Patients with heart failure with reduced ejection fraction (HFrEF) must be studied to clarify the underlying aetiology. However, different diagnosis schemes are being followed in clinical practice. All patients with HFrEF referred to a specialized Heart Failure Unit between 2011 and 2022 were included. Exclusion criteria were: prior coronary artery disease or acute myocardial infarction (AMI) as debut of HFrEF. We analysed two different diagnostic approaches: -Non-invasive study (cardiac magnetic resonance imaging (CMR) / stress echocardiography / coronary CT / SPECT myocardial perfusion imaging as first test) vs invasive study (coronary -angiography (CA) as first test). -CMR guided study (CMR as first test) vs non-invasive coronary ischemia guided study (stress echocardiography /coronary CT/ SPECT myocardial perfusion imaging as first test) vs coronary angiography guided study (coronary angiography as first test). Primary endpoint was mortality. Secondary endpoints were heart failure (HF) hospitalizations, new coronary revascularization, AMI and improvement of ejection fraction. 581 patients were included. Baseline characteristics are shown in Table 1. -Non-invasive study vs invasive study: 381 patients were included in the non-invasive group and 200 in the invasive group. Patients in invasive group were older (66.8 vs 62.5 years old; p<0.001) and more diabetic (45% vs 31%; p>0.001). No other differences in sex neither renal function were found. No differences in mortality among groups were found. Patients with invasive study had less HF hospitalizations (1.0% vs 5.2%; p=0,013) (Figure 1) and a trend to greater improvement in EF (17.1% vs 14.5%; p=0.084). No differences in AMI or follow-up cardiac revascularization were found. -CMR guided study vs non-invasive coronary ischemia guided study vs coronary angiography guided study: 319 patients were included in CMR guided study, 62 in non-invasive ischemia guided study and 200 with coronary angiography. Patients in CMR group were younger (61.7 vs 66.4 vs 66.8 years old; p<0,001). Non-invasive ischemia group patients had better EF (33.5% vs 30.0% and 29.6%; p=0.004). No other differences in sex, renal function or risk factors were found. Non differences in mortality among groups were found. Patients with CMR guided study and CA guided study had greater improvement in EF than patients with coronary ischemia guided study (14,7% and 14,5% vs 7,35%; p<0,001). Patients with CA had less HF hospitalizations (1.0% vs 5.2% and 5%; p=0,045). No differences in AMI or cardiac revascularization were found. The use of coronary angiography as a first strategy for the diagnosis of the aetiology in patients with HFrEF patients is associated with fewer HF hospitalizations. No differences in mortality were found between the different strategies. Based on this data, an invasive study should be considered by protocol in patients with a recent diagnosis of heart failure.Figure 1 Table 1

We present the case of a 91-year-old man with a past medical history of moderate-to-severe aortic stenosis referred due to breathlessness. The routine invasive coronary angiography performed before transcatheter aortic valve replacement confirmed the presence of a severely calcified left anterior descending coronary artery proximal segment (figure 1A; video 1 of the supplementary data). The functional assessment performed showed a fractional flow reserve of 0.79. The optical coherence tomography (OCT) interrogation revealed an arc of calcium > 180°, thickness of 0.6 mm, and length > 5 mm with a calcified nodule with a minimum lumen area of 3.49 mm2 (figure 1C; video 2 of the supplementary data). Orbital atherectomy with the Diamondback 360 Coronary OAS (Cardiovascular Systems, Inc., United States) was selected to prepare the lesion. After 5 runs at low speed (80 000 rpm), a new OCT was performed that confirmed the fracture of the calcified nodule achieving a minimum lumen area of 7.5 mm2 (figure 1D; video 3 of the supplementary data). Consecutively, a 2.5 mm x 15 mm SC balloon (OrbusNeich, China) plus a 3.0 mm x 10 mm NC balloon (Medtronic, United States) were advanced through the lesion and inflated twice. Finally, a Megatron 3.5 mm...

