BACKGROUND AND OBJECTIVE: In recent years, techniques for implantation of aortic prosthesis via catheter have been developed as a therapeutic alternative in patients with severe aortic stenosis rejected for surgery. The correct selection of candidates is one of the more complex aspects of this treatment. We analyzed the acceptance rate in our environment for transcatheter aortic valve implantation in patients referred to our hospital for evaluation as possible candidates, describing the exclusion reasons. PATIENTS AND METHOD: 30 patients with severe aortic stenosis and rejected for surgical aortic valve replacement were referred to our hospital to evaluate transcatheter aortic valve implantation. The patients first underwent clinical evaluation and were studied with echocardiography, angiography and computed tomography. RESULTS: Of the 30 patients, 18 were rejected for the procedure (60%): 4 patients with non-severe aortic stenosis, 2 asymptomatic patients, 2 patients who finally underwent surgery because of a low-surgical-risk, 5 patients with contraindications for the procedure, 2 patients who finally did not want to undergo the procedure and 3 patients were further rejected because the vascular access was inappropriate. Of the remaining 12 patients initially accepted, 3 died before the procedure was performed. Finally, only 9 patients (30%) underwent transcatheter aortic valve implantation. CONCLUSIONS: Of the patients referred for transcatheter aortic valve implantation, only 40% were accepted. The mortality rate during the evaluation process of this procedure is high, showing that these patients are terminally ill.

Introduction and objectives. The PREVESE Study reported the situation of secondary prevention after myocardial infarction in Spain. Similar surveys conducted in Europe have also shown that the implementation of secondary prevention is not adequate. The aim of this second PREVESE study was to compare the situation in Spain four years after the first study.Patients and method. We included retrospectively 2,054 patients discharged after myocardial infarction from 74 Spanish hospitals. We studied the available information recorded in medical records after discharge, the prevalence of risk factors, procedures performed, and medical treatment before admission and at discharge. We compared the data collected with those from the first PREVESE study because the data collection methodology was similar.Results. The information recorded in the hospital medical records was satisfactory in relation to the most important risk factors (hypertension 94.8%; dyslipidemia and diabetes 97.9%; and smoking 89.2%). Compared with the previous study, there was a significant decrease in the percentage of smokers (46.1 vs. 35.4%). The echocardiogram was performed more frequently (60.1 vs. 85.6%) and there were also significant differences related to drug treatment at discharge, with an important increase in the prescription of beta-blockers (33.5 vs. 45.1%), ACE inhibitors (32.5 vs. 46.4%), and lipid-lowering drugs (6.7 vs 30.5%).Conclusions. This study shows some improvement in the management of myocardial infarction patients after a four-year period, mainly due to more prescription of cardioprotective drugs at hospital discharge.