Iñigo Lozano

Hospital Universitario Virgen de la Arrixaca, Murcia, Murcia, Spain

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Publications (120)369.14 Total impact

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    ABSTRACT: To determine whether drug-eluting stents (des) are superior to bare metal stents (bms) in octogenarian patients with angina. Patients aged ≥80 years frequently have complex coronary disease warranting des, but have a higher bleeding risk from prolonged dual antiplatelet treatment. This multicenter, randomized trial was conducted in 20 centers in the uk and spain. Patients aged ≥80 years underwent stenting for angina. The primary endpoint was a 1-year composite of death, myocardial infarction (mi), cerebrovascular accident (cva), target vessel revascularization (tvr), or major haemorrhage. 800 patients aged 83.5±3.2 yrs were randomized to bms (n=401) or des (n=399) for treatment of stable angina (32%) or acute coronary syndrome (68%). Procedural success did not differ between groups (bms 97.7% vs des 95.4%; p=0·07). 38% of patients had ≥2 vessel pci and 66% underwent complete revascularization. Bms patients had shorter stent implantation (24.0±13.4 vs 26.6±14.3mm; p=0.01). Dapt rates at one year were bms 32.2% and des 94.0%. The primary endpoint occurred in 18.7% of bms vs 14.3% of des patients (p=0.09). There was no difference in death (7.2% vs 8.5%; p= 0.5), major haemorrhage (1.7% vs 2.3%; p=0·61) or cva (1.2% vs 1.5%; p= 0.77). Mi (8.7% vs 4.3%; p 0·01) and tvr (7.0% vs 2.0%; p 0.001) occurred more often in the bms group. Bare metal and drug eluting stents offer good clinical outcome in this age group. Drug-eluting stents were associated with a lower incidence of mi and tvr, without an increased incidence of major haemorrhage. Isrctn92243650.
    Journal of the American College of Cardiology 11/2013; · 14.09 Impact Factor
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    ABSTRACT: Introduction Direct stenting has been shown to save costs, procedural time, radiation, and contrast use. We analyze the results of direct stenting in daily practice. Material and methods We retrospectively analyzed the interventions in the first 1,000 lesions that were treated with direct stenting at our center. Primary success, dissection, need for additional dilation, embolism, stent loss, and side branch occlusion were the variables assessed. Results Direct stenting was attempted in 1,000 lesions in 784 patients (age 63 ± 11 years, females 21%, diabetes 37%). Primary or rescue angioplasty was performed in 8%. One or more thrombi were found in 16%, bifurcation in 9%, calcification in 5%, angulation in 2.3%, and tortuosity in 3.2%. The reference diameter was 3.0 ± 0.5 mm. The primary success rate was 93.1%. Failure of direct stenting (6.9%) was associated with the circumflex artery in 38%, calcification in 26%, angulation in 22%, and tortuosity in 31%. In 39 lesions, additional dilation with different balloons was required. Additional stenting was required for dissection in 40 lesions and secondary to incomplete coverage of the lesion in 27. Thrombus embolism occurred in 7 lesions, 6 of them with a previously visible thrombus and one in a vein graft. Stent embolisms occurred in 6 cases, 4 of which were retrieved. Four side branches became occluded, but 2 of them were recovered at the end of the procedure. Conclusions Direct stenting is a safe technique with low percentage of dissection, need for postdilation, thrombus embolism, and side branch occlusion. These results, in addition to those obtained in earlier findings of savings in procedural costs, intervention time, radiation exposure, and contrast use, confirm the advantages of this technique in selected lesions.
    Revista Espa de Cardiologia 08/2013; 55(7):705–712. · 3.20 Impact Factor
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    Iñigo Lozano, Pablo Avanzas, Cesar Moris
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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.
    JACC. Cardiovascular Interventions 07/2012; 5(7):728-37. · 1.07 Impact Factor
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    ABSTRACT: Introduction and objectivesMultivessel disease is usually present in almost half of patients with acute coronary syndromes. Angiography is insufficiently accurate to decide on coronary revascularization in moderate nonculprit lesions. There is some debate about the usefulness of fractional flow reserve assessed by intracoronary pressure wire in acute coronary syndromes. We studied the results of using fractional flow reserve values to decide whether to perform coronary revascularization of nonculprit angiographically moderate lesions in patients with acute coronary syndrome and multivessel disease.Methods The fractional flow reserve was used to decide whether to revascularize angiographically moderate nonculprit lesions in a cohort of consecutive patients with acute coronary syndromes recruited in 2 centers.ResultsOne hundred and seven patients were included. Based on fractional flow reserve values, 81 patients (75.7%) were not revascularized. All lesions studied were revascularized in 26 patients (24.3%). Patient characteristics of