Browsing by Author "Corbalan, Ramon"

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    Attained Educational Level and Incident Atherothrombotic Events in Low- and Middle-Income Compared With High-Income Countries
    (LIPPINCOTT WILLIAMS & WILKINS, 2010) Goyal, Abhinav; Bhatt, Deepak L.; Steg, P. Gabriel; Gersh, Bernard J.; Alberts, Mark J.; Ohman, E. Magnus; Corbalan, Ramon; Eagle, Kim A.; Gaxiola, Efrain; Gao, Runlin; Goto, Shinya; D'Agostino, Ralph B.; Califf, Robert M.; Smith, Sidney C., Jr.; Wilson, Peter W. F.; REACH Registry Investigators
    Background-Studies report a protective effect of higher attained educational level (AEL) on cardiovascular outcomes. However, most of these studies have been conducted in high-income countries (HICs) and lack representation from low and middle-income countries (LMICs), which bear >80% of the global burden of cardiovascular disease.
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    Características basales, manejo de terapias antitrombóticas y pronóstico de pacientes chilenos con FA no valvular. Lecciones del Registro GARFIELD AF en Chile
    (2017) Corbalan, Ramon; Conejeros, Carlos; Rey, Carlos; Stockins, Benjamin; Egers, German; Astudillo, Carlos; Lanas, Fernando; Potthoff, Sergio; Houzvic, Cesar; Montecinos, Humberto; Charme, Gustavo; Bugueno, Claudio; Aguilar, Juan; Ariagada, German; Marin, Patricio; Larico, Martin; Representacion Grp GARFIELD AF
    Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with high rates of death, ischemic stroke and systemic embolism (SE). There is scarce information about clinical characteristics and use of antithrombotic therapies in Chilean patients with non-valvular AF. Aim: To describe the characteristics and 1-year outcomes of patients with recently diagnosed AF recruited in Chile into the prospective global GARFIELD-AF registry. Material and Methods: Between 2011-2016, we prospectively registered information of 971 patients recruited at 15 centers, 85% of them from the public system and 15% from the private sector. Demographics, clinical characteristics and use of antithrombotic therapies were recorded for all patients. Adverse clinical outcomes were analyzed in 711 patients with 1-year follow-up. Results: The mean age was 71.5 years (66-79), 50% were men. Mean CHAD2S2 Vasc and HAS BLED scores for stroke risk were 3.3 (2.0-4.0) and 1.5 (1.0-2.0) respectively. Oral anticoagulants were prescribed in 82% of patients. Seventy percent received Vitamin K antagonists, 10% novel direct anticoagulants or antiplatelet therapy and only 8% did not receive any antithrombotic therapy. Mean time in optimal therapeutic range (an international normalized ratio of 2 to 3), was achieved in only 40.7% (23.0-54.8) of patients receiving Vitamin K antagonists. One year rates of death, stroke/systemic embolism and bleeding were 4.75 (3.36-6.71), 2.40 (1.47-3.92) and 1.64% (0.91-2.97) per 100 person-years. Ischemic stroke occurred in 1.8% and hemorrhagic stroke in 0.8% of patients at 1-year of follow up. Conclusions: Although the use of vitamin K antagonists at baseline was high, the mean time in optimal therapeutic range was low. Mortality and stroke rates are higher than those reported in other contemporary registries.
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    Cardiac dyssynchrony correlates with left ventricular remodeling after myocardial infarction
    (SOC MEDICA SANTIAGO, 2009) McNab, Paul; Castro, Pablo; Gabrielli, Luigi; Verdejo, Hugo; Carlos Quintana, Juan; Rodriguez, Jose A.; Corbalan, Ramon
    Background: Cardiac dyssynchrony is common in advanced heart failure (HF), but the changes in cardiac synchrony after myocardial infarction (MI) have not been adequately described. Aim: To study the relationship between cardiac synchrony and left ventricular remodeling after acute myocardial infarction. Material and methods: Forty nine patients aged 59+/-10 years (77% men) with a first episode of a ST segment elevation MI were studied. Scintigraphic left ventricular function and synchrony analyses were performed at baseline and after a six months follow-up. Determinations were compared with 33 healthy subjects. Results: At baseline, patients with MI had a decreased left ventricular ejection fraction (LVEF) and significant dyssynchrony, when compared with controls. LVEF was 36.4%+/-10%, left ventricular end-diastolic volume (LVEDV) 127+/-38 mL, interventricular delay (IEV) 29+/-35 milliseconds (ms), and intraventricular delay (IAV), 234+/-89 ms. After 6 months, LVEF significantly improved (38%+/-10%, p = 0.042) without significant changes in LVEDV (129+/-32 mL, p = 0.97), IEV (24+/-17, p = 0.96) or IAV (231 +/- 97, p = 0.34). At baseline there were significant correlations between IAV and LVEF, and between IAV and LVEDV (r = -0.48, p = 0.001 and r = -0.41, p = 0.004, respectively). These correlations remained significant after 6 months. There was a positive correlation between IAV and LVEDV changes at six months (r = 0.403, p = 0.04). Conclusions: The development of cardiac dyssynchrony correlates with adverse left ventricular remodeling after MI (Rev Med Chile 2009; 137: 1457-62).
