Revista española de cardiología (English ed.)最新文献

{"title":"Diagnostic accuracy of quantitative flow ratio for nonculprit intermediate lesions in patients with ST-segment elevation myocardial infarction.","authors":"Emilio Alfonso Rodríguez, Josep Gómez-Lara, Ramón López-Palop, Enrique Gutiérrez, Luis Renier Goncalves Ramírez, José Valencia, Alfonso Jurado-Román, Juan Gabriel Córdoba Soriano, Antonio Gómez-Menchero, Estefanía Fernández-Peregrina, Carlos Cortés, Paula Tejedor, Raúl Millan, Guillermo Sánchez-Elvira, Tamara García-Camarero, José Antonio Linares Vicente, Eva Rúmiz, Rosa María Cardenal Piris, Irene Elizondo Rua, Jean Paul Vilchez, Salvatore Brugaletta, Lara Fuentes, Ana Marcano, Pilar Carrillo, Álvaro Gabaldón, Armando Pérez de Prado, Joan Antoni Gómez-Hospital","doi":"10.1016/j.rec.2025.05.010","DOIUrl":"10.1016/j.rec.2025.05.010","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The reliability of quantitative flow ratio (QFR) has been questioned. Our aim was to evaluate the diagnostic accuracy of QFR in intermediate nonculprit lesions during the index ST-segment elevation myocardial infarction (STEMI) procedure compared with positive pressure wire-based fractional flow reserve (FFR ≤0.80) in a staged procedure.</p><p><strong>Methods: </strong>This was a substudy of the multicenter, controlled, and randomized VULNERABLE trial, including 428 intermediate nonculprit lesions from 388 consecutive STEMI patients undergoing FFR assessment in a staged procedure between 1 and 60 days. Off-line QFR analyses were performed during both the index and staged procedures. The primary objective was to assess the diagnostic accuracy of index QFR compared with staged positive FFR.</p><p><strong>Results: </strong>Angiographic vessel diameter (2.80±0.59 vs 2.91±0.57mm; P<.01), stenosis severity (51.33±8.04% vs 50.54±7.63%; P=.053), and QFR values (0.85±0.09 vs 0.86±0.09; P=.120) showed minimal changes between the index and staged procedures. Moderate concordance was observed between index QFR and staged FFR (kappa index=0.629; intraclass correlation coefficient=0.641). The diagnostic accuracy of index QFR for predicting positive FFR was good (area under the curve=0.825). An index QFR cutoff ≤0.80 showed moderate sensitivity (72%) and excellent specificity (91%). An index QFR ≤0.87 achieved a sensitivity of 86% for detecting lesions with positive FFR, with 55% of lesions presenting QFR ≤0.87 at the index procedure.</p><p><strong>Conclusions: </strong>Index QFR demonstrated good diagnostic accuracy for identifying lesions with positive FFR in a staged procedure. However, an index QFR cutoff value of ≤0.80 showed moderate sensitivity and may underdiagnose approximately 3 out of 10 lesions with positive FFR. An index QFR ≤0.87 provided higher sensitivity and may help avoid invasive (staged) procedures in many patients.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased cardiovascular mortality in people with disabilities. A challenge that must be addressed.","authors":"Pedro Armario, Montserrat Martín-Baranera","doi":"10.1016/j.rec.2025.05.008","DOIUrl":"10.1016/j.rec.2025.05.008","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary prevention in older adults: sex differences in statin persistence and cholesterol control.","authors":"Sara Malo, María José Rabanaque, Adriana Gamba, José Manuel Vinuesa-Hernando, Aida Moreno-Juste, María Jesús Lallana, Jesús Cebollada, Isabel Aguilar-Palacio","doi":"10.1016/j.rec.2025.05.007","DOIUrl":"10.1016/j.rec.2025.05.007","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>This study aimed to analyze sex differences in statin persistence and associated factors among individuals aged 70 years and older in Spain who initiated statin therapy for primary prevention of cardiovascular disease. Additionally, it assessed the role of sex in low-density lipoprotein cholesterol (LDL-C) control based on the intensity of statin therapy used.</p><p><strong>Methods: </strong>This was an observational longitudinal study conducted within the CARhES (Cardiovascular risk factors for health services research) cohort. Individuals aged ≥ 70 years who initiated statin therapy for primary prevention of cardiovascular disease between 2018 and 2020 were included. Two-year statin persistence was assessed by sex. Considering major cardiovascular events and death as competing risks, the risk of statin discontinuation and its associated factors were estimated using cumulative incidence functions and Fine and Gray analysis. The proportion of men and women achieving LDL-C target levels was also calculated.