Annual Trends in Total Ischemic Time and One-Year Fatalities: The Paradox of STEMI Network Performance Assessment

This study is aimed at assessing trends and relations between total ischemic time, the major quality measure of systemic delay, and case-fatality at the population or patient level in response to growing cardiovascular risk and a constant need to shorten the time to treatment in ST-segment elevation myocardial infarction (STEMI). Data from a prospective nationwide registry of STEMI patients admitted between 2006 and 2013 who were treated with primary percutaneous coronary intervention (PCI) were analyzed. Total ischemic time was calculated as the time from the onset of symptoms to primary PCI and was determined as individual and annual. The primary end-point was one-year, all-cause case-fat…

Differences in Symptomatology and Clinical Course of Acute Coronary Syndromes in Women ≤45 Years of Age Compared to Older Women

Acute coronary syndromes (ACS) in young people are rare. The data regarding differences in symptoms in relation to age are scarce, which may have an influence on outcomes. The aim of this study was to evaluate the differences in the clinical course of ACS between younger women (≤45 years old) and older women (63-64 years old). We compared 7481 women with ACS from the Polish Registry of ACS between 2007 and 2014 (1834 women aged ≤45 years and 5647 women aged 63-64 years). The predominant symptom of ACS in both groups was chest pain, with a higher incidence occurring in younger women (90.4% vs 88.5%, P = 0.025). Prehospital cardiac arrest occurred more often in younger women (2.1% vs 0.8%, P0…

Management and predictors of clinical events in 75 686 patients with acute myocardial infarction

Background:Although mortality of patients with acute myocardial infarction (MI) has decreased substantially over the last few decades in many countries MI remains a major threat to public health. Aims:To assess the number and outcomes of patients hospitalized for acute MI in Poland in 2018 as well as proportions of patients participating in cardiac rehabilitation and undergoing invasive cardiac procedures following discharge. Methods:We used public databases. We included all patients hospitalized for acute MI in Poland in 2018 and assessed event-free survival along with uptake of invasive cardiac procedures and cardiac rehabilitation and consultations with cardiologists. Results: A total of…

YKL-40 as a predictor of mortality after acute coronary syndrome

Impact of routine invasive strategy on outcomes in patients with non-ST-segment elevation myocardial infarction during 2005–2014: A report from the Polish Registry of Acute Coronary Syndromes (PL-ACS)

Background: Non-ST-segment elevation myocardial infarction (NSTEMI) has become the most frequently encountered type of myocardial infarction. The patient clinical profile and management has evolved over the past decade. As there is still a scarcity of data on the latest trends in NSTEMI, changes herein were observed and assessed in the treatment and outcomes in Poland between 2005 and 2014. Methods: A total of 197,192 patients with NSTEMI who enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) between 2005 and 2014 were analyzed. In-hospital and 12-month mortality were assessed. Results: Coronary angiography use increased from 35.8% in 2005–2007 to 90.7% in 2012–2014 (p < 0…

Comorbidities and clinical outcomes of a lung cancer screening trial participants with chronic obstructive pulmonary disease in three-year follow-up

To improve the effectiveness of lung cancer screening using low-dose computed tomography (LDCT), the presence of smoking-related comorbidities that may significantly affect mortality in this group should be taken into account. Material and methods: A questionnaire survey and spirometry tests were conducted in a group of 730 respondents as part of a lung cancer screening study between 2016 and 2018. People diagnosed with COPD underwent a three-year follow-up to assess the incidence of medical events. Results: Our study confirmed that cardiovascular diseases (CVDs) were the most common comorbidities in patients who were diagnosed with COPD and participated in LDCT lung cancer screening. Among…

Mechanical circulatory support. An expert opinion of the Association of Intensive Cardiac Care and the Association of Cardiovascular Interventions of the Polish Cardiac Society

Mechanical circulatory support (MCS) methods are used in patients with both acute and chronic heart failure, who have exhausted other options for pharmacological or surgical treatments. The purpose of their use is to support, partially or completely, the failed ventricles and ensure adequate organ perfusion, which allows patients to restore full cardiovascular capacity, prolonging their life and effectively improving its quality. The three most popular devices include an intra-aortic balloon pump (IABP), percutaneous assist devices (including Impella, TandemHeart), and venoarterial extracorporeal membrane oxygenation (VA-ECMO). A multidisciplinary approach with the special participation of …

Innovative Managed Care May Be Related to Improved Prognosis for Acute Myocardial Infarction Survivors

Background: Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland. Methods: We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged &lt;18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death …

Organization of intensive cardiac care units in Europe: Results of a multinational survey

Background: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. Methods: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries…

Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study

Abstract Background COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). Aim To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. Design Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients &amp;gt; 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. Results…

Comparison of Nonclassic and Classic Phenotype of Hypertrophic Cardiomyopathy Focused on Prognostic Cardiac Magnetic Resonance Parameters: A Single-Center Observational Study

Patients with nonclassic phenotypes (NCP)—more advanced stages of hypertrophic cardiomyopathy (HCM)—constitute an intriguing and heterogeneous group that is difficult to diagnose, risk-stratify, and treat, and often neglected in research projects. We aimed to compare cardiac magnetic resonance (CMR) parameters in NCP versus classic phenotypes (CP) of HCM with special emphasis given to the parameters of established and potential prognostic importance, including numerous variables not used in everyday clinical practice. The CMR studies of 88 patients performed from 2011 to 2019 were postprocessed according to the study protocol to obtain standard and non-standard parameters. In NCP, the late …

