Juan Carlos Fernández-Guerrero

Complejo Hospitalario de Jaén, Jaén, Andalusia, Spain

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Publications (8)5.34 Total impact

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    ABSTRACT: Background: Sudden death (SD) constitutes one of the principal causes of death and is an important problem in healthcare provision. Cardiovascular diseases have a high prevalence in dialysis patients and constitute the principal cause of death. We sought to analyze retrospectively the incidence of SD in patients commencing dialysis and the factors related to its presence. Methods: We evaluated all the patients who began dialysis in our center between 1/11/2003 and 15/9/2007, and who were followed up until death, transplant, or study completion on 31/12/2012. We determined the presence of SD according to the following criteria: SD at 24 h (SD 24H): unexpected death occurring in the 24 h following the start of symptoms, or when the patient was found dead and had been seen alive 24 h earlier; SD at 1 h (SD 1H): death witnessed as occurring in the first hour following the start of symptoms. Results: We evaluated 285 patients, mean age 65.67 ± 15.7 years. In a follow-up of 39.9 ± 34.2 months (947.6 patient-years of follow-up) 168 died (59%), 28 (10%) patients presented SD 24H (2.9/100 patient-years), and 16 (6%) patients presented SD 1H (1.7/100 patient-years). In the multivariate analysis, having had a myocardial infarction or having had electrocardiographic abnormalities (Q wave, negative T wave, subendocardial lesion or QRS >120 ms) were the principal independent predictors of SD 24H (OR 7.83; 95% CI 2.20-27.86; p = 0.001) and of SD 1H (OR 13.43; 95% CI 1.56-115.42; p = 0.018). Conclusions: SD on dialysis is very frequent. Two groups can be identified easily, with risk profiles clearly differentiated. © 2014 S. Karger AG, Basel.
    American Journal of Nephrology 04/2014; 39(4):331-336. · 2.62 Impact Factor
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    ABSTRACT: The association between kidney disease and coronary disease is well established, so special care must be taken in the cardiological assessment carried out before being added to the renal transplant waiting list. The performing of a routine coronary arteriography has also been proposed.Objective To analyse whether the clinical assessment is sufficient to predict the absence of post-transplant coronary events.Patients and methodA total of 256 current dialysis patients were examined in Cardiology. An electrocardiogram, echo doppler and a clinical assessment were performed on all the patients. Other examinations were not performed if the clinical signs were not suggestive of ischaemia. Post-transplant coronary events were analysed on those who had received a renal graft.ResultsThere were 94 (36.7%) patients on the kidney transplant waiting list. Age: 50.12 ± 13.8 years; 57 (60.6%) men; 13 (13.8%) diabetics. Only one patient (1.06%) showed coronary disease at the time of being added to the waiting list. The coronary arteriography on the first assessment or during the monitoring was performed on 3 patients (3.2%) and two of them showed coronary disease. As result of an acute coronary syndrome, a patient died while on the waiting list. Fifty-two (55%) patients were transplanted after 29.3 ± 13.3 months on the waiting list (median: 35). After the transplant, they were followed up for 22.1 (16.5) months (median: 20), without any cardiological events.Conclusions1. The pre-inclusion of cardiological clinical assessment on the renal transplant list was sufficient to predict the absence of post-transplant coronary complications. 2. Additional procedures were not necessary when there are no clinical signs that suggest the presence of coronary ischaemia.
    Cardiocore 01/2011; 46(1):26-32.
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    ABSTRACT: Introduction and objectiveUrgent intervention and cardiogenic shock are established as the main prognostic indicators in percutaneous revascularization of unprotected left main coronary disease. The outcome and identification of prognostic factors are less established for elective procedures. The purpose of this study is to assess the short and medium-term outcome after elective percutaneous coronary artery intervention for unprotected left main coronary disease.Methods and resultsA multicentre sample of 250 consecutive patients was included between January 2004 and March 2008. A high risk EuroScore was observed in 49.6% of cases. There was 0.4% hospital cardiac mortality and after a medium follow up of 19.6 months the rate of major