</p><p><strong>Results: </strong>A total of 4936 older adults (61.7% women) were included. Compared with men, women had higher mean LDL-C levels prior to statin initiation, a greater pharmacological burden, were less likely to receive high-intensity statins, and demonstrated lower persistence. No variables were statistically associated with discontinuation among women. In men, the adjusted HR for discontinuation was 1.03 (95%CI: 1.00-1.06) per 10mg/dL increase in baseline LDL-C level. Among persistent statin users, women were less likely than men to achieve LDL-C targets, particularly when treated with low- to moderate-intensity statins.</p><p><strong>Conclusions: </strong>Significant sex differences exist in statin persistence, associated factors, and achievement of LDL-C targets among older adults. These findings highlight the importance of considering sex-specific factors when evaluating the appropriateness of statin use in this population.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the stethoscope to artificial intelligence: decoding tricuspid disease.","authors":"Covadonga Fernández-Golfín, Ana García-Martín","doi":"10.1016/j.rec.2025.03.011","DOIUrl":"10.1016/j.rec.2025.03.011","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced stent strategy versus conventional percutaneous coronary revascularization in patients presenting with STEMI: the COPERNICAN trial.","authors":"Jorge Sanz-Sánchez, Sandra Santos Martínez, Eva Rumiz González, Juan Francisco Oteo Domínguez, David Tejada Ponce, Antonio Gómez Menchero, Guillermo Sánchez Elvira, Georgina Fuertes Ferre, Fernando Rivero Crespo, Antonela Lukic Otanovic, José Díaz Fernández, Eladio Galindo Fernández, Cristóbal Urbano Carrillo, Neus Salvatella Giralt, Mauricio Torres Sánchez, Arturo García Touchard, Borja Ibáñez Cabeza, Giulio Stefanini, Fernando Alfonso Manterola, Héctor García García, Ignacio J Amat-Santos","doi":"10.1016/j.rec.2025.05.005","DOIUrl":"10.1016/j.rec.2025.05.005","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Primary percutaneous coronary intervention (PCI) with drug-eluting stent implantation (DES) is the standard of treatment in patients presenting with ST-segment elevation myocardial infarction (STEMI). However, target lesion failure can occur due to stent underexpansion, malapposition, hypersensitivity, fracture, and neoatherosclerosis. Drug-coated balloons (DCB) represent a potential alternative supported by the concept of \"leaving nothing behind.\" The aim is to compare a reduced stent strategy based on DCB- with DES-PCI in patients presenting with STEMI.</p><p><strong>Methods: </strong>Prospective, pragmatic, multicenter, noninferiority, randomized clinical trial.</p><p><strong>Results: </strong>A total of 1 272 patients presenting with STEMI will be randomized to any paclitaxel-DCB vs any sirolimus-DES (both with CE approval) for all culprit and nonculprit lesions during PCI. The primary endpoint will be target-lesion failure: cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization at 12-month follow-up. An independent clinical events committee masked to treatment allocation will adjudicate all suspected events. Clinical follow-up will be performed after 1 month (30 days±5 days) and 1 year (365 days±30 days). An extended follow-up at 3, 5, and 10 years is planned.</p><p><strong>Conclusions: </strong>The COPERNICAN trial will be the first randomized study comparing clinical outcomes of DCB vs DES in STEMI patients.</p><p><strong>Clinicaltrials: </strong>gov: NCT06353594.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular ultrasound to assess adverse pulmonary vascular remodeling in Fontan circulation.","authors":"Yassin Belahnech, Gerard Martí-Aguasca, Enric Domingo-Ribas, Eduard Ródenas-Alesina, Antonia Pijuan-Domenech, Laura Dos-Subirà","doi":"10.1016/j.rec.2025.05.004","DOIUrl":"10.1016/j.rec.2025.05.004","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microaxial flow pump malrotation and cardiogenic shock outcomes.","authors":"Sebastián Aranda-Martínez, Jorge Martínez-Solano, Antonio Portolés-Hernández, Iago Sousa-Casasnovas, Jorge García-Carreño, Manuel Martínez-Sellés","doi":"10.1016/j.rec.2025.05.002","DOIUrl":"10.1016/j.rec.2025.05.002","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The continuity of care in primary care is associated with a more favorable prognosis in patients referred to a cardiology service.","authors":"Sergio Cinza-Sanjurjo, Pilar Mazón-Ramos, Daniel Rey-Aldana, Alfonso Varela-Román, Manuel Portela-Romero, José R González-Juanatey","doi":"10.1016/j.rec.2025.03.010","DOIUrl":"10.1016/j.rec.2025.03.010","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>To analyze the relationship between continuity of care in primary care and hospitalizations and mortality among patients referred from primary care to a cardiology service.