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ABSTRACT Introduction and objectives: The optimal treatment of nonculprit angiographic intermediate lesions (diameter stenosis 40%-69%) in patients with ST-segment elevation myocardial infarction (STEMI) is still unknown. Lesions with fractional flow reserve (FFR) ≤ 0.80 are indicative of ischemia and benefit from revascularization. However, lesions with FFR > 0.80 and optical coherence tomography (OCT) findings of vulnerability have been hypothesized to cause adverse events during follow-up. The study aims to compare the efficacy of a preventive treatment with stent implantation plus optimal medical therapy vs optimal medical therapy alone for nonculprit intermediate lesions with FFR > 0.80 and OCT findings of plaque vulnerability in STEMI patients at 4 years of follow-up. Methods: This parallel-group, multicenter, controlled, single-blind, and 1:1 randomized trial will enroll a total of 600 STEMI patients with ≥ 1 intermediate nonculprit lesions with FFR > 0.80 and OCT findings of plaque vulnerability. The primary endpoint is target vessel failure, defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization. The study will include a parallel registry of patients with FFR > 0.80 but without OCT findings of vulnerability. Vulnerable plaques are defined as lipid-rich fibroathermas with plaque burden ≥ 70% and a thin fibrous cap (≤ 80 μm). Results: The VULNERABLE trial will reveal the role of preventive treatment with stent implantation for nonculprit and functionally nonsignificant vulnerable plaques in STEMI patients. Conclusions: This is the first randomized trial of OCT-guided treatment of vulnerables plaques. Registered at ClinicalTrials.gov (NCT05599061).

Introducción y objetivos: El tratamiento óptimo de las lesiones angiográficas intermedias (diámetro de estenosis 40-69%) no culpables en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) está por determinar. La reserva fraccional de flujo (RFF) permite diagnosticar lesiones causantes de isquemia (RFF ≤ 0,80) que se benefician de una revascularización. No obstante, las lesiones con RFF > 0,80 y criterios de vulnerabilidad por tomografía de coherencia óptica (OCT) también se ha hipotetizado que pueden causar eventos adversos en el seguimiento. El objetivo es comparar la eficacia del tratamiento preventivo con implantación de stent más tratamiento médico óptimo de lesiones intermedias no culpables con RFF > 0,80 y características de placa vulnerable frente a solo tratamiento médico óptimo en pacientes con IAMCEST a 4 años de seguimiento. Métodos: Estudio de grupos paralelos, multicéntrico, controlado, aleatorizado 1:1 y simple ciego. Se incluirán 600 pacientes con IAMCEST y al menos una lesión intermedia no culpable que presenten RFF > 0,80 y características de placa vulnerable por OCT. El objetivo primario se define como fallo del vaso diana, compuesto de muerte cardiaca, infarto del vaso diana y necesidad de revascularización del vaso diana. El estudio incluye un registro paralelo para pacientes con RFF > 0,80 sin características de placa vulnerable. Se define placa vulnerable como fibroateromas lipídicos con carga de placa ≥ 70% y capa fibrosa fina (≤ 80 µm). Resultados: El estudio VULNERABLE permitirá conocer el papel del tratamiento preventivo con stent de placas vulnerables no culpables funcionalmente no significativas en pacientes con IAMCEST. Conclusiones: Se trata del primer estudio aleatorizado para el tratamiento de placas vulnerables guiado por OCT. Registrado en ClinicalTrials.gov (NCT05599061).

