
- - Importantly, SARS-CoV-2 positivity was linked to higher in-hospital mortality (25.7% vs 7%) and significantly increased 30-day mortality rates (34.4% vs 8.5%), indicating that the virus
Background: Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study.
View Article and Find Full Text PDFObjective: Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort.
Methods: The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals.
Background: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment.
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- The study aimed to analyze how the COVID-19 pandemic impacted primary percutaneous coronary intervention (PPCI) procedures and patient outcomes for those with ST elevation myocardial infarction (STEMI) compared to the period before the pandemic.
- It involved a retrospective analysis of data from 16,674 patients across various regions, showing a significant decrease in PPCI procedures during the pandemic (16% reduction) along with increases in treatment delays and mortality rates.
- Findings highlight that older adults were particularly affected, and the increased time to treatment likely contributed to both in-hospital and 30-day mortality rates rising during the pandemic.
Introduction 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.
Article Synopsis
- SARS-CoV-2 infection in patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI is linked to increased thrombotic complications due to inflammation and endothelial dysfunction.
- In a study of 62 SARS-CoV-2 positive STEMI patients compared to 310 matched negative controls, the positive group showed significantly higher in-hospital mortality (29% vs 5.5%) and complications like stent thrombosis and heart failure.
- The findings highlight the need for careful management of STEMI patients infected with SARS-CoV-2, as they may experience worse outcomes compared to non-infected patients.
Objectives: The objective was to evaluate the results of valve-in-valve procedures performed with the Allegra device.
Background: Transcatheter aortic valve implantation to treat degenerated biological aortic valves (valve-in-valve) is an established procedure in most catheterization laboratories, but the results are poorer than procedures done in native aortic stenosis. The Allegra device (Biosensors, Morges, Switzerland) has an excellent design to treat these patients.
Background: During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes.
Objectives: The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome.
Article Synopsis
- Concerns were raised about the interaction between renin-angiotensin system inhibitors (RASI) and COVID-19 susceptibility, prompting a study on their impact on STEMI patients during the pandemic.
- The study analyzed 6095 STEMI patients, finding that RASI therapy at admission significantly lowered mortality rates, with in-hospital RASI therapy showing an even greater reduction in mortality (2.1% vs 16.7%).
- Despite the association of RASI therapy with lower mortality overall, it showed no prognostic benefit in patients who tested positive for SARS-CoV-2.
Spontaneous coronary artery dissection (SCAD) is a relatively rare but well-known cause of acute coronary syndrome in women. The role of sexual hormones has been related to the pathophysiology of SCAD. However, clinical features, angiographic findings, management and outcomes of SCAD women in relation to menopause status remain unknown.
View Article and Find Full Text PDFBackground: It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes-ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19.
Methods: The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April).
Background: During COVID-19 pandemic in Spain, elective procedures were canceled or postponed, mainly due to health care systems overwhelming.
Objective: The objective of this study was to evaluate the consequences of interrupting invasive procedures in patients with chronic cardiac diseases due to the COVID-19 outbreak in Spain.
Methods: The study population is comprised of 2,158 patients that were pending on elective cardiac invasive procedures in 37 hospitals in Spain on the 14th of March 2020, when a state of alarm and subsequent lockdown was declared in Spain due to the COVID-19 pandemic.
Background: The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality.
Objectives: The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment.
Methods: This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020.