Editorial
Utility of calcium and phosphorus metabolism biomarkers in the stratification of acute coronary syndrome
Utilidad de los biomarcadores del metabolismo del calcio y fósforo en la estratificación del síndrome coronario agudo
J.L. Pérez Vela
Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
Read
5255
Timeswas read the article
2273
Total PDF
2982
Total HTML
Share statistics
array:23 [ "pii" => "S2173572718300122" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.01.008" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1129" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2018;42:71-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1511 "formatos" => array:3 [ "EPUB" => 197 "HTML" => 813 "PDF" => 501 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569117302966" "issn" => "02105691" "doi" => "10.1016/j.medin.2017.10.005" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1129" "copyright" => "Elsevier España, S.L.U. y SEMNIM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2018;42:71-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2275 "formatos" => array:3 [ "EPUB" => 199 "HTML" => 1332 "PDF" => 744 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Utilidad de los biomarcadores del metabolismo del calcio y fósforo en la estratificación del síndrome coronario agudo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "71" "paginaFinal" => "72" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Utility of calcium and phosphorus metabolism biomarkers in the stratification of acute coronary syndrome" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.L. Pérez Vela" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.L." "apellidos" => "Pérez Vela" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572718300122" "doi" => "10.1016/j.medine.2018.01.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300122?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117302966?idApp=WMIE" "url" => "/02105691/0000004200000002/v1_201802250513/S0210569117302966/v1_201802250513/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572718300225" "issn" => "21735727" "doi" => "10.1016/j.medine.2017.09.002" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1120" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2018;42:73-81" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1942 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 1113 "PDF" => 645 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Parathyroid hormone, calcidiol, calcitriol and adverse events in the acute coronary syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "73" "paginaFinal" => "81" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hormona paratiroidea, calcidiol, calcitriol y riesgo de eventos adversos en pacientes con síndrome coronario agudo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1795 "Ancho" => 2396 "Tamanyo" => 156115 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Analysis according to subgroups.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Ramos Ruiz, L. Jaulent Huertas, M. Castañeda Sancirilo, J.J. Martínez Díaz, G. Clavel Ruipérez, L. García de Guadiana Romualdo, S. Wasniewski, M. Merelo Nicolás, I. García Escribano, F. Soria Arcos, J.A. Castillo Moreno, L. Consuegra Sánchez" "autores" => array:12 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Ramos Ruiz" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Jaulent Huertas" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Castañeda Sancirilo" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Martínez Díaz" ] 4 => array:2 [ "nombre" => "G." "apellidos" => "Clavel Ruipérez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "García de Guadiana Romualdo" ] 6 => array:2 [ "nombre" => "S." "apellidos" => "Wasniewski" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Merelo Nicolás" ] 8 => array:2 [ "nombre" => "I." "apellidos" => "García Escribano" ] 9 => array:2 [ "nombre" => "F." "apellidos" => "Soria Arcos" ] 10 => array:2 [ "nombre" => "J.A." "apellidos" => "Castillo Moreno" ] 11 => array:2 [ "nombre" => "L." "apellidos" => "Consuegra Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569117302826" "doi" => "10.1016/j.medin.2017.09.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117302826?