Publications (10)31.76 Total impact
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Article: Implantation of a drug-eluting stent with a different drug (switch strategy) in patients with drug-eluting stent restenosis. Results from a prospective multicenter study (RIBS III [Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent]).
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ABSTRACT: This study sought to assess the effectiveness of a strategy of using drug-eluting stents (DES) with a different drug (switch) in patients with DES in-stent restenosis (ISR). Treatment of patients with DES ISR remains a challenge. The RIBS-III (Restenosis Intra-Stent: Balloon Angioplasty Versus Drug-Eluting Stent) study was a prospective, multicenter study that aimed to assess results of coronary interventions in patients with DES ISR. The use of a different DES was the recommended strategy. The main angiographic endpoint was minimal lumen diameter at 9-month follow-up. The main clinical outcome measure was a composite of cardiac death, myocardial infarction, and target lesion revascularization. This study included 363 consecutive patients with DES ISR from 12 Spanish sites. The different-DES strategy was used in 274 patients (75%) and alternative therapeutic modalities (no switch) in 89 patients (25%). Baseline characteristics were similar in the 2 groups, although lesion length was longer in the switch group. At late angiographic follow-up (77% of eligible patients, median: 278 days) minimal lumen diameter was larger (1.86 ± 0.7 mm vs. 1.40 ± 0.8 mm, p = 0.003) and recurrent restenosis rate lower (22% vs. 40%, p = 0.008) in the different-DES group. At the last clinical follow-up (99% of patients, median: 771 days), the combined clinical endpoint occurred less frequently (23% vs. 35%, p = 0.039) in the different-DES group. After adjustment using propensity score analyses, restenosis rate (relative risk: 0.41, 95% confidence interval [CI]: 0.21 to 0.80, p = 0.01), minimal lumen diameter (difference: 0.41 mm, 95% CI: 0.19 to 0.62, p = 0.001), and the event-free survival (hazard ratio: 0.56, 95% CI: 0.33 to 0.96, p = 0.038) remained significantly improved in the switch group. In patients with DES ISR, the implantation of a different DES provides superior late clinical and angiographic results than do alternative interventional modalities.07/2012; 5(7):728-37. · 1.07 Impact Factor -
Article: Thrombosis of second-generation drug-eluting stents in real practice results from the multicenter Spanish registry ESTROFA-2 (Estudio Español Sobre Trombosis de Stents Farmacoactivos de Segunda Generacion-2).
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ABSTRACT: This study sought to evaluate second-generation drug-eluting stent (DES) thrombosis in clinical practice. First-generation DES are associated with a significant incidence of late thrombosis. There is paucity of data regarding real practice late thrombosis incidence and predictors with second-generation DES, zotarolimus-eluting stent (ZES), and everolimus-eluting stents (EES). A prospective, large-scale, non-industry-linked multicenter registry was designed. Complete clinical-procedural data and systematic follow-up of all patients treated with these stents was reported in a dedicated registry supported by the Spanish Working Group on Interventional Cardiology. From 2005 to 2008, 4,768 patients were included in 34 centers: 2,549 treated with ZES, and 2,219 with EES. The cumulative incidence of definite/probable thrombosis for ZES was 1.3% at 1 year and 1.7% at 2 years and for EES 1.4% at 1 year and 1.7% at 2 years (p = 0.8). The increment of definite thrombosis between the first and second year was 0.2% and 0.25%, respectively. In a propensity score analysis, the incidence remained very similar. Ejection fraction (adjusted hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.95 to -0.99; p = 0.008), stent diameter (adjusted HR: 0.37; 95% CI: 0.17to 0.81; p = 0.01) and bifurcations (adjusted HR: 2.1; 95% CI: 1.14 to 3.7; p = 0.02) emerged as independent predictors of thrombosis. In the subgroup of patients with bifurcations, the use of ZES was independently associated with a higher thrombosis rate (adjusted HR: 4; 95% CI: 1.1 to 13; p = 0.03). In a real practice setting, the incidence of thrombosis at 2 years with ZES and EES was low and quite similar. The incidence of very late thrombosis resulted lower than was reported in registries of first-generation DES. In the subset of bifurcations, the use of ZES significantly increased the risk of thrombosis.09/2010; 3(9):911-9. · 1.07 Impact Factor -
Article: Implications of the "watermelon seeding" phenomenon during coronary interventions for in-stent restenosis.
