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Invasive strategy in elderly patients with acute coronary syndrome in 2018: close to the truth?

Journal of Geriatric Cardiology 2019年第2期16卷 114-120页

作者： Sergio García-Blas Clara Bonanad juan Sanchis Servei de Cardiologia Hospital Clínic Universitari de València INCLIVA Universitat de ValènciaCIBERCV

Elderly population constitutes an increasingly larger proportion of patients admitted for acute coronary syndromes(ACS).The optimal management of ACS in these patients is still a challenge due to their clinical peculiarities and the paucity of specific data,and they have been traditionally managed more conservatively mainly based on subjective criteria.In ST^segment elevation acute myocardial infarction urgent reperfusion is the standard of care and there is no upper age limit.In non-ST segment elevation acute myocardial infarction evidence is controversial,incomplete and mainly focused on chronological age.While a strict conservative strategy should be avoided,routine invasive strategy may reduce the occurrence of myocardial infarction and need for revascularization at follow-up with no established benefit in terms of mortality.Clinical characteristics associated with aging,such as comorbidities and frailty,further discriminate patient's risk beyond age.Evidence is scarce,but it suggests that these features may modulate the benefit of invasive strategy in this population.Ongoing trials should clarify the optimal management of ACS based on these parameters.

关键词： Acute coronary syndromes Comorbidity Frailty Percutaneous coronary intervention The elderly

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Clinical and prognostic implications of delirium in elderly patients with non–ST-segment elevation acute coronary syndromes

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Journal of Geriatric Cardiology 2019年第2期16卷 121-128页

作者： Miquel Vives-Borras Manuel Martinez-Selles Albert Ariza-Sole Maria T.Vidan Francesc Formiga Hector Bueno juan Sanchis Oriol Alegre Albert Duran-Cambra Ramon Lopez-Palop Emad Abu-Assi Alessandro Sionis LONGEVO-SCA Investigators Department of Cardiology Hospital de la Santa Creu i Sant PauInstitute of Biomedical Research I1B Sant PauCIBERCVUniversitat Autonoma de BarcelonaBarcelonaSpain department of Cardiology Hospital General Universitario Gregorio MarahonC1BERCVUniversidad ComplutenseUniversidad EuropeaMadridSpain Hospital Universitari de Bellvitge L'Hospitalet de LlobregatBarcelonaSpain Hospital General Universitario Gregorio Maranon IiSGMCIBERFESUniversidad ComplutenseMadrid.Spain Hospital Doce de Octubre Centro Nacional de Investigaciones CardiovascularesMadridSpain Hospital Clinico de Valencia INCLIVAUniversidad de ValenciaCIBERCVSpain Hospital Universitario San juan AlicanteSpain Hospital Alvaro Cunqueiro VigoSpain 不详

Background Elderly patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS)may present delirium but its clinical relevance is unknown.This study aimed at detennining the clinical associated factors,and prognostic implications of delirium in old-aged patients admitted for NSTE-ACS.Methods LONGEVO-SCA is a prospective multicenter registry including unselected patients with NSTE-ACS aged>80 years.Clinical variables and a complete geriatric evaluation were assessed during hospitalization.The association between delirium and 6-month mortality was assessed by a Cox regression model weighted for a propensity score including the potential confounding variables.We also analysed its association with 6-month bleeding and cognitive or functional decline.Results Among 527 patients included,thirty-seven(7%)patients presented delirium during the hospitalization.Delirium was more frequent in patients with dementia or depression and in those from nursing homes(27.0%vs.3.1%,24.3%vs.11.6%,and 11.1%V5.2.2%,respectively;all P<0.05).Delirium was significantly associated with in-hospital infections(27.0%vs.5.3%,P<0.001)and usage of diuretics(70.3%vs.49.8%,P=0.02).Patients with delirium had longer hospitalizations[median 8.5(5.5-14)vs.6.0(4.0-10)days,P=0.02]and higher incidence of 6-month bleeding and mortality(32.3%vs.10.0%and 24.3%vs.10.8%,respectively;both P<0.05)but similar cognitive or functional decline.Delirium was independently associated with 6-month mortality(HR=1.47,95%CI:1.02-2.13,P=0.04)and 6-month bleeding events(OR=2.87;95%CI:1.98-4」6,P<0.01).Conclusions In-hospital delirium in elderly patients with NSTE-ACS is associated with some preventable risk factors and it is an independent predictor of 6-month mortality.