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan su informe anual de actividad hemodinámica en cardiopatías congénitas correspondiente al año 2022. Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos se realizó mediante un cuestionario telemático. Una empresa externa analizó los resultados, que fueron revisados por miembros de la ACI-SEC y el GTH-SECPCC. Resultados: Participaron en el registro 22 centros (19 públicos y 3 privados). Se incorporaron al análisis los datos de intervencionismo en cardiopatías congénitas del adulto aportados por otros 99 hospitales al Registro de Hemodinámica y Cardiología Intervencionista de la ACI-SEC del año 2022. Se registraron 1.141 estudios diagnósticos (un 4,3% más que en 2021) y 2.508 cateterismos intervencionistas (un 61,5% más que en 2021). Las técnicas con mayor casuística fueron el cierre de defectos interauriculares (1.135 casos), el cierre de ductus arterioso (262 casos) y la angioplastia de ramas pulmonares (234 casos). El incremento más significativo se comunicó en la valvuloplastia aórtica (48,9%), el cierre de defectos interauriculares (45,2%) y el cierre de comunicación interventricular (40,7%). La tasa de éxito en los procedimientos intervencionistas fue del 97,6%, con una tasa de complicaciones mayores del 1,4 % y una mortalidad intrahospitalaria del 0,2%. Conclusiones: El presente trabajo es la tercera publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. Se ha comunicado un aumento muy significativo de la mayoría de los procedimientos terapéuticos, destacando el incremento de la valvuloplastia aórtica, del cierre de defectos interauriculares y del cierre de comunicación interventricular. Todas las técnicas intervencionistas han comunicado excelentes datos de seguridad y eficacia.

ABSTRACT Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC) present their annual activity report for 2022. Methods: All Spanish centers with catheterization laboratories and interventional activity in congenital heart diseases were invited to participate. Data were collected online and analyzed by an external company, together with the members of the ACI-SEC and the GTH-SECPCC. Results: A total of 22 centers participated (19 public and 3 private). Interventional data on adult congenital diseases contributed by another 99 hospitals to the Registry of Cardiac Catheterization and Interventional Cardiology of the ACI-SEC in 2022 were incorporated into the analysis. A total of 1141 diagnostic studies (4.3% more than in 2021) and 2508 interventional catheterizations (61.5% more than in 2020) were registered. The most frequent procedures were atrial septal defect closure (1135 cases), percutaneous closure of patent ductus arteriosus (262 cases), and pulmonary branch artery angioplasty (234 cases). The most significant increases in volume were related to balloon aortic valvuloplasty (48.9%), atrial septal defect closure (45.2%), and ventricular septal defect closure (40.7%). Interventional procedures were successful in 97.6%, with major procedural complications occurring in 1.4% and in-hospital mortality in 0.2%. Conclusions: This report is the third publication of the Spanish Cardiac Catheterization in Congenital Heart Diseases Registry. Both diagnostic and interventional procedures substantially increased, particularly in balloon aortic valvuloplasty, atrial septal defect closure, and ventricular septal defect closure. Most interventional techniques continue to demonstrate excellent safety and effectiveness outcomes.

ABSTRACT Introduction and objectives: Delayed vascular healing may induce late stent thrombosis. Optical coherence tomography (OCT) is useful to evaluate endothelial coverage. The objective of this study was to compare stent coverage and apposition in non-complex coronary artery lesions treated with durable polymer-coated everolimus-eluting stents (durable-polymer EES) vs biodegradable polymer-coated everolimus-eluting stents (biodegradable-polymer EES) vs polymer-free biolimus-eluting stents (BES) 1 and 6 months after stent implantation. Methods: Prospective, multicenter, non-randomized study that compared the 3 types of DES. Follow-up angiography and OCT were performed 1 and 6 months later. The primary endpoint was the rate of uncovered struts as assessed by the OCT at 1 month. Results: A total of 104 patients with de novo non-complex coronary artery lesions were enrolled. A total of 44 patients were treated with polymer-free BES, 35 with biodegradable-polymer EES, and 25 with durable-polymer EES. A high rate of uncovered struts was found at 1 month with no significant differences reported among the stents (80.2%, polymer-free BES; 88.1%, biodegradable-polymer EES; 82.5%, durable-polymer EES; P = .209). Coverage improved after 6 months in the 3 groups without significant differences being reported (97%, 95%, and 93.7%, respectively; P = .172). Conclusions: In patients with de novo non-complex coronary artery lesions treated with durable vs biodegradable vs polymer-free DES, strut coverage and apposition were suboptimal at 1 month with significant improvement at 6 months.

