José C. Sánchez-Salado

Bio: José C. Sánchez-Salado is an academic researcher from Bellvitge University Hospital. The author has contributed to research in topics: Myocardial infarction & Cardiogenic shock. The author has an hindex of 14, co-authored 56 publications receiving 600 citations. Previous affiliations of José C. Sánchez-Salado include University of Barcelona.

A multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the FROST-I trial

Abstract: To obtain initial data on the effect of different levels of targeted temperature management (TTM) in out-of-hospital cardiac arrest (OHCA). We designed a multicentre pilot trial with 1:1:1 randomization to either 32 °C (n = 52), 33 °C (n = 49) or 34 °C (n = 49), via endovascular cooling devices during a 24-h period in comatose survivors of witnessed OHCA and initial shockable rhythm. The primary endpoint was the percentage of subjects surviving with good neurologic outcome defined by a modified Rankin Scale (mRS) score of ≤ 3, blindly assessed at 90 days. At baseline, different proportions of patients who had received defibrillation administered by a bystander were assigned to groups of 32 °C (13.5%), 33 °C (34.7%) and 34 °C (28.6%; p = 0.03). The percentage of patients with an mRS ≤ 3 at 90 days (primary endpoint) was 65.3, 65.9 and 65.9% in patients assigned to 32, 33 and 34 °C, respectively, non-significant (NS). The multivariate Cox proportional hazards model identified two variables significantly related to the primary outcome: male gender and defibrillation by a bystander. Among the 43 patients who died before 90 days, 28 died following withdrawal of life-sustaining therapy, as follows: 7/16 (43.8%), 10/13 (76.9%) and 11/14 (78.6%) of patients assigned to 32, 33 and 34 °C, respectively (trend test p = 0.04). All levels of cooling were well tolerated. There were no statistically significant differences in neurological outcomes among the different levels of TTM. However, future research should explore the efficacy of TTM at 32 °C. ClinicalTrials.gov unique identifier: NCT02035839 ( http://clinicaltrials.gov ).

Impacto en tiempos de actuación y perfil de los pacientes tratados con angioplastia primaria en el área metropolitana sur de Barcelona al implantar el programa Código Infarto

Abstract: Resumen Introduccion y objetivos Desde junio de 2009 se ha implantado en Cataluna el Codigo Infarto, mediante el cual se plantea a los pacientes con infarto agudo de miocardio con elevacion del ST en las primeras 12 h de evolucion la realizacion de angioplastia primaria. El objetivo es describir el impacto de aplicar el Codigo Infarto a los pacientes atendidos en nuestro centro en cuanto a volumen, tiempos de actuacion y perfil clinico en comparacion con el periodo previo. Metodos Registro prospectivo de pacientes sometidos a angioplastia primaria en nuestro centro. Analisis de caracteristicas clinicas, tiempos de actuacion y mortalidad en el seguimiento de la fase de aplicacion del Codigo Infarto (junio de 2009-mayo de 2010) y comparacion con el ano previo (junio de 2008-mayo de 2009). Resultados En el periodo del Codigo Infarto se incluyo a 514 pacientes (241 el ano previo). Edad, factores de riesgo, extension de la enfermedad coronaria, infarto anterior y caracteristicas del procedimiento fueron similares en los dos grupos. Se observo una disminucion del tiempo desde el primer contacto medico a la apertura de la arteria (120 frente a 88 min; p Conclusiones La implantacion del Codigo Infarto ha aumentado el numero de pacientes tratados mediante angioplastia primaria, con una reduccion en los tiempos de actuacion y una mejora en el perfil clinico a su llegada.

Eficacia de los scores de riesgo hemorrágico en el paciente anciano con síndrome coronario agudo

Abstract: Resumen Introduccion y objetivos La incidencia de sindrome coronario agudo en pacientes ancianos es elevada Las complicaciones hemorragicas empeoran el pronostico en este escenario; a pesar de ello, los scores de riesgo hemorragico disponibles no han sido validados especificamente en este subgrupo Nuestro objetivo es analizar la capacidad predictiva de los principales scores de riesgo hemorragico en pacientes de edad ≥ 75 anos Metodos Inclusion prospectiva de pacientes con sindrome coronario agudo consecutivos Se registraron caracteristicas basales, datos analiticos y hemodinamicos y la incidencia intrahospitalaria de hemorragias utilizando las definiciones CRUSADE, Mehran, ACTION y BARC Se calcularon los scores CRUSADE, Mehran y ACTION de cada paciente y se analizo su capacidad predictiva de hemorragias mediante regresion logistica binaria, calculo de curvas receiver operating characteristic y areas bajo la curva Resultados Se incluyo a 2036 pacientes con una media de edad de 62,1 anos; el 18,1% (369 pacientes) era ≥ 75 anos Este subgrupo presentaba mayor riesgo hemorragico (CRUSADE, 42 frente a 22; Mehran, 25 frente a 15; ACTION, 36 frente a 28; p Conclusiones Los scores de riesgo hemorragico actualmente disponibles mostraron en el paciente anciano con sindrome coronario agudo un rendimiento claramente inferior al observado en pacientes mas jovenes

Efficacy of Bleeding Risk Scores in Elderly Patients with Acute Coronary Syndromes

