Primary angioplasty versus fibrinolysis in patients at a distance from a hospital with a catheterization laboratory [Angioplastia primaria frente a fibrinolisis en pacientes alejados de un centro con hemodinámica]
Aboal J.,Hospital Universitari Josep Trueta |
Nunez M.,Hospital Universitari Josep Trueta |
Bosch D.,Hospital Universitari Josep Trueta |
Tiron C.,Hospital Universitari Josep Trueta |
And 2 more authors.
Emergencias | Year: 2017
Background and objective. Long distance from a hospital with a catheterization laboratory is associated with a poorer prognosis in patients who undergo primary angioplasty for ST-elevation myocardial infarction (STEMI). An invasive pharmacologic strategy could offer an alternative treatment for these patients. We aimed to establish whether prognosis was better with primary angioplasty or fibrinolysis for reperfusion in cases of STEMI occurring far from a catheterization laboratory. Methods. Prospective registry study of patients with STEMI admitted to our cardiology critical care unit. Patients were included over a 5-year period if they received reperfusion therapy and had required transport of more than 50 km to reach a hospital with a catheterization laboratory. We recorded characteristics of the STEMI event, treatment times, and short- and long-term mortality. The data was used for survival analysis. Results. We registered 584 patients; 194 were treated with primary angioplasty and 390 with fibrinolysis. The mean time between first physician contact and balloon insertion was 160 minutes. The mean time between first physician contact and needle insertion for fibrinolysis was 30 minutes. The 2-year mortality rate was higher in patients treated with angioplasty (12.2%) than with those who underwent fibrinolysis (7.0%)) (P=.04). Survival analysis showed that risk for death was higher in the primary angioplasty group (hazard ratio, 1.97 (95% CI, 0.64-0.95; P=.001). Conclusion. When STEMI occurs more than 50 km from a catheterization laboratory, reperfusion by means of balloon angioplasty delays care considerably and is associated with a higher mortality rate than reperfusion by fibrinolysis. © 2017, Grupo Saned. All rights reserved.
Fuentes-Raspall R.,Catalan Institute of Nanoscience and Nanotechnology |
Fuentes-Raspall R.,Hospital Universitari Josep Trueta |
Vilardell L.,Catalan Institute of Nanoscience and Nanotechnology |
Vilardell L.,Hospital Universitari Josep Trueta |
And 6 more authors.
Journal of Neuro-Oncology | Year: 2011
The purpose of this study was to describe the incidence and survival of primary Central Nervous System (CNS) malignancies using data from the population-based cancer registry for Girona province (north-east Spain). We included all cases of primary CNS malignancies registered between 1994 and 2005. Pathological diagnoses were reviewed and grouped according to the 2007 WHO Classification. Meningeal, soft tissue tumours, spinal cord tumours and primary CNS lymphoma were not included. Cases notified only by death certificate were excluded from the survival analysis. Kaplan and Meier survival curves were calculated from date of diagnosis to death or end of study (31 December 2005), as was relative survival. A total of 493 new CNS cancer patients were registered during the study period: 49.3% astrocytic, 3.4% oligodendroglial and oligoastrocytic tumours, 2.6% ependimal tumours, 3.7% embryonal tumours, 0.2% choroid plexus and 41% without histological confirmation. The mean age (in years) for embryonal tumours was 18.17 years, these being the younger patients in the sample, and 66.34 years for those without histological confirmation, the older patients. Overall, the age standardised incidence rate was 5.88 cases/100,000 people/year (men = 6.81; women = 4.99) with an increasing trend by age until the 70-74 age group. Five-year observed survival rates were: 14.6% for astrocytic tumours, 35.7% for oligodendroglial and oligoastrocytic tumours, 41.0% for ependymal tumours, 32.4% for embryonal tumours and 7.5% for those without histological confirmation (log rank test: P < 0.001). Five-year observed survival rates for astrocytic tumours were analyzed separately by tumour grading, with 37% for diffuse astrocytoma, 7.1% for anaplastic astrocytoma and 4.7% for glioblastoma (log rank test: P < 0.001). Our results show that astrocytic tumours are most frequently diagnosed and glioblastoma patients have the worst survival figures for the area covered by our population cancer registry. The high observed incidence of histologically unverified tumours is most probably due to easy access to state of the art CNS imaging in our area. © 2010 Springer Science+Business Media, LLC.