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300225?idApp=WMIE" "url" => "/21735727/0000004200000002/v1_201803150431/S2173572718300225/v1_201803150431/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Utility of calcium and phosphorus metabolism biomarkers in the stratification of acute coronary syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "71" "paginaFinal" => "72" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J.L. Pérez Vela" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J.L." "apellidos" => "Pérez Vela" "email" => array:1 [ 0 => "jperezv@salud.madrid.org" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de los biomarcadores del metabolismo del calcio y fósforo en la estratificación del síndrome coronario agudo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cardiovascular disease is currently the main health problem in Europe, and the leading cause of mortality and origin of healthcare costs. Patients with acute coronary syndrome (ACS) constitute a population with great variability in terms of both the clinical presentation (this posing a genuine diagnostic and initial management challenge) and outcome–with differences in mortality risk of long-term ischemic recurrence.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Medicina Intensiva</span>,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> the authors carry out an original study to establish the clinical profile and prognostic implications of the presence of high concentrations of biomarkers related to calcium/phosphorus metabolism, such as parathyroid hormone (PTH), calcidiol and calcitriol, in patients admitted to hospital due to ACS. There have been a number of interesting findings:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0015" class="elsevierStylePara elsevierViewall">High PTH levels are frequent in patients admitted due to ACS, being observed in one out of every four cases.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Patients with high PTH levels present more cardiovascular risk factors, suffer more extensive infarction, with higher risk, more heart failure, increased inflammatory response, and a poorer outcome after discharge.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0025" class="elsevierStylePara elsevierViewall">However, the authors also acknowledge that PTH was not an independent predictor of poor outcome following adjustment to the GRACE scale (a routine instrument used for risk stratification in patients of this kind), thus suggesting that most of the data supplied by these biomarkers are already included in this scale that is commonly used in routine clinical practice.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Furthermore, neither calcidiol nor calcitriol were found to be useful in the risk stratification of patients with ACS.</p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">An interesting and current debate therefore arises regarding the relationship between these biomarkers and cardiovascular disease–particularly ACS. In this respect, it is essential to underscore the association between high PTH levels (in patients with hyperparathyroidism) and cardiovascular risk factors, particularly arterial hypertension and diabetes.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> It is also suggested that the surgical correction of hyperparathyroidism has a positive impact upon patient outcome, with a decrease in the number of cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> However, scant clinical evidence is available in established coronary disease or ACS. Only publications involving small numbers of stable patients and other studies in patients with ACS have described an increased number of cardiovascular adverse events during the clinical course of the patients. On the other hand, Martin-Reyes et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> have evidenced the relationship between high PTH levels and more complex coronary disease, with a higher SYNTAX score and greater calcification.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The results of these studies establish a correlation between the biomarkers and the clinical findings, though the true relationship and its clinical repercussions remain to be firmly established.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In this same sense, PTH and vitamin D have been studied in the context of heart failure (HF), with discordant results. While Gruson et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> in a prospective cohort of patients with chronic HF, have shown the calcidiol/PTH ratio to be independently associated to cardiovascular mortality, Meems et al.,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> in a study involving a large sample of patients with HF, concluded that after controlling for confounding factors, the plasma levels of calcidiol, calcitriol or PTH were not associated to the risk of developing HF. In a subgroup of patients subjected to hemodialysis, a calcidiol/PTH ratio of >1 was associated to an increased risk of cardiovascular events, and was considered to be useful in estimating risk in such patients.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> On the other hand, in patients receiving double antiplatelet therapy due to coronary disease, those with high PTH levels show modifications in reactivity of the antiplatelet drugs that act upon the ADP receptor–thus indicating the possible existence of interactions with these drugs.