José A Barrabés

Autonomous University of Barcelona, Cerdanyola del Vallès, Catalonia, Spain

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Publications (116)572.85 Total impact

  • José A Barrabés, Alfredo Bardají
    Revista espanola de cardiologia (English ed.). 12/2014;
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    ABSTRACT: The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1–V3) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1–V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients.
    Annals of Noninvasive Electrocardiology 09/2014; 19(5). · 1.08 Impact Factor
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    ABSTRACT: Introducción y objetivos Conocer la mortalidad y el manejo actuales de los pacientes ingresados por sospecha de síndrome coronario agudo en España. El último registro disponible (2004-2005) reportó una mortalidad hospitalaria del 5,7%. Métodos Se incluyó a los pacientes ingresados consecutivamente de enero a junio de 2012 en 44 hospitales seleccionados al azar. Se recogió la evolución en el ingreso y los eventos a 6 meses. Resultados Se incluyó a 2.557 pacientes ingresados con sospecha de síndrome coronario agudo: 788 (30,8%) con elevación del segmento ST, 1.602 (62,7%) sin elevación del segmento ST y 167 (6,5%) con síndrome coronario agudo inclasificable. La mortalidad hospitalaria fue del 4,1% (el 6,6, el 2,4 y el 7,8% respectivamente), significativamente menor que la registrada en 2004-2005. Se realizó tratamiento de reperfusión (más frecuentemente intervención coronaria percutánea primaria) en el 85,7% de los pacientes con elevación del segmento ST atendidos en < 12 h. La mediana del tiempo desde el primer contacto médico hasta la trombolisis fue 40 min y hasta el inflado del balón, 120 min. Al 80,6% de los pacientes sin elevación del segmento ST, se les realizó coronariografía; al 52,0%, intervención percutánea, y al 6,4%, se le indicó cirugía. La prescripción de tratamientos de prevención secundaria al alta aumentó respecto a registros previos. La mortalidad a 6 meses entre los pacientes dados de alta con vida (seguimiento disponible en el 97,1%) fue del 3,8%. Conclusiones La mortalidad de los pacientes con síndrome coronario agudo en España ha disminuido respecto a los últimos datos disponibles, en paralelo a un uso más frecuente de los principales tratamientos recomendados.
    Revista Espanola de Cardiologia 06/2014; · 3.20 Impact Factor
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    ABSTRACT: Occurrence of moderate-to-severe pericardial effusion (PE; ≥10 mm), cardiac tamponade (CT), and sudden electromechanical dissociation (EMD) was investigated in 4,361 patients with ST-elevation myocardial infarction from 1993 to 2011 in 3 different periods: 1993 to 2000 (n: 1,488); 2001 to 2008 (n: 1,844); and 2009 to 2011 (n: 1,014). Their predictors, including the use of no reperfusion therapy (n: 1,186), thrombolysis (n: 1,607), or primary percutaneous coronary intervention (PPCI, n: 1,562), were also evaluated. Incidence of PE (8.7%, 6.8%, and 5.0%), CT (5.0%, 2.9%, and 1.9%), and EMD (3.7%, 1.7%, and 1.0%), declined over the 3 periods as did mortality (12.0% 8.2%, and 5.9%) with different rates of thrombolytic therapy (52%, 37%, and 14%) and PPCI (7%, 38%, and 76%; all p <0.001). In patients treated without reperfusion therapy, thrombolysis, and PPCI, incidence of PE (12.0%, 5.7%, and 4.3%), CT (6.0%, 3.0%, and 2.2%), and EMD (4.1%, 2.2%, and 0.8%) was different as was mortality (14.4%, 8.3%, and 5.9%; all p <0.001). Independent predictors of PE were lateral infarction (odds ratio [OR] 4.09, 95% confidence interval [CI] 2.57 to 6.49), increasing age (OR 1.05, 95% CI 1.04 to 1.07), number of electrocardiographic leads involved (OR 1.34, 95% CI 1.23 to 1.45), and admission delay (OR 1.01, 95% CI 1.01 to 1.02). Increasing ejection fraction (OR 0.97, 95% CI 0.96 to 0.98), thrombolysis (OR 0.53, 95% CI 0.37 to 0.75), and PPCI (OR 0.35, 95% CI 0.25 to 0.50), however, were protectors (all p <0.001). Lateral infarction, age, number of leads involved, ejection fraction, thrombolytic therapy, and PPCI were also predictors/protectors of CT and EMD. In conclusion, PE, CT, and EMD rates in patients with ST-elevation myocardial infarction have objectively fallen in the last 2 decades, and their predictors are lateral site, increasing age, number of leads involved, and lack of reperfusion therapy. Late hospital admission is also a relevant predictor of PE.
