Hospital Clinico San Carlos

Villanueva de San Carlos, Spain

Hospital Clinico San Carlos

Villanueva de San Carlos, Spain

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Functional intracoronary measurements with pressure guidewires assess how much a stenosis limits blood flow. They are currently used mainly in patients with coronary stenosis of intermediate severity. However, there is limited evidence on the safety of deferring revascularisation based on functional measurements in this subset of patients. Two recent large randomised clinical trials, DEFINE FLAIR and iFR SWEDEHEART, showed good outcomes in patients with intermediate stenosis undergoing physiology-guided revascularisation but did not report on patients where procedures were deferred. The new analysis pooled patient-level data for the 4,529 patients enrolled in these two studies and looked at the impact of deferring procedures. Results showed that significantly fewer patients underwent interventions when iFR was used for decision making compared to FFR (50% vs. 45%, p=0.01). The rate of major adverse cardiovascular events (MACE) was low in the 2,130 patients where myocardial revascularisation was deferred (4.12% with iFR and 4.05% with FFR at one year). "The findings support the safety of deferring revascularisation based on iFR or FFR," said lead author Javier Escaned, Consultant Interventional Cardiologist at Hospital Clinico San Carlos, Madrid, Spain. The event rate was higher in deferred patients who had acute coronary syndromes (ACS) than in those with stable coronary disease (SCD) (5.9% vs. 3.6%, p=0.04). Outcomes between ACS and SCD were significantly different when FFR was used for assessment (6.4% in ACS vs. 3.4% in SCD, p=0.049) but the difference was less marked when iFR was used (5.4% in ACS vs. 3.8% in SCD, p=0.37). "Deferral of myocardial revascularisation was associated with a higher rate of MACE in patients with acute coronary syndromes than in those with stable coronary disease," said Escaned. He added, "The findings support the importance of further research into the physiological evaluation of patients with ACS." Commenting on the study, Colin Berry, Professor of Cardiology and Imaging, University of Glasgow and Golden Jubilee National Hospital, UK, said, "Congratulations to the investigators! In ACS patients, invasive management reduces the risk of recurrent spontaneous MI and cardiac death, but these data are not reported in this meta-analysis, nor is the use of evidence-based medicines. This information would be helpful to better understand the results for translation to practice." EuroPCR 2017 session: Tuesday 16 May 11:30-12:50, Hot Line/Late-breaking trials, Coronary interventions, interventions for valvular disease, left main and multivessel disease, NSTEMI, STEMI, Stents and scaffolds, TAVI; Main Arena For any press-related inquiries, please contact: Press registration for EuroPCR is open to accredited journalists, free of charge. Journalists must hold a valid press card and/or provide a letter of assignment from a recognised publication. To register as press go to https:/ EuroPCR press releases can be found at https:/ Abstracts are available online at https:/ EuroPCR, the official annual meeting of the European Association for Percutaneous Cardiovascular Interventions (EAPCI), a registered branch of the European Society of Cardiology, is the world-leading course in interventional cardiovascular medicine. PCR has established a distinctive format for educational activities in the field of cardiovascular interventions. Beyond its flagship course in Paris that gathers more than 11,500 participants every year, PCR organises annual courses in Singapore, London UK, Dubai EAU, Johannesburg RSA, Milan Italy, Chengdu China and Tokyo Japan. For further information on EuroPCR, PCR London Valves, PCR Peripheral, PCR-CIT China Chengdu Valves, GulfPCR-GIM, AsiaPCR, AfricaPCR, PCR Tokyo Valves, and all PCR activities, please contact: Célia Vilà: For more information, please visit: https:/ and follow us on Twitter https:/ using the hashtag #EuroPCR

Miravitlles M.,Hospital Universitari Vall dHebron | Soler-Cataluna J.J.,Hospital Of Requena | Calle M.,Hospital Clinico San Carlos | Soriano J.B.,Program of Epidemiology and Clinical Research
European Respiratory Journal | Year: 2013

The new Global Initiative for Chronic Obstructive Lung Disease update has moved the principles of treatment of stable chronic obstructive pulmonary disease (COPD) forward by including the concepts of symptoms and risks into the decision of therapy. However, no mention of the concept of clinical phenotypes is included. It is recognised that COPD is a very heterogeneous disease and not all patients respond to all drugs available for treatment. The identification of responders to therapies is crucial in chronic diseases to provide the most appropriate treatment and avoid unnecessary medications. The classically defined phenotypes of chronic bronchitis and emphysema, together with the newly described phenotypes of overlap COPD-asthma and frequent exacerbator, allow a simple classification of patients that share clinical characteristics and outcomes and, more importantly, similar responses to existing treatments. These clinical phenotypes can help clinicians identify patients that respond to specific pharmacological interventions. For example, frequent exacerbators are the only subjects with an indication for anti-inflammatory treatment in COPD. Among them, those with chronic bronchitis are the only candidates to receive phosphodiesterase-4 inhibitors. Patients with overlap COPDasthma phenotype show an enhanced response to inhaled corticosteroids and infrequent exacerbators should only receive bronchodilators. These well-defined clinical phenotypes could potentially be incorporated into treatment guidelines. Copyright©ERS 2013.

