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Biomedical subjects

Xavier Bosch

Publications and source records attributed to Xavier Bosch.

At least 109 records · Page 6Linked to original sources
PubMed2003

Technetium 99m-labeled tetrofosmin and iodine 123-labeled metaiodobenzylguanidine scintigraphy in the assessment of transmyocardial laser revascularization.

OBJECTIVE: Transmyocardial laser revascularization is a new technique that improves symptoms in patients with refractory angina not amenable to conventional revascularization. The aim of this study was to assess whether transmyocardial laser revascularization produces changes in innervation, perfusion scintigraphy, or both that could explain the benefit to patients. METHODS: Sixteen patients (12 men and 4 women; mean age, 60 +/- 8 years) with coronary artery disease were studied. Transmyocardial laser revascularization was performed in 39 myocardial areas supplied by a stenotic vessel. A technetium 99m-labeled tetrofosmin stress-rest tomographic scan and iodine 123-labeled metaiodobenzylguanidine planar scans were performed before and after transmyocardial laser revascularization (3 and 12 months later) to evaluate myocardial perfusion and innervation. Stress and rest perfusion images were quantified on a polar map. Ischemia uptake was also defined as the difference between rest and stress uptake for each area. Innervation planar images were visually analyzed and semiquantified. RESULTS: A significant decrease in angina class from baseline was observed at 3, 6, and 12 months after transmyocardial laser revascularization (P <.005). A significant decrease in ischemia uptake was also found between the pre-transmyocardial laser revascularization and the post-transmyocardial laser revascularization studies in treated areas (P <.001). A significant improvement in stress myocardial perfusion at 3 and 12 months after transmyocardial laser revascularization was only found in treated areas that were considered ischemic in the pre-transmyocardial laser revascularization study (P <.05). At 3 months, a significant myocardial innervation worsening was observed in treated areas (P <.001), with partial recovery at 12 months (P <.05). CONCLUSION: The transmyocardial laser revascularization mechanism involves both perfusion improvement and denervation, mainly at 3 months, that partially recovered at 12 months.

3-Iodobenzylguanidine↗
PubMed2003

[Clinical characteristics, management, and prognosis of patients with acute myocardial infarction not admitted to the coronary care unit. Usefulness of an intermediate care unit as the initial admission site].

INTRODUCTION AND OBJECTIVES: There is little information about the management and prognosis of patients with acute myocardial infarction (AMI) who are not admitted to coronary care units (CCU) because of the lack of available beds. The aim of this study was to evaluate the characteristics and prognosis of the patients who were admitted to the intermediate care unit (INTCU) of a cardiology department. METHODS: We compared the clinical profile, management, and 12-month prognosis of the patients admitted to the INTCU or general ward (Ward) instead of the CCU. RESULTS: Out of 242 patients with AMI, 62 (23%) were not admitted to the CCU due to the lack of available beds. Of these, 29 (12%) were admitted to the INTCU and 26 (11%) to the Ward after being monitored for at least 24 h in the emergency room. Patients admitted to the CCU arrived at the hospital early, were younger, less frequently female, and had a lower prevalence of diabetes. ST-segment elevation AMI was more frequent in patients admitted to the CCU than in patients admitted to the INTCU or Ward (67 vs 17 and 23%, respectively; p < 0.0001), and non-Q wave AMI was less frequent (30 vs 76 and 81%; p < 0.0001). No differences were found between groups in the number of stress tests or revascularization procedures performed after the first 24 h, the duration of the hospital stay (median 8 days), or in-hospital mortality. The 12-month survival was 82, 80, and 64% in the patients admitted to the CCU, INTCU, or Ward (p < 0.05), respectively. These differences ceased to be significant after adjusting for the patients' baseline clinical profile and treatment received at admission. CONCLUSION: Compared to patients with AMI admitted to the CCU, patients admitted to the INTCU or Ward after being monitored at least 24 h had non-ST elevation and non-Q wave AMI more frequently, but a less favorable risk profile for long-term mortality. The different types of AMI were managed similarly and had a similar 12-month prognosis. Intermediate care units may be useful for palliating the lack of CCU beds and care for some patients with AMI.

