Alfredo E Rodríguez

Alfredo E Rodríguez
Centro de Estudios en Cardiología Intervencionista | CECI · Clinical Research

MD PhD

About

263
Publications
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Publications

Publications (263)
Article
Background: Hypertensive disorders of pregnancy (HDP) complicate 10% of pregnancies. They are the main cause of maternal mortality and require a multidisciplinary team to address them. Objectives: The aim of this study was to quantify the prevalence and define the characteristics and outcome of HDP in a center with a program focused on its manageme...
Article
Background: Hypertensive disorders of pregnancy (HDP) complicate 10% of pregnancies. They are the main cause of maternal mortality and require a multidisciplinary team to address them. Objectives: The aim of this study was to quantify the prevalence and define the characteristics and outcome of HDP in a center with a program focused on its manageme...
Article
Full-text available
Objective The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of...
Article
Background New‐generation drug‐eluting stents (DES) reduce target‐vessel revascularization compared with bare‐metal stents (BMS), and recent data suggest that DES have the potential to decrease the risk of myocardial infarction and cardiovascular mortality. We evaluated the treatment effect of DES versus BMS according to the target artery (left ant...
Article
Full-text available
Background: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavi...
Article
Background: The optimal duration of antiplatelet therapy (APT) in patients at high bleeding risk with or without oral anticoagulation (OAC) after coronary stenting remains unclear. Methods: In the investigator-initiated, randomized, open-label MASTER DAPT trial, 4579 patients at high bleeding risk were randomized after 1-month dual APT (DAPT) to ab...
Article
Background: The appropriate duration of dual antiplatelet therapy in patients at high risk for bleeding after the implantation of a drug-eluting coronary stent remains unclear. Methods: One month after they had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent, we randomly assigned patients at high bleeding risk...
Article
To the Editor In the last 3 decades, several randomized clinical trials (RCTs) have compared percutaneous coronary interventions (PCIs) with coronary artery bypass grafting (CABG) for the revascularization of patients with coronary artery disease (CAD). In the meta-analysis by Gaudino and colleagues,¹ the authors pooled 23 RCTs and concluded that P...
Article
The use of colchicine is associated with a significant reduction of cardiac adverse events in patients with coronary artery disease. Past small randomized trials with oral immunosuppressive or anti-inflammatory therapies have demonstrated a reduction of adverse clinical events after bare metal stent implantation. The potential role of adjunctive co...
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Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in pre-drug-eluting stents (DESs) era, randomized trials and meta-analysis showed that the extension of coronary artery disease was not associated with a better survival with CABG, and only diabetic patients had an inferior survival with PCI. After the introduction of...
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Aim: The present study aimed to assess the benefits of two-stent techniques for patients with DEFINITION criteria-defined complex coronary bifurcation lesions. Methods and results: In total, 653 patients with complex bifurcation lesions at 49 international centres were randomly assigned to undergo the systematic two-stent technique (two-stent gr...
Article
Background: New-generation drug-eluting stents (DES) have mostly been investigated in head-to-head non-inferiority trials against early-generation DES and have typically shown similar efficacy and superior safety. How the safety profile of new-generation DES compares with that of bare-metal stents (BMS) is less clear. Methods: We did an individu...
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Full-text available
Background: The optimal duration of antiplatelet therapy in high-bleeding risk (HBR) patients with coronary artery disease treated with newer-generation drug-eluting bioresorbable polymer-coated stents remains unclear. Design: MASTER DAPT (clinicaltrial.govNCT03023020) is an investigator-initiated, open-label, multicenter, randomized controlled...
Article
Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required t...
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Full-text available
Introduction Provisional stenting (PS) for simple coronary bifurcation lesions is the mainstay of treatment. A systematic two-stent approach is widely used for complex bifurcation lesions (CBLs). However, a randomised comparison of PS and two-stent techniques for CBLs has never been studied. Accordingly, the present study is designed to elucidate t...
Article
In recent years angiographic risk scores have been introduced in clinical practice to stratify different levels of risk after percutaneous coronary interventions (PCI). The SYNTAX score included all intermediate lesions in vessels ≥1.5 mm, consequently, multiple stent implantation was required. Four years ago, we built a new angiographic score in o...