Introduction and objectives: Advanced interatrial block has been linked with atrial fibrillation (AF) (Bayes syndrome). On the other hand, the aetiology of the stroke remains unknown in approximately 20-25% of patients admitted due to ischaemic stroke. The aim of this study was to evaluate whether advanced interatrial block and CHADS2-VASC scale is linked to AF in patients admitted due to ischaemic stroke without previous AF history. Methods: A prospective analysis of consecutive in-hospital patients admitted with ischemic stroke between January/2018 and April/2019 in a stroke hospital was performed. Patients had to be in sinus rhythm at admission and without previous history of AF/atrial flutter. During follow up patients receive the usual care. Results: A total of 236 patients were included. The median follow-up was 540 days (407-695). 19 patients (8.1%) had advanced interatrial block at admission. Advanced interatrial block was associated with the diagnosis of AF during follow up (5 (26.3%) Vs 21 (9.7%) p = 0.027). A CHADS2-VASC score > 4 at admission was also associated with AF diagnosis during follow up (23(14.6%) vs 3(3.9%) p = 0.009). Conclusion: This study confirms the association of advanced interatrial block and CHADS2-VASC > 4 at admission with the diagnosis of AF during follow up in patients with ischemic stroke. This association could have important implications in patients with ischemic stroke who present advanced interatrial block and without previous history of AF. (c) 2021 Elsevier Espan tilde a, S.L.U. All rights reserved.

Presentamos el caso de un varón de 91 años con una historia clínica de estenosis aórtica entre moderada y grave derivado con un cuadro de disnea. La coronariografía invasiva rutinaria previa al implante percutáneo de prótesis valvular aórtica confirmó la presencia de un segmento proximal gravemente calcificado en la descendente anterior (figura 1A; vídeo 1 del material adicional). Según la valoración funcional, los valores de la reserva fraccional de flujo fueron 0,79. La interrogación con tomografía de coherencia óptica (OCT) reveló la presencia de un arco de calcio > 180°, un grosor de 0,6 mm y una longitud > 5 mm acompañado de un nódulo calcificado y una área luminal mínima de 3,49 mm2 (figura 1C; vídeo 2 del material adicional). Se optó por una aterectomía orbital con el dispositivo estándar de AO coronaria Diamondback 360 (Cardiovascular Systems, Inc., Estados Unidos) para preparar la lesión. Tras 5 pasadas a baja velocidad (80.000 rpm), se hizo una nueva OCT que confirmó la fractura del nódulo calcificado, alcanzando un área luminal mínima de 7,5 mm2 (figura 1D; vídeo 3 del material adicional). Consecutivamente, se avanzaron 2 balones, uno semidistensible de 2,5 × 15 mm (OrbusNeich, China) y otro no distensible de 3,0...

Aims. The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. Prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. The purpose of this study was to analyze the prognostic significance of diastolic function in asymptomatic patients with sAR. Methods and results. A total of 126 patients with asymptomatic sAR were included. Conventional echocardiographic systolic and diastolic function parameters were assessed. LA auto-strain analysis was performed in a subgroup of 57 patients. During a mean follow up of 33±19 months, 25 (19,8%) patients reached the combined end-point. Univariate analysis showed that LV volumes, LVEF, E wave, E/e’ ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events. Multivariate model 1 that tested all echocardiographic variables statistically significant in the univariate model showed that LVEDV [HR=1,02;95% CI:1,01-1,03 (p<0,001)] and E/e’ ratio [HR=1,12;95% CI:1,03-1,23 (p=0,01)] were significant predictors of events. In the subgroup of patients with LA auto-strain analyzed, a second multivariate model including the previous significant variables for the first model as well as LASr, showed that LVEDV [HR=1,05;95% CI:1,01-1,08 (p=0,016)] and LASr [HR=0,8;95% CI:0,65-0,98 (p<0,035)] were the most significant predictors of cardiovascular events. Conclusions. In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LASr played a strong independent predictor role.

This is the case of a 72-year-old man with mitral and aortic mechanical prosthetic valves, chronic kidney disease, and severe pulmonary hypertension. In 2019, a mitral anterolateral paravalvular leak (PVL) was percutaneously closed with implantation of 2 devices (the AVP III 10 mm x 5 mm, and the AVP III 8 mm x 4 mm, St Jude Medical, United States) due to heart failure. The patient’s clinical progression was favorable with moderate mitral regurgitation. One year later, the patient’s symptoms worsened, and the transesophageal echocardiogram performed revealed severe mitral regurgitation due to recurrent PVL around the devices (figure 1A). A second percutaneous closure attempt was scheduled to close the PVL. The initial procedure was to implant another device next to the other devices, but they embolized into the left ventricle when the deflectable catheter touched them (figure 1B). They were captured using a gooseneck loop snare through the PVL and then retrieved using 2 sheaths in the left atrium (figure 1C). Two hours later, the patient developed hemodynamic instability, and ST-segment elevation. An emergency coronary angiogram revealed the presence of severe stenosis in the left main coronary artery (LMCA) that was not present in the previous angiogram (figure 1D). The...