Pulmonary vascular resistance as a potential marker of reactive pulmonary hypertension reduction following sildenafil therapy in patients disqualified from orthotopic heart transplantation

Purpose:We sought to determine the predictors of restoration of heart transplantation (HTx) candidacy in pa-tients with systolic heart failure (HF) and reactive fixed pulmonary hypertension (RFPH) defined as pulmonaryvascular resistance (PVR) > 2.5 Wood units (WU), transpulmonary gradient (TPG) > 12 mmHg or ≤2.5 WUwith systolic arterial pressure ≤85 mmHg during vasoreactivity test, following sildenafil therapy.Material and methods:Between2007and20181136patientswereevaluatedatourdepartmentascandidatesforHTx. Thirty-five of them, who presented with systolic HF and were not eligible for HTx due to RFPH, wereincluded in the study (31 men aged 55.1 ± 7.4 years). In all the patients sildenafil wa…

Mortality of patients with ST-segment elevation myocardial infarction and cardiogenic shock treated by PCI is correlated to the infarct-related artery - Results from the PL-ACS Registry

Background: Mortality of patients with ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock (CS) on admission remains high despite invasive treatment. The aim of this analysis was to assess the relationship between the infarct-related artery (IRA) and the early and 12-month outcomes of patients with STEMI and CS treated by percutaneous coronary intervention (PCI). Methods: Two thousand ninety patients with STEMI and CS registered in the prospective Polish Registry of Acute Coronary Syndromes from October 2003 to November 2009 were included. Results: The in-hospital mortality in the left main (LM), left anterior descending artery (LAD), circumflex artery (Cx), and right …

High progesterone levels are associated with family history of premature coronary artery disease in young healthy adult men.

Background & aimsThe offspring of patients with premature coronary artery disease (P-CAD) are at higher risk for cardiovascular disease, compared with subjects without a family history (FH) of P-CAD. The increased risk for cardiovascular disease in subjects with FH of early-onset CAD results from unfavorable genetic variants as well as social, behavioral and environmental factors, which are more prevalent in this group. Previous studies have shown that specific sex hormone levels may be associated with the risk of cardiovascular disease. The aim of this study was to compare wide range of biochemical marker levels including i.e. the levels of luteinizing hormone (LH), follicle-stimulating ho…

Predictors of diuresis response to levosimendan administration in patients with acute heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Levosimendan, a calcium sensitizer and potassium channel-opener, is appreciated  for its effects on systemic and pulmonary hemodynamic and for the relief of symptoms in acute heart failure (AHF). Positive effects of levosimendan on renal function have been also described. The aim of the present analysis was to assess the predictors of the diuresis response to levosimendan administration in high risk acute heart failure patients. Methods We analysed 34 consecutive patients admitted with high risk AHF to one centre and treated in intensive cardiac care unit. Levosimendan was administered on top of other treatment as a 24-hour in…

Cusp overlap technique for transcatheter self-expanding aortic valve implantation

Transcatheter aortic valve implantation (TAVI) may cause atrioventricular conduction disturbances and, consequently, the necessity for permanent pacemaker implantation (PPI). This is because the His bundle surfaces at the basal part of the membranous septum (in the neighbourhood of the non-coronary cusp) and implant depth greater than the length of the membranous septum may interfere with the conduction system [1]. To mitigate this risk, the valve should be implanted at a high position to minimize the contact of the valve frame with the base of membranous septum. During TAVI, the valve is usually positioned in a coplanar fluoroscopic projection with 3 cusps view, but for a self-expanding va…

Current status and needs for changes in critical care training: the voice of the young cardiologists

Abstract Aims The implementation of the 2013 European Society of Cardiology (ESC) Core Curriculum guidelines for acute cardiovascular care (acc) training among European countries is unknown. We aimed to evaluate the current status of acc training among cardiology trainees and young cardiologists (&amp;lt;40 years) from ESC countries. Methods and results The survey (March–July 2019) asked about details of cardiology training, self-confidence in acc technical and non-technical skills, access to training opportunities, and needs for further training in the field. Overall 614 young doctors, 31 (26–43) years old, 55% males were surveyed. Place and duration of acc training differed between countr…

Levosimendan in the treatment of patients with acute cardiac conditions: an expert opinion of the Association of Intensive Cardiac Care of the Polish Cardiac Society

Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitivity of cardiomyocytes, acts as a vasodilator due to the opening of potassium channels, and has a cardioprotective effect. Levosimendan is mainly used in the treatment of acute decompensated heart failure (class IIb recommendation according to the European Society of Cardiology guidelines). However, numerous clinical trials indicate the validity of repeated infusions of levosimendan in patients with stable heart failure as a bridge therapy to heart transplantation, and in patients with accompanying right ventricular heart failure and pulmonary hypertension. Due to the complex mechanism of action,…

One-Year Outcome of Glycoprotein IIb/IIIa Inhibitor Therapy in Patients with Myocardial Infarction-Related Cardiogenic Shock

Background: We aimed to evaluate the effect of intravenous glycoprotein IIb/IIIa receptor inhibitors (GPIs) on in-hospital survival and mortality during and at the 1-year follow-up in patients undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI) complicated by cardiogenic shock (CS), who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). Methods: From 2003 to 2019, 466,566 MI patients were included in the PL-ACS registry. A total of 10,193 patients with CS received PCI on admission. Among them, GPIs were used in 3934 patients. Results: The patients treated with GPIs were younger, had lower systolic blood pressure on admission, required i…

Observed and relative survival and 5-year outcomes of patients discharged after acute myocardial infarction: the nationwide AMI-PL database.