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    Cardiovascular risk factors among young subjects with high carotid intima media thickness
    (SOC MEDICA SANTIAGO, 2011) Acevedo, Monica; Kraemer, Veronica; Tagle, Rodrigo; Arnaiz, Pilar; Corbalan, Ramon; Berrios, Ximena; Navarrete, Carlos
    Background: Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. Aim: To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). Material and Methods: We studied 689 subjects (50% women, mean age 36 6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. Results: Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). Conclusions: There is a negative influence of cardiovascular RF on CIMT among young subjects. (Rev Med Chile 2011; 139: 1322-1329).
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    Characteristics, management, and outcomes of illicit drug consumers with acute myocardial infarction
    (SOC MEDICA SANTIAGO, 2016) Bartolucci, Jorge; Nazzal N, Carolina; Verdugo, Fernando J.; Carlos Prieto, Juan; Sepulveda, Pablo; Corbalan, Ramon; GEMI
    Background: Consumption of illicit drugs (ID) has been associated with an increased risk of acute myocardial infarction (AMI). There is limited national evidence about the impact of substance use over the clinical presentation, management and outcomes of AMI patients. Aim: To describe the prevalence of ID consumption in patients within the Chilean Registry of Myocardial Infarction (GEMI), comparing clinical characteristics, management and outcome according to consumption status. Material and Methods: We reviewed data from the GEMI registry between 2001 and 2013, identifying 18,048 patients with AMI. The sample was stratified according to presence or absence of previous ID consumption, comparing different demographic and clinical variables between groups. Results: Two hundred eighty five patients (1.6%) had history of ID consumption (cocaine in 66%, cannabis in 35% and central nervous system stimulants in 24.0%). Compared with non-users, ID consumers were younger, predominantly male and had a lower prevalence of cardiovascular risk factors, except for tobacco smoking (86.3% and 42.5% respectively, p < 0.01). Among consumers, there was a higher percentage of ST segment elevation (85.2% and 67.8% respectively, p < 0.01) and anterior wall AMI (59.9 and 49.5% respectively, p = 0.01). Additionally, they had a higher rate of primary angioplasty (48.8% and 25.5% respectively, p < 0.01). There was no difference in hospital mortality between groups when stratified by age. Conclusions: A low percentage of patients with AMI had a previous history of ID consumption in our national setting. These patients were younger and had a greater frequency of ST segment elevation AMI, which probably determined a more invasive management.
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    Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials
    (OXFORD UNIV PRESS, 2009) Metra, Marco; Eichhorn, Eric; Abraham, William T.; Linseman, Jennifer; Boehm, Michael; Corbalan, Ramon; DeMets, David; De Marco, Teresa; Elkayam, Uri; Gerber, Michael; Komajda, Michel; Liu, Peter; Mareev, Vyacheslev; Perrone, Sergio V.; Poole Wilson, Philip; Roecker, Ellen; Stewart, Jennifer; Swedberg, Karl; Tendera, Michal; Wiens, Brian; Bristow, Michael R.; ESSENTIAL Investigators
    Use of inotropic agents in patients with heart failure (HF) has been limited by adverse effects on outcomes. However, administration of positive inotropes at lower doses and concomitant treatment with beta-blockers might increase benefit-risk ratio. We investigated the effects of low doses of the positive inotrope enoximone on symptoms, exercise capacity, and major clinical outcomes in patients with advanced HF who were also treated with beta-blockers and other guideline-recommended background therapy.
