Papers by Francisco López pico
Microalbuminuria cannot be ignored by cardiologists because it is considered a predictor of coron... more Microalbuminuria cannot be ignored by cardiologists because it is considered a predictor of coronary artery disease in patients with type 2 diabetes. Angiotensin II receptor blockers (ARB-II) have been accepted nephroprotective agents in patients with type 2 diabetes with microalbuminuria since publication of the Irbesartan Patients with Diabetes and Microalbuminuria (IRMA-2) study. In patients with macroalbuminuria, the Reduction of Endpoints in NIDDM with Angiotensin II Antagonist Losartan (RENAAL) and Irbesartan in Diabetic Nephropathy Trial (IDNT) studies showed a slowing of progression to terminal kidney disease. However, in patients with diabetes with microalbuminuria, the Diabetic Retinopathy Candesartan Trial (DIRECT) showed no significant reduction in microalbuminuria. Recently, the Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study has been published. Interestingly, it found that the use of olmesartan vs placebo to be associated with a significantly reduced incidence of microalbuminuria (23% relative reduction). However, it also showed increased incidence of cardiovascular death with olmesartan
Revista Española de Cardiología (English Edition), 2004
The influence of stent diameter in a direct stenting technique was analyzed. We retrospectively i... more The influence of stent diameter in a direct stenting technique was analyzed. We retrospectively identified 987 consecutive lesions in 773 patients in whom direct stenting was attempted. Lesions were divided into two groups: group 1, nominal stent diameter 2.5 mm (237 lesions) and group 2, ≥2.75 mm (n=750). Differences between groups were found in age (64.4 [10.4] vs 62.3 [11] P=.009), female sex (33.2% vs 17%; P<.0001), diabetes (44% vs 33.1%; P=.003), tortuosity (5.4% vs 2.5%; P=.034), reference diameter (2.5 [0.3] vs 3.3 [0.6]; P<.0001) and location in distal segments (44.5% vs 29.4%; P<.0001). Primary deployment (85.5% vs 95.5%; P<.0001) and postdilatation success rates (1.9% vs 4.8%; P=.039) were higher in group 2, with no differences in vessel dissection rate (4.7% vs 4.4%; P=.85). Direct stenting with 2.5 mm stents was associated with a lower success rate than larger stents. Vessel tortuosity, angulation, calcification, lesion severity and distal location were also associated with a higher failure rate. The predictive power of our model was 0.87 (95% CI, 0.82-0.92).
Revista española de cardiología, 2002
Earlier studies have established the value of coronary pressure wires for diagnosing and monitori... more Earlier studies have established the value of coronary pressure wires for diagnosing and monitoring the treatment of patients with coronary artery disease. In this study we demonstrated their usefulness in the daily clinical practice of a catheterization laboratory. A retrospective study of the use of pressure wires in our laboratory between October 1998 and November 2000. The pressure wire was inserted whenever the interventional cardiologist considered it to be indicated. In all cases, pressures were recorded with a Waveguide Cardiometrics 0.014 guide (Endosonics) and hyperemia was induced by intracoronary adenosine. Two hundred fifty-three lesions were studied in 190 patients. Indications were functional evaluation of lesions of intermediate severity for 82% (9% intrastent restenoses); guidance of balloon PTCA for 5%; and fulfillment of a research protocol for 13%. Twenty-six percent of lesions considered to be of moderate severity based on angiography were treated as a consequen...
Revista Española de Cardiología, 2002
INTRODUCCIÓN Recientes estudios han demostrado que el tratamiento de reperfusión con angioplastia... more INTRODUCCIÓN Recientes estudios han demostrado que el tratamiento de reperfusión con angioplastia primaria mejora el pronóstico a corto y largo plazo en los pacientes con infarto agudo de miocardio (IAM) en relación con el tratamiento con trombólisis 1-5 .