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ABSTRACT: The occurrence of balloon slippage ("watermelon seeding"; WMS) during treatment of patients with in-stent restenosis (ISR) has been described, but predisposing factors and the potential implications of this phenomenon remain unknown. In the Restenosis Intrastent: Balloon Angioplasty vs. Elective Stenting (RIBS) randomized study, 450 patients with ISR were included. Of these, 42 patients (9%) presented WMS during the procedure. WMS was detected in 26 patients (12%) in the balloon arm and 16 (7%) in the stent arm (P=0.11). In the stent arm, WMS was only noticed during balloon predilation, never during stent implantation. As compared with 408 patients without WMS, patients with WMS had more severe (TIMI flow 1; 21% vs. 8%; P=0.01) and diffuse (length>15 mm: 45% vs. 28%; P=0.02) ISR lesions. Patients with WMS required more balloon inflations, longer total inflation time, had more frequent crossover to stenting or ended the procedure with residual dissections, and eventually obtained poorer acute results (minimal lumen diameter, 2.35+/-0.5 vs. 2.53+/-0.5 mm; P=0.03). In addition, at 6-month follow-up, patients with WMS had a smaller minimal lumen diameter (1.26+/-0.7 vs. 1.61+/-0.7 mm; P=0.007) and a higher restenosis rate (56% vs. 37%; P=0.017). On logistic regression analysis, the WMS phenomenon emerged as an independent predictor of recurrent restenosis (adjusted RR=2.1; 95% CI=1.1-4.1; P=0.04). The WMS phenomenon may complicate treatment of patients with ISR. Long and severe lesions appear to predispose to this technical problem that never occurs during stent deployment. In patients with ISR, WMS is associated with cumbersome procedures and poorer acute and long-term angiographic results.Catheterization and Cardiovascular Interventions 01/2006; 66(4):521-7. · 2.29 Impact Factor -
Article: Early results of direct coronary stenting in consecutive patients when multivessel, complex, long lesions, and small vessels are included.
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ABSTRACT: Direct coronary stenting is the dominant technique for coronary stent implantation, but previous randomized studies have strongly selected lesions to treat. To evaluate whether the results can be generalized to routine clinical practice, all consecutive patients with direct stenting in 15 hospitals were entered into a prospective registry. Single vessels and simple lesions, but also multivessel, complex and long lesions, and small vessels size (< or =2.5 mm) were included. Immediately results as well as clinical events within 30 days after the procedure were evaluated. Between April and November 2002, direct coronary stenting was performed in 452 consecutive patients (559 lesions) at 15 sites. Stents edge-protected by "sleeves" (SOX technology, NIR Stent, Boston Scientific) or with short transitional edge protection (STEP technology, Multilink Stents, Guidant) were selected to minimize vessel injury outside the stent edges during balloon inflation/deployment. Stents were successfully implanted in 96% of lesions. Lesions were multivessel in 27%, type B2-C in 40%, very angulated in 28%, calcified in 18%, and longer than 20 mm in 10% of patients. Vessels were smaller than < or =2.5 mm in 27% of patients. Direct coronary stenting was unsuccessful in 25 lesions (24 patients) characterized by more unstable angina (p=0.07), more treated lesions (p<0.01), and more distal locations (p=0.001). Dissection occurred in 6% of patients, and one stent embolised. The 30-day follow-up period included 1 death (due to subacute occlusion), 11 (2.4%) acute myocardial infarctions (8 non-Q wave), and one stroke (following carotid surgery). Direct coronary stenting yielded excellent results at 30 days although some expanded indications will be included.International Journal of Cardiology 10/2005; 104(3):282-7. · 7.08 Impact Factor -
Article: Long-term results (three to five years) of the Restenosis Intrastent: Balloon angioplasty versus elective Stenting (RIBS) randomized study.