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    Enoxaparin is superior to unfractionated heparin in patients with ST elevation myocardial infarction undergoing fibrinolysis regardless of the choice of lytic: an ExTRACT-TIMI 25 analysis
    (OXFORD UNIV PRESS, 2007) Giraldez, Roberto R.; Nicolau, Jose Carlos; Corbalan, Ramon; Gurfinkel, Enrique P.; Juarez, Ursulo; Lopez Sendon, Jose; Parkhomenko, Alexander; Molhoek, Peter; Mohanavelu, Satishkumar; Morrow, David A.; Antman, Elliott M.
    Aims We compared outcomes of ST-elevation myocardial infarction (STEMI) patients randomized to a strategy of either enoxaparin or unfractionated heparin (UFH) to support fibrinolysis. Methods and results In the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis in Myocardial Infarction Study 25 (ExTRACT-TIMI 25) trial, 20 479 patients undergoing fibrinolysis for STEMI with a fibrin-specific agent (N = 16 283) or streptokinase (SK) IN = 4139) were randomized to enoxaparin throughout their hospitalization or UFH for at [east 48 h. The primary end point of death or nonfatal recurrent MI through 30 days occurred in 12.0% of patients in the UFH and 9.8% in the enoxaparin groups when treated with fibrin-specific lytics [odds ratio(adjusted) (ORadj) 0.78; 95% Cl 0.70-0.87; P < 0.001] and 11.8 vs. 10.2%, respectively, when treated with SK (ORadj 0.83; 95% CI 0.66-1.04; P = 0-10; P-interaction = 0.58). Major bleeding rates including intracranial hemorrhage within the fibrin specific cohort were 1.2 and 2.0% in the UFH and enoxaparin groups, respectively (P < 0.001) and 2.0% in UFH and 2.4% in enoxaparin patients in the SK cohort (P = 0.16). Interaction tests between antithrombin- and lytic-type were non-significant (P = 0.20). Death, nonfatal MI, or major bleeding was significantly reduced with enoxaparin in the fibrin-specific cohort (ORadj 0.82; 95% Cl 0.74-0.91; P < 0.001) and favoured enoxaparin in the SK cohort (ORadj 0.89; 95% Cl 0.72-1.10; P = 0.29; P-interaction = 0.53). Conclusion The benefits of an enoxaparin strategy over UFH were observed in both SK and fibrin -specific-treated STEMI patients. Therefore, an enoxaparin strategy is preferred over UFH to support fibrinolysis for STEMI regardless of lytic agent.
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    Global Variation in the Prevalence of Elevated Cholesterol in Outpatients With Established Vascular Disease or 3 Cardiovascular Risk Factors According to National Indices of Economic Development and Health System Performance
    (LIPPINCOTT WILLIAMS & WILKINS, 2012) Venkitachalam, Lakshmi; Wang, Kaijun; Porath, Avi; Corbalan, Ramon; Hirsch, Alan T.; Cohen, David J.; Smith, Sidney C., Jr.; Ohman, E. Magnus; Steg, Ph Gabriel; Bhatt, Deepak L.; Magnuson, Elizabeth A.; REACH Registry Investigators
    Background-Elevated serum cholesterol accounts for a considerable proportion of cardiovascular disease worldwide. An understanding of the relationship between country-level economic and health system factors and elevated cholesterol may provide insight for prioritization of cardiovascular prevention programs.