The optimal duration of anticoagulation in patients with left-ventricular thrombus (LVT) is unclear. In the present study, we aimed to analyze the effect of treatment duration (≤12 months [short-term anticoagulation, (STA)] versus >12 months [long-term anticoagulation, (LTA)]) in the incidence of stroke and other secondary outcomes (acute myocardial infarction, bleeding, and mortality). Multivariate Cox regression was used to determine the association between treatment duration and stroke, adjusted for baseline embolic risk. A total of 98 cases of LVT (age 64.3 ± 12.8 years, female 18 [18%]) were identified. Sixty-one patients (62%) received LTA. Patients receiving LTA were older than those receiving STA (66.5 ± 11.6 vs 60.7 ± 13.9 years, p = 0.029), more often had atrial fibrillation (31% vs 0%, p <0.001), and had a higher CHA2DS2-VASc score (4.3 ± 1.6 vs 3.6 ± 1.6, p = 0.046). Stroke occurred in 2 and 10 patients (3% vs 27%, p <0.001), acute myocardial infarction in 2 and 3 patients (3% vs 8%, p = 0.292), bleeding in 4 and 3 patients (7% vs 8%, p = 0.773), and mortality in 12 and 7 patients (20% vs 19%, p = 0.927) in the LTA and STA groups, respectively. In multivariate analysis, after adjusting for embolic risk, LTA was associated with decreased risk of stroke at 5 years (adjusted hazard ratio 0.16; 95% confidence interval 0.03 to 0.72, p = 0.017). In conclusion, our data suggest that prolonged anticoagulation in patients with LVT may be associated with significantly lower risk of stroke.

Abstract Introduction Severe tricuspid regurgitation is a prevalent valve disease with a negative impact on the prognosis and quality of life of patients. Transcatheter tricuspid annuloplasty with band implantation is an alternative for the treatment of this pathology in patients with high surgical risk. Due to the recent development of this device, data regarding its safety are scarce. The objective of this study was to describe the adverse events and complications related to transcatheter tricuspid annuloplasty with band implantation in our center in order to assess its safety. Methods In a series of 27 patients, the incidence of adverse events related to the procedure was analysed, considering death, stroke, myocardial infarction (MI), bleeding complications (extensive or life-threatening), vascular complications (pseudoaneurism), coronary complications, device-related secondary intervention (DRSI), device-related cardiac surgery (DRCS), renal failure (RF) or conduction system disturbance (CSD). Likewise, the incidence of death and hospitalizations due to heart failure in a 15-month follow-up was evaluated. Results No deaths, stroke, MI, DRCS, RF or CSD were recorded in relation with the percutaneous band implantation. There was 1 (3.7%) bleeding related to femoral venous vascular access that required suture and compression for 30 minutes. Development of 1 (3.7%) pseudoaneurysm was observed which was resolved with ultrasound-guided thrombin injection and 2 (7.4%) perforations of the right coronary artery (1 requiring stent implantation and another one self-limited without flow compromise). There was 1 (3.7%) patient with failed band implantation and eventual percutaneous bicaval prosthesis implantation was required. After a follow-up of 15 months, 2 (7.4%) deaths from non-cardiological causes (exacerbation of chronic obstructive pulmonary disease and traumatic brain injury) and 3 (11.1%) admissions due to decompensated heart failure were documented. Conclusion Transcatheter tricuspid annuloplasty with band implantation appears to be a safe technique with a low incidence of complications for treating patients with severe tricuspide regurgitation and high surgical risk. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Gobierno de España