Background: Long‑term follow‑up data from a large Polish acute myocardial infarction (AMI‑PL) database are still unavailable. Aims: This study aimed to assess the 5‑year outcomes of patients discharged after hospitalization for AMI in Poland in relation to age. Methods: The studywas based on the nationwide AMI‑PL registry including data on the management and long‑term outcomes of all patients admitted to hospitals with AMI (codes I21–I22 according to the International Classification of Diseases and Related Health Problems, 10th Revision [ICD ‑10]), derived from the database of the obligatory healthcare payer in Poland.The current analysis included all patients after AMI who were discharged …

Metformin and heart injury after acute coronary syndrome in diabetic patients with no previous history of cardiovascular disease: data from the PLACS registry

Decline in the number of coronary angiography and percutaneous coronary intervention procedures in patients with acute myocardial infarction in Poland during the coronavirus disease 2019 pandemic.

Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention

Abstract Objectives The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery. Background A routine use of IABP is contraindicated in patients with myocardial infarction and CS. There are no data regarding the subpopulation of patients who may benefit from such support besides patients with mechanical complications of myocardial infarction. Methods Prospective nationwide registry data of patients with myocardial infarction and CS treated with PCI between 2003 and 2014 wer…

Safety and efficacy of biodegradable polymer-coated thin strut sirolimus-eluting stent vs. durable polymer-coated everolimus-eluting stent in patients with acute myocardial infarction

Introduction The biodegradable polymer drug-eluting stents were developed to improve vascular healing. However, further data are needed to confirm the safety and efficacy of these stents in patients with acute myocardial infarction (AMI). Aim We sought to determine the 1-year clinical follow-up in patients with AMI treated with a thin strut biodegradable polymer-coated sirolimus-eluting stent (BP-SES) versus a durable coating everolimus-eluting stent (DP-EES). Material and methods We analyzed patients with AMI (STEMI and NSTEMI) treated with either a BP-SES (ALEX, Balton, Poland, n = 886) or DP-EES (XIENCE, Abbott, USA, n = 1054) with available 1-year clinical follow-up using propensity sco…

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study

The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-is…

Impact of chronic total occlusion artery on 12-month mortality in patients with non-ST-segment elevation myocardial infarction treated by percutaneous coronary intervention (from the PL-ACS Registry).

Abstract Background Three-vessel coronary artery disease is associated with high mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The purpose of this study was to assess the impact on 12‐month mortality of chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA), as assessed by coronary angiography during percutaneous coronary intervention (PCI) for NSTEMI, of patients with 3-vessel disease. Methods The study included all of the NSTEMI patients with 3-vessel disease by coronary angiogram who were treated by PCI and who were registered in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) from July 2007 to November 2009. T…

Epidemiology, monitoring, and treatment strategy in cardiogenic shock. A multinational cross-sectional survey of ESC-acute cardiovascular care association research section

Abstract Aims Cardiogenic shock (CS) is a life-threatening condition burdened by mortality in up to 50% of cases. Few recommendations exist with intermediate–low level of evidence on CS management and no data on adherence across centres exist. We performed a survey to frame CS management at multinational level. Methods and results An international cross-sectional survey was created and approved by European Society of Cardiology-Acute Cardiovascular Care Association board. A total of 337 responses from 60 countries were obtained. Data were assessed by the hospital level of care of the participants. The most common cause of CS was AMI (AMI-CS—79.9%) with significant difference according to ho…

Clinical manifestations of cancer in patients with acute pulmonary embolism

Background Neoplasmatic disease increases the risk of acute pulmonary embolism (APE) by different pathophysiological mechanisms that favor thrombosis in patients with cancer. Recently, the role of cancer (active and occult) in the prevalence of venous thromboembolism has been discussed more thoroughly in the subject literature. Material Medical records of 366 consecutive patients with a diagnosis of APE (aged: mean = 65.0 ± 16.6, median = 68, range = 19–94; men = 41%/women = 59%) were collected with a wide range of demographic data, medical history of coexisting diseases, computer examination, and laboratory tests. Methods The APE patients were analyzed in two groups: negative cancer cases …

Gender-related disparities in the treatment and outcomes in patients with non-ST-segment elevation myocardial infarction: results from the Polish Registry of Acute Coronary Syndromes (PL-ACS) in the years 2012–2014

Introduction: Gender-related differences in the treatment of patients with non-ST elevation myocardial infarction (NSTEMI) have been reported in many previous studies despite the fact that an equal approach is recommended in all current guidelines. The aim of the study was to investigate whether gender-related discrepancies in the management of NSTEMI patients have changed. Material and methods: Between 2012 and 2014 a total of 66,667 patients (38.3% of whom were women) with the final diagnosis of NSTEMI were included into the retrospective analysis of the Polish Registry of Acute Coronary Syndromes (PL-ACS). Differences in clinical profile, treatment, and outcomes were analysed. Results: W…

