1er Hospital con Angioplastia Primaria Sistemática

Eulogio García

Inspiración: “In Laboratory events during primary angioplasty“ Kahn/Haztler group . Circulation, 1991

Motivación: Incrementar actividad C. Intervencionista

 Apoyo: Jefe de servicio ( J.L. Delcán) dirección, enfermería

 Oposición: Médicos U.C. y el club t-pa 

Julio 1991. Hospital Universitario Gregorio Marañón

Compromiso

Estudio Randomizado de Infarto Anterior ( AP vs t-pa )

Paciente con menos de 5 horas desde comienzo del dolor

Los pacientes con IAM anterior y contraindicación fibrinolisis…AP

Pacientes con infartos extensos…AP

Pacientes con Killip 3-4…AP

Muy pronto…todos AP. Dificultad para incluir pacientes en protocolo

Impacto

Incremento actividad 25%

Recelo exterior

Debates

Dificultad en convencer autoridades de establecimiento de redes

Rentabilidad : mejoría progresiva de resultados y producción científica

Acumulación de experiencia clínica

1. Capacidad de respuesta : 40 minutos llamada – balón

2. Establecimiento de sistemática de trabajo ( condicionamiento clínico )

3. 1991-2000 : más de 2000 casos realizados4. Introducción de cambios en tratamiento :

stent, antiplaquetarios, aspiración …etc5. Tratamiento de elección en cualquier

contexto clínico

NUMEROS ( 1991-2007)

Procedimientos : 3750

Stents : 3300

Dispositivos de aspiración : 392

Balones de contrapulsación : 330

Médicos tratados : 25

Políticos tratados : 12

Debates científicos

Congreso nacional SEC ( Madrid 1995 )

Congresos regionales

Congreso nacional SEC ( 1998 )

Eulogio García Hospital Gregorio Marañon

MADRID

Eulogio García MDHospital Gregorio Marañon

MADRID - Spain

CONVENCIMIENTO ADMINISTRATIVO

1. Situación geográfica idónea

2. Sistema de trasporte médico adecuado

3. Población concentrada

4. Hospitales preparados,

con experiencia, geográficamente

bien situados

Tiene Madrid los medios necesarios ?

Con tiempos de traslado razonables, los resultados de ACTP primaria post –traslado son superiores al tratamiento trombolítico in situ.

A la espera de resultados de angioplastia facilitada, parece razonable el tratamiento antiagragante pre-traslado.

Las premisas anteriores y experiencia en otras disciplinas ( trauma, cancer ) indican la necesidad urgente de centros de infarto.

CONCLUSIONES

INICIATIVAS Y RESPUESTAS

1. Sesiones de información y proyectos

2. Elaboración de programa de colaboración

3. Buena acogida de la iniciativa

COLABORACIÓN CON SISTEMAS DE TRASPORTE

RESPUESTA ADMINISTRATIVA

RIMA Proyecto presentado en 2001 :

Respuesta : Silencio

Razones : Proyecto inadecuado ?, Argumentación poco convincente?

Temor al gasto ? Influencias negativas ajenas ?

EDITORIAL  

[Primary angioplasty: this balloon is of general interest, indeed]. Eulogio García Revista Esp de

Cardiologia 07/2002; 55(6):565-7. · 3.20 Impact Factor

ESTUDIOS MONOCENTRICOS 

[Primary coronary angioplasty in acute anterior myocardial infarction: immediate results].E J García, J L Delcán, J Elízaga, M Abeytua, J Soriano, J A García Robles, J Botas, L López-Bescós, T Echeverría, A Beloscar[show abstract]Revista Espa de Cardiologia 02/1994; 47(1):40-6. · 3.20 Impact Factor   Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction.E García, J Elízaga, N Pérez-Castellano, J A Serrano, J Soriano, M Abeytua, J Botas, R Rubio, E López de Sá, J L López-Sendón, J L Delcán[Show abstract]Journal of the American College of Cardiology 03/1999; 33(3):605-11. · 14.09 Impact Factor

METANÁLISIS

Comparison of Primary Coronary Angioplasty and Intravenous Thrombolytic Therapy for Acute Myocardial InfarctionA Quantitative ReviewW. Douglas Weaver, R. John Simes, Amadeo Betriu, Cindy L. Grines, Felix Zijlstra, Eulogio Garcia, Lilliana Grinfeld, Raymond J. Gibbons, Expedito E. Ribeiro, Marcus A. DeWood, Flavio Ribichini[show abstract]JAMA The Journal of the American Medical Association 278(23):2093-2098. · 29.98 Impact Factor 

