Damian Pres

Comparison of Five-Year Outcomes of Patients With and Without Chronic Total Occlusion of Noninfarct Coronary Artery After Primary Coronary Intervention for ST-Segment Elevation Acute Myocardial Infarction

The aim of the present study was to evaluate the effect of concurrent chronic total occlusion (CTO) in a noninfarct-related artery (IRA) on the long-term prognosis in patients with ST-segment elevation myocardial infarction and multivessel coronary disease. Of 1,658 consecutive patients with ST-segment elevation myocardial infarction, 666 with multivessel coronary disease who underwent percutaneous coronary intervention from 1999 to 2004 were included in the present analysis. The patients were divided into 2 groups: no CTO and CTO. The first group included 462 patients without CTO (69%) and the second group included 204 patients with CTO in a non-IRA (31%). The in-hospital mortality rate was 6.3% and 21.1% (p < 0.0001) and the 5-year mortality rate was 22.5% and 40.2% (p < 0.0001) for the no-CTO and CTO patients, respectively. Multivariate analysis revealed that after correction for baseline differences CTO in a non-IRA was a strong, independent predictor of 5-year mortality in patients undergoing percutaneous coronary intervention (hazard ratio 1.85; 95% confidence interval 1.35 to 2.53; p = 0.0001). In conclusion, the presence of CTO in a non-IRA in patients with ST-segment elevation myocardial infarction and multivessel coronary disease is a strong and independent risk factor for greater 5-year mortality.

Effect of Glycemic Control on Response to Antiplatelet Therapy in Patients With Diabetes Mellitus and ST-Segment Elevation Myocardial Infarction

Impaired glycemic control (GC) is a troubling clinical condition with an unclear prognostic value that is frequent in diabetics, especially in the setting of acute coronary syndrome. Residual platelet reactivity can be also affected by GC. We evaluated the relation between response to dual antiplatelet therapy and GC in diabetics with STEMI treated with primary coronary angioplasty (PCI). Sixty diabetic patients were prospectively enrolled in the study. All patients were treated with clopidogrel and aspirin. Platelet reactivity (whole blood aggregation and phosphorylation of vasodilator-stimulated phosphoprotein, VASP) were assessed serially before and 24 hours, 7 days, and 30 days after the PCI. Blood glucose >8.5 mmol/L on admission was an independent predictor of a impaired clopidogrel response measured with platelet reactivity index (PRI) >50% on admission (OR 7.8, 95% CI 1.4-17.7, p<0.02) and 24 hours after PCI (OR 13.1, 95% CI 3.4-28.1, p<0.01). In conclusion, diabetic patients with STEMI and glycemia >8.5 mmol/L on admission is related to a poorer response to clopidogrel. There were no interaction between glycated hemoglobin level or glycemia on admission and platelet reactivity measured with collagen, arachidonic acid or thrombin receptor agonist peptide-induced aggregation. Further clinical studies of the role of GC in the efficacy of antiplatelet agents are warranted.

Comparison between five-year mortality of patients with and without red blood cell transfusion after percutaneous coronary intervention for ST-elevation acute myocardial infarction

BACKGROUND Red blood cell (RBC) transfusion can be lifesaving. However, in many clinical cases, including acute coronary syndromes, percutaneous coronary interventions (PCI), cardiac surgery, and acute critical care, detrimental effects (excess death and myocardial infarction [MI], and also lung infections) have been observed in patients after a RBC transfusion. AIM To evaluate the long-term impact on the prognosis of patients who received a RBC transfusion after PCI for the treatment of ST-segment elevation MI (STEMI). METHODS Between 1999 and 2004, 2,415 consecutive patients, with an STEMI treated with PCI, were included in the analysis. The patients were divided into two groups: 82 patients with a RBC transfusion (3.5%) and 2,333 without a RBC transfusion (96.5%). RESULTS The in-hospital mortality rate was 15.8% and 4.2% (p < 0.0001) and the five-year mortality rate was 42.7% and 19% (p < 0.0001) for patients who received and who did not receive a RBC transfusion, respectively. Moreover, multivariate analysis revealed that, after correction for baseline differences, RBC transfusion was an independent predictor of five-year mortality in patients treated with PCI (HR 1.45; 95% CI 1.0-2.1; p = 0.04). CONCLUSIONS Red blood cell transfusion is associated with higher five-year mortality in STEMI patients treated with PCI.