Abstract Introduction Transcatheter tricuspid annuloplasty is a promising therapeutic alternative for the treatment of tricuspid regurgitation (TR) in patients with a high surgical risk. To date, the published experience with percutaneous tricuspid devices is quite limited. The objective of this study is to present the impact of the transcatheter tricuspid annuloplasty with band implantation on the degree of TR and on several echocardiographic parameters in a series of 27 patients. Methods A single-center cohort of 27 patients was followed up prospectively after the transcatheter tricuspid annuloplasty with band implantation (mean follow-up: 10,39 months) (Figure 1). The degree of tricuspid regurgitation (mild, moderate, severe, massive, torrential) was measured before and after the procedure, as well as at 6 months and one year of follow-up. Other parameters have also been considered, such as the septal-lateral end-diastolic diameter of the tricuspid annulus, the vena contracta (VC), regurgitant orifice area (ROA) 2D, tricuspid annular plane systolic excursion (TAPSE), right ventricular ejection fraction (RVEF) and fractional area change (FAC). Results Initially, there were 22.3% of patients with torrential TR, 29.6% massive and 48% severe. After the procedure, these percentages were reduced to 3.8%, 7.7% and 23.1% respectively, leading to an amount of 65% of patients with mild or moderate TR. With respect to the the diameter of the lateral septum ring, the mean was initially 44.74 mm. After the procedure, it decreased to 34.5 mm (22% of reduction) and, as can be seen during follow-up, it remains stable over time. The ROA and VC were also significantly reduced while TAPSE, CAF and RVEF do not show significant changes (Figure 2). Percutaneous tricuspid annuloplasty demonstrated a notable impact on the degree of tricuspid regurgitation reduction in the patients in our study. The differences are already noticeable from the moment of the procedure and are maintained throughout the follow-up, where the stability of the diameter of the septolateral ring, the ERO and the vena contracta is observed. Funding Acknowledgement Type of funding sources: None.

Se presenta el caso de un varón de 72 años con válvulas protésicas mecánicas mitral y aórtica, insuficiencia renal crónica e hipertensión pulmonar grave. En 2019, se procedió al cierre percutáneo de una fuga periprotésica (FPP) anterolateral mitral con implante de 2 dispositivos (el AVP III 10 x 5 mm y el AVP III 8 x 4 mm, St Jude Medical, Estados Unidos) ante la presencia de insuficiencia cardiaca. La evolución clínica del paciente fue favorable con insuficiencia mitral moderada. Un año después, los síntomas empeoraron y un ecocardiograma transesofágico reveló la presencia de insuficiencia mitral grave por FPP recurrente alrededor de los dispositivos (figura 1A). Se programó un segundo intento de cierre percutáneo de la FPP. La intervención inicial consistió en implantar otro dispositivo al lado de los ya implantados, pero embolizaron dentro del ventrículo izquierdo con la manipulación del catéter guía orientable (figura 1B). Fueron capturados empleando un lazo a través de la FFP y recuperados usando 2 vainas en la aurícula izquierda (figura 1C). Dos horas después, el paciente desarrolló inestabilidad hemodinámica y elevación del segmento ST. Una angiografía coronaria de urgencia confirmó la presencia de estenosis grave en el tronco común izquierdo (TC) que no se...

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fundacion del Corazon Introduction COVID19 has emerged as a new disease, spreading around the world, leading to a complete lockdown. It is known that other infectious diseases can affect the heart inducing myocarditis. As a new entity, it was unknown if SARS-COV2 could provoke that cardiovascular manifestation. This national registry was created to describe COVID19 cardiac affection and its severity. Methods and results A multicenter registry was conducted, including 28 centers in Spain. Patients with COVID19 diagnosis presenting an acute cardiovascular event between March 1st and May 30th were included. Eighty-two patients were included. Of them, 9 (14,1%, excluding missing data) presented with acute myocarditis; the rest were diagnosed of acute myocardial infarction or stress cardiomyopathy. Baseline characteristics of these patients are summarised in Table 1. The 83,3% of patients with myocarditis presented with heart failure and 25% simulating an acute coronary syndrome. According to severity, 5 patients (62,5%) were admitted in the Intensive Care Unit, requiring orotracheal intubation 4 patients (57,1%). Left ventricle was affected in 66,7% of patients, whereas the remaining 33,3% presented biventricular failure. Mean left ventricle ejection fraction was 46% [30,0%-52%]. One patient developed refractory cardiogenic shock requiring implantation of both intra-aortic balloon pump and VA- ECMO. Three patients died during hospitalization. Cardiac magnetic resonance was conducted in 2 patients (28,6%), showing oedema and subepicardial enhacement in postero-lateral segments. Cardiac biopsy was performed in one patient showing significant lymphoid infiltration and intersticial oedema. Conclusions Patients with COVID 19 who develop acute myocarditis usually present with heart failure secondary to ventricular failure. This entity has a bad prognosis with high in-hospital mortality rate. Table 1. Baseline characteristics. n (%) Age 65,0[47,0-77,0] Sex (female) 3 (42,9%) Hypertension 3 (42,9%) Dyslipidemia 3 (42,9%) Diabetes mellitus 2 (28,6%) Chronic coronary disease 1 (14,3%) Previous stroke 1 (14,3%) Cancer 1 (14,3%)

