Ana Belen Cid Alvarez

Bio: Ana Belen Cid Alvarez is an academic researcher from University of Santiago de Compostela. The author has contributed to research in topics: Percutaneous coronary intervention & Myocardial infarction. The author has an hindex of 8, co-authored 26 publications receiving 231 citations.

In-hospital outcomes of COVID-19 ST-elevation myocardial infarction patients.

Abstract: AIMS The aim of this study was to assess clinical and prognosis differences in patients with COVID-19 and STEMI. METHODS AND RESULTS Using a nationwide registry of consecutive patients managed within 42 specific STEMI care networks, we compared patient and procedure characteristics and in-hospital outcomes in two different cohorts, according to whether or not they had COVID-19. Among 1,010 consecutive STEMI patients, 91 were identified as having COVID-19 (9.0%). With the exception of smoking status (more frequent in non-COVID-19 patients) and previous coronary artery disease (more frequent in COVID-19 patients), clinical characteristics were similar between the groups, but COVID-19 patients had more heart failure on arrival (31.9% vs 18.4%, p=0.002). Mechanical thrombectomy (44% vs 33.5%, p=0.046) and GP IIb/IIIa inhibitor administration (20.9% vs 11.2%, p=0.007) were more frequent in COVID-19 patients, who had an increased in-hospital mortality (23.1% vs 5.7%, p<0.0001), that remained consistent after adjustment for age, sex, Killip class and ischaemic time (OR 4.85, 95% CI: 2.04-11.51; p<0.001). COVID-19 patients had an increase of stent thrombosis (3.3% vs 0.8%, p=0.020) and cardiogenic shock development after PCI (9.9% vs 3.8%, p=0.007). CONCLUSIONS Our study revealed a significant increase in in-hospital mortality, stent thrombosis and cardiogenic shock development after PCI in patients with STEMI and COVID-19 in comparison with contemporaneous non-COVID-19 STEMI patients.

Registro Español de Hemodinámica y Cardiología Intervencionista. XXVII Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2017)

Abstract: Resumen Introduccion y objetivos La Seccion de Hemodinamica y Cardiologia Intervencionista presenta su informe anual con los datos del registro de actividad de 2017. Metodos Los centros espanoles con laboratorio de hemodinamica proporcionan sus datos voluntariamente. La informacion se introduce online y la analiza la Junta Directiva de la Seccion de Hemodinamica y Cardiologia Intervencionista. Resultados Han participado en el registro nacional 107 centros, 82 de ellos, publicos. Se realizaron 154.218 estudios diagnosticos, entre ellos 138.448 coronariografias, un 2,2% mas que en 2016. Se registro un incremento significativo en la utilizacion de tecnicas de diagnostico intracoronarias, especialmente en la guia de presion (el 23,2% mas que en 2016, n = 7.003). Los procedimientos intervencionistas coronarios aumentaron un 3,2%, y se registraron 70.928. De ellos, 21.395 fueron en el infarto agudo de miocardio. Se implantaron 105.529 stents (el 90,3% farmacoactivos, un 6% mas que en 2016). El acceso radial alcanzo el 85,7% de los procedimientos diagnosticos y el 88,4% de los intervencionistas. En intervencionismo estructural, destaca un aumento del 28,2% (n = 2.821) en implante transcateter de valvula aortica, del 14,1% (n = 270) en reparacion percutanea de la valvula mitral y del 14,8% (n = 582) en cierre de orejuela izquierda. Conclusiones En 2017 se ha registrado un incremento en los procedimientos diagnosticos y terapeuticos en intervencionismo coronario, a expensas de un aumento de intervenciones en el infarto agudo de miocardio. Destaca el alto porcentaje de abordaje radial y el mayor uso de stents farmacoactivos. El intervencionismo estructural presenta un aumento significativo con respecto a anos anteriores.