Gender-related differences in men and women with ST-segment elevation myocardial infarction and incomplete infarct-related artery flow restoration: a multicenter national registry

Introduction: Little is known about gender-related differences in ST-segment elevation myocardial infarction (STEMI) and incomplete infarct-related artery (IRA) reperfusion after primary percutaneous coronary intervention (pPCI). Aim: To evaluate gender-related differences in clinical characteristics and prognosis in patients with STEMI and incomplete IRA reperfusion after pPCI. Material and methods: From 42,752 STEMI patients hospitalized between 2009 and 2011 in Poland we analyzed a group of 984 (36%) females and 1,746 (64%) males with less than Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow following pPCI. Results: Women were older than men (72.0 ±11.3 vs. 64.0 ±11.7 years; p …

Fluid therapy in non-septic, refractory acute decompensated heart failure patients – The cautious role of central venous pressure

Purpose Fluid therapy in congestive acute decompensated heart failure (ADHF) patients might be inappropriate and worsening the prognosis. The aim of our study was to analyze the effect of fluid administration on mortality in non-septic, ADHF patients with reduced ejection fraction. Material and methods We analyzed 41 ADHF consecutive ‘cold-wet’ patients (mean age 69.3 ± 14.9 years, 27 men, LVEF 22.8 ± 11.1%, lactates 2.2 ± 1.6 mmol/L) without sepsis. At admission central venous pressure (CVP) was measured (17.6 ± 7.2 cm H2O), and ultrasound examination of inferior vena cava (IVC) was performed (IVC min. 18.6 ± 7.3 mm and IVC max. 24.6 ± 4.3 mm). Moreover, the groups were compared (survivors…

P1699Non-ST segment elevation miocardial infarction (NSTEMI) vs. Unstable angina (UA) in young women aged &lt; 45 years - differences in symptomatology, clinical course, treatment and prognosis

Abstract Background Almost 50% of all ACS in young women are NSTEMI and UA. Due to the type of ACS we observed differences in the symptomatology, treatment and outcomes. The aim was to evaluate the differences in the clinical course and prognosis in young women aged ≤45 years with NSTEMI vs. UA. Methods We compared 1143 women aged ≤45y.o. with acute cardiac syndromes: 51% NSTEMI, 49% UA from the PL-ACS registry between 2007 - 2014. Results Chest pain was predominant in both group, with a higher incidence in NSTEMI group (91.7% vs. 84.7, p=0.0002). UA group was older (42y.o. vs. 41y.o p=0.003), more often presents atypical symptoms (8.0% vs. 1.5%, p&lt;0,0001) mostly with dyspnea (3.9%vs. 1.…

Effects of the coronavirus disease 2019 pandemic on the number of hospitalizations for myocardial infarction: regional differences. Population analysis of 7 milion people

Real-Life Outcomes of Coronary Bifurcation Stenting in Acute Myocardial Infarction (Zabrze–Opole Registry)

Percutaneous coronary intervention (PCI) of bifurcation lesions is a technical challenge associated with high risk of adverse events, especially in primary PCI. The aim of the study is to analyze long-term outcomes after PCI for coronary bifurcation in acute myocardial infarction (AMI). The outcome was defined as the rate of major adverse cardiac event related to target lesion failure (MACE-TLF) (death-TLF, nonfatal myocardial infarction-TLF and target lesion revascularization (TLR)) and the rate of stent thrombosis (ST). From 306 patients enrolled to the registry, 113 were diagnosed with AMI. In the long term, AMI was not a risk factor for MACE-TLF. The risk of MACE-TLF was dependent on th…

Which patients at risk of cardiovascular disease might benefit the most from inclisiran? – The expert opinion of the Polish experts. The compromise between EBM and possibilities in healthcare

It is the statement of the Polish Experts on the group of patients that might benefit the most from inclisiran. We indicated the fastest way to have inclisiran available for the polish patients, with the necessary changes of the existing drug program for PCSK9 inhibitors (B-101), explaining why it is the optimal way, and why, taking into account available EBM data (the ORION program), inclisiran should be added to this program. We also present some perspective on the future necessary changes in the availability of the innovative therapies such us PCSK9 targeted therapy, what, taking into account the effectiveness of LDL-C goal achievement in Poland for very high CVD risk patients (only 17%)…

Management of bleeding in patients hospitalized in the intensive cardiac care unit: expert opinion of the Association of Intensive Cardiac Care and Section of Cardiovascular Pharmacotherapy of the Polish Cardiac Society in cooperation with specialists in other fields of medicine.

ABSTRACT Nowadays, the intensive cardiac care unit (ICCU) provides care for patients with acute coronary syndrome, acute and exacerbated chronic heart failure, cardiogenic shock, sudden cardiac arrest, electrical storm, as well as with indications for urgent cardiac surgical treatment. Most of these patients require the use of 1, 2, or frequently even 3 drugs that act on the blood coagulation pathway. While antithrombotic drugs prevent thromboembolic events, they are associated with a higher risk of bleeding. In this population of patients, bleeding may often have a worse impact on prognosis than the primary disease. In this expert opinion of the Association of Intensive Cardiac Care, we pr…

Balloon aortic valvuloplasty, Impella insertion and complex coronary intervention: is this all feasible fully percutaneously via upper limb access?