Comparison of early and long-term results of percutaneous coronary interventions in patients with ST elevation myocardial infarction, complicated or not by cardiogenic shock.

ObjectivesCardiogenic shock (CS) still remains one of the most important factors affecting the mortality rate of patients with ST segment elevation myocardial infarction (STEMI). However, the data with follow-up longer than 1 year are limited. The aim of this study was to evaluate the early and long-term treatment results of patients with STEMI, complicated or not by CS, who underwent percutaneus coronary interventions. MethodsA retrospective registry included data of all patients with STEMI admitted to our centre from January 1999 to December 2001. ResultsOne thousand three hundred and eighty-five patients with STEMI were hospitalized and 1237 of them were treated with immediate percutaneus coronary interventions. Among this subpopulation, 117 (9.5%) patients were with STEMI complicated with CS on admission (group I) and 1120 (90.5%) patients were with STEMI without complications from CS on admission (group II). The groups differed significantly with regard to baseline clinical characteristics, angiographic picture, and in-hospital course. A total of 38.5% of patients with myocardial infarction complicated by CS and 2.5% of patients without shock (P<0.001) died during hospitalization. At the 5-year follow-up, 58.1% of group I patients and 14.8% of group II patients (P<0.001) died. A significant difference in the 5-year mortality rate was also observed in patients who survived the in-hospital period (31.9 vs. 12.6%; P<0.001). ConclusionCS continues to be closely connected with a very high mortality rate both in the hospital and in the long-term, also among patients who survived the in-hospital period.

Mechanical circulatory support in cardiogenic shock - what every interventional cardiologist should know.

Cardiogenic shock (CS) remains the main cause of death in patients with myocardial infarction. Conservative treatment alone does not sufficiently improve prognosis. Mortality in CS can only be significantly reduced with revascularization, both surgical and percutaneous. However some patients present with haemodynamic instability despite optimal medical treatment and complete revascularization, resulting in very high mortality rates. These patients require the implementation of mechanical circulatory support in order to increase systemic blood flow, protect against organ hypoperfusion and protect the myocardium through a decrease in oxygen consumption. In contemporary interventional cardiology it seems that every operator should be aware of all available mechanical circulatory support methods for their patients. This article aims to present the current state of knowledge and technical possibilities in this area.

Causes of hospitalisation and prognosis in patients with cardiovascular diseases – secular trends 2006-2014. SILesian CARDiovascular (SILCARD) database covering a population of 4.6 million subjects

INTRODUCTION Despite the progress in cardiology in recent years, cardiovascular (CV) diseases remain the main cause of death in European countries. The knowledge concerning the structure of hospital admissions for CV diseases and clinical outcomes is fragmentary. OBJECTIVES The aim of the study was to analyze the characteristics and outcome of patients with CV disease, hospitalized between 2006 and 2014 and included in the Silesian Cardiovascular Database (SILCARD) covering a population of 4.6 million patients. PATIENTS AND METHODS SILCARD is based on the data from the Regional Department of the National Health Fund in Poland. The enrollment criteria were any hospitalization at a department of cardiology, cardiac surgery, diabetology or vascular surgery and hospitalization with a cardiovascular diagnosis at a department of internal medicine or intensive care. The data come from 310 hospital departments and 1863 outpatient clinics, and contain information on 487 518 patients and 956 634 hospitalizations. RESULTS Heart failure (20%) and stable coronary artery disease (18.5%) were the most frequent primary causes of hospitalization. The number of hospitalizations due to heart failure, aortic stenosis, and pulmonary embolism significantly increased. The highest 12‑month mortality was reported in patients with heart failure and pulmonary embolism (>30%). A decrease in 12‑month mortality in patients with heart failure, stable coronary artery disease, myocardial infarction, and atrial fibrillation was noted, although for some disease entities, it remained relatively high. CONCLUSIONS Between the years 2006 and 2014, in‑hospital and 12‑month mortality showed a trend for decline in many disease entities, with considerable space for prognostic improvement.