El síndrome coronario agudo sin elevación del segmento ST (SCASEST) es un cuadro que entra dentro del diagnóstico diferencial de dolor torácico, y que debe ser correctamente diagnosticado dado su potencial riesgo para la vida del paciente. El diagnóstico se basa fundamentalmente en una correcta interpretación del electrocardiograma y de los marcadores de lesión miocárdica (troponina) en el análisis de sangre. El tratamiento debe ser precoz, incluyendo antiagregación, anticoagulación y, según la estratificación de riesgo, coronariografía.

El síndrome coronario agudo (SCA) es una causa importante de mortalidad. Es fundamental identificar a los pacientes con elevación del segmento ST (SCACEST). Estos pacientes presentan un mayor riesgo de complicaciones y es fundamental una actuación en urgencias rápida y estructurada. Entre las medidas iniciales, se debe comprobar la estabilidad hemodinámica, realizar un electrocardiograma, monitorizar al paciente y asegurar la disponibilidad de un desfibrilador. El tratamiento de los pacientes con SCACEST se basa en el tratamiento médico y la revascularización. Inicialmente, el tratamiento médico tendrá como objetivo el control sintomático y la doble antiagregación con AAS y un inhibidor de P2Y12, preferiblemente prasugrel o ticagrelor. Existen dos técnicas de revascularización: angioplastia primaria (de elección si se encuentra disponible en menos de 120 minutos) o fibrinólisis.

El envejecimiento poblacional ha llevado a un aumento de la prevalencia y la complejidad de la enfermedad cardiovascular. La presencia de una alta carga de comorbilidades es frecuente entre estos pacientes, y es un factor pronóstico importante. La evaluación de la comorbilidad se ha convertido en una preocupación, por lo que se han desarrollado índices para evaluar la comorbilidad, como el índice de comorbilidad de Charlson. Algunas de las principales comorbilidades que afectan al pronóstico de estos pacientes son: fragilidad, diabetes mellitus, enfermedad renal crónica, enfermedad pulmonar obstructiva crónica y patología inflamatoria. El peor pronóstico en estos pacientes parece estar relacionado con retrasos diagnósticos ocasionados por su clínica atípica, alteraciones analíticas y electrocardiográficas basales y una menor utilización de terapias con eficacia probada.

Abstract Background Left ventricular thrombus (LVT) is a potential complication of acute myocardial infarction and is associated with a high rate of thromboembolic events. With the advent of more potent antithrombotic medications and quicker reperfusion strategies, the incidence of LVT has been reduced. However, current guidelines recommendations are based on older evidence and some aspects of the treatment are being questioned, such as the optimal duration of anticoagulation. Purpose To determine how length of anticoagulation influences the risk of thromboembolic events and mortality in a tertiary-care cardiac center with primary percutaneous coronary intervention (PCI) capability. Methods A cohort of consecutive cases of patients with IVT diagnosed by transthoracic echocardiography between 2014 and 2020 was retrospectively analyzed. Results A total of 72 cases of LVT were identified. Etiology was ischemic cardiomyopathy in 60 (82.0%) patients and 13 (20.0%) were female. LVT was diagnosed in the setting of acute myocardial infarction in 23 (32.0%) of cases. Prolonged anticoagulation regimes were significantly associated with fewer systemic thromboembolic events (21.4% vs 6.1%; p=0.04), without a significant effect on mortality (Figure 1). Conclusion Clinical manifestations and epidemiology of LVT has recently changed after the advent of improved treatments. In our cohort, an indefinite anticoagulation strategy was significantly associated with fewer thromboembolic events, suggesting that future investigations should clarify these issues. Funding Acknowledgement Type of funding sources: None.

La combinación de insuficiencia cardíaca y cardiopatía isquémica es frecuente y se asocia a peor pronóstico. En el manejo de estos pacientes, es necesario diferenciar entre daño miocárdico e infarto agudo de miocardio tipo 1 y tipo 2, para lo cual serán fundamentales la historia clínica, el electrocardiograma y el análisis de troponina. En presencia de insuficiencia cardíaca o shock cardiogénico desencadenados por síndrome coronario agudo, está indicada la realización de una coronariografía inmediata y revascularización. El tratamiento médico del síndrome coronario agudo no difiere respecto a los pacientes sin insuficiencia cardíaca. Los pacientes con insuficiencia cardíaca y/o fracción de eyección del ventrículo izquierdo igual o inferior al 40% se benefician del tratamiento con inhibidores de la enzima convertidora de angiotensina, bloqueadores beta-adrenérgicos y antagonistas de los mineralocorticoides.