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The study commented herein, involving patients with ACS in which calcium/phosphorus metabolism biomarkers are analyzed, with the positive results described above, also has some limitations: (1) The number of patients is small, and therefore few events are analyzed–a fact that complicates the drawing of definitive clinical conclusions; and (2) Although the patients with high PTH have a greater incidence of cardiovascular events, on adjusting to the GRACE scale, no independent effect upon patient prognosis is evidenced. Likewise, no association is observed to either calcidiol or calcitriol. This makes it difficult to establish relations of clinical relevance. On the other hand, the possible relationship between the calcium/phosphorus metabolism biomarkers and renal function and the development of cardiovascular events remains to be established.</p><p id="par0055" class="elsevierStylePara elsevierViewall">There is no doubt that this interesting study–which should be regarded as of an exploratory nature–paves the way for new clinical investigations seeking to clarify the relationship among cardiovascular disease, ACS and calcium/phosphorus metabolism biomarkers. If clinical implications are effectively confirmed, these biomarkers in turn will lead to new options in the risk stratification and clinical management of these patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez Vela JL. Utilidad de los biomarcadores del metabolismo del calcio y fósforo en la estratificación del síndrome coronario agudo. Med Intensiva. 2018;42:71–72.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estrategias de prevención secundaria del síndrome coronario agudo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Quiles" 1 => "B. Miralles-Vicedo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.recesp.2014.04.015" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2014" "volumen" => "67" "paginaInicial" => "844" "paginaFinal" => "848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25262131" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii: S0210-5691(17)30282-6 [Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hormona paratiroidea, calcidiol, calcitriol y riesgo de eventos adversos en pacientes con síndrome coronario agudo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ramos Ruiz" 1 => "L. Jaulent Huertas" 2 => "M. Castañeda Sancirilo" 3 => "J.J. Martínez Díaz" 4 => "G. Clavel Ruipérez" 5 => "L. García de Guadiana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2017.09.011" "Revista" => array:3 [ "tituloSerie" => "Med Intensiva" "fecha" => "2017" "itemHostRev" => array:3 [ "pii" => "S0039606015005358" "estado" => "S300" "issn" => "00396060" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin secretion, insulin sensitivity and hepatic insulin extraction in primary hyperparathyroidism before and after surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Kautzky-Willer" 1 => "G. Pacini" 2 => "B. Niederle" 3 => "G. Schernthaner" 4 => "R. Prager" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Endocrinol (Oxf)" "fecha" => "1992" "volumen" => "37" "paginaInicial" => "147" "paginaFinal" => "155" "itemHostRev" => array:3 [ "pii" => "S0016508505025266" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular risk factors in patients with asymptomatic primary hyperparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. García-Martín" 1 => "R. Reyes-García" 2 => "J.M. García-Castro" 3 => "M. Quesada-Charneco" 4 => "F. Escobar-Jiménez" 5 => "M. Muñoz-Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.endonu.2014.05.007" "Revista" => array:6 [ "tituloSerie" => "Endocrinol Nutr" "fecha" => "2014" "volumen" => "61" "paginaInicial" => "516" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25106709" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Vestergaard" 1 => "L. Mosekilde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.327.7414.530" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2003" "volumen" => "327" "paginaInicial" => "530" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12958111" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma levels of monocyte chemoattractant protein-1, N-terminal fragment of brain natriuretic peptide and calcidiol are independently associated with the complexity of coronary artery disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Martín-Reyes" 1 => "J.A. Franco-Peláez" 2 => "Ó. Lorenzo" 3 => "M.L. González-Casaus" 4 => "A.M. Pello" 5 => "Á. Aceña" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0152816" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "e0152816" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27171378" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "1,25-Dihydroxyvitamin D to PTH(1-84) ratios