Revista Española de Cardiología, 2002
Trabajos ya antiguos estiman en 58.000 nuevos casos la incidencia anual del infarto agudo de mioc... more Trabajos ya antiguos estiman en 58.000 nuevos casos la incidencia anual del infarto agudo de miocardio (IAM) en nuestro país 1. Existe un acuerdo generalizado C ARDIOLOGÍA I NTERVENCIONISTA
Revista Española de Cardiología, 2002
Clinical Utilization of the Coronary Pressure Wire Introduction. Earlier studies have established... more Clinical Utilization of the Coronary Pressure Wire Introduction. Earlier studies have established the value of coronary pressure wires for diagnosing and monitoring the treatment of patients with coronary artery disease. In this study we demonstrated their usefulness in the daily clinical practice of a catheterization laboratory. Material and methods. A retrospective study of the use of pressure wires in our laboratory between October 1998 and November 2000. The pressure wire was inserted whenever the interventional cardiologist considered it to be indicated. In all cases, pressures were recorded with a Waveguide Cardiometrics 0.014 guide (Endosonics) and hyperemia was induced by intracoronary adenosine. Results. Two hundred fifty-three lesions were studied in 190 patients. Indications were functional evaluation of lesions of intermediate severity for 82% (9% intrastent restenoses); guidance of balloon PTCA for 5%; and fulfillment of a research protocol for 13%. Twenty-six percent of lesions considered to be of moderate severity based on angiography were treated as a consequence of the pressures measured by the wire. A decision to begin or continue a procedure was based on wire pressures in 24% and intervention was avoided in 60%. No major complications attributable to the wire were observed. A lesion was dissected in one patient (0.5%) but it was treated without consequences. Twenty pressure wires (11%) failed to work properly during the procedure, fourteen of them (7%) before insertion. The wire could not be advanced across the lesion in one case. Conclusions. The pressure wire is useful in the daily clinical practice of a catheterization laboratory. Its most common indication is the evaluation of lesions of intermediate or unknown severity, and use is associated with few complications.
Revista Española de Cardiología, 2004
Introducción y objetivos. El implante del stent sin predilatación es una técnica segura con resul... more Introducción y objetivos. El implante del stent sin predilatación es una técnica segura con resultados clínicos similares y menores costes, contraste y radiación que el implante con predilatación. En el implante directo, la expansión del stent podría ser menor al no haber una modificación previa de la placa con la predilatación. Los objetivos de este trabajo son comparar entre ambas técnicas: a) los parámetros de expansión del stent por ultrasonidos; b) los resultados angiográficos a 6 meses y clínicos a un año. Pacientes y método. Se aleatorizaron 100 lesiones consecutivas susceptibles de implante directo de stent a implante con y sin predilatación. Se utilizaron stents Multilink Duet/Tri-Star/Tetra y NIR Sox/Elite de longitud ≤ 25 mm. Tras un resultado angiográfico óptimo, se realizó un estudio con ultrasonidos que no modificó el tratamiento de la lesión, salvo riesgo potencial para el paciente. Los parámetros de expansión por ultrasonidos fueron comparados entre las 2 técnicas de implante. Se realizó una revisión angiográfica sistemática a los 6-9 meses, y clínica al año. Resultados. No hubo diferencias clínicas ni angiográficas basales entre los 2 grupos. No se encontraron diferencias significativas en los parámetros de expansión ni en los eventos clínicos. La reestenosis binaria (23 frente a 20%) y la pérdida tardía (0,92 [0,81] frente a 0,88 [0,60]) tampoco fueron significativamente diferentes entre ambos grupos. Conclusiones. El implante directo de stent no se asocia con parámetros de expansión diferentes en comparación con la técnica convencional. La reestenosis angiográfica y los eventos clínicos a largo plazo son similares en ambos grupos.
Revista Española de Cardiología, 2003
A pesar de los continuos avances en la técnica de re-vascularización percutánea, algunas situacio... more A pesar de los continuos avances en la técnica de re-vascularización percutánea, algunas situaciones clíni-cas y angiográficas siguen asociándose a peores re-sultados, tanto inmediatos como a largo plazo. La ... Resultados angiográficos del empleo de dos nuevos dispositivos de ...
Revista Española de Cardiología, 2006
El diámetro luminal mínimo intra-stent es predictor de reestenosis. Las dimensiones suministradas... more El diámetro luminal mínimo intra-stent es predictor de reestenosis. Las dimensiones suministradas por el fabricante son el resultado de pruebas in vitro. El objetivo del trabajo es comparar las dimensiones reales, mediante angiografía y ultrasonidos, con las teóricas en una cohorte prospectiva de 100 lesiones no complejas susceptibles a priori de stenting directo. Se encontraron diferencias significativas entre los diámetros teóricos y reales por angiografía y ultrasonidos intracoronarios; la relación diámetro real/teórico por angiografía fue de 0,83 ± 0,09 y por ultrasonidos intracoronarios, 0,78 ± 0,10. Las medidas reales obtenidas en lesiones sin calcificación severa son significativamente inferiores que las teóricas. Las medidas nominales no deberían utilizarse como medida de referencia en el implante.