Abstract: Introduction and objectives The incidence of acute coronary syndromes is high in the elderly population. Bleeding is associated with a poorer prognosis in this clinical setting. The available bleeding risk scores have not been validated specifically in the elderly. Our aim was to assess predictive ability of the most important bleeding risk scores in patients with acute coronary syndrome aged ≥ 75 years. Methods We prospectively included consecutive acute coronary syndromes patients. Baseline characteristics, laboratory findings, and hemodynamic data were collected. In-hospital bleeding was defined according to CRUSADE, Mehran, ACTION, and BARC definitions. CRUSADE, Mehran, and ACTION bleeding risk scores were calculated for each patient. The ability of these scores to predict major bleeding was assessed by binary logistic regression, receiver operating characteristic curves, and area under the curves. Results We included 2036 patients, with mean age of 62.1 years; 369 patients (18.1%) were ≥ 75 years. Older patients had higher bleeding risk (CRUSADE, 42 vs 22; Mehran, 25 vs 15; ACTION, 36 vs 28; P P =.250). The predictive ability of these 3 scores was lower in the elderly (area under the curve, CRUSADE: 0.63 in older patients, 0.81 in young patients; P = .027; Mehran: 0.67 in older patients, 0.73 in younger patients; P = .340; ACTION: 0.58 in older patients, 0.75 in younger patients; P = .041). Conclusions Current bleeding risk scores showed poorer predictive performance in elderly patients with acute coronary syndromes than in younger patients.

General Cardiology AbstractsPredictors of major bleeding in acute coronary syndromes: the global registry of acute coronary events (GRACE)

Abstract: AIMS There have been no large observational studies attempting to identify predictors of major bleeding in patients with acute coronary syndromes (ACS), particularly from a multinational perspective. The objective of our study was thus to develop a prediction rule for the identification of patients with ACS at higher risk of major bleeding. METHODS AND RESULTS Data from 24045 patients from the Global Registry of Acute Coronary Events (GRACE) were analysed. Factors associated with major bleeding were identified using logistic regression analysis. Predictive models were developed for the overall patient population and for subgroups of patients with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. The overall incidence of major bleeding was 3.9% (4.8% in patients with STEMI, 4.7% in patients with NSTEMI and 2.3% in patients with unstable angina). Advanced age, female sex, history of bleeding, and renal insufficiency were independently associated with a higher risk of bleeding (P<0.01). The association remained after adjustment for hospital therapies and performance of invasive procedures. After adjustment for a variety of potential confounders, major bleeding was significantly associated with an increased risk of hospital death (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.28). CONCLUSIONS In routine clinical practice, major bleeding is a relatively frequent non-cardiac complication of contemporary therapy for ACS and it is associated with a poor hospital prognosis. Simple baseline demographic and clinical characteristics identify patients at increased risk of major bleeding.

Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention : A Consensus Document From the Academic Research Consortium for High Bleeding Risk

Abstract: Identification and management of patients at high bleeding risk undergoing percutaneous coronary intervention are of major importance, but a lack of standardization in defining this population limi ...

A validated prediction model for all forms of acute coronary syndrome: Estimating the risk of 6-month postdischarge death in an international registry

Abstract: CONTEXT Accurate estimation of risk for untoward outcomes after patients have been hospitalized for an acute coronary syndrome (ACS) may help clinicians guide the type and intensity of therapy. OBJECTIVE To develop a simple decision tool for bedside risk estimation of 6-month mortality in patients surviving admission for an ACS. DESIGN, SETTING, AND PATIENTS A multinational registry, involving 94 hospitals in 14 countries, that used data from the Global Registry of Acute Coronary Events (GRACE) to develop and validate a multivariable stepwise regression model for death during 6 months postdischarge. From 17,142 patients presenting with an ACS from April 1, 1999, to March 31, 2002, and discharged alive, 15,007 (87.5%) had complete 6-month follow-up and represented the development cohort for a model that was subsequently tested on a validation cohort of 7638 patients admitted from April 1, 2002, to December 31, 2003. MAIN OUTCOME MEASURE All-cause mortality during 6 months postdischarge after admission for an ACS. RESULTS The 6-month mortality rates were similar in the development (n = 717; 4.8%) and validation cohorts (n = 331; 4.7%). The risk-prediction tool for all forms of ACS identified 9 variables predictive of 6-month mortality: older age, history of myocardial infarction, history of heart failure, increased pulse rate at presentation, lower systolic blood pressure at presentation, elevated initial serum creatinine level, elevated initial serum cardiac biomarker levels, ST-segment depression on presenting electrocardiogram, and not having a percutaneous coronary intervention performed in hospital. The c statistics for the development and validation cohorts were 0.81 and 0.75, respectively. CONCLUSIONS The GRACE 6-month postdischarge prediction model is a simple, robust tool for predicting mortality in patients with ACS. Clinicians may find it simple to use and applicable to clinical practice.

Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk

Abstract: Identification and management of patients at high bleeding risk undergoing percutaneous coronary intervention are of major importance, but a lack of standardization in defining this population limits trial design, data interpretation, and clinical decision-making. The Academic Research Consortium for High Bleeding Risk (ARC-HBR) is a collaboration among leading research organizations, regulatory authorities, and physician-scientists from the United States, Asia, and Europe focusing on percutaneous coronary intervention-related bleeding. Two meetings of the 31-member consortium were held in Washington, DC, in April 2018 and in Paris, France, in October 2018. These meetings were organized by the Cardiovascular European Research Center on behalf of the ARC-HBR group and included representatives of the US Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, as well as observers from the pharmaceutical and medical device industries. A consensus definition of patients at high bleeding risk was developed that was based on review of the available evidence. The definition is intended to provide consistency in defining this population for clinical trials and to complement clinical decision-making and regulatory review. The proposed ARC-HBR consensus document represents the first pragmatic approach to a consistent definition of high bleeding risk in clinical trials evaluating the safety and effectiveness of devices and drug regimens for patients undergoing percutaneous coronary intervention.