    The American journal of cardiology 01/2014; · 3.58 Impact Factor
  • International journal of cardiology 01/2014; · 6.18 Impact Factor
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    ABSTRACT: Introduction and objectives To identify the current mortality and management of patients admitted for suspected acute coronary syndrome in Spain. The last available registry (2004-2005) reported an in-hospital mortality of 5.7%. Methods The study included patients consecutively admitted between January and June 2012 at 44 hospitals selected at random. Information was collected on clinical course at admission and on events at 6 months. Results A total of 2557 patients admitted with suspected acute coronary syndrome were included: 788 (30.8%) with ST-segment elevation, 1602 (62.7%) without ST-segment elevation, and 167 (6.5%) with unclassified acute coronary syndrome. In-hospital mortality was 4.1% (6.6%, 2.4%, and 7.8% respectively), significantly lower than that observed for 2004-2005. Reperfusion treatment (most commonly, primary percutaneous coronary intervention) was administered to 85.7% of patients with ST-segment elevation attended within 12 h. The median time from first medical contact to thrombolysis was 40 min and to balloon inflation, 120 min. Among patients without ST-segment elevation, coronary angiography was performed in 80.6%, percutaneous intervention in 52.0%, and surgery in 6.4%. Secondary prevention treatments at discharge was prescribed more often than in earlier registries. In patients alive at discharge (follow-up available for 97.1%), 6-month mortality was 3.8%. Conclusions Mortality among patients with acute coronary syndrome in Spain was lower than that reported in the most recent published studies, in parallel with a more frequent use of the main treatments recommended. Full English text available from: www.revespcardiol.org/en
    Revista Española de Cardiología. 01/2014;
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    ABSTRACT: Oral anticoagulation (OAC) is the recommended therapy for patients with atrial fibrillation (AF) because it reduces the risk of stroke and other thromboembolic events. Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention and stenting (PCI-S). In patients with AF requiring PCI-S, the association of DAPT and OAC carries an increased risk of bleeding, whereas OAC therapy or DAPT alone may not protect against the risk of developing new ischemic or thromboembolic events. The MUSICA-2 study will test the hypothesis that DAPT compared with triple therapy (TT) in patients with nonvalvular AF at low-to-moderate risk of stroke (CHADS2 score ≤2) after PCI-S reduces the risk of bleeding and is not inferior to TT for preventing thromboembolic complications. The MUSICA-2 is a multicenter, open-label randomized trial that will compare TT with DAPT in patients with AF and CHADS2 score ≤2 undergoing PCI-S. The primary end point is the incidence of stroke or any systemic embolism or major adverse cardiac events: death, myocardial infarction, stent thrombosis, or target vessel revascularization at 1 year of PCI-S. The secondary end point is the combination of any cardiovascular event with major or minor bleeding at 1 year of PCI-S. The calculated sample size is 304 patients. The MUSICA-2 will attempt to determine the most effective and safe treatment in patients with nonvalvular AF and CHADS2 score ≤2 after PCI-S. Restricting TT for AF patients at high risk for stroke may reduce the incidence of bleeding without increasing the risk of thromboembolic complications.
    American heart journal 10/2013; 166(4):669-675. · 4.65 Impact Factor
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    ABSTRACT: To investigate the relationship between in-hospital mortality due to acute myocardial infarction and type of hospital, discharge service, and treatment provided. Retrospective analysis of 100 993 hospital discharges with a principal diagnosis of myocardial infarction in hospitals of the Spanish National Health Service. In-hospital mortality was adjusted for risk following the models of the Institute for Clinical Evaluative Sciences (Canada) and the Centers for Medicare & Medicaid Services (United States). Hospital characteristics are relevant to explain the variation in the individual probability of dying from myocardial infarction (median odds ratio: 1.3561). The risk-adjusted in-hospital mortality in cluster 3 and especially in cluster 4 hospitals (500 beds to 1000 beds and medium-high complexity) was significantly lower than in hospitals with less than 200 beds. Cluster 5 (more than 1000 beds), which includes a diverse group of hospitals, had a higher mortality rate than clusters 3 and 4. The adjusted mortality in the groups with the best and worst outcomes was 6.74% (cluster 4) and 8.49% (cluster 1), respectively. Mortality was also lower when the cardiology unit was responsible for the discharge or when angioplasty had been performed. The typology of the hospital, treatment in a cardiology unit, and percutaneous coronary intervention are significantly associated with the survival of a patient hospitalized for myocardial infarction. We recommend that the Spanish National Health Service establish health care networks that favor percutaneous coronary intervention and the participation of cardiology units in the management of patients with acute myocardial infarction. Full English text available from:www.revespcardiol.org/en.