ESTUDIOS MULTICENTRICOS

Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group.C L Grines, D A Cox, G W Stone, E Garcia, L A Mattos, A Giambartolomei, B R Brodie, O Madonna, M Eijgelshoven, A J Lansky, W W O'Neill, M C Morice[Show abstract]New England Journal of Medicine 12/1999; 341(26):1949-56. · 51.66 Impact Factor   Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction.Gregg W Stone, Cindy L Grines, David A Cox, Eulogio Garcia, James E Tcheng, John J Griffin, Giulio Guagliumi, Thomas Stuckey, Mark Turco, John D Carroll, Barry D Rutherford, Alexandra J Lansky[show abstract]New England Journal of Medicine 04/2002; 346(13):957-66. · 51.66 Impact Factor

ROTURA CARDIACA

Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction.Raúl Moreno, José López-Sendón, Eulogio García, Leopoldo Pérez de Isla, Esteban López de Sá, Ana Ortega, Mar Moreno, Rafael Rubio, Javier Soriano, Manuel Abeytua, Miguel-Angel García-Fernández[show abstract]Journal of the American College of Cardiology 02/2002; 39(4):598-603. · 14.09 Impact Factor Frequency of left ventricular free-wall rupture in patients with acute myocardial infarction treated with primary angioplasty.R Moreno, E López de Sá, J L López-Sendón, E García, J Soriano, M Abeytua, J Elízaga, J Botas, R Rubio, M Moreno, M A García-Fernández, J L Delcán[Show abstract]The American Journal of Cardiology 04/2000; 85(6):757-60, A8. · 3.21 Impact Factor  

CIRCULACION COLATERAL

Influence of collateral circulation on in-hospital death from anterior acute myocardial infarction.N Pérez-Castellano, E J García, M Abeytua, J Soriano, J A Serrano, J Elízaga, J Botas, J L López-Sendón, J L Delcán[show abstract]Journal of the American College of Cardiology 03/1998; 31(3):512-8. · 14.09 Impact Factor 

EDAD Y SEXOOutcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.Giulio Guagliumi, Gregg W Stone, David A Cox, Thomas Stuckey, James E Tcheng, Mark Turco, Giuseppe Musumeci, John J Griffin, Alexandra J Lansky, Roxana Mehran, Cindy L Grines, Eulogio Garcia[show abstract]Circulation 09/2004; 110(12):1598-604. · 15.20 Impact Factor

Gender differences in outcomes after primary angioplasty versus primary stenting with and without abciximab for acute myocardial infarction: results of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.Alexandra J Lansky, Cody Pietras, Ricardo A Costa, Yoshihiro Tsuchiya, Bruce R Brodie, David A Cox, Eve D Aymong, Thomas D Stuckey, Eulogio Garcia, James E Tcheng, Roxana Mehran, Manuela Negoita, Martin Fahy, Ecaterina Cristea, Mark Turco, Martin B Leon, Cindy L Grines, Gregg W Stone[show abstract]Circulation 04/2005; 111(13):1611-8. · 15.20 Impact Factor

PERFUSION MIOCÁRDICA Combined prognostic utility of ST-segment recovery and myocardial blush after primary percutaneous coronary intervention in acute myocardial infarction.Paul Sorajja, Bernard J Gersh, Costantino Costantini, Michael G McLaughlin, Peter Zimetbaum, David A Cox, Eulogio Garcia, James E Tcheng, Roxana Mehran, Alexandra J Lansky, David E Kandzari, Cindy L Grines, Gregg W Stone[show abstract]European Heart Journal 05/2005; 26(7):667-74. · 14.10 Impact Factor

Relationship between infarct artery location, epicardial flow, and myocardial perfusion after primary percutaneous revascularization in acute myocardial infarction.David E Kandzari, James E Tcheng, Bernard J Gersh, David A Cox, Thomas Stuckey, Mark Turco, Roxana Mehran, Eulogio Garcia, Peter Zimetbaum, Michael G McGlaughlin, Alexandra J Lansky, Costantino O Costantini, Cindy L Grines, Gregg W Stone[show abstract]American heart journal 06/2006; 151(6):1288-95. · 4.65 Impact Factor