</p><p><strong>Methods: </strong>Continuity of care was assessed using 3 measures: a) whether the referral was made by the patient's regular family medicine physician (FMP) or a different FMP, b) FMP turnover within a patient panel, and c) turnover of the referring FMP among different patient panels. The association between continuity of care and hospitalizations and mortality was assessed using a multivariate analysis, with adjustment for potential confounding variables. The results are expressed as odds ratios (OR) with 95% confidence intervals (95%CI).</p><p><strong>Results: </strong>A total of 67 889 patients, referred from 2010 to 2023, were included, of whom 80.5% were referred by their FMP. Patients referred by an FMP other than their own had a higher annual referral rate (2.3 [2.9]) vs 1.5 [0.6]); P<.001) and were assigned to panels with a higher referral rate (10.5 [12.7] vs 1.6 (1.1]; P<.001). Patients referred by their FMP had a lower risk of overall hospitalizations (OR, 0.90; 95%CI, 0.86-0.94), hospitalizations for cardiovascular causes (OR, 0.88; 95%IC, 0.82-0.95), all-cause mortality (OR, 0.84; 95%CI, 0.80-0.89), cardiovascular-related mortality (OR, 0.86; 95%CI, 0.78-0.96), and heart failure-related mortality (OR, 0.77; 95%CI, 0.66-0.89).</p><p><strong>Conclusions: </strong>Continuity of care, measured by the persistence of the FMP within the same patient panel, improves health outcomes by reducing hospitalizations and mortality, as well as the number of cardiology service referrals.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical implications of sex-specific upper reference limits for high-sensitivity cardiac troponin I in myocardial infarction diagnosis.","authors":"María Rubini Giménez, Luca Koechlin, Pedro López-Ayala, Carlos Spagnuolo, Jasper Boeddinghaus, Karin Wildi, Thomas Nestelberger, Hanna Tkachenko, Daniel Basic, Emel Kaplan, Jude Formambuh, Paolo Bima, Jonas Glaeser, Luca Crisanti, Óscar Miró, F Javier Martín-Sánchez, Michael Christ, Dagmar I Keller, Danielle M Gualandro, Damian Kawecki, Katharina Rentsch, Andreas Buser, Ivo Strebel, Felix Mahfoud, Christian Mueller, Gabrielle Hure, Klara Rumora, Tamar Muench-Gerber, Noemi Glarner, Christian Puelacher, Raphael Twerenbold, Desiree Wussler, Jeanne du Fay de Lavallaz, Tobias Zimmermann, Julia Reinhardt, Beata Morawiec, Piotr Munzk, Nicolas Geigy, Samyut Shrestha, Gemma Martinez-Nadal, Carolina Fuenzalida, Sofia Calderón, Esther Rodriguez Adrada, Eva Ganovská, Jiri Parenica, Arnold von Eckardstein","doi":"10.1016/j.rec.2025.05.003","DOIUrl":"10.1016/j.rec.2025.05.003","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>It is unclear whether applying sex-specific rather than uniform upper reference limits (URLs) for high-sensitivity cardiac troponin I (hs-cTnI) improves diagnostic equity between women and men with suspected myocardial infarction (MI). We compared the diagnostic performance of these 2 approaches.</p><p><strong>Methods: </strong>In an international, prospective, multicenter study of patients presenting with suspected MI, the final diagnosis was centrally adjudicated twice by 2 independent cardiologists using all available information, including serial measurements of hs-cTnI-Architect, once using the uniform URL (26.2 ng/L) and once using sex-specific URLs (women: 15.6 ng/L; men: 34.2 ng/L). The primary outcome was the diagnostic performance of uniform vs sex-specific URLs at presentation for MI.</p><p><strong>Results: </strong>Among 7137 eligible patients, 2434 were women (34%), median age 65 years, and 4703 were men (66%), median age 59 years. Using the uniform URL, 348 women and 880 men were adjudicated as having MI. At presentation, the sensitivity and specificity of hs-cTnI were high and similar in women (77%; 95%CI, 72-81, and 93%; 95%CI, 92-94, respectively) and men (79%; 95%CI, 77-82, and 94%; 95%CI, 93-94). Using sex-specific URLs, the sensitivity and specificity were 85% (95%CI, 81-89) and 91% (95%CI, 89-92) in women vs 74% (95%CI, 71-77), and 95% (95%CI, 94-95) in men (P<.001). Using sex-specific URLs, diagnostic reclassification occurred in 27 patients, 12 women (upgrade to MI) and 15 men (downgrade from MI), representing 0.4%, (95%CI, 0.3-0.6) of all patients.</p><p><strong>Conclusions: </strong>Using a uniform URL for hs-cTnI provides high and similar diagnostic sensitivity and specificity in women and men. Contrary to expectations, sex-specific URLs introduced sex-related disparities. These findings support the use of a uniform rather than sex-specific URL in the diagnosis of MI.</p>","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Juan José Rufilanchas Sánchez","authors":"José Luis Pomar","doi":"10.1016/j.rec.2025.05.001","DOIUrl":"10.1016/j.rec.2025.05.001","url":null,"abstract":"","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":"78 8","pages":"Page 751"},"PeriodicalIF":7.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}