    Revista Espa de Cardiologia 09/2013; · 3.20 Impact Factor
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    ABSTRACT: Long-term effects on the left ventricular (LV) function of acute ST re-elevation (STRE) during thrombolysis in ST segment elevation myocardial infarction (STEMI) patients have not been investigated. Patients with anterior STEMI treated with TNK within 12 h from symptom onset (n=191) were investigated. We compared the clinical, the electrocardiographic, and the angiographic data of patients with STRE (additional ≥2.0 mm ST elevation during the first 60 min, followed by >50% ST resolution, n=31) with those with conventional ST resolution (>50%, n=88) and those without ST resolution (<50%, n=72). We also compared the ejection fraction (EF) and LV volumes by echocardiography in the acute phase and at 12 months between the three groups. Maximum ST elevation before TNK was higher in conventional ST resolution patients than in the other two groups (P=0.01) and additional STRE was 4.7±2.4 mm. Time from pain onset to TNK in STRE and ST resolution groups was similar but shorter than that in patients without ST resolution (P=0.01), whereas the levels of creatine kinase MB mass, EF, and LV volumes were comparable in the three groups. At 12 months, EF was also similar in patients with STRE than in those with ST resolution (51±8 vs. 53±12%, P=0.52), but LV systolic (60±24 vs. 53±12 ml, P=0.01) and diastolic volumes (124±39 vs. 101±31 ml, P=0.02) were significantly larger in the former. STRE during lytic therapy is associated with greater ventricular dilatation at 12 months than conventional ST resolution, suggesting an impaired reperfusion process. These differences, however, are often not visible in the acute phase.
    Coronary artery disease 09/2013; 24(6):455-60. · 1.56 Impact Factor
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    ABSTRACT: Introduction and objectivesHigh-sensitivity troponin assays have improved the diagnosis of acute coronary syndrome in patients presenting with chest pain and normal troponin levels as measured by conventional assays. Our aim was to investigate whether N-terminal pro-brain natriuretic peptide provides additional information to troponin determination in these patients.MethodsA total of 398 patients, included in the PITAGORAS study, presenting to the emergency department with chest pain and normal troponin levels as measured by conventional assay in 2 serial samples (on arrival and 6 h to 8 h later) were studied. The samples were also analyzed in a central laboratory for high-sensitivity troponin T (both samples) and for N-terminal pro-brain natriuretic peptide (second sample). The endpoints were diagnosis of acute coronary syndrome and the composite endpoint of in-hospital revascularization or a 30-day cardiac event.ResultsAcute coronary syndrome was adjudicated to 79 patients (20%) and the composite endpoint to 59 (15%). When the N-terminal pro-brain natriuretic peptide quartile increased, the diagnosis of acute coronary syndrome also increased (12%, 16%, 23% and 29%; P=.01), as did the risk of the composite endpoint (6%, 13%, 16% and 24%; P=.004). N-terminal pro-brain natriuretic peptide elevation (>125 ng/L) was associated with both endpoints (relative risk= 2.0; 95% confidence interval, 1.2-3.3; P=.02; relative risk=2.4; 95% confidence interval, 1.4-4.2; P=.004). However, in the multivariable models adjusted by clinical and electrocardiographic data, a predictive value was found for high-sensitivity T troponin but not for N-terminal pro-brain natriuretic peptide.Conclusions In low-risk patients with chest pain of uncertain etiology evaluated using high-sensitivity T troponin, N-terminal pro-brain natriuretic peptide does not contribute additional predictive value to diagnosis or the prediction of short-term outcomes.Full English text available from:www.revespcardiol.org/en.
    Revista Española de Cardiología. 07/2013; 66(7):532–538.