Ibanez B.,Hospital Clinico San Carlos | Heusch G.,University of Duisburg - Essen | Ovize M.,Service dExplorations Fonctionnelles Cardiovasculaires | Van De Werf F.,Catholic University of Leuven
Journal of the American College of Cardiology | Year: 2015

The damage inflicted on the myocardium during acute myocardial infarction is the result of 2 processes: ischemia and subsequent reperfusion (ischemia/reperfusion injury). During the last 3 decades, therapies to reduce ischemic injury (mainly reperfusion strategies) have been widely incorporated into clinical practice. The remarkable reduction in death rates achieved with these therapies has resulted in a shift in emphasis from efforts to reduce mortality to a focus on tackling the downstream consequence of survival: post-infarction heart failure. Infarct size is the main determinant of long-term mortality and chronic heart failure, and thus, the possibility of limiting the extent of necrosis during an ST-segment elevation myocardial infarction is of great individual and socioeconomic value. After the great success of therapies to reduce ischemic injury, the time has come to focus efforts on therapies to reduce reperfusion injury, but in the recent few years, few interventions have successfully passed the proof-of-concept stage. In this review, we examine the past, present, and future therapies to reduce ischemia/reperfusion injury. © 2015 American College of Cardiology Foundation.

Benitez-del-Castillo J.M.,Hospital Clinico San Carlos
Clinical Ophthalmology | Year: 2012

Disorders of the lacrimal functional unit are common in ophthalmological practice, with meibomian gland dysfunction, blepharitis, and dry eye forming a significant part of the general ophthalmologist's practice. The eyelid and its associated structures form a complex organ designed to protect the fragile corneal surface and improve visual acuity. This organ is subject to a number of disorders, including meibomian gland dysfunction, dry eye syndrome, anterior blepharitis, allergic and dermatological conditions, and disorders associated with contact lens use. Although commonly described separately, disorders of the lacrimal function unit are better considered as a group of interacting pathologies that have inflammatory mediators as a central feature. Eyelid hygiene, in the sense of routine cleansing and massage of the eyelids, is well accepted in the management of many disorders of the eyelid. However, a broader concept of eyelid health may be appropriate, in which eyelid cleansing is but a part of a more complete program of care that includes screening and risk assessment, patient education, and coaching. The ophthalmologist has an important role to play in helping patients persist with routine eyelid care that may be long-term or lifelong. A number of preparations exist to make routine eyelid care both more effective and more pleasant, and might also improve compliance. Several such preparations have been devised, and are being assessed in clinical studies, and appear to be effective and preferred by patients over traditional soap and water or baby shampoo. © 2012 Simpson et al.

RATIONALE:: Refractory angina (RA) constitutes a clinical problem.OBJECTIVE:: The aim of this study was to assess the safety and the feasibility of transendocardial injection of CD133+cells to foster angiogenesis in patients with RA.METHODS AND RESULTS:: in this randomized, double-blinded, multicenter controlled trial, eligible patients were treated with granulocyte-colony-stimulating factor, underwent an apheresis and NOGA mapping and were randomized to receive treatment with CD133+cells or no treatment. The primary endpoint was the safety of transendocardial injection of CD133+cells, as measured by the occurrence of major adverse cardiac and cerebrovascular event at 6-month. Secondary endpoints analyzed the efficacy. Twenty-eight patients were included (n=19 treatment; n=9 control). At 6-month, 1 patient in each group suffered ventricular fibrillation and 1 patient in each group died. One patient (treatment group) had a cardiac tamponade during mapping. There were no significant differences between groups with respect to efficacy parameters, however, the comparison within groups showed: a significant improvement in the number of angina episodes/per month (median-absolute difference (mAD):-8.5(95%CI, -15.0;-4-0) and in angina functional class in the treatment arm but not in the control group. At 6-months, only one SPECT parameter: Summed Score improved significantly in the treatment group: at rest and at stress:(mAD:-1.0(95%CI,-1.9;-0.1) but not in the control arm.CONCLUSIONS:: Our findings support feasibility and safety of transendocardial injection of CD133cells in patients with RA. The promising clinical results and favorable data observed in SPECT summed score may set up the basis to test the efficacy of cell therapy in a larger randomized trial. © 2014 American Heart Association, Inc.

Fernandez-Rivas M.,Hospital Clinico San Carlos
Chemical Immunology and Allergy | Year: 2015

Fruit and vegetable allergies are the most prevalent food allergies in adolescents and adults. The identification of the allergens involved and the elucidation of their intrinsic properties and cross-reactivity patterns has helped in the understanding of the mechanisms of sensitisation and how the allergen profiles determine the different phenotypes. The most frequent yet contrasting fruit and vegetable allergies are pollen-food syndrome (PFS) and lipid transfer protein (LTP) syndrome. In PFS, fruit and vegetable allergies result from a primary sensitisation to labile pollen allergens, such as Bet v 1 or profilin, and the resulting phenotype is mainly mild, consisting of local oropharyngeal reactions. In contrast, LTP syndrome results from a primary sensitisation to LTPs, which are stable plant food allergens, inducing frequent systemic reactions and even anaphylaxis. Although much less prevalent, severe fruit allergies may be associated with latex (latex-fruit syndrome). Molecular diagnosis is essential in guiding the management and risk assessment of these patients. Current management strategies comprise avoidance and rescue medication, including adrenaline, for severe LTP allergies. Specific immunotherapy with pollen is not indicated to treat pollen-food syndrome, but sublingual immunotherapy with LTPs seems to be a promising therapy for LTP syndrome. © 2015 S. Karger AG, Basel.