Complex high-risk indicated patients (CHIP) with a limited vascular access constitute a real challenge for percutaneous coronary interventions (PCI), particularly if they require mechanical circulatory support devices. A 73-year-old man with recent non-ST segment elevation myocardial infraction, depressed left ventricular function (ejection fraction, 40%), aortic stenosis (max/mean gradient, 50/32 mm Hg; aortic valve area and its index, 1.0 cm2 and 0.5 cm2/m2) and numerous comorbidities (including recently diagnosed lung cancer in the initial phase) was scheduled by the heart team for balloon aortic valvuloplasty (BAV) and Impella-supported complex PCI of the left main (LM) and the left ant…

Comprehensive coordinated care after myocardial infarction (KOS-Zawał) : a patient's perspective

Antiplatelets in acute coronary syndrome in Poland – from guidelines to clinical practice

Acute coronary syndrome is a factor for poor prognosis and recurrent cardiovascular events. Adequate antiplatelet therapy is crucial in patients with the acute coronary syndrome for risk reduction. Such treatment is well described in four documents issued by the European Society of Cardiology, which precisely illustrate the use of antiplatelets in the settings of ST-elevated and non-ST elevated myocardial infarction. Despite its unquestioned role in the treatment of acute coronary syndrome, recent real-world-data from Polish registries reveal poor adherence to the guidelines-recommended antiplatelet treatment in Poland. Thus, we present here a comprehensive review of the use of antiplatelet…

Fully percutaneous insertion and removal of the Impella CP via a subclavian approach

The Impella (Abiomed) is a mechanical circulatory support device which augments cardiac output, but may also unload a left ventricle during venoarterial extracorporeal membrane oxygenation (ECMO) [1]. However, the Impella requires an access to a large artery and this may be problematic in a severe peripheral arterial disease. The presented case demonstrates how to insert and remove the Impella CP via a subclavian approach without surgical cutting.

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

MitraClip Implantation in Holography.

Factors Affecting Early Mortality and 1-Year Outcomes in Young Women With ST-Segment-Elevation Myocardial Infarction Aged Less Than or Equal to 45 Years.

Given that up to 2% of patients with myocardial infarction (MI) are young women, the purpose of this study was to evaluate factors affecting outcomes in young women with ST-segment-elevation myocardial infarction (STEMI) aged less than or equal to 45 years. We evaluated 796 women with STEMI aged less than or equal to 45 years between 2007 and 2014, and mortality was 4.0%. Death occurred more often in women with prehospital sudden cardiac arrest, and severe symptoms of heart failure; less commonly, the women were subjected to percutaneous coronary intervention (PCI), with a higher rate of incomplete revascularization. Beta blockers (BB) and angiotensin converting enzyme inhibitors were frequ…

Bleeding events in Polish cardiology wards: the results of a 2-week survey

Aspiration thrombectomy for patients with acute coronary syndromes and culprit lesions located in coronary bypass grafts. Data from the PL-ACS registry

Ultra-low contrast coronary angiography and zero-contrast percutaneous coronary intervention for prevention of contrast-induced nephropathy: step-by-step approach and review

Contrast-induced nephropathy is a serious complication after intravascular administration of iodinated contrast media and is associated with numerous adverse outcomes. Its prevalence is particularly high in patients with multiple comorbidities who undergo coronary angiography and percutaneous coronary intervention (PCI). Currently, the only effective method to prevent contrast-induced kidney injury is adequate hydration and a reduction of contrast volume during the intervention. Recently, new approaches aiming to minimize contrast usage have been proposed, i.e., ultra-low contrast angiography and zero-contrast PCI. However, neither tutorials for these techniques nor reviews of their outcome…

Subarachnoid Haemorrhage-Incidence of Hospitalization, Management and Case Fatality Rate-In the Silesian Province, Poland, in the Years 2009-2019.

Little is known about the epidemiology of subarachnoid haemorrhage (SAH) in Poland, and until now no such research has been conducted for Silesia, which is the second largest province with circa 4.5 million inhabitants. Therefore, the current study was done to assess the data on SAH in the Silesian Province, Poland. The study was based on the data obtained from the administrative databases of the only public health insurer in Poland (the National Health Fund, NHF) from 2009 to 2019. The SAH cases were selected based on primary diagnosis coded in ICD-10 as I60. The total number of SAH cases was 2014 (41.8% men, 58.2% women). The number of SAH hospitalizations decreased from 199 in 2009 to 16…

Epidemiological analysis of hospitalisations due to recurrent stroke in the Silesian Province, Poland, between 2009 and 2015

Background and aim. There is a lack of recent epidemiological studies on recurrent stroke (RS) in Poland. The aim of this study was to analyse all hospitalisations related to RS in Silesia – an industrial region covering 12% of the Polish population. Material and methods. We carried out statistical analysis of data contained in stroke questionnaires transferred to the Polish National Health Fund by hospitals in Silesia, Poland, between 2009 and 2015. Results. In the analysed period, the number of RS hospitalisations in Silesia was 18,063 (22.2% of all acute strokes). The percentage of RS significantly decreased during the period under consideration (p < 0.001). The same observation concerne…