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    ABSTRACT: Whether admission myocardial wall motion score (WMS) in non-ST-segment elevation acute coronary syndromes might be a better predictor of 30-day mortality than currently recognized prognostic markers is unknown. Admission echocardiographic and electrocardiographic data as well as coronary angiographic data were prospectively evaluated in 488 patients. Variables analyzed were clinical data, quantitative ST-segment depression, peak troponin I, WMS, ejection fraction, extent of coronary artery disease, and Thrombolysis In Myocardial Infarction (TIMI) risk score. Severity of WMS in quartiles was associated with peak troponin I (quartile 1, 5.2 μg/L; quartile 2, 9.4 μg/L; quartile 3, 11.7 μg/L; quartile 4, 23.7 μg/L; P < .001) and with the sum of all leads with ST-segment depression (quartile 1, -2.5 mm; quartile 2, -3.2 mm; quartile 3, -3.8 mm; quartile 4, -5.1 mm; P < .001). Thirty-day mortality was associated with increased worsening of WMS (quartiles 1, 0.7%; quartile 2, 3.4%; quartile 3, 3.8%; quartile 4, 11.5%; P = .001) and quantitative ST-segment depression (0 mm, 2.7%; <1.0 mm, 1.8%; 1.0-1.9 mm, 3.5%; 2.0-2.9 mm, 7.3%; ≥3.0 mm, 15.0%; P = .008). Mortality was also associated with age (P = .002), diabetes (P = .007), peripheral vascular disease (P < .001), Killip class ≥ II (P < .001), ejection fraction (P < .001), troponin I level (P < .001), three-vessel and/or left main coronary artery disease (P < .001), and admission TIMI risk score (P < .001). Nevertheless, WMS predicted 30-day mortality after adjusting for TIMI risk score (odds ratio per unit increase, 1.14; 95% confidence interval, 1.06-1.21; P < .001) or for TIMI score and Killip class > I (odds ratio per unit increase, 1.11; 95% confidence interval, 1.04-1.19; P = .004). In comparison with quantitative ST-segment depression, troponin I, and TIMI risk score, WMS on admission is a better early predictor of 30-day mortality in patients with first non-ST-segment elevation acute coronary syndromes.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 06/2013; · 2.98 Impact Factor
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    ABSTRACT: This article summarizes the main developments reported during the year 2012 concerning ischemic heart disease, together with the most relevant innovations in the management of acute cardiac patients.Full English text available from:www.revespcardiol.org/en.
    Revista Espa de Cardiologia 03/2013; 66(3):198–204. · 3.20 Impact Factor
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: High-sensitivity troponin assays have improved the diagnosis of acute coronary syndrome in patients presenting with chest pain and normal troponin levels as measured by conventional assays. Our aim was to investigate whether N-terminal pro-brain natriuretic peptide provides additional information to troponin determination in these patients. METHODS: A total of 398 patients, included in the PITAGORAS study, presenting to the emergency department with chest pain and normal troponin levels as measured by conventional assay in 2 serial samples (on arrival and 6 h to 8h later) were studied. The samples were also analyzed in a central laboratory for high-sensitivity troponin T (both samples) and for N-terminal pro-brain natriuretic peptide (second sample). The endpoints were diagnosis of acute coronary syndrome and the composite endpoint of in-hospital revascularization or a 30-day cardiac event. RESULTS: Acute coronary syndrome was adjudicated to 79 patients (20%) and the composite endpoint to 59 (15%). When the N-terminal pro-brain natriuretic peptide quartile increased, the diagnosis of acute coronary syndrome also increased (12%, 16%, 23% and 29%; P=.01), as did the risk of the composite endpoint (6%, 13%, 16% and 24%; P=.004). N-terminal pro-brain natriuretic peptide elevation (>125ng/L) was associated with both endpoints (relative risk= 2.0; 95% confidence interval, 1.2-3.3; P=.02; relative risk=2.4; 95% confidence interval, 1.4-4.2; P=.004). However, in the multivariable models adjusted by clinical and electrocardiographic data, a predictive value was found for high-sensitivity T troponin but not for N-terminal pro-brain natriuretic peptide. CONCLUSIONS: In low-risk patients with chest pain of uncertain etiology evaluated using high-sensitivity T troponin, N-terminal pro-brain natriuretic peptide does not contribute additional predictive value to diagnosis or the prediction of short-term outcomes. Full English text available from:www.revespcardiol.org/en.
    Revista Espa de Cardiologia 01/2013; · 3.20 Impact Factor
  • Revista Espanola de Cardiologia 01/2013; · 3.20 Impact Factor
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    ABSTRACT: This article summarizes the main developments reported during the year 2012 concerning ischemic heart disease, together with the most relevant innovations in the management of acute cardiac patients. Full English text available from:www.revespcardiol.org/en.