the nontreated group and treated group were, respectively, diseased vessels, 1.3 (0.7) vs 1.4 (0.6) (P<.4); fractional flow reserve-studied lesions, 1.2 (0.5) vs 1.1 (0.4) (P=.3); stenosis, 46.1 (8.3)% vs 47.9 (10.3)% (P=.4); fractional flow reserve, 0.86 (0.1) vs 0.70 (0.1) (P<.005). After 1 year of follow-up, no significant differences in major cardiovascular events were observed between groups. There no deaths or nonfatal myocardial infarctions attributable to fractional flow reserve -deferred lesions. Coronary revascularization of the studied lesions was performed in 3 nontreated group patients (3.7%) due to disease progression.Conclusions Fractional flow reserve assessed by intracoronary pressure wire is useful in deciding whether to revascularize angiographically moderate nonculprit lesions in patients with acute coronary syndrome and multivessel disease.Full English text available from:www.revespcardiol.org
    Revista Española de Cardiología. 02/2012; 65(2):164–170.
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    ABSTRACT: Multivessel disease is usually present in almost half of patients with acute coronary syndromes. Angiography is insufficiently accurate to decide on coronary revascularization in moderate nonculprit lesions. There is some debate about the usefulness of fractional flow reserve assessed by intracoronary pressure wire in acute coronary syndromes. We studied the results of using fractional flow reserve values to decide whether to perform coronary revascularization of nonculprit angiographically moderate lesions in patients with acute coronary syndrome and multivessel disease. The fractional flow reserve was used to decide whether to revascularize angiographically moderate nonculprit lesions in a cohort of consecutive patients with acute coronary syndromes recruited in 2 centers. One hundred and seven patients were included. Based on fractional flow reserve values, 81 patients (75.7%) were not revascularized. All lesions studied were revascularized in 26 patients (24.3%). Patient characteristics of the nontreated group and treated group were, respectively, diseased vessels, 1.3 (0.7) vs 1.4 (0.6) (P<.4); fractional flow reserve-studied lesions, 1.2 (0.5) vs 1.1 (0.4) (P=.3); stenosis, 46.1 (8.3)% vs 47.9 (10.3)% (P=.4); fractional flow reserve, 0.86 (0.1) vs 0.70 (0.1) (P<.005). After 1 year of follow-up, no significant differences in major cardiovascular events were observed between groups. There no deaths or nonfatal myocardial infarctions attributable to fractional flow reserve -deferred lesions. Coronary revascularization of the studied lesions was performed in 3 nontreated group patients (3.7%) due to disease progression. Fractional flow reserve assessed by intracoronary pressure wire is useful in deciding whether to revascularize angiographically moderate nonculprit lesions in patients with acute coronary syndrome and multivessel disease.
    Revista Espa de Cardiologia 12/2011; 65(2):164-70. · 3.20 Impact Factor
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    ABSTRACT: The clinical impact of patient-prosthesis mismatch on the outcome in octogenarians who undergo surgery for aortic valve replacement due to severe stenosis is unknown. Our objective was to quantify the frequency of some degree of patient-prosthesis mismatch and its impact on mortality and life quality. We analyzed all the octogenarian patients who underwent surgery for aortic valve replacement due to severe stenosis in our center from February 2004 to April 2009. Patient-prosthesis mismatch was considered to exist when the indexed effective orifice area was ≤ 0.85 cm²/m². The influence of patient-prosthesis mismatch on in-hospital mortality, medium-term survival, and New York Heart Association functional class was studied using an analysis adjusted for propensity score. Of 149 patients studied, 61.7% had some degree of patient-prosthesis mismatch (mean follow-up was 32.71 ± 14.42 months). After adjusting for propensity score, there were no differences in in-hospital mortality (odds ratio=0.75; 95% confidence interval, 0.15-3.58; P=.72), medium-term survival (hazard ratio=1; 95% confidence interval, 0.36-2.78; P=.99) or functional class during follow-up (odds ratio=1.46; 95% confidence interval, 0.073-29.24; P=.8). Although moderate patient-prosthesis mismatch is a very common finding in octogenarian patients who undergo aortic valve replacement, its influence on mortality and quality of life does not seem to be relevant. The biological profile of elderly patients with lower metabolic requirements and limited physical activity could justify the results obtained.
    Revista Espa de Cardiologia 09/2011; 64(9):774-9. · 3.20 Impact Factor