RESUMEN Introducción y objetivos: A pesar del desarrollo de los stents farmacoactivos, el retraso en la endotelización puede causar trombosis tardía. La tomografía de coherencia óptica puede evaluar la cobertura intimal. El objetivo de este estudio fue comparar la cobertura y la aposición en lesiones coronarias no complejas de 3 tipos de stent: stent de everolimus con polímero persistente, stent de everolimus con polímero bioabsorbible y stent de biolimus sin polímero, a 1 y 6 meses del implante. Métodos: Se diseñó un estudio prospectivo, multicéntrico, no aleatorizado, que comparó 3 stents farmacoactivos. Se realizaron angiografía y tomografía de coherencia óptica a 1 o 6 meses. El objetivo primario fue comparar la cobertura. Resultados: Se incluyeron 104 pacientes con lesiones coronarias de novo no complejas. Se implantó stent sin polímero a 44 pacientes, stent con polímero bioabsorbible a 35 pacientes y stent con polímero persistente a 25 pacientes. Al mes, se observó una alta tasa de struts no cubiertos, sin diferencias significativas entre los grupos (80,2% sin polímero, 88,1% con polímero bioabsorbible y 82,5% con polímero persistente; p = 0,209). La cobertura mejoró a los 6 meses en los 3 stents, sin diferencias significativas entre ellos (97, 95 y 93,7%, respectivamente; p = 0,172). Conclusiones: En los pacientes con lesiones coronarias no complejas tratados con stent con polímero persistente, con polímero bsorbible o sin polímero, la cobertura y la aposición fueron subóptimas a 1 mes del implante, con mejoría significativa a los 6 meses.

BackgroundMicroRNAs (miRNAs) are noncoding RNAs involved in post-transcriptional genetic regulation with a proposed role in intercellular communication. miRNAs are considered promising biomarkers in ischemic heart disease. Invasive physiological evaluation allows a precise assessment of each affected coronary compartment. Although some studies have associated the expression of circulating miRNAs with invasive physiological indexes, their global relationship with coronary compartments has not been assessed. Here, we will evaluate circulating miRNAs profiles according to the coronary pattern of the vascular compartment affectation.Study and designThis is an investigator-initiated, multicentre, descriptive study to be conducted at three centres in Spain (NCT05374694). The study will include one hundred consecutive patients older than 18 years with chest pain of presumed coronary cause undergoing invasive physiological evaluation, including fractional flow reserve (FFR) and index of microvascular resistance (IMR). Patients will be initially classified into four groups, according to FFR and IMR: macrovascular and microvascular affectation (FFR≤0.80 / IMR≥25), isolated macrovascular affectation (FFR≤0.80 / IMR0.80 / IMR ≥25) and normal coronary indexes (FFR>0.80 / IMRConclusionsThe results of this study will identify miRNA profiles associated with patterns of coronary affectation and will contribute to a better understanding of the mechanistic pathways of coronary pathology.

BackgroundWe aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures.MethodsScores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared.ResultsMean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, pConclusionProcedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

The formation of environmental culture in the Physical Education teacher turns out to be an important factor in the integral preparation of this professional. The objective of this study is focused on: proposing a system of methodological workshops oriented to the appropriation of the environmental culture by the Physical Education teacher at the University of Oriente in Santiago de Cuba. The research has a mixed approach of explanatory type. Theoretical and empirical methods, techniques and instruments were applied to gather the necessary information for the study. A diagnosis was made to 15 teachers of the Physical Education discipline at the University of Oriente. Its results showed the insufficiencies in the environmental culture of the Physical Education teacher. In the processing of the data, the contrast statistics were used: Kendall's W test and T-Student test, with a significance level established at 0.05. The concordance of the criteria issued by the specialists consulted and the difference in the results between the pretest and posttest and with the control group, both with a significance of 0.00, allowed assessing the proposal as feasible and functional.