adverse cardiac events was 18.4% (myocardial infarction 2.0%, target vessel revascularization 6.8%, cardiac mortality 9.6%). High risk EuroScore and implantation of two stents for left main lesion were identified as independent predictors of mayor adverse cardiac events during follow up (HR, 2.59; 95%CI, 1.35-5.00; P = .004 and HR, 2.05; 95%CI, 1.05-4.00; P = .035, respectively).Conclusions In our study elective percutaneous coronary intervention for unprotected left main disease is mainly performed on high risk patients resulting in a feasible procedure with favourable short and medium-term results. High risk EuroScore and implantation of two stents for left main lesion are identified as main predictors of events during follow up.
    Cardiocore 01/2011; 46(4):143-149.
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    ABSTRACT: Introduction and objectivesThe use of platelet glycoprotein IIb/IIIa inhibitors (IGP) in patients undergoing high risk percutaneous coronary angioplasty (PCA) is increasing. In this prospective randomized study we compare abciximab (ABX) vs eptifibatide (EPT). The primary endpoints were to compare the incidence of major adverse events during the first month after PCA (death, stroke, the need for revascularisation, and myocardial infarction) and vascular complications in both groups.
    Cardiocore 10/2010; 45(4):165-171.
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    ABSTRACT: The zotarolimus-eluting stent (ZES) has been documented as significantly reducing restenosis and target lesion revascularization (TLR) requirement compared to bare metal stents (BMS). In this single-centered, prospective study we sought to evaluate the short- and medium-term outcomes of ZES placement in bifurcated coronary artery lesions. Between August 2006 and December 2007, 107 consecutive patients (110 bifurcations) were recruited to have ZES placement in the lesion. The provisional T stenting (PTS) technique was used in 96.3%. Angiographic success was 100% in main vessel (MV) cases and 97.2% in that of side branch (SB). With a mean follow-up of 12.4 +/- 1.77 (mean +/- SD) months there were four deaths, three from cardiac cause (2.85%). There were 18 patients (19 bifurcations) requiring TLR (17.59%) for clinical reasons. The only predictor of TLR was the use diameter of ZES <or=3 mm. ZES can be used for bifurcation lesions using the PTS technique with a high rate of intraprocedural success; however, frequency of TLR is high, especially for stents with a diameter <or=3 mm.
    Journal of Interventional Cardiology 03/2010; 23(2):188-94. · 1.50 Impact Factor
  • Cardiovascular Revascularization Medicine. 01/2010; 11(3):209-209.
  • Juan Carlos Fernández-Guerrero, Juan Ángel Herrador Fuentes, Manuel Guzmán Herrera
    Cardiocore 01/2010; 45(3):122-122.
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    ABSTRACT: To evaluate the frequency and factors associated with cardiogenic shock (CS) in acute myocardial infarction (AMI) and unstable angina (UA) and percutaneous coronary intervention (PCI). Spanish registry. The study period was June 1996 to December 2005. Follow-up was length of stay in an intensive care or coronary care unit (ICU/CCU). Multivariate studies evaluated factors associated with CS, mortality in CS, and PCI performance. The study included 45.688 AMI patients and 17.277 UA patients. Cardiogenic shock occurred in 9.3% of patients with AMI and 1.79% of those with UA, frequencies that decreased over time. Variables associated with cardiogenic shock in AMI patients were female sex, age, type of infarction, diabetes, previous stroke, arrhythmia, previous angiography, complicated angina, and reinfarction. Hypertension and oral beta-blocking, ACE inhibitor, and hypolipidemic agents protected against CS. In UA, these variables were age, previous angina or AMI, right ventricular heart failure, arrhythmia. Beta-blocking agents were associated with a reduction in CS. Deaths from CS and AMI, respectively, were 62.8% and 38.7% in persons with UA. Doing PCIs has increased significantly; it is more prevalent in ex-smokers and those with right ventricular heart failure and mechanical ventilation; lower performance is associated with need for cardiopulmonary resuscitation; patients who die are older or have a history of AMI. There has been a slight drop in the frequency of CS and its mortality. Factors associated with CS are similar to those associated with acute coronary syndromes. The frequency of PCI was low.
    Medical science monitor: international medical journal of experimental and clinical research 12/2008; 14(11):PH46-57. · 1.22 Impact Factor