Revista Española de Cardiología, 2002
Long-Term Prognosis of Patients with Myocardial Bridge and Angiographic Milking of the Left Anter... more Long-Term Prognosis of Patients with Myocardial Bridge and Angiographic Milking of the Left Anterior Descending Coronary Artery Introduction. Myocardial bridging with systolic compression (milking) of the left anterior descending coronary artery may be associated with myocardial ischemia. Little information is available about the long-term prognosis of patients with this coronary anomaly. Material and methods. A review was made of coronary angiographies of patients diagnosed as ischemic heart disease made between 1994 and 1999 in two centers. The long-term follow-up of patients with myocardial bridging and systolic compression of the left anterior descending coronary artery was analyzed. Data were collected by reviewing medical records and completed by telephone interview. Results. Prevalence: 0.72%. Milking was observed in 60 patients, but 25 of them were excluded due to associated hypertrophic cardiomyopathy, severe valvular disease, or coronary artery disease. The clinical follow-up was available for all patients (median: 43 months, range: 12-80 months). Mean age 55.7 years (SD = 11.9). Men 74%. Clinical presentation: angina 26 patients, atypical chest pain with positive non-invasive test 8, acute myocardial infarction 1. During follow-up, 1 patient died of sudden cardiac death. Seven patients continued to present stable angina CCS class I-II, coronary angiography was repeated in 5 patients, and one required percutaneous revascularization for symptoms. In 63% of cases, antianginal drugs were still needed at the end of follow-up period (beta-blockers or calcium antagonists). Conclusions. Patients with myocardial bridging and systolic compression of the left anterior descending artery have a good long-term prognosis, although more than half of them continue regular treatment with antianginal drugs. In a small percentage of cases percutaneous intervention must be performed and ischemic heart disease may appear in more aggressive forms (acute myocardial infarction or sudden death).
Revista Española de Cardiologia, 2004
Revista Española de Cardiología, 2002
Introducción. El implante directo de stent ha demostrado un ahorro en costes, tiempo, radiación y... more Introducción. El implante directo de stent ha demostrado un ahorro en costes, tiempo, radiación y contraste. Analizamos los resultados del implante directo en la actividad de un centro. Material y métodos. Estudiamos retrospectivamente las intervenciones de las primeras 1.000 lesiones tratadas con stent directo. Se analizó el éxito primario, disección, necesidad de posdilatación, embolización, pérdida de stent y afectación de ramas laterales. Resultados. Se trataron 1.000 lesiones en 784 pacientes. Edad 63 ± 11, mujeres 21%, diabetes 37%, angioplastia primaria o rescate 8%, trombo 16%, bifurcación 9%, calcificación 5%, angulación 2,3%, tortuosidad 3,2%. Diámetro de referencia 3,0 ± 0,5 mm. Éxito primario: 93,1%. El fracaso (6,9%) se asoció a localización en circunfleja en 38%, calcificación en 26%, angulación en 22% y tortuosidad en 31%. En 39 lesiones se requirió posdilatación con balón diferente, en 40 lesiones stent adicional por disección y en 27 por cobertura incompleta. Hubo embolización de trombo en 7 lesiones, seis con imagen de trombo previo y una en safena. Embolizaron 6 stents, de los cuales cuatro se recuperaron. Se ocluyeron 4 ramas laterales y dos de ellas también se pudieron recuperar. Conclusiones. El implante directo de stent es una técnica segura con un bajo porcentaje de disección, necesidad de posdilatación, embolización de trombo y oclusión de ramas. Estos resultados, unidos a los de estudios previos referidos al ahorro en tiempo, coste, radiación y contraste, avalan las ventajas de esta técnica en lesiones seleccionadas.
