David García Dorado

University Hospital Vall d'Hebron, Barcino, Catalonia, Spain

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Publications (4)14.73 Total impact

  • [Show abstract] [Hide abstract]
    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 12/2011; 154(3):370-2. · 6.18 Impact Factor
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    ABSTRACT: Among patients with acute cardiac syndromes without coronary stenosis, the clinical, electrocardiographic, echocardiographic, and angiographic features of those with a first acute myocardial infarction (AMI) were compared with those with apical-ballooning syndrome (ABS). Data of consecutive patients admitted with a first AMI (n=30) or ABS (n=45) were reviewed. Patients with ABS were older (72 vs. 56 years; P=0.001) and presented a higher frequency of female sex (91 vs. 43%; P=0.001), triggering emotional or physical stress (47 vs. 17%; P=0.003) and a lower rate of tobacco smoking (27 vs. 50%; P=0.051) than those with the first AMI. They also presented a greater number of leads (5.5 vs. 3.6; P=0.01) and more anterior or anterior+inferior involvement (96 vs. 40%; P<0.001), more depressed ejection fraction (45 vs. 57%; P=0.001), more proportion of akinesia or diskinesia (89 vs. 27%; P=0.001) that extended beyond the boundaries of a single-vessel territory, and a greater rate of left ventricular outflow obstruction (29 vs. 0%; P=0.001) and heart failure (38 vs. 10%; P=0.015). Frequency of nonsignificant coronary stenosis or smooth vessels, however, was similar in both groups. Patients with ABS were older and more frequently were women than those with first AMI without significant coronary stenosis and had larger hypocontractile areas. The preponderance of tobacco smoking, pain without triggers, and hypocontractility limited to one-vessel territory in the latter, however, may suggest a transient thrombotic/vasospastic event as their underlying mechanism as opposed to patients with ABS.
    Coronary artery disease 06/2011; 22(6):435-41. · 1.56 Impact Factor
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    ABSTRACT: Patients with variant angina pectoris showed greater serotonin plasma levels than did control subjects and patients with healed myocardial infarction. The levels also tended to be greater in those with >1 episode/month than in those with fewer episodes. Moreover, patients with variant angina pectoris also had greater levels of nitrite and nitrate plasma levels than did control subjects or patients with healed myocardial infarction, partly, perhaps, as a compensatory mechanism.
    The American Journal of Cardiology 07/2005; 96(2):204-7. · 3.43 Impact Factor