El síndrome coronario agudo sin elevación del segmento ST (SCASEST) es un cuadro provocado por una necrosis miocárdica, cuya manifestación clínica primordial es el dolor torácico. El diagnóstico de esta entidad requiere un estudio completo del paciente, incluyendo historia clínica, exploración física, electrocardiograma, ecocardiograma y analítica con marcadores de lesión miocárdica (troponina). El tratamiento en la fase aguda se sustenta en dos pilares fundamentales: antiagregación y revascularización. Posteriormente, será vital una adecuada estrategia de seguimiento y prevención secundaria.

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Off-label use of drugs with potential for QT interval prolongation was common in COVID-19 patients. We tested a portable EKG recording device to measure and monitor corrected QT (QTc) intervals in a cohort of COVID-19 patients treated with azithromycin, hydroxychloroquine, lopinavir/ritonavir, or combinations of these drugs. Methods and results Sixty-nine patients hospitalized with pneumonia and confirmed SARS-CoV 2 infection were included in an observational single-centre study. Six-lead EKG recordings were obtained using a KardiaMobile6L® at physicians’ discretion. In a subgroup of 16 patients with early discharge, a device was provided for at-home daily monitoring. Significant QTc interval prolongation was observed in patients taking a combination of 2 or 3 drugs (426 ± 33 vs 408 ± 33 ms, p = 0,002; and 435 ± 30 vs 394 ± 31 ms, p = 0,001, respectively). The use of the device prompted a change in the treatment of 9 patients (13%) because of prolongation of QTc interval and anticoagulation was started in one patient because of atrial fibrillation diagnosis. In the subgroup of patients with daily recording, QTc interval prolongation peaked at day 2 ± 1,8, with a shorter final QT interval than that recorded before drug initiation (350,0 ± 31,4 vs 381,0 ± 21,2; p = 0,019), pointing to a possible role of the disease itself in QT interval modification. To assess the consistency of measurements of QTc interval, a random sample of 120 EKG recordings were analyzed by two different physicians. Inter-operator intraclass correlation coefficient was 0,702, 95% CI (0,578-0,789). Conclusions Portable EKG-recording device was useful for QTc interval monitoring in COVID-19 patients receiving drugs with QTc prolonging potential, allowing physicians to adapt management. Significant QT prolongation was observed in these patients. Characteristics of the three groups. Group 1(one drug)N= 9 (13,0%) Group 2(two drugs)N= 37 (53,6%) Group 3(three drugs)N= 23 (33,3%) p-value Clinical characteristics Age (years) 55,0 ± 18,3 66,0 ± 16,2 58,0 ± 15,8 p = 0,248 Male sex (%) 6 (66,7%) 25 (67,6%) 18 (78,3%) p = 0,643 Dislipidaemia (%) 5 (55,6%) 9 (24,3%) 7 (30,4%) p = 0,749 Diabetes (%) 7 (77,8%) 4 (10,8%) 5 (21,7%) p = 0,525 Hypertension (%) 3 (33,3%) 16 (43,2%) 8 (34,8%) p = 0,387 Previous cardiopathy (%) 6 (66,7%) 11 (29,7%) 3 (13,0%) p = 0,305 COPD (%) 7 (77,8%) 6 (16,2%) 1 (8,7%) p = 0,679 COPDchronic obstructive pulmonary disease. Abstract Figure. Baseline and maximum QTc intervals

Los pacientes con cardiopatía isquémica, con o sin revascularización, tienen un riesgo trombótico elevado. El manejo, por tanto, se basa en diferentes combinaciones de tratamiento antitrombótico. No obstante, en numerosas ocasiones son pacientes añosos o con comorbilidades, que sufren un aumento del riesgo hemorrágico al introducir este tipo de medicación. Por ello, es importante sopesar ambos riesgos, isquémico y hemorrágico, apoyándonos en escalas de riesgo, y seleccionar, de manera individualizada, el esquema terapéutico más apropiado para cada paciente.