strongly predict cardiovascular death in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Gruson" 1 => "B. Ferracin" 2 => "S.A. Ahn" 3 => "C. Zierold" 4 => "F. Blocki" 5 => "D.M. Hawkins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0135427" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "e0135427" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26308451" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma calcidiol, calcitriol, and parathyroid hormone and risk of new onset heart failure in a population-based cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M.G. Meems" 1 => "F.P. Brouwers" 2 => "M.M. Joosten" 3 => "H.J. Lambers Heerspink" 4 => "D. de Zeeuw" 5 => "S.J.L. Bakker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ehf2.12089" "Revista" => array:5 [ "tituloSerie" => "ESC Heart Fail" "fecha" => "2016" "volumen" => "33" "paginaInicial" => "189" "paginaFinal" => "197" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The PTH (1-84)/non-PTH (1-84) ratio is a risk factor for cardiovascular events in hemodialysis patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Zitt" 1 => "A.H. Kirsch" 2 => "M. Haueis" 3 => "A. Strasak" 4 => "U. Neyer" 5 => "G. Mayer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Nephrol" "fecha" => "2011" "volumen" => "75" "paginaInicial" => "309" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21426885" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parathyroid hormone levels and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with acetylsalicylic acid and clopidogrel or ticagrelor" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Verdoia" 1 => "P. Pergolini" 2 => "R. Rolla" 3 => "M. Nardin" 4 => "L. Barbieri" 5 => "A. Schaffer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1755-5922.12188" "Revista" => array:6 [ "tituloSerie" => "Cardiovasc Ther" "fecha" => "2016" "volumen" => "34" "paginaInicial" => "209" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27086085" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000002/v1_201803150431/S2173572718300122/v1_201803150431/en/main.assets" "Apartado" => array:4 [ "identificador" => "406" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000002/v1_201803150431/S2173572718300122/v1_201803150431/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300122?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 8 | 13 |
| 2024 October | 54 | 60 | 114 |
| 2024 September | 48 | 26 | 74 |
| 2024 August | 57 | 36 | 93 |
| 2024 July | 44 | 26 | 70 |
| 2024 June | 39 | 42 | 81 |
| 2024 May | 45 | 34 | 79 |
| 2024 April | 48 | 33 | 81 |
| 2024 March | 40 | 31 | 71 |
| 2024 February | 32 | 41 | 73 |
| 2024 January | 29 | 33 | 62 |
| 2023 December | 27 | 52 | 79 |
| 2023 November | 26 | 37 | 63 |
| 2023 October | 27 | 31 | 58 |
| 2023 September | 28 | 37 | 65 |
| 2023 August | 21 | 8 | 29 |
| 2023 July | 29 | 23 | 52 |
| 2023 June | 28 | 18 | 46 |
| 2023 May | 34 | 29 | 63 |
| 2023 April | 22 | 19 | 41 |
| 2023 March | 49 | 31 | 80 |
| 2023 February | 44 | 28 | 72 |
| 2023 January | 21 | 20 | 41 |
| 2022 December | 61 | 30 | 91 |
| 2022 November | 56 | 38 | 94 |
| 2022 October | 45 | 30 | 75 |
| 2022 September | 32 | 34 | 66 |
| 2022 August | 31 | 34 | 65 |
| 2022 July | 30 | 36 | 66 |
| 2022 June | 24 | 22 | 46 |
| 2022 May | 27 | 33 | 60 |
| 2022 April | 23 | 43 | 66 |
| 2022 March | 39 | 52 | 91 |
| 2022 February | 21 | 30 | 51 |
| 2022 January | 28 | 31 | 59 |
| 2021 December | 37 | 43 | 80 |
| 2021 November | 34 | 38 | 72 |
| 2021 October | 75 | 70 | 145 |
| 2021 September | 28 | 36 | 64 |
| 2021 August | 27 | 32 | 59 |
| 2021 July | 34 | 26 | 60 |
| 2021 June | 28 | 23 | 51 |
| 2021 May | 34 | 39 | 73 |
| 2021 April | 83 | 83 | 166 |
| 2021 March | 65 | 24 | 89 |
| 2021 February | 57 | 25 | 82 |
| 2021 January | 48 | 24 | 72 |
| 2020 December | 46 | 14 | 60 |
| 2020 November | 33 | 16 | 49 |
| 2020 October | 45 | 47 | 92 |
| 2020 September | 43 | 23 | 66 |
| 2020 August | 39 | 20 | 59 |
| 2020 July | 24 | 22 | 46 |
| 2020 June | 26 | 16 | 42 |
| 2020 May | 38 | 9 | 47 |
| 2020 April | 49 | 12 | 61 |
| 2020 March | 38 | 9 | 47 |
| 2020 February | 75 | 24 | 99 |
| 2020 January | 71 | 27 | 98 |
| 2019 December | 48 | 26 | 74 |
| 2019 November | 21 | 24 | 45 |
| 2019 October | 32 | 16 | 48 |
| 2019 September | 35 | 23 | 58 |
| 2019 August | 29 | 29 | 58 |
| 2019 July | 31 | 22 | 53 |
| 2019 June | 22 | 18 | 40 |
| 2019 May | 53 | 33 | 86 |
| 2019 April | 21 | 13 | 34 |
| 2019 March | 22 | 25 | 47 |
| 2019 February | 25 | 33 | 58 |
| 2019 January | 24 | 37 | 61 |
| 2018 December | 55 | 31 | 86 |
| 2018 November | 45 | 53 | 98 |
| 2018 October | 75 | 20 | 95 |
| 2018 September | 42 | 15 | 57 |
| 2018 August | 34 | 7 | 41 |
| 2018 July | 32 | 14 | 46 |
| 2018 June | 45 | 14 | 59 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 0 | 1 | 1 |
Show all