No-reflow and platelet reactivity in diabetic patients with ST-segment elevation myocardial infarction: is there a link?

Introduction The no-reflow phenomenon in percutaneous coronary intervention (PCI) is defined classically as the absence of flow after restoration of arterial patency. Further research has shown that despite flow restoration in myocardial infarction (MI) there is still a considerable percentage of patients with a lack of perfusion at the level of the microvasculature caused by microvascular obstruction (MVO) [1]. This has a deleterious effect on outcomes and should be considered as a form of no-reflow [2]. It can be diagnosed with angiography or as the absence of ST-segment normalization in ECG after PCI, but the reference method for MVO diagnosis is contrast-enhanced cardiac magnetic resonance (CMR) [3]. Causes of MVO are thought to include peripheral embolism caused by debris originating in and flushed from the atherosclerotic plaque, ischemia/reperfusion injury, and individual predispositions such as diabetes [4]. Recently, increased platelet reactivity was proposed as one of the reasons for MVO occurrence [5–7]. Increased platelet reactivity is present in diabetes and together can increase MVO. Nevertheless, there is still a considerable lack of data regarding platelet reactivity and MVO assessed with the reference method of CMR in diabetic patients with ST-segment elevation MI (STEMI).

The role of balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation

Balloon aortic valvuloplasty is recommended in patients not suitable for transcatheter aortic valve implantation/aortic valve replacement (TAVI/AVR) or when such interventions are temporarily contraindicated. The number of performed balloon aortic valvuloplasty (BAV) procedures has been increasing in recent years. Valvuloplasty enables the selection of individuals with severe left ventricular dysfunction or with symptoms of uncertain origin resulting from concomitant disorders (including chronic obstructive pulmonary disease [COPD]) who can benefit from destination therapy (AVR/TAVI). Thanks to improved equipment, the number of adverse effects is now lower than it was in the first years after the advent of BAV. Valvuloplasty can be safely performed even in unstable patients, but long-term results remain poor. In view of the limited availability of TAVI in Poland, it is reasonable to qualify patients for BAV more often, as it is a relatively safe procedure improving the clinical condition of patients awaiting AVR/TAVI.

In-hospital and long-term prognosis in patients after the implantation of implantable cardioverter-defibrillators and cardiac resynchronization therapy: ten-year results of the SILCARD register

Introduction During the last 20 years, there has been a considerable increase in the number of implanted implantable cardioverter‑defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices. However, there have been only single reports on clinical events, including rehospitalizations, in the long‑term follow‑up. Objectives We analyzed the baseline clinical characteristics, medical procedures used, and complications of patients with implantation of an ICD or CRT device. Moreover, we analyzed the causes of rehospitalization and the types of treatment used in the 12‑month follow‑up. Patients and methods Out of 1 208 440 hospitalizations of patients with cardiovascular diseases included in the SILCARD registry, hospitalizations with an ICD‑9 code for an ICD or CRT device implantation between 2006 and 2016 were selected. Results The analysis included 12 147 patients with an ICD or CRT device. The total number of hospitalizations was 14 552. Over the years, a significant increase in the number of implanted devices and a higher percentage of CRT defibrillators was observed. Before the implantation, approximately 48.2% of patients underwent revascularization. In‑hospital and 12‑month mortality rates were 0.4% and 8.1%, respectively. Rehospitalizations due to cardiovascular causes were reported for approximately 40.3% of patients, with a significant reduction in the analyzed period. The most frequent cause of rehospitalization was heart failure (51.4%), while stable coronary artery disease and acute coronary syndromes constituted approximately 16% of the causes. In the 12‑month follow‑up, nearly every tenth patient was subjected to coronary angiography. Approximately 5% of patients required revascularization. Conclusions The relatively high rates of hospital readmissions and their causes indicate the need for a comprehensive care of patients before implantation of ICD or CRT devices and after discharge.