Search

Introduction and Objectives: To help to illustrate the trends in isolated surgical aortic valve replacement (SAVR) in Spain, we performed a national-level analysis to investigate the changes from 1998 to 2017 in a) SAVR volume, b) patients' risk profiles, c) in-hospital mortality, and d) types of aortic valve prostheses., Methods: We included all episodes of patients undergoing isolated SAVR from January 1998 to December 2017 recorded in the Minimum Basic Data Set (Ministry of Health, Consumer Affairs, and Social Welfare, Spain). The study duration was divided into four 5-year periods. We analyzed the trends in SAVR volume, comorbidity prevalence, and in-hospital mortality. Through multivariate logistic regression, we identified factors associated with mortality and type of prosthesis. The risk-adjusted mortality rate was compared over the study period., Results: In total, 73 668 patients underwent an isolated SAVR from 1998 to 2017. The annual volume of procedures increased from 16 363 between 1998 and 2002 to 22 685 between 2013 and 2017. The prevalence of all investigated comorbidities increased, except for history of previous myocardial infarction and unplanned admission. The Charlson comorbidity index worsened from 1998-2002 (2.3; SD, 1.4) to 2013-2017 (3.6; SD, 1.7) (P <.001). In-hospital mortality decreased from 7.2% to 3.3% (P <.001) while the risk-adjusted mortality index improved from 1.3 to 0.7. The proportion of bioprostheses increased from 20.7% (1998-2002) to 59.6% (2013-2017) (P <.001)., Conclusions: We detected an increase in the annual SAVR volume in Spain, with more patients receiving bioprostheses. Despite an increased risk profile of the patients, in-hospital mortality substantially reduced., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Spain is one of the countries with the lowest rates of revascularisation and highest ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG)., Objectives: To investigate the changes and trends in the two revascularisation procedures between 1998 and 2017 in Spain., Design: Retrospective cohort study. Analysis of in-hospital outcomes., Setting: Minimum basic data set from the Spanish National Department of Health: mandatory database collecting information of patients who are attended in the Spanish public National Health System., Participants: 603 976 patients who underwent isolated CABG or PCI in the Spanish National Health System. The study period was divided in four 5-year intervals. Patients with acute myocardial infarction on admission were excluded., Primary and Secondary Outcomes: We investigated the volume of procedures nationwide, the changes of the risk profile of patients and in-hospital mortality of both techniques., Results: We observed a 2.2-fold increase in the rate of any type of myocardial revascularisation per million inhabitants-year: 357 (1998) to 776 (2017). 93 682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2 (1998-2002) to 8.1 (2013-2017). Charlson's index increased by 0.8 for CABG and 1 for PCI. The median annual volume of PCI/hospital augmented from 136 to 232, while the volume of CABG was reduced from 137 to 74. In the two decades, we detected a significant reduction of CABG in-hospital mortality (6.5% vs 2.6%, p<0.001) and a small increase in PCI (1.2% vs 1.5%, p<0.001). Risk adjusted mortality rate was reduced for both CABG (1.51 vs 0.48, p<0.001), and PCI (1.42 vs 1.05, p<0.001)., Conclusion: We detected a significant increase in the volume of revascularisations (particularly PCI) in Spain. Risk-adjusted in-hospital mortality was significantly reduced., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction and Objectives: Asian desert dust has recently been recognized as a trigger for acute myocardial infarction. The inflow of dust from the Sahara into Spain impairs air quality due to an increase in particulate matter concentrations in the ambient air. The aim of the present study was to elucidate whether Saharan dust events are associated with the incidence of acute coronary syndrome (ACS) in patients living near North Africa, the major global dust source., Methods: We prospectively collected data on hospitalizations due to ACS in 2416 consecutive patients from a tertiary care hospital (Canary Islands, Spain) from December 2012 to December 2017. Concentrations of particulate matter with an aerodynamic diameter 10 microns