Few types of cancer have had their treatment evolve as rapidly as metastatic renal cell carcinoma (mRCC). Since 2005, six new targeted therapies with proven efficacy have been approved for the treatment of mRCC. The downside is that our knowledge about the mechanisms of action of these therapies and the intrinsic and extrinsic mechanism of resistance has not evolved equally fast, and many questions remain unanswered. The only approved agent to date in the European Union for patients who progress on sunitinib or sorafenib is everolimus. The results of the phase III trial comparing axitinib vs. sorafenib after failure on sunitinib, bevacizumab, temsirolimus, or cytokines have recently been published, and axitinib has recently been licensed by the Food and Drugs Administration. Other phase III trials that are being conducted include a comparison between everolimus plus bevacizumab and everolimus after failure on tyrosine kinase inhibitors, and between temsirolimus and sorafenib after failure on sunitinib. In this article, we will review the available evidence from clinical studies on sequential therapy for mRCC, including those that are still in progress. In addition, information on the mechanism of resistance or tolerance to first-line therapy, recommendations of the main practice guidelines for second-line treatment, potential therapies for third or successive treatment lines, and the major reasons why patients who progress may benefit from a change of mechanism of action will also be discussed.

Escaned J.,Hospital Clinico San Carlos
Nature Reviews Cardiology | Year: 2012

CABG surgery is an effective way to improve symptoms and prognosis in patients with advanced coronary atherosclerotic disease. Despite multiple improvements in surgical technique and patient treatment, graft failure after CABG surgery occurs in a time-dependent fashion, particularly in the second decade after the intervention, in a substantial number of patients because of atherosclerotic progression and saphenous-vein graft (SVG) disease. Until 2010, repeat revascularization by either percutaneous coronary intervention (PCI) or surgical techniques was performed in these high-risk patients in the absence of specific recommendations in clinical practice guidelines, and within a culture of inadequate communication between cardiac surgeons and interventional cardiologists. Indeed, some of the specific technologies developed to reduce procedural risk, such as embolic protection devices for SVG interventions, are largely underused. Additionally, the implementation of secondary prevention, which reduces the need for reintervention in these patients, is still suboptimal. In this Review, graft failure after CABG surgery is examined as a clinical problem from the perspective of holistic patient management. Issues such as the substrate and epidemiology of graft failure, the choice of revascularization modality, the specific problems inherent in repeat CABG surgery and PCI, and the importance of secondary prevention are discussed. © 2012 Macmillan Publishers Limited. All rights reserved.

Estrada V.,Hospital Clinico San Carlos | Portilla J.,Hospital General Universitario Of Alicante
AIDS Reviews | Year: 2011

Dyslipidemia is frequently observed in HIV-infected patients. Its pathogenesis is complex and includes factors related to the virus, the host, and antiretroviral treatment. Dyslipidemia is a main cardiovascular risk factor and it is partially modifiable. Whereas HIV infection and its treatment are associated with a state of accelerated atherosclerosis and an increase in the number of cases of myocardial infarction, dyslipidemia management must be a priority in the clinical care of patients with HIV infection. In this review, we discuss the major pathogenic mechanisms of dyslipidemia associated with antiretroviral therapy and the effect of the currently used drugs on the lipid profile. The current recommendations for dyslipidemia management include the control of other cardiovascular risk factors, the choice of antiretroviral drugs with a better lipid profile, and lipid-lowering drug use when clinically indicated. © Permanyer Publications 2011.

Veganzones-de-Castro S.,Hospital Clinico San Carlos
Revista española de enfermedades digestivas : organo oficial de la Sociedad Española de Patología Digestiva | Year: 2012

p16 gene plays an important role in the cell cycle regulation and is considered an important tumor suppressor gene. Several mechanisms of gene inactivation have been described; in this study we have focused on p16 gene promoter methylation. In colorectal cancer p16 gene methylation is a frequent event. 326 patients with sporadic colorectal cancer were included. DNA was extracted from tumor tissue samples obtained during the surgical procedure. Promoter methylation was analyzed using bisulfite modification and was detected by quantitative methylation-specific PCR. Frequency of p16 methylation was analyzed and compared with other clinicopathological variables. p16 gene methylation was detected in 24.8% of patients. Methylation was associated with differentiation grade and with tumor location: methylation was frequent in poorly differentiated tumors and had low frequency in distal colon. The p16 promoter methylation discriminated a subgroup of patients with better prognosis in poorly differentiated tumors. p16 methylation was a frequent event in our population and was able to induce differences in the overall survival of patients with poorly differentiated tumors.

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