Sabate S.,Fundacio Puigvert IUNA |
Mases A.,Hospital del Mar |
Guilera N.,Hospital Of Sabadell |
Canet J.,Hospital Germans Trias i Pujol |
And 6 more authors.
British Journal of Anaesthesia | Year: 2011
Background. Major adverse cardiac and cerebrovascular events (MACCE) represent the most common cause of serious perioperative morbidity and mortality. Our aim was to identify risk factors for MACCE in a broad surgical population with intermediate-to-high surgery-specific risk and to build and validate a model to predict the risk of MACCE. Methods. A prospective, multicentre study of patients undergoing surgical procedures under general or regional anaesthesia in 23 hospitals. The main outcome was the occurrence of at least one perioperative MACCE, defined as any of the following complications from admittance to discharge: cardiac death, cerebrovascular death, non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure, new cardiac arrhythmia, angina, or stroke. The MACCE predictive index was based on β-coefficients and validated in an external data set. Results. Of 3387 patients recruited, 146 (4.3%) developed at least one MACCE. The regression model identified seven independent risk factors for MACCE: history of coronary artery disease, history of chronic congestive heart failure, chronic kidney disease, history of cerebrovascular disease, preoperative abnormal ECG, intraoperative hypotension, and blood transfusion. The area under the receiver-operating characteristic curve was 75.9% (95 confidence interval, 71.2-80.6%). Conclusions. The risk score based on seven objective and easily assessed factors can accurately predict MACCE occurrence after non-cardiac surgery in a population at intermediate-to-high surgery-specific risk. © The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
Garre-Olmo J.,Institute dAssistencia Sanitaria |
Garre-Olmo J.,University of Girona |
Genis Batlle D.,Hospital Universitari Josep Trueta |
Del Mar Fernandez M.,Hospital Of Figueres |
And 7 more authors.
Neurology | Year: 2010
Objective: To estimate the incidence of early-onset dementia (EOD) and to compare the clinical characteristics of EOD vs late-onset dementia (LOD) in a geographically defined area. Methods: We used data from the Registry of Dementia of Girona (ReDeGi), an epidemiologic surveillance system of dementia. The ReDeGi is a standardized clinical registry of new dementia cases diagnosed in the 7 hospitals of the Health Region of Girona (Catalonia, Spain), which encompasses an area of 5,517 km and 690,207 inhabitants. EOD cases were defined as those patients residing in the target area at the time of diagnosis who were diagnosed with dementia with an age at onset of symptoms before 65 years. Results: The ReDeGi registered 2,083 patients between January 1, 2007, and December 31, 2009 (6.9% EOD). The incidence rate of EOD for the age range 30-64 was 13.4 cases per 100,000 person-years (95% confidence interval 11.3-15.8). Alzheimer disease was the most frequent cause of EOD (42.4%), followed by secondary dementia (18.1%), vascular dementia (13.8%), and frontotemporal dementia (9.7%). EOD cases at the time of diagnosis were less impaired on the Mini-Mental State Examination and had a greater score on the Blessed Dementia Rating Scale behavior subscale than LOD cases. The frequency of a personal history of depression was higher in EOD cases. Conclusions: The incidence of EOD was less than 6 cases per 100,000 person-years in the age group 30-49 years; in the age group 50-64 years, the incidence rate was 3-fold higher and doubled with each 5-year increase. © 2010 by AAN Enterprises, Inc. All rights reserved.
Zabalza M.,Hospital Universitari Josep Trueta |
Subirana I.,CIBER ISCIII |
Sala J.,Hospital Universitari Josep Trueta |
Sala J.,University of Girona |
And 9 more authors.