关键词： Acute coronary syndromes Delirium Prognosis The elderly

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Long Coronary Lesions: Challenging Cases for Percutaneous Coronary Intervention

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International Journal of Clinical Medicine 2016年第1期7卷 89-93页

作者： Julio Núñez Gema Miñana juan Sanchis Department of Cardiology Hospital Clínico Universitario Valencia Spain

Long coronary lesions are associated with adverse outcomes after percutaneous coronary intervention since the era of plain balloon angioplasty. Long lesion and long stent length are considered as important predictors of restenosis after percutaneous coronary intervention. With the advent of newer generation drug eluting stents, there has been dramatic reduction in the rates of restenosis and repeat revascularization, even in complex cohort of patients with long coronary lesions. We report one such case of long coronary lesion which was intervened successfully with newer generation, thin strut, biodegradable polymer coated sirolimus-eluting stents.

关键词： Drug Eluting Stents Biodegradable Polymer Percutaneous Coronary Intervention Treatment Outcome

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Prospective application of a bleeding and ischemic risks-adjusted antithrombotic protocol in elderly patients revascularized with everolimus-eluting stents:EPIC05-Sierra75 study

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Journal of Geriatric Cardiology 2022年第5期19卷 354-366页

作者： Jose M de la Torre Hernandez Ramon Lopez Palop Jesus M Jimenez Mazuecos Pilar Carrillo Sáez Alejandro Gutierez-Barrios Eduardo Pinar Belen Cid Luis Fernandez Tamara Garcia Camarero Cristóbal Urbano-Carrillo juan F Oteo Dominguez Victor A Jimenez Diaz Antonio EGomez Menchero Eladio Galindo Fernández juan GCórdoba Soriano Raymundo Ocaranza Eduardo ArroyoÚcar Koldobika Garcia San Roman Silvio Leal Ginés Martínez Cáceres Jose A Linares Vicente Georgina Fuertes Ferre Xavier Carrillo juan CRama Merchán Catia Costa juan Sanchis Renato Fernandes Alberto Rodrigues Jose M Vegas Valle Hélder Pereira Armando Perez de Prado Cardiology Department Hospital Universitario Marqués de ValdecillaIDIVALSantanderSpain Cardiology Department Hospital Universitario San JuanAlicanteSpain Cardiology Department Complejo Hospitalario Universitario de AlbaceteAlbaceteSpain Cardiology Department Hospital Universitario Puerta del MarCadizSpain Cardiology Department Hospital Clínico Universitario Virgen de la ArrixacaMurciaSpain Cardiology Department Hospital Clinico Universitario de SantiagoCIBERCVSantiago de CompostelaSpain Cardiology Department Hospital Universitario de CrucesBilbaoSpain Cardiology Department Hospital Regional Universitario de MálagaMalagaSpain Cardiology Department Hospital Universitario Puerta de HierroMadridSpain Cardiology Department Hospital Alvaro CunqueiroVigoSpain Cardiology Department Hospital Juan Ramon JimenezHuelvaSpain Cardiology Department Hospital Universitario de BadajozBadajozSpain Cardiology Department Hospital Universitario Lucus AugustiLugoSpain Cardiology Department Hospital de Torrevieja/VinalopóRibera SaludTorreviejaSpain Cardiology Department Hospital Santa CruzLisboaPortugal Cardiology Department Hospital Clínico Universitario Lozano BlesaZaragozaSpain Cardiology Department Hospital Universitario Miguel ServetZaragozaSpain Cardiology Department Hospital Germans Trias i PujolBadalonaSpain Cardiology Department Hospital de MeridaMeridaSpain Cardiology Department Hospital São BernardoSetúbalPortugal Cardiology Department Hospital Clinico Universitario de ValenciaUniversidad de ValenciaCIBERCVValenciaSpain Cardiology Department Hospital do Espirito SantoEvoraPortugal Cardiology Department Centro Hospitalar de Vilanova de GaiaVilanova de GaiaPortugal Cardiology Department Hospital de CabueñesGijonSpain Cardiology Department Hospital Garcia de OrtaAlmadaPortugal Cardiology Department Complejo Asistencial Universitario de LeónLeonSpain