Long-term outcomes in men and women with ST-segment elevation myocardial infarction and incomplete reperfusion after a primary percutaneous coronary intervention

Background The failure of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) is more frequent than considered previously. Aim To evaluate sex-related differences in long-term outcomes in patients with STEMI and incomplete infarct-related artery reperfusion after a primary percutaneous coronary intervention. Patients and methods Of consecutive 42 752 patients with STEMI hospitalized between 2009 and 2011 in Poland, we analyzed a group of 766 (35%) women and 1453 (65%) men with less than thrombolysis in myocardial infarction (TIMI) flow grade 3 following a primary percutaneous coronary intervention. Results In the 2-year follow-up, the mortality rate among…

Reperfusion strategy in Europe: temporal trends in performance measures for reperfusion therapy in ST-elevation myocardial infarction

Aims The rate and type of reperfusion, as well as time delays to reperfusion are directly associated with mortality and are established as performance measures (PMs) in the treatment of ST elevation myocardial infarction (STEMI). To date, little information exists about PMs for reperfusion in clinical practice in Europe and their temporal changes. Methods and results Using the Euro Heart Survey ACS-III data set (2 years of inclusions between 2006 and 2008, 138 centres in 21 countries), we selected patients with STEMI eligible for reperfusion therapy. Recorded variables corresponded to the CARDS data set. The rate and type of reperfusion, as well as door to needle and door to artery times we…

Family History of Premature Coronary Artery Disease (P-CAD)—A Non-Modifiable Risk Factor? Dietary Patterns of Young Healthy Offspring of P-CAD Patients: A Case-Control Study (MAGNETIC Project)

Dietary habits of healthy offspring with a positive family history of premature coronary artery disease (P-CAD) have not been studied so far. The aim of this study was twofold: (1) to identify dietary patterns in a sample of young healthy adults with (cases) and without (controls) family history of P-CAD, and (2) to study the association between dietary patterns and family history of P-CAD. The data came from the MAGNETIC case-control study. The participants were healthy adults aged 18&ndash

Survival benefit from recent changes in management of men and women with ST-segment elevation myocardial infarction treated with percutaneous coronary interventions

Background: Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting. Methods: Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 an…

Assessment of quality of care of patients with ST-segment elevation myocardial infarction

Aims:The 2017 European Society of Cardiology guidelines for the management of ST-elevation myocardial infarction recommended assessing quality of care to establish measurable quality indicators in order to ensure that every ST-elevation myocardial infarction patient receives the best possible care. We investigated the quality indicators of healthcare services in Poland provided to ST-elevation myocardial infarction patients.Methods and results:The Polish Registry of Acute Coronary Syndromes is a nationwide, multicentre, prospective study of acute coronary syndrome patients in Poland. For the purpose of assessing quality indicators, we included 8279 patients from the Polish Registry of Acute…

Biodegradable polymer-coated thin strut sirolimus- -eluting stent versus durable polymer-coated everolimus-eluting stent in the diabetic population.

Background: The number of patients with diabetes mellitus (DM) presenting with coronary artery disease is increasing and accounts for more than 30% of patients undergoing percutaneous coronary interventions (PCI). The biodegradable polymer drug-eluting stents were developed to improve vascular healing. It was sought herein, to determine 1-year clinical follow-up in patients with DM treated with the thin strut biodegradable polymer-coated sirolimus-eluting stent (BP-SES) versus durable coating everolimus-eluting stent (DP-EES). Methods: Patients were retrospectively analyzed with DM were treated with either a BP-SES (ALEX™, Balton, Poland, n = 670) or a DP-EES (XIENCE™, Abbott, USA, n = 884)…

Optimal use of lipid-lowering therapy after acute coronary syndromes: A Position Paper endorsed by the International Lipid Expert Panel (ILEP)

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), “lower is better for longer”, and the recent data have strongly emphasized the need of also “the earlier the better”. In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approa…

Non-vitamin K antagonist oral anticoagulants in the treatment of coronary and peripheral atherosclerosis

Oral anticoagulants (OACs) are widely used for prevention of systemic thromboembolism, including the reduction of the risk of stroke in patients with atrial fibrillation (AF) and prosthetic heart valves. There is also an increasing population of patients who require not only OACs, but also double antiplatelet therapy (DAPT). A typical example is a patient with AF and stable coronary artery disease or acute coronary syndrome (ACS), treated by percutaneous coronary intervention. In recent years, with the introduction of NOACs, triple or dual therapy has become safer. Regardless of these indications for the use of NOACs, rivaroxaban at a reduced dose has proved to efficiently reduce the risk o…

Cardiac magnetic resonance in the assessment of hypertrophic cardiomyopathy phenotypes and stages : pictorial review

The aim of this paper is to present recent advances in hypertrophic cardiomyopathy (HCM) diagnosis and treatment based on a literature review. Special emphasis has been placed on the role of cardiac magnetic resonance imaging (CMR) for the assessment of morphological and functional consequences of different stages of HCM including prognostication. The text is illustrated with the images and data of the HCM patients diagnosed with CMR study in our hospital. CMR is an important tool, particularly relevant in novel risk factors and LV dysfunction groups. The HCM group with overt left ventricular dysfunction is underrecognized, often labelled by clinicians as dilated cardiomyopathy. Advanced di…

Is neural network better than logistic regression in death prediction in patients after ST-segment elevation myocardial infarction?