Registro Español de Hemodinámica y Cardiología Intervencionista. XXVIII Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2018)

Abstract: Resumen Introduccion y objetivos La Seccion de Hemodinamica y Cardiologia Intervencionista presenta su informe anual con los datos del registro de actividad correspondiente a 2018. Metodos Los centros espanoles con laboratorio de hemodinamica proporcionan sus datos voluntariamente. La informacion se introduce online y la analiza la Junta Directiva de la Seccion de Hemodinamica y Cardiologia Intervencionista. Resultados Han participado en el registro nacional 109 centros, de los cuales 83 son publicos. Se realizaron 157.632 estudios diagnosticos, entre ellos 140.670 coronariografias, un 1,6% mas que en 2017. Los procedimientos intervencionistas coronarios aumentaron en un 2,2% (n = 72.520), y se registro un incremento en la complejidad del intervencionismo: del 10,6% en el tratamiento de oclusiones cronicas y del 4,2% en tronco no protegido. Se realizaron en total 21.261 procedimientos en infarto agudo de miocardio, de los cuales un 91% fueron angioplastias primarias (el 9,6% mas que en el ano previo). El acceso radial alcanzo el 89,4% de los procedimientos intervencionistas. En intervencionismo estructural, destaca un incremento en el implante percutaneo de valvula aortica del 25,3% (n = 3.537), en las reparaciones percutaneas de la valvula mitral del 21,4% (n = 328), en los cierres de la orejuela izquierda del 10,6% (n = 644) y en los cierres del foramen oval permeable del 81% (n = 514). Conclusiones En 2018 se ha registrado un incremento en los procedimientos diagnosticos y terapeuticos en intervencionismo coronario, especialmente en angioplastia primaria. Destaca el alto porcentaje de abordaje radial y el incremento en intervencionismo complejo. El intervencionismo estructural continua con el crecimiento exponencial registrado en anos anteriores.

Spanish Cardiac Catheterization and Coronary Intervention Registry. 27th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2017)

Abstract: Introduction and objectives To present the annual report of the Working Group on Cardiac Catheterization and Interventional Cardiology on the activity data for 2017. Methods Data were voluntarily provided by Spanish centers with a catheterization laboratory. The information was introduced online and was analyzed by the Steering Committee of the Working Group on Cardiac Catheterization and Interventional Cardiology. Results In 2017, data were reported by 107 hospitals, of which 82 are public. A total of 154 218 diagnostic procedures (138 448 coronary angiograms) were performed (2.2% increase vs 2016). The use of intracoronary diagnostic techniques significantly increased, especially that of pressure wire (23.2% vs 2016, n = 7003). In 2017, the number of percutaneous coronary interventions rose to 70 928 (3.2% increase), of which 21 395 interventional procedures were performed in the acute myocardial infarction setting. A total of 105 529 stents were implanted, of which 90.3% were drug-eluting stents (6% increase). Radial access was used in 85.7% of diagnostic procedures and in 88.4% of interventional procedures. The number of transcatheter aortic valve implantations continued to increase (28.2% increase, n = 2821), as did the number of left atrial appendage closures (14.8% increase, n = 582) and percutaneous mitral valve repair procedures (14.1% increase, n = 270). Conclusions Diagnostic and therapeutic procedures in acute myocardial infarction increased in 2017. The use of the radial approach and drug-eluting stents also increased in therapeutic procedures. The number of structural procedures rose significantly compared with previous years.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Abstract: Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline

Abstract: Objective: The aim was to formulate clinical practice guidelines for pheochromocytoma and paraganglioma (PPGL). Participants: The Task Force included a chair selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), seven experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. The Task Force reviewed primary evidence and commissioned two additional systematic reviews. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, European Society of Endocrinology, and Americal Association for Clinical Chemistry reviewed drafts of the guidelines. Conclusions: The Task Force recommends that initial biochemical testing for PPGLs shou...

Biochemical diagnosis of pheochromocytoma: which test is best?