Heart | Year: 2012
Aims: To perform a meta-analysis of the association between CYP2C19 loss- and gain-of-function variants and cardiovascular outcomes and bleeding in patients with coronary artery disease treated with clopidogrel, and to explore the causes of heterogeneity between studies. Methods: A comprehensive literature search was conducted. A random-effects model was used to summarise the results. In the presence of between-study heterogeneity, a meta-regression analysis was performed to identify study characteristics explaining this heterogeneity. Results: Patients who carried a loss-of-function allele, mainly CYP2C19*2, did not present an increased risk of a cardiovascular event, HR =1.23 (95% CI 0.97 to 1.55). Substantial heterogeneity was observed between studies (I 2 =35.6), which was partially explained by the study sample size: the pooled HR was higher among studies with a sample size <500 patients (HR =3.55; 95% CI 1.66 to 7.56) and lower among studies with a sample size ≥500 (HR =1.06; 95% CI 0.89 to 1.26). CYP2C19*2 was associated with an increased risk of a stent thrombosis (HR =2.24; 95% CI 1.52 to 3.30). The gain-of-function allele, mainly CYP2C19*17, was associated with a lower risk of cardiovascular events (HR =0.75; 95% CI 0.66 to 0.87) and a higher risk of major bleeding (HR =1.26; 95% CI 1.05 to 1.50). Conclusions: Not only CYP2C19 loss-of-function but also gain-of-function alleles should be considered to define the pharmacogenetic response to clopidogrel. The results question the relevance of the CYP2C19 loss-of-function alleles in the prediction of major cardiovascular events beyond stent thrombosis in coronary patients treated with clopidogrel. The gain-of-function variant is associated with a lower risk of cardiovascular events but a higher risk of bleeding.
Cano J.F.,Hospital Universitari del Mar |
Baena-Diez J.M.,Cardiovascular Epidemiology and Genetics Research Group |
Baena-Diez J.M.,Institute Catala Of La Salut |
Franch J.,Institute Catala Of La Salut |
And 7 more authors.
Diabetes Care | Year: 2010
OBJECTIVE - The aim of this study was to determine whether long-term cardiovascular risk differs in type 2 diabetic patients compared with first acute myocardial infarction patients in a Mediterranean region, considering therapy, diabetes duration, and glycemic control. RESEARCH DESIGN AND METHODS - A prospective population-based cohort study with 10-year follow-up was performed in 4,410 patients aged 30-74 years: 2,260 with type 2 diabetes without coronary heart disease recruited in 53 primary health care centers and 2,150 with first acute myocardial infarction without diabetes recruited in 10 hospitals. We compared coronary heart disease incidence and cardiovascular mortality rates in myocardial infarction patients and diabetic patients, including subgroups by diabetes treatment, duration, and A1C. RESULTS - The adjusted hazard ratios (HRs) for 10-year coronary heart disease incidence and for cardiovascular mortality were significantly lower in men and women with diabetes than in myocardial infarction patients: HR 0.54 (95% CI 0.45- 0.66) and 0.28 (0.21- 0.37) and 0.26 (0.19-0.36) and 0.16 (0.10-0.26), respectively. All diabetic patient subgroups had significantly fewer events than myocardial infarction patients: the HR of cardiovascular mortality ranged from 0.15 (0.09-0.26) to 0.36 (0.24-0.54) and that of coronary heart disease incidence ranged from 0.34 (0.26-0.46) to 0.56 (0.43- 0.72). CONCLUSIONS - Lower long-term cardiovascular risk was found in type 2 diabetic and all subgroups analyzed compared with myocardial infarction patients. These results do not support equivalence in coronary disease risk for diabetic and myocardial infarction patients. © 2010 by the American Diabetes Association.
Register of short-stay units in Spain, the REGICE project, study 1: Location, organizational features, and staffing [Proyecto REGICE: Registro de las unidades de corta estancia en España. localización, aspectos estructurales y dotación de profesionales (REGICE 1)]
Llopis Roca F.,Hospital Universitari Of Bellvitge |
Juan Pastor A.,Hospital Universitari Josep Trueta |
Ferre Losa C.,Hospital Universitari Of Bellvitge |
Martin Sanchez F.J.,Hospital Clinico San Carlos |
And 4 more authors.
Emergencias | Year: 2014
Objective: The aim of the REGICE project is to describe the real situation of short-stay units (SSU) in Spain. The project's first study provided information on their organizational structure, location, responsible hospital department, and staffing. Methods: Cross-sectional study based on a survey of all Spanish hospitals listed on the web page of the Ministry of Health in 2012. Hospital directors who reported that their facilities had SSU were asked to provide information on how they were structured and how staff were organized. Results: Of the 591 hospitals surveyed, 67 (11.3%) had a SSU; 48 of them (71.6%) were included in the database for the REGICE 1 study. Sixty-five percent of the units were administered by the emergency department (ED), 23% by internal medicine and 12% by another department. Fifty-two percent were located on a conventional hospital ward and 44% in the ED area. The mean (SD) number of beds was 15.08 (6.34) (range, 5-30 beds). The ED chief was responsible for the unit in 60% of the hospitals and the internal medicine department in 23%; 42% of the units had a chief of service other than the head of the department the unit belonged to. The number of staff physicians and their work scheduled varied greatly. The ratio of physicians to beds was 1:5.8 (range, 1:2-1:12). Nursing staff was more similar across hospitals. Seventy percent of the short-stay units participated in training resident physicians. Conclusions: Only 11.3% of the surveyed hospitals have a SSU. These units usually belong to the ED. Staff organization in these units varies greatly from hospital to hospital.