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    History of hypertension and eplerenone in patients with acute myocardial infarction complicated by heart failure
    (LIPPINCOTT WILLIAMS & WILKINS, 2008) Pitt, Bertram; Ahmed, Ali; Love, Thomas E.; Krum, Henry; Nicolau, Jose; Cardoso, Jose S.; Parkhomenko, Alexander; Aschermann, Michael; Corbalan, Ramon; Solomon, Henry; Shi, Harry; Zannad, Faiez
    In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study ( n = 6632), eplerenone- associated reduction in all- cause mortality was significantly greater in those with a history of hypertension ( Hx- HTN). There were 4007 patients with Hx- HTN ( eplerenone: n = 1983) and 2625 patients without Hx- HTN ( eplerenone: n = 1336). Propensity scores for eplerenone use, separately calculated for patients with and without Hx- HTN, were used to assemble matched cohorts of 1838 and 1176 pairs of patients. In patients with Hx- HTN, all- cause mortality occurred in 18% of patients treated with placebo ( rate, 1430/ 10 000 person- years) and 14% of patients treated with eplerenone ( rate, 1058/ 10 000 person- years) during 2350 and 2457 years of follow- up, respectively ( hazard ratio [ HR]: 0.71; 95% CI: 0.59 to 0.85; P < 0.0001). Composite end point of cardiovascular hospitalization or cardiovascular mortality occurred in 33% of placebo-treated patients ( 3029/ 10 000 person- years) and 28% of eplerenone- treated patients (2438/10 000 person- years) with Hx- HTN ( HR: 0.82; 95% CI: 0.72 to 0.94; P = 0.003). In patients without Hx- HTN, eplerenone reduced heart failure hospitalization ( HR: 73; 95% CI: 0.55 to 0.97; P = 0.028) but had no effect on mortality ( HR: 0.91; 95% CI: 0.72 to 1.15; P = 0.435) or on the composite end point ( HR: 0.91; 95% CI: 0.76 to 1.10; P = 0.331). Eplerenone should, therefore, be prescribed to all of the post - acute myocardial infarction patients with reduced left ventricular ejection fraction and heart failure regardless of Hx- HTN.
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    Impaired cardiac autophagy in patients developing postoperative atrial fibrillation
    (MOSBY-ELSEVIER, 2012) Garcia, Lorena; Verdejo, Hugo E.; Kuzmicic, Jovan; Zalaquett, Ricardo; Gonzalez, Sergio; Lavandero, Sergio; Corbalan, Ramon
    Objectives: Postoperative atrial fibrillation (POAF) is a common complication after on-pump heart surgery. Several histologic abnormalities, such as interstitial fibrosis and vacuolization, have been described in atrial samples from patients developing POAF. This ultrastructural remodeling has been associated with the establishment of a proarrhythmic substrate. We studied whether atrial autophagy is activated in patients who develop POAF.
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    Left Atrial Dysfunction Is a Predictor of Postcoronary Artery Bypass Atrial Fibrillation: Association of Left Atrial Strain and Strain Rate Assessed by Speckle Tracking
    (WILEY, 2011) Gabrielli, Luigi; Corbalan, Ramon; Cordova, Samuel; Enriquez, Andres; Mc Nab, Paul; Verdejo, Hugo E.; Godoy, Ivan; Zalaquett, Ricardo; Lavandero, Sergio
    Background: Even though atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG), its etiology remains poorly understood. Several factors are linked to postoperative AF (POAF), including advanced age and systemic inflammation. However, left atrial (LA) contractile dysfunction has not been evaluated in the perioperative scenario. Aim: To evaluate LA function through strain and strain rate in patients with coronary artery disease undergoing CABG and its correlation with POAF. Methods: We studied 70 patients undergoing CABG in sinus rhythm at the time of surgery. Preoperative echocardiography with evaluation of LA strain and strain rate by speckle tracking was performed. The occurrence of POAF was evaluated by continuous monitoring. Baseline and postoperative C-reactive protein (CRP) levels were measured to evaluate systemic inflammation. Results: After 1-week follow-up 26% of subjects developed AF. LA strain s wave (LASs) and LA strain rate s (LASRs) and a wave (LASRa) were significantly decreased in patients who developed POAF: LASs (10 +/- 1% vs. 24 +/- 1%, P < 0.001), LASRs (0.6 +/- 0.1 sec1 vs. 1.2 +/- 0.1 sec-1, P < 0.001), LASRa (-0.6 +/- 0.1 sec1 vs. 1.8 +/- 0.1 sec-1, P < 0.001). LASRs, LASRa, age, and LA volume were independent predictors of POAF. CRP at baseline was similar irrespective of POAF development. Conclusions: LA dysfunction, evaluated by strain and strain rate is an independent predictor of POAF and contributes to classic risk factors like age and atrial volume. (Echocardiography 2011;28:1104-1108)