    Revista Espa de Cardiologia 01/2013; · 3.20 Impact Factor
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    Revista Espa de Cardiologia 01/2013; 66(1):5-11. · 3.20 Impact Factor
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    ABSTRACT: Introduction and objectives To investigate the relationship between in-hospital mortality due to acute myocardial infarction and type of hospital, discharge service, and treatment provided. Methods Retrospective analysis of 100 993 hospital discharges with a principal diagnosis of myocardial infarction in hospitals of the Spanish National Health Service. In-hospital mortality was adjusted for risk following the models of the Institute for Clinical Evaluative Sciences (Canada) and the Centers for Medicare & Medicaid Services (United States). Results Hospital characteristics are relevant to explain the variation in the individual probability of dying from myocardial infarction (median odds ratio: 1.3561). The risk-adjusted in-hospital mortality in cluster 3 and especially in cluster 4 hospitals (500 beds to 1000 beds and medium-high complexity) was significantly lower than in hospitals with less than 200 beds. Cluster 5 (more than 1000 beds), which includes a diverse group of hospitals, had a higher mortality rate than clusters 3 and 4. The adjusted mortality in the groups with the best and worst outcomes was 6.74% (cluster 4) and 8.49% (cluster 1), respectively. Mortality was also lower when the cardiology unit was responsible for the discharge or when angioplasty had been performed. Conclusions The typology of the hospital, treatment in a cardiology unit, and percutaneous coronary intervention are significantly associated with the survival of a patient hospitalized for myocardial infarction. We recommend that the Spanish National Health Service establish health care networks that favor percutaneous coronary intervention and the participation of cardiology units in the management of patients with acute myocardial infarction. Full English text available from:www.revespcardiol.org/en
    Revista Española de Cardiología. 01/2013; 66(12):935–942.
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    Revista Española de Cardiología. 01/2013; 66(1):5–11.
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: Distension of the ischemic region has been related to an increased incidence of spontaneous ventricular arrhythmias following coronary occlusion. This study analyzed whether regional ischemic distension predicts increased ventricular fibrillation inducibility after coronary occlusion in swine. METHODS: In 18 anesthetized, open-chest pigs, the left anterior descending coronary artery was ligated for 60min. Myocardial segment length in the ischemic region was monitored by means of ultrasonic crystals. Programmed stimulation was applied at baseline and then continuously between 10 and 60min after coronary occlusion. RESULTS: Coronary occlusion induced a rapid increase in end-diastolic length in the ischemic region, which reached 109.4% (0.9%) of baseline values 10min after occlusion (P<.001). On average, 6.6 (0.5) stimulation protocols were completed and 5.4 (0.6) ventricular fibrillation episodes induced between 10 and 60min of coronary occlusion. Neither baseline serum potassium levels nor the size of the ischemic region were significantly related to ventricular fibrillation inducibility. In contrast, the increase in end-diastolic length 10min after coronary occlusion was associated directly (r=0.67; P=.002) with the number of induced ventricular fibrillation episodes and inversely (r=-0.55; P=.018) with the number of extrastimuli needed for ventricular fibrillation induction. CONCLUSIONS: Regional ischemic expansion predicts increased ventricular fibrillation inducibility following coronary occlusion. These results highlight the potential influence of mechanical factors, acting not only on the triggers but also on the substrate, in the genesis of malignant ventricular arrhythmias during acute ischemia. Full English text available from: www.revespcardiol.org.
    Revista Espa de Cardiologia 11/2012; · 3.20 Impact Factor
  • International journal of cardiology 10/2012; · 6.18 Impact Factor

Publication Stats

934 Citations
572.85 Total Impact Points

Institutions

  • 2011–2014
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
  • 1993–2014
    • University Hospital Vall d'Hebron
      • • Department of Cardiology
      • • Laboratorio de Cardiología Experimental
      Barcino, Catalonia, Spain
  • 2012–2013
    • Fundación de Investigación del Hospital Clínico Universitario de Valencia INCLIVA
      Valenza, Valencia, Spain
    • Hospital Clínico San Carlos
      • Servicio de Cardiología
      Madrid, Madrid, Spain
  • 2008–2010
    • Hospital Universitari Joan XXIII de Tarragona
      Tarraco, Catalonia, Spain