Impact of ST-segment resolution after primary angioplasty on outcomes after myocardial infarction in elderly patients: an analysis from the CADILLAC trial.Abhiram Prasad, Gregg W Stone, Eve Aymong, Peter J Zimetbaum, Michael McLaughlin, Roxana Mehran, Eulogio Garcia, James E Tcheng, David A Cox, Cindy L Grines, Bernard J Gersh [show abstract]American heart journal 04/2004; 147(4):669-75. · 4.65 Impact Factor 

PERFUSION MIOCÁRDICA

Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.Michael G McLaughlin, Gregg W Stone, Eve Aymong, Graham Gardner, Roxana Mehran, Alexandra J Lansky, Cindy L Grines, James E Tcheng, David A Cox, Thomas Stuckey, Eulogio Garcia, Giulio Guagliumi, Mark Turco, Mark E Josephson, Peter Zimetbaum[show abstract]Journal of the American College of Cardiology 09/2004; 44(6):1215-23. · 14.09 Impact Factor

Frequency, correlates, and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction.Costantino O Costantini, Gregg W Stone, Roxana Mehran, Eve Aymong, Cindy L Grines, David A Cox, Thomas Stuckey, Mark Turco, Bernard J Gersh, James E Tcheng, Eulogio Garcia, John J Griffin, Giulio Guagliumi, Martin B Leon, Alexandra J Lansky[show abstract]Journal of the American College of Cardiology 08/2004; 44(2):305-12. · 14.09 Impact Factor 

PLATELETS

Impact of in-hospital acquired thrombocytopenia in patients undergoing primary angioplasty for acute myocardial infarction.

Eugenia Nikolsky, H Mehrdad Sadeghi, Mark B Effron, Roxana Mehran, Alexandra J Lansky, Yingbo Na, David A Cox, Eulogio Garcia, James E Tcheng, John J Griffin, Thomas D Stuckey, Mark Turco, John D Carroll, Cindy L Grines, Gregg W Stone[show abstract]The American Journal of Cardiology 08/2005; 96(4):474-81. · 3.21 Impact Factor Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial).

Eugenia Nikolsky, Cindy L Grines, David A Cox, Eulogio Garcia, James E Tcheng, Mehrdad Sadeghi, Roxana Mehran, Alexandra J Lansky, Yingbo Na, Gregg W Stone[show abstract]The American Journal of Cardiology 04/2007; 99(8):1055-61. · 3.21 Impact Factor

REOPROBenefits and risks of abciximab use in primary angioplasty for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.James E Tcheng, David E Kandzari, Cindy L Grines, David A Cox, Mark Effron, Eulogio Garcia, John J Griffin, Giulio Guagliumi, Thomas Stuckey, Mark Turco, Martin Fahy, Alexandra J Lansky, Roxana Mehran, Gregg W Stone[show abstract]Circulation 10/2003; 108(11):1316-23. · 15.20 Impact FactorImpact of stenting and abciximab in patients with diabetes mellitus undergoing primary angioplasty in acute myocardial infarction (the CADILLAC trial).Thomas D Stuckey, Gregg W Stone, David A Cox, James E Tcheng, Eulogio Garcia, John Carroll, Giulio Guagliumi, Barry D Rutherford, John J Griffin, Mark Turco, Alexandra J Lansky, Roxana Mehran, Martin Fahy, Bruce R Brodie, Cindy L Grines[show abstract]The American Journal of Cardiology 02/2005; 95(1):1-7. · 3.21 Impact FactorOutcomes following bail-out abciximab administration during primary intervention in acute myocardial infarction (The CADILLAC Trial).Dale T Ashby, Eve A Aymong, James E Tcheng, Cindy L Grines, David A Cox, Roxana Mehran, Eulogio Garcia, John J Griffin, Giulio Guagliumi, Thomas Stuckey, Mark Turco, Alexandra J Lansky, Gregg W Stone[show abstract]The American Journal of Cardiology 12/2003; 92(9):1091-4. · 3.21 Impact Factor

ASPIRACION DE TROMBO STENT.