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    ABSTRACT: Traditionally, the oral glucose tolerance test has been useful to diagnose unknown diabetes. Recently, the American Diabetes Association committee has accepted glycated hemoglobin ≥ 6.5% as a criterion for unknown diabetes. The aim was to determine the benefit of glycated hemoglobin for diagnosing unknown diabetes and also create a predictive model that adjusts the indication for oral glucose tolerance test in coronary patients. We examined the glycemic profile of 338 coronary patients without previous diagnosis of diabetes, applying 2010 American Diabetes Association criteria. A unknown diabetes risk predictive model was developed using logistic regression analysis, and then validated in another cohort. Using the glycated hemoglobin criteria and/or fasting plasma glucose, unknown diabetes was diagnosed in 26 patients. The remaining patients were classified according to oral glucose tolerance test as follows: unknown diabetes 53 (17%), prediabetes 144 (46.2%), and normoglycemic 115 (36.8%). The diagnostic method for unknown diabetes was fasting plasma glucose in 25.3%, glycated hemoglobin in 7.6%, and oral glucose tolerance test in 67.1%. A risk model including fasting plasma glucose, glycated hemoglobin, left ventricular ejection fraction, age, and noncoronary vascular disease was shown to effectively predict unknown diabetes after oral glucose tolerance test: area under the ROC curve 0.8 (95% confidence interval: 0.74-0.87). When the oral glucose tolerance test is restricted to patients with a risk score >6 (31% of our sample) we properly identify 83% of unknown diabetes cases (sensitivity: 75%, specificity: 73%, positive predictive value: 40%, negative predictive value: 93%). The model was adequately validated in another cohort of 115 patients (area under the ROC curve 0.84 [95% confidence interval: 0.74-0.95]). In coronary patients, glycated hemoglobin alone failed to detect many cases of unknown diabetes. However, its inclusion in a risk prediction model leads to optimizing the usefulness of oral glucose tolerance test.
    Revista Espa de Cardiologia 09/2011; 64(9):759-65. · 3.20 Impact Factor
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    ABSTRACT: This study is a prospective validation of 6 mm(2) as a minimum lumen area (MLA) cutoff value for revascularization of left main coronary artery (LMCA) lesions. Lesions involving the LMCA are prognostically relevant. Angiography has important limitations in the evaluation of LMCA lesions with intermediate severity. An MLA of 6 mm(2) assessed by intravascular ultrasound has been proposed as a cutoff value to determine lesion severity, but there are no large studies evaluating the prospective application and safety of this approach. We have designed a multicenter, prospective study. Consecutive patients with intermediate lesions in unprotected LMCA were evaluated with intravascular ultrasound. An MLA <6 mm(2) was used as criterion for revascularization. A total of 354 patients were included in 22 centers. LMCA revascularization was performed in 90.5% (152 of 168) of patients with an MLA <6 mm(2) and was deferred in 96% (179 of 186) of patients with an MLA of 6 mm(2) or more. A large scatter was observed between both groups regarding angiographic parameters. In a 2-year follow-up period, cardiac death-free survival was 97.7% in the deferred group versus 94.5% in the revascularized group (p = 0.5), and event-free survival was 87.3% versus 80.6%, respectively (p = 0.3). In the 2-year period, only 8 (4.4%) patients in the deferred group required subsequent LMCA revascularization, none with an infarction. Angiographic measurements are not reliable in the assessment of intermediate LMCA lesions. An MLA of 6 mm(2) or more is a safe value for deferring revascularization of the LMCA, given the application of the clinical and angiographic inclusion criteria used in this study.
    Journal of the American College of Cardiology 07/2011; 58(4):351-8. · 14.09 Impact Factor
  • Revista Espa de Cardiologia 06/2011; 64(11):1073-4. · 3.20 Impact Factor
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    ABSTRACT: Atrioventricular (AV) block is one of the most frequent complications of CoreValve transcatheter aortic valve implantation (TAVI). The aim of this study was to analyze the effects of CoreValve implantation on AV conduction. Electrophysiological study was performed immediately before and after CoreValve implantation in 18 consecutive, permanent pacemaker-free patients. An electrode was placed on the His bundle during valve implantation, and data were continuously recorded during the procedure. With surface ECG, a median (first, third quartile) QRS width of 96 (84, 116) to 150 (121, 164) ms (P=0.001) and PR interval of 180 (159, 216) to 210 (190, 240) ms (P=0.008) were significantly prolonged, and QRS axis was left deviated 30° (-32°, 46°) to -20° (-60°, 2°) (P=0.005). With intracardiac electrograms, the AH (97 [70, 123] to 115 [96, 135] ms, P=0.021) and HV (52 [42, 55] to 60 [50, 70] ms, P=0.002) intervals were increased. At the end of the procedure, we observed significant ECG- or electrophysiological study-persistent conduction disturbances in 14 (78%) patients. Five patients experienced transient changes (2 AV blocks and 3 left bundle branch blocks). CoreValve implantation worsens AV conduction in most patients, either transiently or permanently. This worsening is the result of direct damage either on the His bundle or on the AV node.
    Circulation Cardiovascular Interventions 06/2011; 4(3):280-6. · 6.54 Impact Factor
  • European Heart Journal – Cardiovascular Imaging 03/2011; 12(5):371. · 2.39 Impact Factor