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PubMed2003

[Clinical characteristics, prognosis, and variability in the management of non-ST-segment elevation acute coronary syndromes. Data from the PEPA registry].

OBJECTIVES: To assess the clinical characteristics and inter-hospital variability in the treatment and prognosis of patients with non-ST-segment elevation acute coronary syndromes. PATIENTS AND METHOD: Data from the PEPA study, a prospective registry that enrolled 4,115 patients in 18 Spanish hospitals, were analyzed. RESULTS: The mean age of the patients enrolled was 65 years, 33% were women, and 26% had diabetes. Large differences were observed in the clinical profile of patients admitted to different centers, especially relative the history of previous disease, prior coronary revascularization, and co-morbidity. Antiplatelet treatment was used in 93% of patients, heparin in 45%, beta-blockers in 42%, nitrates in 67%, and calcium antagonists in 46%. During hospitalization, exercise stress testing was performed in 37% of patients, coronary angiography in 32%, coronary angioplasty in 9%, and coronary surgery in 4%. Inter-hospital variability was minimal for the use of antiplatelet agents, wide for the use of heparin and beta-blockers, and huge for the use of revascularization procedures. Mortality and the incidence of death or myocardial infarction were 2.6% and 4.4% during hospitalization, and 4.6% and 8% at 3 months, with wide inter-hospital variability. These differences were not significant once adjusted for clinical characteristics and the treatment received at admission. CONCLUSIONS: Patients with non-ST-segment elevation acute coronary syndromes represent an heterogeneous group with a high incidence of complications. Pharmacologic and, especially, invasive treatment varies widely in different hospitals. These results underline the importance of correct initial risk stratification and uniform treatment following the recommendations of clinical guidelines.

Adrenergic beta-Antagonists↗
PubMed2003

[Management of myocardial infarction in Spain in the year 2000. The PRIAMHO II study].

INTRODUCTION AND OBJECTIVES: Hospital registries are useful tools to measure the degree of implementation of new treatments and clinical practice guidelines. PATIENTS AND METHOD: The hospital registry described here was developed in the prospective PRIAMHO II study, which involved a random selection of Spanish hospitals with a coronary intensive care unit and external quality control. This study investigated patients admitted to the coronary care unit with acute myocardial infarction. Demographic and clinical characteristics were recorded, as well as the management, clinical course and survival after 28 days and one year. RESULTS: From May 15 to December 15 2000 we included in the registry 6,221 patients from the 58 hospitals that complied with the quality control requirements (71.6% of all participating hospitals). Acute mortality was 9.6%; 28-day and one-year mortality were 11.4% and 16.5%, respectively. Of the patients with ST elevation-myocardial infarction of less than 12 hours' duration, 71.6% were reperfused and 89.3% received fibrinolysis with a median door-to-needle time of 48 minutes. Ejection fraction was measured in 81% of the patients, and 43% were tested for inducible ischemia. About nine-tenths (91%) of the patients were discharged on least one antiplatelet drug, 56% on a beta blocker, 45% on an ACE inhibitor, and 45% on a lipid-lowering agent, with a coefficient of variation between hospitals greater than 25% for the last three drugs. CONCLUSIONS: The percentage of patients with ST elevation treated with reperfusion should increase, as it probably will thanks to the increasing use of primary angioplasty. The door-to-needle time was longer than the recommended interval. In-hospital risk stratification was good but nonsystematic for the evaluation of ejection fraction, and unsatisfactory for inducible ischemia testing. At discharge the percentages of patients receiving beta blockers, ACE inhibitors and statins were not optimal, and there were wide variations in prescribing practices between hospitals.

Aged↗