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Introduction: TAVI-related complications, such as conduction disturbances, vascular complications or death may be related to increased inflammatory response. The aim of this study was to elucidate the efficacy and safety of the systemic glucocorticoid therapy regarding the adverse events after TAVI deployment. Evidence acquisition: We conducted a systemic search of PubMed, a reference list of relevant articles, and Medline. The main efficacy outcomes of interest were all-cause death, cardiac and non-cardiac death, permanent pacemaker implantation (PPM), new left bundle branch block (LBBB), stroke, and myocardial infarction (MI). Safety endpoints were major vascular complications, major bleeding events, and cardiac tamponade. Evidence synthesis: A total of 7 studies including data from 3439 patients with a median follow-up was 30 days. Systemic glucocorticoid compared to the control group were associated with an increased risk of non-cardiac death (Relative Risk [RR] 5.90 95%CI [2.95; 11.80], P<0.001) major vascular complications (RR 1.78, 95%CI [1.22 - 2.61], P=0.003) and cardiac tamponade (RR 3.42, 95%CI [1.69 - 6.92], P<0.001). However, there were no differences in all-cause death, cardiac death, new LBBB, stroke, MI, or major bleeding events (all P values >0.05). Conclusions: Glucocorticoid therapy before the TAVI procedure was associated with an increase in non-cardiac death, major vascular events and cardiac tamponade. There were no differences in the risk of all-cause death, cardiac death, PPM or LBBB, stroke, or MI.

Iatrogenic coronary artery dissections (ICAD) are rare but potentially devastating complications during coronary angiography and percutaneous coronary interventions (PCI). Intima media complex separation may be produced either by the catheter tip or during PCI. Patient characteristics and procedure related risk factors are intimately linked to catheter induced ICAD over diagnostic angiography. Moreover, the increasing complexity of patients undergoing PCI, which frequently involves treatment of heavily calcified or occluded vessels, has increased the likelihood of dissections during PCI. A prompt recognition, along with a prompt management (either percutaneous, surgical or even careful watching), are key in preventing catastrophic consequences of ICAD, such as left ventricular dysfunction, cardiogenic shock, periprocedural myocardial infarction (MI) or cardiac death. This review aims to summarize the main updates concerning the pathophysiology, highlight key risk factors and suggest recommendations in management and treatment of ICAD.

Background: Coronary percutaneous intervention in octogenarian patients is growing due to the rise in life expectancy. However, this population is underrepresented in randomized trials due to its high risk. Objectives: The aim of this study was to evaluate short and long-term outcomes of coronary percutaneous intervention in octogenarian patients, and to identify independent predictors of adverse outcome. Methods: This was a retrospective study including consecutive patients undergoing percutaneous coronary intervention at a general hospital from June 2011 to September 2013. Octogenarian patients (age ≥80 years) were compared with younger patients. Medical history, procedure characteristics and clinical outcomes were evaluated. Major adverse cardiovascular events (MACE consisting of death, myocardial infarction or stroke) were evaluated at 1 month, and 1 and 3 years. Multivariate analysis was performed to assess independent predictors of adverse outcome. Results: A total of 1,030 patients (20.2% octogenarians) were included in the study. Mean age of octogenarian patients was 83 years (IQR 81-86). This population had more cardiovascular risk factors and comorbidities. No differences were observed in procedure success and number of implanted stents. The rate of MACE was significantly higher in octogenarian patients at 1 month (14.4% vs. 4.9%; p<0.001), 1 year (23.9% vs. 8.5%; p<0.001) and 3 years (p<0.0001), due to increased mortality, without differences in myocardial infarction (4.8% vs. 3.8%), stroke (1.7% vs. 1.6%), or procedural complications. Independent predictors of mortality in octogenarian patients were kidney failure, chronic obstructive pulmonary disease and ventricular dysfunction. Age ≥80 years was an independent predictor of MACE in the overall population. Conclusions: Technical success was acceptable in octogenarian patients undergoing percutaneous coronary intervention, but octogenarian patients showed increased early and long-term mortality that appe, INTRODUCCION: La angioplastia coronaria en octogenarios aumenta, pero esta población está poco representada en los estudios randomizados por su alto riesgo. OBJETIVOS: Evaluar los resultados de angioplastia coronaria de pacientes octogenarios e identificar predictores independientes de mala evolución en el seguimiento.MÉTODOS: Estudio retrospectivo, pacientes consecutivos con angioplastia coronaria Junio 2011 a Septiembre 2013 en un Hospital Polivalente. Se compararon octogenarios (edad≥80 años) del resto. Se evaluaron características basales y del procedimiento. Se evaluó mortalidad y los eventos cardiovasculares mayores (MACE, muerte infarto o stroke) a 30 días, 1 y 3 años. Se realizó análisis univariado y multivariado para predictores de mala evolución. RESULTADOS: Se incluyeron 1030 pacientes, 20.2% octogenarios. Edad de octogenarios: 83 años (RIC 81-86). Los octogenarios presentaron más factores de riesgo y comorbilidades. La tasa de éxito y la cantidad de stents fue similar entre los grupos. La tasa de MACE fue mayor en octogenarios a 30 días (14.4% v 4.9%; p<0,001), 1 año (23.9% vs 8.5%; p<0,001) y a 3 años (p<0.0001), a expensas de mortalidad sin diferencias en los otros puntos, ni en complicaciones del procedimiento. Los predictores independientes de muerte en octogenarios incluyen IRC, EPOC y deterioro de la función ventricular. La edad≥80 años fue un predictor independiente de MACE en la población general. CONCLUSIONES: Observamos una aceptable tasa de éxito de ATC en pacientes octogenarios, asociado a aumento de la mortalidad inmediata y alejada que no parece relacionada con el procedimiento. La IRC, el EPOC y el deterioro de la función ventricular son predictores independientes de mal pronóstico en estos pacientes.

After acute myocardial infarction, ventricular remodeling is characterized by changes at the molecular, structural, geometrical and functional level that determine progression to heart failure. Inflammation plays a key role in wound healing and scar formation, affecting ventricular remodeling. Several, rather different, components of the inflammatory response were studied as biomarkers in ST-elevation acute myocardial infarction. Widely available and inexpensive tests, such as leukocyte count at admission, as well as more sophisticated immunoassays provide powerful predictors of adverse outcome in patients with ST-elevation acute myocardial infarction. We review the value of inflammatory markers in ST-elevation acute myocardial infarction and their association with ventricular remodeling, heart failure and sudden death. In conclusion, the use of these biomarkers may identify subjects at greater risk of adverse events and perhaps provide an insight into the mechanisms of disease progression.