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ABSTRACT: We sought to analyze the very late outcomes of patients treated for in-stent restenosis (ISR) according to treatment allocation and 10 prespecified variables. Long-term results (>2 years) of patients with ISR undergoing repeat coronary interventions are not well established. The Restenosis Intrastent: Balloon angioplasty versus elective Stenting (RIBS) randomized study compared these two strategies in 450 patients with ISR. A detailed systematic protocol was used for late clinical follow-up. At one-year follow-up (100% of patients), the event-free survival was similar in the two groups (77% stent implantation [ST] arm, 71% balloon angioplasty [BA] arm, log-rank p = 0.19). Additional long-term clinical follow-up (median 4.3 years, range 3 to 5 years) was obtained in 98.6% of patients. During this time 22 additional patients died (9 ST arm, 13 BA arm), 7 suffered a myocardial infarction (3 ST arm, 4 BA arm), 23 required coronary surgery (11 ST arm, 12 BA arm), and 9 underwent repeat coronary interventions (4 ST arm, 5 BA arm) (nonexclusive events). At four years the event-free survival was 69% in the ST arm and 64% in the BA arm (log-rank p = 0.21). Among the 10 prespecified variables, vessel size > or = 3 mm had a major influence on the clinical outcome at four years, with better results in the ST group (hazard ratio 0.51, 95% confidence interval 0.3 to 0.89, p = 0.016). Patients with ISR undergoing repeat interventions have a significant event rate at late follow-up. Continued medical surveillance should be continued after one year. Patients with large vessels have a better outcome after repeat stenting.Journal of the American College of Cardiology 10/2005; 46(5):756-60. · 14.16 Impact Factor -
Article: [Spanish Registry on Cardiac Catheterization and Coronary Interventions. Twelfth official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (1990-2002)].
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ABSTRACT: The results of the Registry of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology for 2002 are presented. Data were obtained from 101 centers representing all cardiac catheterization laboratories in Spain; 95 centers performed mainly adult catheterization and 6 carried out only pediatric procedures. In 2002, 97,609 diagnostic catheterization procedures were performed, including 83,667 coronary angiograms, representing a total increase of 5.1% in comparison to 2001. The population-adjusted rate was 2,053 coronary angiograms per 106 inhabitants. Coronary interventions increased by 11% in comparison to 2001, with a total of 34,723 procedures and a rate of coronary interventions of 850 per 106 inhabitants. Coronary stents were the devices used most frequently, with 47,249 implanted in 2002, for a total increase of 20% in comparison to 2001. Stenting accounted for 91.7% of all procedures. Direct stenting was done in 13 768 procedures (43.2%). IIb-IIIa glycoprotein inhibitors were used in 9966 procedures (28.7%). Multivessel percutaneous coronary interventions were performed in 9,830 patients (28%), and ad hoc interventions were done in the course of diagnostic coronary angiography in 26,341 patients (76%).A total of 4,766 percutaneous coronary interventions were done in patients with acute myocardial infarction, representing an increase of 23.9% in comparison to 2001, and accounting for 13.7% of all interventional procedures. Of the noncoronary interventions recorded, we note the decrease in percutaneous mitral valvuloplasties (21.2%) and atrial septal defect closures (11.1%), and the slight increase in pediatric interventions (3.7%). In conclusion, we emphasize the high rate of reporting by laboratories, which allows the Registry to compile data that are highly representative of the activity at cardiac catheterization laboratories in SpainRevista Espa de Cardiologia 12/2003; 56(11):1105-18. · 2.53 Impact Factor -
Article: Is static spatial performance distinguishable from dynamic spatial performance? A latent-variable analysis.
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ABSTRACT: There is disagreement among researchers about the distinction between dynamic and static spatial performance. Given that dynamic spatial performance is supposed to be important for some occupations, such as air traffic control (ATC), it is germane to have evidence about the likelihood of that distinction. In the present study, a battery of printed static spatial and reasoning tests were applied to 480 applicants for an ATC training course. Two dynamic spatial tests were also applied. Confirmatory factor analyses were performed for testing three models. In Model A, static and dynamic spatial tests were grouped, whereas in Model B, spatial tests were separated according to their static or dynamic character, and in Model C, spatial tests were segregated according to the construct they tapped (visualization or spatial relations). The authors found that Model B, which distinguished static and dynamic spatial tests, showed the best fit. They also discuss some implications of the findings.The Journal of General Psychology 08/2003; 130(3):277-88. · 1.04 Impact Factor -
Article: [Spanish Registry on Cardiac Catheterization Interventions. 11th official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001)].