Article
Background: Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies. Methods: We did a systematic review up to July 19,...
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Background: According to ACC/ AHA guidelines, a minimum of 1 year of dual anti- platelet therapy (DAPT) consisting of aspirin and a platelet ADP-receptor antagonist (P2Y12 inhibitor) is recommended for patients presenting acute coronary syndromes (ACS), regardless of which type of revascularization is performed during the acute event. Methods: T...
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Purpose of review: In spite of the benefits of drug eluting (DES), these advantages were not translated to better outcome when percutaneous coronary interventions (PCI) were compared with coronary artery bypass surgery. PCI strategy allowing stent deployment in all intermediate lesions including small vessels together with DES design may be the re...
Article
BACKGROUND: Although percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES- 1) did not show a benefit in terms of death rate and myocardial infarction (MI) compared to bypass surgery (coronary artery bypass graft [CABG]), DES platforms have seen a remarkable improvement in the last few years, and a significant incr...
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En este número 4 de su séptimo año, el Editorial que me toca escribir será muy corto. La razón es muy senci-lla. La calidad de los trabajos que se presentan y el interés que seguramente despertarán en todos los colegas de nuestra especialidad, pero a no dudarlo de todo el espectro de la Cardiologia, me limita a hacer solo una breve reseña y comenta...
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Randomized clinical trials (RCTs) with first- and second-generation drug-eluting stents (DESs) confirmed the superiority of coronary artery bypass surgery (CABG) in patients with multiple vessel disease. In spite of different DES designs, investigators in these trials used similar percutaneous coronary intervention (PCI) strategies hoping to achiev...
Article
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Background: Although PCI with 1° generation drug eluting stents (DES-1) did not showed a benefit in terms of death and myocardial infarction (MI) in comparison with by-pass surgery (CABG) in the last years a large improvement in the DES platforms were seen, including a significant increase in safety and efficacy observed in RCT and observational s...
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Background: In-stent restenosis and poor re-endothelization usually follow percutaneous transluminal coronary angioplasty, even using drug-eluting stents, due to inflammation and oxidative stress. Medical ozone has antioxidant and anti-inflammatory properties and has not been evaluated in this context. Objectives: To evaluate whether ozonotherap...
Article
La comunicación interventricular (CIV) es la cardiopatía congénita más frecuente aislada o asociada a otras cardiopatías congénitas. El defecto acarrea consecuencia sobre las cavidades derechas y, desde su histórico diagnóstico por Roger, fue siempre de resorte quirúrgico, hasta que Lock et al. realizaran los primeros cierres por vía percutánea en...
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Coronary atherosclerotic disease is highly prevalent in chronic kidney disease (CKD). Although revascularization improves outcomes, procedural risks are increased in CKD, and unbiased data comparing coronary artery bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD,...
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Objective: To compare second generation drug eluting stents (2DES) with first generation (1DES) for the treatment of patients (pts) with multiple coronary vessel disease (MVD). Background: Although 2DES improved safety and efficacy compared to 1DES, MVD remains a challenge for percutaneous coronary interventions. Methods: ERACI IV was a prospe...
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Full-text available
RESUMEN La comunicación interventricular (CIV) es la cardiopatía congénita más frecuente ais-lada o asociada a otras cardiopatías congénitas. El defecto acarrea consecuencia so-bre las cavidades derechas y, desde su histórico diagnóstico por Roger, fue siempre de resorte quirúrgico, hasta que Lock et al. realizaran los primeros cierres por vía per-...
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Full-text available
Desde su inicio, el reemplazo de válvula aórtica por vía percutánea (TAVR) se fue transformando rápi-damente en el tratamiento de elección de pacientes con estenosis aórtica severa (área <0,9 cm) en quie-nes la cirugía convencional de reemplazo valvular (SAVR) presentaba alto riesgo o directamente estaba contraindicada 1-3. Estudios aleatorizados y...
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A 79-year-old female was admitted with sudden onset dyspnea, mild oppressive chest pain, and severe anxiety disorder. Patient had history of hypertension, dyslipidemia, smoking, and chronic obstructive pulmonary disease. On admission blood pressure was 160/90 and heart rate was 130 bpm. Transthoracic echocardiography (TE) and contrast tomography sh...