OBJECTIVES Elderly patients show a higher incidence of ischemic and bleeding events after percutaneous transluminal coron-ary intervention(PCI).We sought to investigate outcomes in elderly patients treated with antithrombotic strategy guided by bleeding and ischemic risks after revascularization with last generation everolimus-eluting stent(EES).METHODS Prospective multicenter registry including patients over 75 years revascularized with EES and antithrombotic ther-apy guided by clinical presentation,PCI complexity and PRECISE DAPT score.Co-primary safety endpoints were:(1)composite of cardiac death,myocardial infarction and stent thrombosis and;(2)bleeding(BARC 2-5).Primary efficacy endpoint was target lesion revascularization.A matched group of patients revascularized with current drug-eluting stents and no such tailored antith-rombotic therapy was used as control.RESULTS Finally,1064 patients were included in SIERRA-75 cohort,80.8±4.2 years,36.6%women,71%acute coronary syn-dromes(ACS)and 53.6%complex PCI.Co-primary safety endpoint of major adverse cardiovascular events was met in 6.2%,co-primary safety endpoint of bleeding in 7.8%and primary efficacy endpoint of TKLR in 1.5%.The multivariable adjusted model showed no significant association of the prescribed short/long dual antiplatelet therapy(DAPT)durations with any endpoint suggesting a well tailored therapy.No stent thrombosis reported in the subgroup with 1-3 months DAPT duration.As compared to control group,bleeding BARC 2-5 was significantly lower in SIERRA-75 group(7.4%vs.10.2%,P=0.04)as well as the net safety-efficacy endpoint(14.3%vs.18.5%,P=0.02).CONCLUSIONS In elderly population,the application of this risks-adjusted antithrombotic protocol after revascularization with last generation EES seems to be associated with an improved prognosis in terms of ischemic and bleeding outcomes.

关键词： patients bleeding antithrombotic

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Management of primary achalasia: The role of endoscopy

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World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 593-605页

作者： Marisol Luján-sanchis Patricia Suárez-Callol Ana Monzá-Gallego Inmaculada Bort-Pérez Lydia Plana-Campos Luis Ferrer-Barceló Laura sanchis-Artero María Llinares-Lloret juan Antonio Tuset-Ruiz Javier Sempere-Garcia-Argüelles Pilar Canelles-Gamir Enrique Medina-Chuliá Digestive Diseases Unit General University Hospital of Valencia

Achalasia is an oesophageal motor disorder which leads to the functional obstruction of the lower oesophageal sphincter(LES) and is currently incurable. The main objective of all existing therapies is to achieve a reduction in the obstruction of the distal oesophagus in order to improve oesophageal transit, relieve the symptomatology, and prevent long-term complications. The most common treatments used are pneumatic dilation(PD) and laparoscopic Heller myotomy, which involves partial fundoplication with comparable shortterm success rates. The most economic non-surgical therapy is PD, with botulinum toxin injections reserved for patients with a higher surgical risk for whom the former treatment option is unsuitable. A new technology is peroral endoscopic myotomy, postulated as a possible non-invasive alternative to surgical myotomy. Other endoluminal treatments subject to research more recently include injecting ethanolamine into the LES and using a temporary self-expanding metallic stent. At present, there is not enough evidence permitting a routine recommendation of any of these three novel methods. Patients must undergo follow-up after treatment to guarantee that their symptoms are under control and to prevent complications. Most experts are in favour of some form of endoscopic follow-up, however no established guidelines exist in this respect. The prognosis for patients with achalasia is good, although a recurrence after treatment using any method requires new treatment.

