4 results on '"Fernando Macaya"'
Search Results
2. Multivessel spontaneous coronary artery dissection: Clinical features, angiographic findings, management, and outcomes
- Author
-
Jorge Salamanca, Marcos García-Guimarães, Manel Sabaté, Ricardo Sanz-Ruiz, Fernando Macaya, Gerard Roura, Marcelo Jimenez-Kockar, Juan Manuel Nogales, Helena Tizón-Marcos, Maite Velazquez-Martín, Gabriela Veiga, Santiago Camacho-Freire, Ainhoa Pérez-Guerrero, Xacobe Flores-Rios, Teresa Alvarado, Pablo Díez-Villanueva, David Del Val, Teresa Bastante, and Fernando Alfonso
- Subjects
Risk Factors ,Coronary Vessel Anomalies ,Myocardial Infarction ,Humans ,Prospective Studies ,Vascular Diseases ,Cardiology and Cardiovascular Medicine ,Coronary Angiography ,Coronary Vessels - Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Multivessel (MV) SCAD is a challenging clinical presentation that might be associated to a worse prognosis compared with patients with single-vessel (SV) involvement.The Spanish multicentre nationwide prospective SCAD registry included 389 consecutive patients. Patients were classified, according to the number of affected vessels, in SV or MV SCAD. Major adverse events (MAE) were analyzed during hospital stay and major cardiac or cerebrovascular adverse events (MACCE) at long-term clinical follow-up.A total of 41 patients (10.5%) presented MV SCAD. These patients had more frequently a previous history of hypothyroidism (22% vs 11%, p = 0.04) and anxiety disorder (32% vs 16%, p = 0.01). MV SCAD patients presented more often as non-ST segment elevation myocardial infarction (73% vs 52%, p = 0.01) and showed less frequently type 1 angiographic lesions (12% vs 21%, p = 0.04). An impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0-1 was less frequent (14% vs 29%, p 0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p = NS). No differences were found regarding in-hospital MAE or MACCE at late follow-up (median 29 ± 11 months). However, the rate of stroke was higher in MV SCAD patients, both in-hospital (2.4% vs 0%, p 0.01) and at follow-up (5.1% vs 0.6%, p = 0.01).Patients with MV SCAD have some distinctive clinical and angiographic features. Although composite clinical outcomes, in-hospital and at long-term follow-up, were similar to those seen in patients with SV SCAD, stroke rate was significantly higher in patients with MV SCAD.
- Published
- 2022
3. Incidence, clinical impact and predictors of thrombocytopenia after transcatheter aortic valve replacement
- Author
-
Gabriela Tirado-Conte, Carlos H. Salazar, Angela McInerney, Alejandro Cruz-Utrilla, Pilar Jiménez-Quevedo, Javier Cobiella, Nieves Gonzalo, Manuel Carnero, Iván Núñez-Gil, Hernán Mejía-Rentería, Pablo Salinas, Fernando Macaya, Luis C. Maroto, Isidre Vilacosta, Antonio Fernández-Ortiz, Javier Escaned, Carlos Macaya, and Luis Nombela-Franco
- Subjects
Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Heart Valve Prosthesis ,Incidence ,Humans ,Aortic Valve Stenosis ,Cardiology and Cardiovascular Medicine ,Thrombocytopenia ,Retrospective Studies - Abstract
Thrombocytopenia is a common, yet poorly understood, complication after transcatheter aortic valve replacement (TAVR). Balloon-expandable transcatheter heart valve has been associated with higher incidence of thrombocytopenia, compared with self-expandable valves. The aim of this study was to analyze the incidence, clinical impact and predictors of acquired thrombocytopenia in patients undergoing TAVR.We performed an observational study from consecutive patients with severe aortic stenosis undergoing TAVR (n = 679) in a single center. Association and best cut-off point of platelet decrease with early mortality was analyzed. Patients were classified according to postprocedural percentage decrease in platelet count (PDPC), comparing clinical outcomes and analyzing predictors of platelet decrease.The median PDPC was 37.1 [IQR: 27.4-46.9]. PDPC was associated with early mortality (OR: 2.1, 95%IC: 1.7-2.5 for each 10% decrease, AUC:0.81, 95%CI:0.72-0.89) with an optimal cut-off point of 46%. PDPC≥46% and late nadir (≥4 days) were both independent predictors of early mortality (OR: 6.0 [IQR: 2.4-14.9] and OR: 5.1 [IQR: 2.2-11.6], respectively). The combination of both factors (PDPC≥46% and nadir ≥4 day) was associated with higher 2-year mortality (55.7%) compared to an early significant nadir (PDPC≥46% and nadir4 day, 28.9%) and non-significant nadir (PDPC46%, 21.0%), p 0.001. Independent predictors of PDPC≥46% were baseline platelet count, Portico™, Abbott valve, intraprocedural major vascular complication and residual aortic regurgitation ≥grade 2.The platelet count decreased almost 40% after TAVR. Late nadir and PDPC≥46% predicted short-term clinical outcomes. Concomitant late and significant platelet decrease was associated with mid-term mortality.
- Published
- 2020
4. Non-invasive assessment of endothelial function in patients with spontaneous coronary artery dissection: A case-control study
- Author
-
Hernán Mejía-Rentería, Amir Lerman, Javier Escaned, Takumi Toya, Ricardo Mori, Jaskanwal D. Sara, Fernando Macaya, and Nieves Gonzalo
- Subjects
Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Vascular Diseases ,Endothelial dysfunction ,Reactive hyperemia ,business.industry ,Dissection ,Case-control study ,Middle Aged ,medicine.disease ,Coronary Vessels ,Pathophysiology ,Migraine ,Case-Control Studies ,Cohort ,Cardiology ,Observational study ,Female ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,business ,Scad - Abstract
Background The physiopathology underlying spontaneous coronary artery dissection remains largely unknown. Endothelial dysfunction is an early feature of many vascular disorders. We sought to determine the endothelial function assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with SCAD and compare it to that of non-SCAD patients with similar cardiovascular risk profile. Methods This is a case-control study with the participation of 2 centers. Patients (cases) were diagnosed with SCAD between 2008 and 2018. Control subjects were individually matched 2:1 to SCAD cases from a cohort recruited for assessment with RH-PAT between 2006 and 2013. The primary measure variable was the mean difference in the log-transformed reactive hyperemia index (LnRH-PAT Index) between groups. Results LnRH-PAT data from 23 patients with SCAD and 46 matched controls were analyzed. No significant differences were noted in the matching variables (overall, 95.7% female with mean age 52.7 years). In the SCAD group, more patients reported migraine (61 vs. 21%) and more patients were on betablockers (70 vs 28%), ACE inhibitors (65 vs. 13%) and statins (70 vs. 28%), all differences statistically significant. The mean LnRH-PAT value was 0.55 ± 0.22 in patients with SCAD and 0.77 ± 0.23 in controls (mean difference: 0.22, p Conclusions In this observational study, patients with SCAD had a poorer endothelial function than similar subjects without prior SCAD. This finding opens a new venue in the research of the physio pathologic mechanisms underlying SCAD.
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.