Introduction. The cervical sprain is defined as the lesion of the soft fabrics of the neck product of a sudden shake or a sudden movement of the head, in which muscles and ligaments are tensed beyond its normal range. Objective. To compare the analgesic effects of the laser of low intensity with microdosis of 0.5 j/cm² vs. Dose of 2 j/cm², in the treatment of patient with sprain cervical grade I in sharp stage. Method. It is a clinical, controlled rehearsal, divided in two group applying dose and microdosis in 12 points located to two centimeters of the cervical thorny apophyses in both sides, with a separation of two centimeter down, have more than enough ligament interespinoso and painful points, for an I finish of 10 sessions with a time of application in each point of 16 seconds and 1 minute 6 seconds for each group respectively. Results. The age range went from 18 to 48 years, the distribution for sexes was in males of 25% and in women 75%, the valuation of the pain by means of the E.V.A for the group one reveals in the intermediate one 27.3% of improvement and in the final one 40%, the group two in the intermediate one an improvement of 30.5% and final of 58.9% Conclusions. The use of the standardized doses (2 j/cm²) he/ she gave as a result to be the best option in the handling and control of the pain of this pathology. [ABSTRACT FROM AUTHOR]

Introduction: in Mexico, tobacco and alcohol consumption represent a public health problem. Screening, brief intervention, and treatment models had shown effectiveness to reduce substances use, which is why they have been widely used in a variety of settings. The proximity of trained human resources with consumption problems and diverse situations is one of the most important opportunities they offer. Despite the extensive experience in developing these models, they have been poorly adapted for use by medical and health personnel at the first level of care. Objective: describe barriers and opportunities encountered during the operational implementation of a pilot project for screening, brief counseling and treatment aimed at medical personnel and related to the first level of health care in a Sanitary Jurisdiction of the State of Mexico. Method: two focus groups were carried out on a randomized sample of 15 of 64 certified health professionals who developed practical experience performing interventions with the population of their Health Establishment. Results: communication, personal and organizational barriers were found, however, opportunities that emerged from the implementation of this intervention model were also identified. Discussion and conclusions: the implementation of these interventions in the first level of care has various advantages for the personnel who apply them and the population that receives it, among which the increase in productivity of the screening and brief counseling actions reported in the System of Health Information as well as the opportunity to provide the user a personalized intervention specifically focused on their local population-based problems. ---------- Introducción: en México el consumo de tabaco y alcohol representa un problema de salud pública. Modelos de tamizaje, intervención breve y referencia a tratamiento han mostrado eficacia en disminuir dicho consumo, por lo que se emplean en distintos escenarios. Una de sus características más importantes es la cercanía de los profesionales con las situaciones y problemáticas sobre el consumo. Pese a la amplia experiencia en el desarrollo de estos modelos, han sido poco adaptados para su uso en personal médico y de salud en el primer nivel de atención. Objetivo: describir barreras y oportunidades encontradas durante la implementación de un proyecto piloto de tamizaje, consejería breve y referencia a tratamiento dirigido al personal médico y afín del primer nivel de atención en salud. Método: se realizaron dos grupos focales en una muestra aleatorizada de 15 profesionales de salud certificados de un total de 64, que desarrollaron experiencia práctica realizando intervenciones con la población de su establecimiento de salud. Resultados: se encontraron diversas barreras de comunicación, personales y organizacionales; sin embargo, también se identificaron oportunidades que emergen de la implementación de este modelo. Discusión y conclusiones: el uso de intervenciones breves en el primer nivel de atención tiene ventajas para quien las aplica y las recibe, como el incremento en la productividad de las acciones de tamizaje y consejería breve reportadas en el Sistema de Información en Salud, así como la oportunidad de brindar al usuario una intervención personalizada enfocada específicamente en los problemas de la población local.