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    Revista Espa de Cardiologia 02/2011; 64(3):247-8. · 3.20 Impact Factor
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    Iñigo Lozano, Juan Rondan, Pablo Avanzas
    EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 02/2011; 6(7):904-5. · 3.17 Impact Factor
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    ABSTRACT: To validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals. We included patients with severe symptomatic aortic stenosis at very high or prohibitive surgical risk, selected by a multidisciplinary team, for transcatheter aortic valve implantation, and had contraindication to the femoral approach. We included 19 of 186 (10.5%) patients, who were implanted a percutaneous aortic valve, between November 2008 and March 2010. The mean age was 78.3 (standard deviation [SD]±8.65) years and 73.7% were males. The mean logistic EuroSCORE was 28.7% (SD±16.3%). The procedural success rate was 100%. After the procedure the maximum transvalve gradient decreased from 81.7 mmHg (SD±21.5) to 15.8 mmHg (SD±5.5), and no patient presented residual aortic regurgitation >2. The all-cause mortality, with a mean follow-up time of 9.2 (SD±3.2) months was 10.5%, and the in-hospital and 30-day mortality rates were 0%. The global incidence of major complications due to the procedure was 15.7%. Definitive pacemaker implantation was carried out for atrioventricular block in 8 patients (44.4%). The axillary approach for transcatheter aortic valve implantation using the CoreValve(®) and contraindication to the femoral approach is safe and efficient for selected patients, with excellent results in terms of success implantation and in hospital and 30-day mortality.
    Revista Espa de Cardiologia 02/2011; 64(2):121-6. · 3.20 Impact Factor
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    Revista española de cardiologia. 01/2011;
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    ABSTRACT: Although drug-eluting stents have reduced the restenosis rate, some patients are not good candidates for prolonged double-antiplatelet therapy. Our goal was to learn the results of implanting cobalt-chromium stents in long lesions of large vessels.All consecutive patients with ≥1 lesion treated with a cobalt-chromium stent ≥28 mm in length and ≥3.5 mm in diameter during a 12-month period in 2 centers were monitored clinically and angiographically to determine the clinical status, restenosis rate, pattern of restenosis, and need for revascularization.The series comprised 78 patients with 81 lesions, mean age, 62.6 ± 15.2 yr; diabetes mellitus,19.2%; and primary or rescue intervention, 20.6%. Target vessels were the left anterior descending coronary artery, 12 (14.8%); left circumflex coronary artery, 12 (14.8%); and right coronary artery, 57 (70.4%). The mean lesion length was 35.18 ± 12.65 mm. The proximal reference diameter after percutaneous coronary intervention was 3.64 ± 0.54 mm; the distal, 3.2 ± 0.43 mm; and the mean, 3.42 ± 0.44 mm. The mean stent length was 38.05 ± 12.78 mm (range, 28-90 mm). The binary restenosis rate was 23% (15/64), with pattern IB in 2 cases, IC in 5, II in 7, and IV in 1. Revascularization was needed in 6 patients.In treating long lesions of large vessels, we found that cobalt-chromium stents achieved a moderate rate of target-vessel restenosis and a low rate of repeat revascularization. The pattern of restenosis was focal in almost half of the cases, and, in most remaining cases, restenosis affected short segments of the vessel.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2011; 38(1):35-41. · 0.67 Impact Factor
  • Cardiovascular Revascularization Medicine. 01/2011; 12(3).
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    ABSTRACT: Introduction and objectivesTo validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals.
    Revista Espanola De Cardiologia - REV ESPAN CARDIOL. 01/2011; 64(2):121-126.
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    ABSTRACT: Tangier disease is a rare inherited autosomal recessive genetic dyslipaemia, caused by mutations of the gene that codes ABCA1. In the absence of this cholesterol transporter, there is a pathological accumulation of lipids which creates an authentic cholesterol thesaurismosis. At cardiovascular level, the association of this syndrome with early atherosclerosis is well known. Furthermore, cholesterol deposits can alter valve structure and function, with varying clinical severity and repercussions. We present a case of Tangier Disease with extensive cardiovascular involvement in the form of an ischaemic heart and valve disease.
    Cardiocore 01/2011; 46(3).

Publication Stats

468 Citations
369.14 Total Impact Points

Institutions

  • 2002–2013
    • Hospital Universitario Virgen de la Arrixaca
      • Departamento de Cardiología
      Murcia, Murcia, Spain
  • 2006–2012
    • Hospital Universitario Central de Asturias
      • Departamento de Cardiología
      Oviedo, Asturias, Spain
  • 2004–2012
    • Hospital Central de Asturias
      Oviedo, Asturias, Spain
  • 2005
    • Hospital Universitari de Bellvitge
      • Department of Cardiology
      l'Hospitalet de Llobregat, Catalonia, Spain