Mid-term results of thrombus extraction in patients with ST elevation myocardial infarction: One center experience with the X-SIZER catheter systemEulogio Garcia, Alejandro Alvarez, Jose M. Cubero, Agustin LaCorte, Manuel Abeytua, Jose L. Lopez-Sendon, Esteban Lopez de Sa, Amalia MotaJournal of the American College of Cardiology , 2003; 41:356. · 14.09 Impact Factor

XAMINE ST trial T. Lefevre, E. Garcia, Reimers B et al. JACC 2005;46:246-252. 14.09 Impact factor

Journal of the American College of Cardiology,

[Results of coronary stenting in acute myocardial infarction].R Moreno, E García, J Soriano, M Abeytua, J Elízaga, J Botas, J L López Sendón, J L Delcán[Show abstract]Revista Espa de Cardiologia 01/2000; 53(1):27-34. · 3.20 Impact Factor

NEUTROPHILS

Relation between leucocyte count, myonecrosis, myocardial perfusion, and outcomes following primary angioplasty.

Abhiram Prasad, Gregg W Stone, Thomas D Stuckey, Costantino O Costantini, Roxana Mehran, Eulogio Garcia, James E Tcheng, David A Cox, Cindy L Grines, Alexandra J Lansky, Bernard J Gersh[show abstract]The American Journal of Cardiology 04/2007; 99(8):1067-71. · 3.21 Impact Factor 

Neutrophil count and infarct size in patients with acute myocardial infarction.

Pablo Avanzas, Juan Quiles, Esteban López de Sá, Ana Sánchez, Rafael Rubio, Eulogio García, José Luis López-SendónInternational Journal of Cardiology 11/2004; 97(1):155-6. · 5.51 Impact Factor

MULTIVASO, SHOCK.

[Results of primary angioplasty in patients with multivessel disease].R Moreno, E García, J Elízaga, M Abeytua, J Soriano, J Botas, J L López-Sendón, J L Delcán[Show abstract]Revista Espa de Cardiologia 07/1998; 51(7):547-55. · 3.20 Impact Factor 

Efficacy of invasive strategy for the management of acute myocardial infarction complicated by cardiogenic shock.N Pérez-Castellano, E García, J A Serrano, J Elízaga, J Soriano, M Abeytua, J Botas, R Rubio, E López de Sá, J L López-Sendón, J L Delcán[Show abstract]The American Journal of Cardiology 05/1999; 83(7):989-93. · 3.21 Impact Factor 

INSUFICIENCIA RENAL

Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction.H Mehrdad Sadeghi, Gregg W Stone, Cindy L Grines, Roxana Mehran, Simon R Dixon, Alexandra J Lansky, Martin Fahy, David A Cox, Eulogio Garcia, James E Tcheng, John J Griffin, Thomas D Stuckey, Mark Turco, John D Carroll[show abstract]Circulation 12/2003; 108(22):2769-75. · 15.20 Impact Factor

RESCATE, GUIAS

Coronary stenting during rescue angioplasty after failed thrombolysis.R Moreno, E García, M Abeytua, J Soriano, J Elizaga, J Botas, J L López-Sendón, J L Delcán[Show abstract]Catheterization and Cardiovascular Interventions 06/1999; 47(1):1-5. · 2.51 Impact Factor [The clinical management guidelines of the Sociedad Española de Cardiología in acute myocardial infarct].F Arós, A Loma-Osorio, A Alonso, J J Alonso, A Cabadés, I Coma-Canella, L García-Castrillo, E García, E López de Sá, P Pabón, J M San José, A Vera, F Worner[Show abstract]Revista Espa de Cardiologia 11/1999; 52(11):919-56. · 3.20 Impact Factor

BETA-BLOQUEANTES

Impact of intravenous beta-blockade before primary angioplasty on survival in patients undergoing mechanical reperfusion therapy for acute myocardial infarction.Amir Halkin, Cindy L Grines, David A Cox, Eulogio Garcia, Roxana Mehran, James E Tcheng, John J Griffin, Giulio Guagliumi, Bruce Brodie, Mark Turco, Barry D Rutherford, Eve Aymong, Alexandra J Lansky, Gregg W Stone[show abstract]Journal of the American College of Cardiology 06/2004; 43(10):1780-7. · 14.09 Impact Factor Effects of prior beta-blocker therapy on clinical outcomes after primary coronary angioplasty for acute myocardial infarction.Kishore J Harjai, Gregg W Stone, Judith Boura, Lorelei Grines, Eulogio Garcia, Bruce Brodie, David Cox, William W O'Neill, Cindy Grines[show abstract]The American Journal of Cardiology 04/2003; 91(6):655-60. · 3.21 Impact Factor 

TOTAL PUBLICACIONES:

242

FACTOR DE IMPACTO: 1130.32   

IAM 

PUBLICACIONES : 68

FACTOR DE IMPACTO : 475.66  

Muchas Gracias