Background: There is a need to develop patient classification methods to adjust post-discharge care, improving survival after ST-segment elevation myocardial infarction (STEMI). Aims: The study aimed to determine whether a neural network (NN) is better than logistic regression (LR) in mortality prediction in STEMI patients. Material and methods: The study included patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS). Patients with the first anterior STEMI treated with the primary percutaneous coronary intervention (pPCI) of the left anterior descending (LAD) artery between 2009 and 2015 and discharged alive were included in the study. Patients were randomly divided into th…

Results of targeted temperature management of patients after sudden out‐of‐hospital cardiac arrest: a comparison between intensive general and cardiac care units

ABSTRACT Background: Targeted temperature management (TTM) is used to treat patients after sudden out‑of‑hospital cardiac arrest (OHCA). Aims: The aim of the study was to compare the results of TTM between intensive general and cardiac care units (ICCUs). Methods: The Polish Registry of Therapeutic Hypothermia obtained data on 377 patients with OHCA from 26 centers (257 and 120 patients treated at the ICCU and intensive care unit [ICU], respectively). Eligibility for TTM was based on the current inclusion criteria for therapy. Medical history as well as data on TTM and additional treatment were analyzed. The main outcomes included in‑hospital survival and complications as well as neurologic…

A Multicenter, Phase 2, Randomized, Placebo-Controlled, Double-Blind, Parallel-Group, Dose-Finding Trial of the Oral Factor XIa Inhibitor Asundexian to Prevent Adverse Cardiovascular Outcomes After Acute Myocardial Infarction

Background: Oral activated factor XI (FXIa) inhibitors may modulate coagulation to prevent thromboembolic events without substantially increasing bleeding. We explored the pharmacodynamics, safety, and efficacy of the oral FXIa inhibitor asundexian for secondary prevention after acute myocardial infarction (MI). Methods: We randomized 1601 patients with recent acute MI to oral asundexian 10, 20, or 50 mg or placebo once daily for 6 to 12 months in a double-blind, placebo-controlled, phase 2, dose-ranging trial. Patients were randomized within 5 days of their qualifying MI and received dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor. The effect of asundexian on FXIa inhibition…

Bioresorbable polymer-coated thin strut sirolimus-eluting stent vs durable polymer-coated everolimus-eluting stent in daily clinical practice: Propensity matched one-year results from interventional cardiology network registry

Objectives We sought to determine the 1-year clinical follow-up in patients treated with the thin strut (71 μm) bioabsorbable polymer-coated sirolimus-eluting stent (BP-SES) vs durable coating everolimus eluting stent (DP-EES) in daily clinical routine. Background Presence of durable polymers may be associated with late/very late stent thrombosis occurrence and the need for prolonged dual antiplatelet therapy. Bioabsorbable polymers may facilitate stent healing, thus enhancing clinical safety. Methods Interventional Cardiology Network Registry is a prospective, multicenter, observational registry of 21,400 consecutive patients treated with PCI since 2010. We analyzed 4,670 patients treated …

In-Hospital and One-Year Outcomes of Patients after Early and Late Resuscitated Cardiac Arrest Complicating Acute Myocardial Infarction&mdash;Data from a Nationwide Database

The prognostic role of early (less than 48 h) resuscitated cardiac arrest (ErCA) complicating acute myocardial infarction (AMI) is still controversial. The present study aimed to analyse the short-term and one-year outcomes of patients after ErCA and late resuscitated cardiac arrest (LrCA) compared to patients without cardiac arrest (CA) complicating AMI. Data from the prospective nationwide Polish Registry of Acute Coronary Syndromes (PL-ACS) were used to assess patients with resuscitated cardiac arrest (rCA) after AMI. Baseline clinical characteristics and the predictors of all-cause death were assessed. The all-cause mortality rate, complications, performed procedures, and re-hospitalisa…

Occlusion of the abdominal aorta during coronary angiography with fractional flow reserve due to migration of the left ventricle thrombus in a patient with thrombocytosis

Smoking ban in public places and myocardial infarction hospitalizations in high cardiovascular risk European country – insights from the Polish nationwide AMI-PL database

Introduction Previous studies demonstrated a possible positive effect of a smoking ban in public places on cardiovascular outcomes. However, little is known about the influence of such regulations in Poland, a country with a high cardiovascular risk. Objectives We aimed to evaluate the association of hospitalization rates for acute myocardial infarction (AMI) in Poland before and after the introduction of the smoking ban in public places in November 2010. Patients and methods The Nationwide Acute Myocardial Infarction Database (AMI‑PL) was searched for the cases of AMI that occurred between 2009 and 2014. The analysis considered sex, age (20-64 years vs 65 years or older), and the place of …

Multivessel Intervention in Myocardial Infarction with Cardiogenic Shock: CULPRIT-SHOCK Trial Outcomes in the PL-ACS Registry