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ABSTRACT: The results of the Spanish Registry of the Working Group on cardiac catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001) are presented. One-hundred-and-three centers contributed data, all the cardiac catheterization laboratories in Spain; 97 centers performed mainly adult catheterization and 6 carried out only pediatric procedures. In 2001, 95,430 diagnostic catheterization procedures were performed, with 79,607 coronary angiograms, representing a total increase of 8.4% over 2000. The population-adjusted incidence was 1947 coronary angiograms per 106 inhabitants. Coronary interventions increased by 15.4% compared with 2000, with a total of 31,290 procedures and an incidence of coronary interventions of 761 per 106 inhabitants. Coronary stents were the most frequently used devices with 39,356 implanted in 2001, and increase of 33.4% over 2000. Stenting accounted for 88.2% of procedures. Direct stenting was done in 11,280 procedures (40.9%). IIb-IIIa glycoprotein inhibitors were given in 7,012 procedures (22.4%). Multivessel percutaneous coronary interventions were performed in 8,445 cases (27%) and interventions were performed ad hoc during diagnostic study in 23,144 cases (74 %).A total of 3,845 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, an increase of 22.9% over 2000 and 12.3% of all interventional procedures. Among non-coronary interventions, atrial septal defect closure was performed more often (161 cases, a 60% increase over 2000). Pediatric interventions increased by 15.4% (from 817 to 943 cases).Lastly, we would like to underline the high rate of reporting by laboratories, which allowed the Registry to compile data that are highly representative of hemodynamic interventions in Spain.Revista Espa de Cardiologia 12/2002; 55(11):1173-84. · 2.53 Impact Factor -
Article: La evaluación objetiva de la minuciosidad. Diseño de una prueba conductual
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ABSTRACT: En: Análisis y modificación de conducta Valencia 2003, v. 29, n. 125; p. 456-479 El propósito de este estudio ha sido el diseño de un test objetivo para la evaluación del comportamiento minucioso. La evaluación de la personalidad mediante pruebas objetivas (datos T) debe cumplir una serie de requisitos: situación de contingencias abiertas y ausencia de interferencia de la competencia y la motivación. La conducta minuciosa se entiende como un patrón sistemático de comportamiento por el que las personas ejecutan una tarea de una forma ordenada y organizada. Para la evaluación de este patrón se ha diseñado una prueba informatizada. Los resultados muestra una amplia variabilidad en la distribución de puntuaciones, lo que apoya que la situación es de contingencias abiertas, así como ausencia de correlación entre los índices de competencia y motivación, por una parte, con las puntuaciones en minuciosidad. Adicionalmente, se presentan resultados de consistencia interna de la prueba y estabilidad temporal de las puntuaciones. Finalmente se discuten las posibilidades futuras de uso de pruebas objetivas para la evaluación de la personalidad, p. 476-479http://www.redined.mec.es/oai/indexg.php?registro=005200430026. -
Article: Registro Español de Hemodinámica y Cardiología Intervencionista: XII Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2002)
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ABSTRACT: Se presentan los resultados del Registro de actividad de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología del año 2002. Se han recogido datos de 101 centros, la práctica totalidad de los laboratorios del país, de los que 95 realizaron su actividad sobre todo en pacientes adultos y 6 exclusivamente en pacientes pediátricos. Se realizaron 97.609 estudios diagnósticos, con una cifra de 83.667 coronariografías, con un incremento de éstas del 5,1% respecto al año 2001 y una tasa de 2.053 coronariografías por millón de habitantes. Se efectuaron 34.723 procedimientos de intervencionismo coronario, con un incremento del 11% respecto al año anterior y una tasa de 850 intervenciones por millón de habitantes. El stent intracoronario fue el dispositivo más empleado, en el 91,7% de los procedimientos, con 47.249 unidades utilizadas (incremento del 20%). El stent con carácter directo, sin predilatación, fue utilizado en 13.768 procedimientos, el 43,2% de los casos. Los inhibidores de la glucoproteína IIb/IIIa fueron utilizados en 9.966 procedimientos (28,7%). En 9.830 casos (28%) se efectuó un procedimiento en multivaso, y en 26.341 casos (76%) la intervención coronaria percutánea se realizó en la misma sesión que la coronariografía diagnóstica. Se llevaron a cabo 4.766 procedimientos de intervencionismo en el infarto agudo de miocardio, lo que supone un 23,9% más respecto al año 2001 y el 13,7% del total de las intervenciones coronarias percutáneas. En el intervencionismo no coronario destaca el descenso del número de valvuloplastias mitrales (21,2%), un descenso en los cierres percutáneos de comunicación interauricular en pacientes adultos (11,1%), y un ligero incremento de los procedimientos intervencionistas en pacientes en edad pediátrica (3,7%). Finalmente, destacamos el alto grado de participación de centros en el registro, lo que hace que los datos aquí presentados sean representativos de la actividad hemodinámica en nuestro país.Revista española de cardiología, ISSN 0300-8932, Vol. 56, Nº. 11, 2003, pags. 1105-1118.
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2002–2003
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Sociedad Española de Cardiología
Madrid, Madrid, Spain
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