Revista Española de Cardiología, 1997
Introduccion y objetivos La ergometria precozes el procedimiento mas utilizado para estratificare... more Introduccion y objetivos La ergometria precozes el procedimiento mas utilizado para estratificarel riesgo postinfarto y detectar enfermedad multivaso,hecho asociado a una menor supervivencia alargo plazo. No existen datos al respecto en el grupode pacientes jovenes. El objetivo del estudio esevaluar la sensibilidad, especificidad y valor predictivode la prueba de esfuerzo precoz para detectarenfermedad multivaso en pacientes jovenespostinfarto. Metodos A pacientes de hasta 40 anos, supervivientesa un infarto agudo de miocardio (IAM) seles realizaron prueba de esfuerzo y coronariografiapreviamente al alta, valorando la sensibilidad, especificidad,valor predictivo positivo y negativo dela prueba de esfuerzo. Resultados Se incluyeron 100 pacientes consecutivos,de los que se realizo ergometria a 83 y coronariografiaa 96. En los 83 sujetos con ambaspruebas, 27 presentaron enfermedad multivaso, delos que 15 tuvieron ergometrias positivas, 6 positivasde alto riesgo y 12 normales. En los 56 individuossin enfermedad multivaso, en 41 hubo un testnormal y anormal en los 15 restantes, lo que arrojauna sensibilidad del 56%, una especificidad del73%, un valor predictivo positivo del 50% y un valorpredictivo negativo del 77% en la deteccion deenfermedad multivaso. El valor predictivo positivoaumento hasta el 80% en casos de ergometria positivacon criterios de alto riesgo. Conclusiones Es necesario en este grupo de pacientesel uso de tecnicas complementarias con laprueba de esfuerzo como la ecografia de estres,isotopos o coronariografia, por el bajo poder predictivode aquella para descartar la enfermedadmultivaso.
Revista Española de Cardiologia, 2004
Introduction and objectives. Surgical revascularization is the procedure of choice for unprotecte... more Introduction and objectives. Surgical revascularization is the procedure of choice for unprotected left main coronary artery stenosis, but it may be unsuitable in some patients. We report short-and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery stenosis in a series of patients who were poor candidates for surgery. Patients and method. Descriptive study of a historic cohort of consecutive patients with unprotected left main coronary artery stenosis who were not candidates for surgery, treated with percutaneous coronary intervention at a single center between April 1999 and December 2003. Results. A total of 83 patients (mean age 72 [9] years) were included. Twenty patients (24%) were in shock on presentation. Surgery was considered unsuitable because of unacceptable surgical risk, poor condition of the distal vessels or comorbid conditions in 61 (73.5%) patients, or acute myocardial infarction in 22 (27%). An intraaortic balloon pump was used in 34 (40%); abciximab in 30 (36%) and stenting in 79 (95%) procedures. The intervention was considered successful in 76 patients (92%). Total in-hospital mortality was 28.9% (55% in patients with acute myocardial infarction and 20% in those without acute myocardial infarction). Median follow-up was 17 months. Average survival was 19.7 (2) months. Eighteen (22%) patients were hospitalized again for a new ischemic event, and 14 (17%) underwent revascularization. In 9 cases (10.8%) a new angioplasty was performed, and in 5 (6.0%) surgical revascularization was necessary. Conclusions. Percutaneous coronary intervention is an option for revascularization in left main coronary artery stenosis in patients who are poor candidates for surgery, although in-hospital and long-term mortality remain high.
European Heart Journal, 2004
Aims The evaluation of in-stent restenosis (ISR) is usually based on angiographic quantification.... more Aims The evaluation of in-stent restenosis (ISR) is usually based on angiographic quantification. This evaluation is sometimes difficult and it has not an accurate clinical correlation. Fractional flow reserve (FFR) measured by intracoronary pressure wire has demonstrated its value in determining the functional repercussion of coronary stenosis. The aim of this study was to evaluate the relation between quantitative angiography-FFR in borderline in-stent restenotic lesions and the accuracy of FFR in deciding the treatment of ISR. Methods and results Quantitative angiographic values of 65 lesions in 62 patients with angiographically moderate ISR are compared with the FFR value obtained by pressure wire. An FFR value < 0.75 was considered significant. Patients with non-revascularized ISR (FFR P 0.75) were clinically followed during a year. An FFR value P 0.75 was obtained in 41 lesions (63%), 21 of them with stenosis P 50%. The coefficient of correlation between parameters of quantitative angiography and FFR value was <0.5. No events related to the non-treated lesions were observed. Conclusions A poor correlation between angiographic quantification and FFR of moderate ISR was found. Conservative management of moderate 40-70% in-stent restenotic lesions with FFR value P 0.75 is safe avoiding unnecessary revascularizations based solely on the angiography.
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Papers by Francisco López pico