Data
TEE before and after ventricular septal rupture (a and b) and after it was repaired with the Amplatzer device(c)
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Transcatheter Aortic Valve Replacement (TAVR) is performed in patients who are poor surgical candidates. Many patients have inadequate femoral access, and alternative access sites have been used such as the transapical approach discussed in this paper. We present an elderly and fragile patient not suitable for surgery for unacceptable high risk, in...
Article
Full-text available
In recent years an angiographic score was introduced in clinical practice to stratified different levels of risk after percutaneous coronary interventions (PCI) with drug eluting stents. The SYNTAX score (SS) classified patients in three different risk levels and was included in revascularization guidelines that patients allocated with low SS could...
Article
Full-text available
Dual antiplatelet therapy after drug-eluting stent implantation: long-term, short-term, tailored or related to stent type? Doble antiagregación plaquetaria luego del implante de stent farmacológico: ¿por largo o corto tiempo, a medida o relacionada con el diseño del stent? ABSTRACT Duration of dual antiplatelet therapy after drug eluting stent impl...
Article
Full-text available
RESUMEN El presente artículo es una guía para la utilización de la tomografía de coherencia óp-tica (OCT), incluyendo sus ventajas sobre otros métodos de imágenes endovascula-res y las recomendaciones de seguridad para los pacientes con falla renal. ABSTRACT The present article is a guide for the utilization of optical coherence tomography (OCT), i...
Article
Recent data from randomized clinical trials (RCT) between PCI with 1 st generation drug--eluting stent (DES) versus coronary artery by--pass graft (CABG) showed a lack of benefit in the incidence of death and myocardial infarction (MI) with PCI.However in the last years a large improvement in the DES platforms was seen and was translated to a signi...
Chapter
Neo intimal hyperplasia after implantation of a bare metal stent (BMS) has become the main pathophysiology mechanism of coronary restenosis and stent failure during percutaneous coronary interventions (PCI). The use of drug eluting stents (DES) with local immunosuppressive drugs minimized the high frequency of in stent restenosis (ISR) observed aft...
Chapter
Computed tomography coronary angiography (CTCA) has emerged as an accurate means to evaluate coronary atherosclerosis, not only the lumen but the vessel wall as well. In fact, CTCA is more closely related to intravascular ultrasound than to invasive angiography. Conventional CTCA remains limited by a number of technical, patient-related, or lesion...
Chapter
In the past, randomized clinical trials (RCT) either with the use of plain old balloon angioplasty or bare metal stents (BMS) did not show a survival advantage with coronary artery graft surgery (CABG) in spite of a greater number of repeat revascularization procedures (TVR) with angioplasty. Moreover, meta-analysis from RCT in the BMS era showed s...
Chapter
Left main disease (LMD) is a stenosis of ≥50 %, and occurs in 3–5 % of patients, associated with multi-vessel coronary artery disease (CAD) in more than 75 %. With bare metal stents (BMS), left main stenting became more popular and the technique was used mainly in high risk patients such as acute myocardial infarction (AMI) or with contraindication...
Chapter
The triage of low-to-intermediate risk patients presenting at the emergency department (ED) with acute chest pain based on symptoms, initial 12-lead ECG, and a single set of biomarkers of myocardial necrosis usually fails to provide a fast and safe discharge without further diagnostic testing. Among low risk patients with normal or non-diagnostic E...
Chapter
In reviewing the chapters, we realize that no chapter can be completely up to date given the time delay to publication. As cardiology continues to evolve and new therapies/procedures/techniques are developed, new studies often in the form of randomized trials may provide insight into some of the unresolved issues contained in the book. Furthermore,...
Book
This book considers several clinical and interventional topics for which there is either uncertainty, continued debate and/or no consensus based on current guidelines. Leading international experts explore each controversy, probing the existing evidence and current opinions. Each chapter outlines the unresolved issues and includes a balanced and sc...
Article
Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events,...
Article
Objective: The role of oral immunosuppressive therapy (OIT) to prevent restenosis after percutaneous coronary intervention (PCI) and stenting is still controversial. This study evaluates the impact of oral administration of prednisone or sirolimus to prevent restenosis. Methods: We conducted a meta-analysis of trials in which PCI-patients were rand...
Article
Background The prospective, randomized FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial found coronary artery bypass graft surgery (CABG) was associated with better clinical outcomes than percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease, manag...