Background: The aim of the study was a comparison of culprit-lesion-only (CL-PCI) with the multivessel percutaneous coronary intervention (MV-PCI) in terms of 30-day and 12-month mortality in a national registry. Methods: Patients from the PL-ACS registry with MI and CS were analyzed. Patients meeting the criteria of the CULPRIT-SHOCK trial were divided into two groups: CL-PCI and MV-PCI groups. Results: Of the 3265 patients in the PL-ACS registry with MI complicated by CS, the criteria of the CULPRIT-SHOCK trial were met by 2084 patients (63.8%). The CL-PCI was performed in 883 patients, and MV-PCI was performed in 1045 patients. After the propensity score matching analysis, 617 well-match…

Outcomes of a routine invasive strategy in elderly patients with non-ST-segment elevation myocardial infarction from 2005 to 2014: results from the PL-ACS registry.

Background Elderly patients (≥75 years old) with non-ST-segment elevation myocardial infarction (NSTEMI) represent a large subgroup of all cases. They are rarely included in randomized trials because of comorbidities and concerns about complications. Furthermore, invasive treatments are used less frequently in this patient group. The aim of this study was to analyze trends in invasive procedures and outcomes in elderly patients with NSTEMI from 2005 to 2014. Patients and methods We analyzed 68 978 elderly patients with NSTEMI enrolled in the prospective, nationwide Polish Registry of Acute Coronary Syndromes from 2005 to 2014. Results Elderly patients accounted for 34.9% of all patients wit…

P2711Place of residence and its impact on time to invasive treatment and outcomes of patients with STEMI - analysis from the PL-ACS and AMI-PL registries

Clinical Characteristics, Treatments, and Outcomes of Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Results from a Multicenter National Registry

Background: Diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) requires both clinical evidence of acute myocardial infarction (AMI) and demonstration of non-obstructive coronary arteries using angiography. We compared the clinical features, treatments, and three-year outcomes in patients with MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD). Methods: We retrospectively analyzed data for 205,606 hospitalized patients with AMI. MINOCA was indicated as a working diagnosis in 6063 patients (2.94% of all AMI patients). For the control group we included 160,886 patients with MI-CAD. We evaluated the baseline characteristics, medica…

Repetitive use of LEvosimendan in Ambulatory Heart Failure patients (LEIA-HF) - The rationale and study design

Abstract Purpose Clinical practice forces the necessity to conduct a clinical trial concerning the group of outpatients with chronically advanced heart failure in III or IV NYHA functional class, frequently requiring hospitalizations due to HF exacerbation, and often left without any additional therapeutic option. The current trial aims to determine the efficacy and safety of repeated levosimendan infusions in the group of severe outpatients with reduced ejection fraction (HFrEF). Material and methods LEIA-HF (LEvosimendan In Ambulatory Heart Failure Patients) is a multicentre, randomized, double-blind, placebo-controlled, phase 4 clinical trial to determine whether the repetitive use of le…

Does the origin of ablated premature ventricular contractions determine the level of left ventricular function improvement?

Background: Premature ventricular contractions (PVCs) are associated with tachycardiomyopathy and high mortality rate. The treatment depends on the engaged ventricle. For PVCs originating from the right outflow tract (OT), radiofrequency catheter ablation (RFCA) is recommended (class IB‑R recommendation) in preference to pharmacotherapy. In those originating from the left ventricle, ablation is a class IIa B‑NR recommendation. Aims: The aim of the study was to assess the success of RFCA of PVCs based on arrhythmia origin. Methods: A total of 110 consecutive patients with monomorphic PVCs referred for ablation were enrolled and divided according to the site of ablation to the OT group and th…

Characteristics of patients from the Polish Registry of Acute Coronary Syndromes during the COVID-19 pandemic: the first report

Impact of diabetes mellitus on outcomes in patients with myocardial infarction according to varying degrees of left ventricular systolic dysfunction.

Background: Diabetes mellitus (DM) is known to contribute to unfavorable short- and long-term outcomes in patients with myocardial infarction (MI). Particularly poor outcomes are associated with left ventricular systolic dysfunction after an MI. The aim of our study was to compare the short- and long-term outcomes of MI in patients with DM and varied degrees of left ventricular systolic dysfunction with the corresponding outcomes in a non-diabetic control group. Methods: This analysis focused on patients with MI registered in the Polish National Registry of Acute Coronary Syndrome between 2009 and 2011. For the purposes of this analysis, diabetic patients were additionally stratified into t…

Zero-contrast percutaneous coronary interventions to preserve kidney function in patients with severe renal impairment and hemodialysis subjects

Introduction Zero-contrast percutaneous coronary intervention (zero-PCI) is a new method for prevention of contrast-induced acute kidney injury (AKI) in patients with chronic kidney disease (CKD). However, evidence for its feasibility, safety and clinical utility is limited to reports of single cases or series of patients. Aim To present outcomes of zero-PCI in patients with severe CKD, including hemodialysis subjects, who were treated with this procedure in order to preserve their renal function. Material and methods Twenty-nine zero-PCIs were performed, mostly as a staged procedure, in 20 patients with advanced CKD. In this group, 4 patients were treated with hemodialysis but presented pr…

Fully Percutaneous Transaxillary Aortic Valve Replacement With Effective Bailout Plan for Vascular Complications.