or smaller (PM 10 ) and reactive gases were measured in the European Air Quality Network implemented in the Canary Islands. We applied the time-stratified case crossover design using conditional Poisson regression models to estimate the impact of PM 10 Saharan dust events on the incidence of ACS., Results: The occurrence of Saharan dust events observed 0 to 5 days before the onset of ACS was not significantly associated with the incidence of ACS. Incidence rate ratios (IRR) of PM 10 levels 1, 2, 3, 4 and 5 days before ACS onset (for changes in 10μg/m 3 ) were 1.27 (95%CI, 0.87-1.85), 0.92 (95%CI, 0.84-1.01), 0.74 (95%CI, 0.45-1.22), 0.98 (95%CI, 0.87-1.11), and 0.95 (95%CI, 0.84-1.06), respectively., Conclusions: Exposure to Saharan desert dust is unlikely to be associated with the incidence of ACS., (Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Epidemiological studies found that increases in the concentrations of airborne particulate matter (PM) smaller than 10 microns diameter (PM 10 ) in the ambient air due to desert dust outbreaks contribute to global burden of diseases, primarily as a result of increased risk of cardiovascular morbidity and mortality. No studies have investigated the possible association between desert dust inhalation and airway inflammation in patients with ischemic heart disease (IHD). Induced sputum was collected in 38 patients and analyzed to determine markers of airway inflammation (Transforming Growth Factor-β1 [TGF-β1] and hydroxyproline) concentrations. For the purpose of the investigation, PM 10 and reactive gases concentrations measured in the European Air Quality Network implemented in the Canary Islands were also used. We identified Saharan desert dust using meteorology and dust models. Patients affected by smoking, chronic obstructive pulmonary disease (COPD), asthma, pulmonary abnormalities, acute bronchial or pulmonary disease were excluded. The median of age of patients was 64.71 years (56.35-71.54) and 14 (38.84%) of them were women. TGF-β1 and hydroxyproline in sputum were highly associated to PM 10 inhalation from the Saharan desert. According to a regression model, an increase of 1 µg/m 3 of PM 10 concentrations due to desert dust, results in an increase of 3.84 pg/gwt of TGF-β1 (R2 adjusted = 89.69%) and of 0.80 μg/gwt of hydroxyproline (R 2 adjusted = 85.28%) in the sputum of patients. The results of this study indicate that the exposure to high PM 10 concentrations due to Saharan dust events are associated with intense inflammatory reaction in the airway mucosae of IHD-patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Surgical aortic valve replacement (SAVR) changes the natural history of severe aortic stenosis. However, whether the life expectancy of patients with severe aortic stenosis undergoing this surgical procedure is fully restored is unknown. The objective of this study was to assess if the life expectancy of patients aged >75 years is fully restored after undergoing surgery for severe aortic stenosis., Methods: We compared long-term survival of a group of patients aged >75 years, who underwent SAVR at our institution with the long-term survival of the general population. We matched each patient with 100 simulated individuals (control group) of the same age, sex and geographical region who died as indicated by the National Institute of Statistics. We compared survival curves and calculated hazard ratio (HR) or incidence rate ratio. Statistical significance existed if confidence intervals (CIs) did not overlap or did not include the value 1, as appropriate., Results: Average life expectancy of surgical patients who survived the postoperative period was 90.91 months (95% CI 82.99-97.22), compared to 92.94 months (95% CI 92.39-93.55) in the control group. One-, 5- and 8-year survival rates for SAVR patients who were discharged from the hospital were 94.9% (95% CI 92.74-96.43%), 71.66% (95% CI 67.37-75.5%) and 44.48% (95% CI 38.14-50.61%), respectively, compared to that of the general population: 95.8% (95% CI 95.64-95.95%), 70.64% (95% CI 70.28%-71%) and 47.91% (95% CI 47.52-48.31%), respectively (HR 1.07, 95% CI 0.94-1.22)., Conclusion: For patients over the age of 75 years who underwent SAVR and survived the postoperative period, life expectancy and survival rates were similar to that of the general population., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)