关键词： Achalasia Endoscopic treatment Dilation Botulinum toxin Myotomy

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Role of capsule endoscopy in suspected celiac disease: A European multi-centre study

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World Journal of Gastroenterology 2017年第4期23卷 703-711页

作者： Marisol Luján-sanchis Enrique Pérez-Cuadrado-Robles Javier Garcia-Lledo José-Francisco juanmartinena Fernandez Luca Elli Victoria-Alejandra Jiménez-García juan Egea-Valenzuela Julio Valle-Munoz Cristina Carretero-Ribón Ignacio Fernández-Urién-Sainz Antonio López-Higueras Noelia Alonso-Lazaro Mileidis Sanjuan-Acosta Francisco Sanchez-Ceballos Bruno Rosa Santiago González-Vázquez Federica Branchi Lucía Ruano-Díaz César Prieto-de-Frías Vicente Pons-Beltrán Pilar Borque-Barrera Begona González-Suárez Sofía Xavier Federico Argüelles-Arias juan-Manuel Herrerías-Gutiérrez Enrique Pérez-Cuadrado-Martínez Javier Sempere-García-Argüelles Digestive Diseases Unit General University Hospital of Valencia Small Bowel Unit Hospital Morales Meseguer Digestive Diseases Unit General University Gregorio Maranón Unit of Gastroenterology and Endoscopy Complejo Hospitalario de Navarra Center for prevention and Diagnosis of Celiac Disease Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Unit of Gastroenterology and Endoscopy University Hospital Virgen Macarena Gastroenterology department Hospital Virgen de la Arrixaca Department of Gastroenterology Complejo Hospitalario de Toledo Department of Gastroenterology University of Navarra Clinic1 Endoscopy Digestive Unit Digestive Diseases AreaUniversitari i Politècnic La Fe Hospital1 Digestive Diseases Unit University Hospital Nuestra Senora de Candelaria1 Digestive Diseases Unit Clinical Hospital San Carlos1 Digestive Diseases Unit Hospital da Senhora da Oliveira-Guimaraes1 Endoscopy Digestive Unit Hospital Clinic de Barcelona

AIM To analyze the diagnostic yield(DY), therapeutic impact(TI) and safety of capsule endoscopy(CE).METHODS This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease(CD)(mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy(Group-Ⅰ, n = 19), seropositive CD without atrophy(Group-Ⅱ, n = 39), contraindication to gastroscopy(Group-Ⅲ, n = 6), seronegative CD without atrophy, but with a compatible context(Group-Ⅳ, n = 99). DY, TI and the safety of CE were analysed.RESULTS The overall DY was 54% and the final diagnosis was villous atrophy(n = 65, 39.9%), complicated CD(n = 12, 7.4%) and other enteropathies(n = 11, 6.8%; 8 Crohn's). DY for groups Ⅰ to Ⅳ was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases(36.9%), diffuse in 19(29.2%), jejunal in 11(16.9%), and patchy in 10 cases(15.4%). Factors associated with a greater DY were positive serology(68.3% vs 49.2%, P = 0.034) and older age(P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE resultschanged the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI(92.3% vs 45.3%, P < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention(0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD.CONCLUSION CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.

关键词：囊内视镜检查法腹的疾病 Anti-transglutaminase 抗体没有面筋的饮食非腹的面筋敏感

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