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    Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization
    (MASSACHUSETTS MEDICAL SOC, 2012) Roe, Matthew T.; Armstrong, Paul W.; Fox, Keith A. A.; White, Harvey D.; Prabhakaran, Dorairaj; Goodman, Shaun G.; Cornel, Jan H.; Bhatt, Deepak L.; Clemmensen, Peter; Martinez, Felipe; Ardissino, Diego; Nicolau, Jose C.; Boden, William E.; Gurbel, Paul A.; Ruzyllo, Witold; Dalby, Anthony J.; McGuire, Darren K.; Leiva Pons, Jose L.; Parkhomenko, Alexander; Gottlieb, Shmuel; Topacio, Gracita O.; Hamm, Christian; Pavlides, Gregory; Goudev, Assen R.; Oto, Ali; Tseng, Chuen Den; Merkely, Bela; Gasparovic, Vladimir; Corbalan, Ramon; Cinteza, Mircea; McLendon, R. Craig; Winters, Kenneth J.; Brown, Eileen B.; Lokhnygina, Yuliya; Aylward, Philip E.; Huber, Kurt; Hochman, Judith S.; Ohman, E. Magnus; TRILOGY ACS Investigators
    Background
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    Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis
    (MOSBY-ELSEVIER, 2008) Goto, Shinya; Hatt, Deepak L.; Roether, Joachim; Alberts, Mark; Hill, Michael D.; Ikeda, Yasuo; Uchiyama, Shinichiro; D'Agostino, Ralph; Ohman, E. Magnus; Liau, Chiau Suong; Hirsch, Alan T.; Mas, Jean Louis; Wilson, Peter W. F.; Corbalan, Ramon; Aichner, Franz; Steg, P. Gabriel; REACH Registry Invest
    Background Atrial fibrillation (AF) is a major risk factor (RF) for ischemic stroke. Its prevalence and prognostic impact in patients with atherothrombosis are unclear.
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    Resultados Chilenos del registro internacional de factores de riesgo y tratamiento de angina inestable e infarto al miocardio sin supradesnivel del segmento ST: ACCORD (ACute CORonary syndrome Descriptive study)
    (SOC MEDICA SANTIAGO, 2011) Stockins, Benjamin; Albornoz, Francisco; Martinez, Dario; Campos, Pabla; Gajardo, Jorge; Lamich, Ruben; Manriquez, Leopoldo; Perez, Victor; Rojo, Pamela; Sepulveda, Pablo; Gabriela Pumarino, M.; Corbalan, Ramon
    Background: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however current practices are unknown in Chile. Aim: To evaluate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. Material and Methods: One year prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. Results: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5% at the end of the follow-up. Mean age was 61.6 years, and 30.6% were female. Most of the patients had at least one risk factor (98%): hypertension (84%), previous myocardial infarction (33%), dyslipidemia (54%), diabetes (33%), current smoking (30%). Main procedures during the hospitalization were coronary angiogram (67%), angioplasty (33%; 88% with stent) and coronary bypass surgery (7%). During procedures, 31% of patients received clopidogrel, and 4.2% glycoprotein IIb/IIIa antagonists. Medical management was selected for 60% of patients. In comparison to men, women received less interventional procedures despite having more risk factors. Treatments prescribed at discharge were aspirin (97%), clopidogrel (49%), beta blockers (78%), diuretics (21%), lipid lowering agents (78%), oral hypoglycemic agents (13%) and insulin (9%). At the end of the 1-year follow-up, treatments were aspirin (84%), beta blockers (72%), diuretics (19%), and dual antiplatelet therapy with clopidogrel (16%). Conclusions: A high prevalence of multiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50% at discharge and decreases during the one year-follow-up. (Rev Med Chile 2011; 139: 19-26).
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    Total/HDL cholesterol ratio and non HDL cholesterol as predictors for increased intima media thickness
    (SOC MEDICA SANTIAGO, 2012) Acevedo, Monica; Kraemer, Veronica; Tagle, Rodrigo; Corbalan, Ramon; Arnaiz, Pilar; Berrios, Ximena; Navarrete, Carlos
    Background: LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting. Aim: To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis. Material and Methods: Lipid profile, height, weight, blood pressure and bilateral IMT measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 +/- 11 years, in Santiago de Chile. Results: Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. Mean IMT was 0.62 mm. All lipid markers were significantly correlated with IMT This correlation was higher for non-HDL cholesterol (r = 0.24, p < 0.0001) and total/HDL cholesterol ratio(r = 0.23, p < 0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p < 0.01). Conclusions: Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis. (Rev Med Chile 2012; 140: 969-976).