Sala-Cunill A.,Autonomous University of Barcelona |
Bartra J.,Hospital Clinic IDIBAPS |
Dalmau G.,Hospital Universitari Joan Tarragona |
Tella R.,Hospital Universitari Josep Trueta |
And 3 more authors.
Journal of Investigational Allergology and Clinical Immunology | Year: 2013
Background: Allergic rhinitis (AR) is an increasingly prevalent worldwide disease that has a considerable impact on quality of life and health care costs. Asthma and AR may be part of the same disease, with AR leading to an increased risk of asthma. Objectives: To assess the prevalence of asthma in patients with AR due to house dust mites (HDMs) or Parietaria judaica and analyze the characteristics of asthma and AR in each group. Methods: Cross-sectional, multicenter study with recording of demographic and clinical characteristics. All patients had AR confi rmed by symptoms and a positive skin prick test to HDMs or P judaica. They were classifi ed according to the severity and frequency of AR following the Allergic Rhinitis and its Impact on Asthma (ARIA) and modifi ed ARIA criteria and according to the severity of asthma following the Global Initiative for Asthma criteria. Results: We studied 395 patients (226 in the HDM group and 169 in the P judaica group) with a mean (SD) age of 43 (15.3) years. Using the modifi ed ARIA criteria, we detected more severe and persistent AR in the P judaica group than in the HDM group (44.5% vs 24.8%, P<.001). Nevertheless, there were no statistically signifi cant differences between the groups in terms of the severity or prevalence (50% in HDM vs 47.9% in P judaica, P=.685) of asthma. Conclusion: AR due to P judaica pollen, which behaves like a perennial allergen, is associated with the same prevalence of asthma and with more severe rhinitis than AR due to HDMs. © 2013 Esmon Publicidad.
Castro J.,University of Girona |
Castro J.,Hospital Universitari Josep Trueta |
Ribo M.,University of Girona |
Ribo M.,Hospital Universitari Josep Trueta |
And 4 more authors.
Current Medicinal Chemistry | Year: 2013
Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries. This global burden of cancer continues to increase largely because of the aging and growth of the world population. Although very much progress has been attained in the development of new therapies, there is a clear need of more efficient and selective antitumor drugs for the effective treatment of many types of cancer. Among the different strategies developed to create new antitumor drugs, pleiotropic non-genotoxic effectors have gained interest since this approach is less susceptible to known resistance mechanisms. The cell nucleus is the subcellular compartment where the genetic information and the transcription machinery reside and accordingly where numerous therapeutic agents efficiently work. Hence, nuclear-targeted drugs are expected to kill cancer cells more directly and efficiently. In this review, we discuss the potential of nuclear-targeted drugs as antineoplastic therapeutics and reason the benefits of the strategy to endow ribonucleases with cytotoxic properties based on its targeting into the nucleus. © 2013 Bentham Science Publishers.
Aboal J.,Hospital Universitari Josep Trueta
Revista Espanola de Cardiologia Suplementos | Year: 2015
The use of colloid and crystalloid fluids for the restoration of blood volume is a common clinical strategy for stabilizing patients receiving critical care. In general, colloids have been found to be more effective and faster-acting than crystalloids for volume restoration and hemodynamic stabilization, but several studies have shown that they are also associated with a greater risk of acute renal failure and the need for renal replacement therapy. The variation in survival and kidney injury rates observed between different studies might be explained by differences in the patient population selected or the speed of blood volume restoration. In general, patients with hemodynamic evidence of hypovolemia who receive colloids at a low fluid replacement rate achieve similar results to those treated with crystalloids. It is important to note that, although volume expansion is helpful in the management of critically ill patients, it does not resolve the etiological factors underlying shock. Finally, strict hemodynamic control of the effects of volume restoration is essential and should be based on real-time parameters and clearly defined objectives. © 2015 Sociedad Española de Cardiología. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.