Abstract: ContextDiagnosis of pheochromocytoma depends on biochemical evidence of catecholamine production by the tumor. However, the best test to establish the diagnosis has not been determined.ObjectiveTo determine the biochemical test or combination of tests that provides the best method for diagnosis of pheochromocytoma.Design, Setting, and ParticipantsMulticenter cohort study of patients tested for pheochromocytoma at 4 referral centers between 1994 and 2001. The analysis included 214 patients in whom the diagnosis of pheochromocytoma was confirmed and 644 patients who were determined to not have the tumor.Main Outcome MeasuresTest sensitivity and specificity, receiver operating characteristic curves, and positive and negative predictive values at different pretest prevalences using plasma free metanephrines, plasma catecholamines, urinary catecholamines, urinary total and fractionated metanephrines, and urinary vanillylmandelic acid.ResultsSensitivities of plasma free metanephrines (99% [95% confidence interval {CI}, 96%-100%]) and urinary fractionated metanephrines (97% [95% CI, 92%-99%]) were higher than those for plasma catecholamines (84% [95% CI, 78%-89%]), urinary catecholamines (86% [95% CI, 80%-91%]), urinary total metanephrines (77% [95% CI, 68%-85%]), and urinary vanillylmandelic acid (64% [95% CI, 55%-71%]). Specificity was highest for urinary vanillylmandelic acid (95% [95% CI, 93%-97%]) and urinary total metanephrines (93% [95% CI, 89%-97%]); intermediate for plasma free metanephrines (89% [95% CI, 87%-92%]), urinary catecholamines (88% [95% CI, 85%-91%]), and plasma catecholamines (81% [95% CI, 78%-84%]); and lowest for urinary fractionated metanephrines (69% [95% CI, 64%-72%]). Sensitivity and specificity values at different upper reference limits were highest for plasma free metanephrines using receiver operating characteristic curves. Combining different tests did not improve the diagnostic yield beyond that of a single test of plasma free metanephrines.ConclusionPlasma free metanephrines provide the best test for excluding or confirming pheochromocytoma and should be the test of first choice for diagnosis of the tumor.

Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?

Abstract: Objective: To assess the performance of current clinical recommendations for the evaluation of an adrenal incidentaloma. Design and methods: Literature review. Electronic databases (Pubmed, Ovid and citation searches from key articles) from 1980 to 2008 were searched. Eligible studies were those deemed most applicable to the clinical scenario of a patient referred to an endocrinologist for assessment of an incidentally detected adrenal mass. Surgical series, histopathological series and oncological series were reviewed and most were excluded. Results: The prevalence of functional and malignant lesions presenting as adrenal incidentaloma was similar to that quoted in most reviews, other than a lower incidence of adrenal carcinoma (1.9 vs 4.7%) and metastases (0.7 vs 2.3%). The development of functionality or malignancy during follow-up was rare (!1% becoming functional and 0.2% becoming malignant). During follow-up, false-positive rates of the recommended investigations are typically 50 times greater than true positive rates. The average recommended computed tomography (CT) scan follow-up exposes each patient to 23 mSv of ionising radiation, equating to a 1 in 430 to 2170 chance of causing fatal cancer. This is similar to the chance of developing adrenal malignancy during 3-year follow-up of adrenal incidentaloma. Conclusion: Current recommendations for evaluation of adrenal incidentaloma are likely to result in significant costs, both financial and emotional, due to high false-positive rates. The dose of radiation involved in currently recommended CT scan follow-up confers a risk of fatal cancer that is similar to the risk of the adrenal becoming malignant. This argues for a review of current guidelines.

A current review of the etiology, diagnosis, and treatment of pediatric pheochromocytoma and paraganglioma.

Abstract: Context: Pheochromocytomas and paragangliomas (PHEO/PGL) are neuroendocrine tumors that arise from sympathetic and parasympathetic paraganglia. Diagnosed rarely during childhood, PHEO/PGL are nonetheless important clinical entities, particularly given our evolving understanding of their pathophysiology. Evidence Acquisition: We identified articles through the U.S. National Library of Medicine by using the search terms pheochromocytoma and paraganglioma. Results were narrowed to manuscripts that included children and studies related to the genetics of PHEO/PGL. Web-based resources for genetic disorders were also used. For all articles, we performed subsequent reference searches and verification of source data. Evidence Synthesis: Up to 20% of PHEO/PGL are diagnosed in children. Most are functional tumors, and clinical presentation includes symptoms related to catecholamine hypersecretion and/or tumor mass effect. Increasingly, PHEO/PGL are identified during presymptomatic screening in children with genetic...