Grzegorz Opolski

Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries

Aims Patient access to reperfusion therapy and the use of primary percutaneous coronary intervention (p-PCI) or thrombolysis (TL) varies considerably between European countries. The aim of this study was to obtain a realistic contemporary picture of how patients with ST elevation myocardial infarction (STEMI) are treated in different European countries. Methods and results The chairpersons of the national working groups/societies of interventional cardiology in European countries and selected experts known to be involved in the national registries joined the writing group upon invitation. Data were collected about the country and any existing national STEMI or PCI registries, about STEMI epidemiology, and treatment in each given country and about PCI and p-PCI centres and procedures in each country. Results from the national and/or regional registries in 30 countries were included in this analysis. The annual incidence of hospital admission for any acute myocardial infarction (AMI) varied between 90–312/100 thousand/year, the incidence of STEMI alone ranging from 44 to 142. Primary PCI was the dominant reperfusion strategy in 16 countries and TL in 8 countries. The use of a p-PCI strategy varied between 5 and 92% (of all STEMI patients) and the use of TL between 0 and 55%. Any reperfusion treatment (p-PCI or TL) was used in 37–93% of STEMI patients. Significantly less reperfusion therapy was used in those countries where TL was the dominant strategy. The number of p-PCI procedures per million per year varied among countries between 20 and 970. The mean population served by a single p-PCI centre varied between 0.3 and 7.4 million inhabitants. In those countries offering p-PCI services to the majority of their STEMI patients, this population varied between 0.3 and 1.1 million per centre. In-hospital mortality of all consecutive STEMI patients varied between 4.2 and 13.5%, for patients treated by TL between 3.5 and 14% and for patients treated by p-PCI between 2.7 and 8%. The time reported from symptom onset to the first medical contact (FMC) varied between 60 and 210 min, FMC-needle time for TL between 30 and 110 min, and FMC-balloon time for p-PCI between 60 and 177 min. Conclusion Most North, West, and Central European countries used p-PCI for the majority of their STEMI patients. The lack of organized p-PCI networks was associated with fewer patients overall receiving some form of reperfusion therapy.

Chemotherapy-Induced Takotsubo Syndrome

Cardiovascular complications are a significant problem in systemically treated cancer patients. One such complication is Takotsubo cardiomyopathy, also known as Takotsubo syndrome. It is most frequently defined as a sudden and transient left or right ventricular systolic dysfunction; mimicking acute coronary syndrome, but without the associated changes in coronary arteries. Takotsubo syndrome is a relatively little known complication that appears in the course of oncological treatment, and its incidence has not yet been established. In this study, we reviewed Medline database according to case reports concerning takotsubo syndrome appearing after systemic treatment in oncological patients. We took into consideration all types of anticancer drugs. We reviewed the changes reported in the electrocardiography, echocardiography, and coronary angiography, and also the level of troponin, a marker of acute coronary syndrome elevation. In view of the increasing frequency of cardiac complications reported in patients receiving systemic oncological treatment, Takotsubo syndrome appears to be underdiagnosed. However, the syndrome may be linked to potentially fatal complications such as cardiogenic shock or cardiac arrest. Therefore, it seems essential to carry out appropriate diagnostic procedures for every patient experiencing clinical side effects of onco-pharmacotherapy. In patients with chest pain and dyspnea during or after treatment, Takotsubo syndrome should be considered, particularly that the syndrome requires a different therapy approach than that used in a coronary syndrome. Diagnostic procedures should include echocardiogram and the assessment of myocardial necrosis markers and natriuretic peptides.

Pneumothorax after pacemaker implantation localized contralaterally to the side of implantation - rare, but possible complication.

Case report – An 86-year old patient developed pneumothorax a few hours after pacemaker implantation. Surprisingly, the pneumothorax localized contralaterally to the site of subclavian vein puncture. It was treated with chest tube puncture, under the care of a pneumonologist, resulting in full recovery. Although pneumothorax localized contralaterally to the site of subclavian vein puncture during pacemaker implantation is very rare, it has been reported in the literature.

Transvenous lead removal with a fragment of a papillary muscle - a silent complication.

Tricuspid valve (TV) insufficiency is one of the more important complications in patients with cardiac implantable electronic devices due to the endocardial lead [1]. The frequency of this complication is growing with the increasing number of implanted and removed leads crossing the TV [2] and with trauma upon removal of the old lead that increasingly grows into the heart tissue. However, in some cases, even serious heart damage, tricuspid regurgitation and other symptoms are not observed [3].

Atrioventricular block registration with smart phone associated ECG device.

The prevalence of cardiac rhythm disturbances increases with age and requires active screening for early detection. However, time, resources and costs are the main limiting factors for wider adoption of cardiac screening in the community setting. The ubiquitous access to the Internet and the dynamic adoption of smartphones provide opportunities for new technologies that transmit biomedical data, such as ECG. An example of such technology is Kardia Heart Monitor (AliveCor, Inc) that connects wirelessly to the smartphone and allows 30-second rhythm strips to be recorded. Pocket-size, mobile health devices provide an unprecedented opportunity for physicians to detect abnormalities in a quick and hassle-free fashion [1].

A subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation in infection high-risk patient - a case study.

The cardiac device related infective endocarditis (CDRIE) is an important indication for the implantable cardiac device extraction. In patients after recovery from CDRIE, who present indication for implantable cardioverter-defibrilator (ICD) but without necessity for pacing therapy the subcutaneous ICD (S-ICD) seems to be a reasonable alternative. Here we present a patient with CRT-D device transferred to our hospital with the diagnosis of CDRIE and many comorbidities. The patient presented increased inflammatory markers serum level during the entire period of hospitalization, after device explanation and termination of antibiotic therapy. The blood culture tests were negative and transesophageal echocardiography showed no sign of endocarditis, therefore despite inflammatory biomarkers the patient has been implanted with S-ICD.

POL-TAVI – Polish Registry of Transcatheter Aortic Valve Implantation – simple tool, great value, rationale and design

Aortic stenosis (AS) is the most common valvular heart disease in adults in Europe and North America. Management of AS patients depends on accurate diagnosis of the cause and stage of the disease process: the first and definitive therapeutic choice for a growing number of elderly patients with symptomatic AS is surgical treatment. In patients not eligible for surgery, transcatheter aortic valve implantation (TAVI) constitutes a safe and effective alternative. As an innovative, costly method of treatment, it requires however careful monitoring of its course, documenting its early and long-term results, and assessment of its safety and medical-economic cost-effectiveness. A medical registry seems to be an excellent tool to perform such analysis. The aim of this paper is to present the design and rationale for creation of the first National Cardiac-Cardiac Surgical Registry of Percutaneous Aortic Valve Treatment POL-TAVI, to describe its genesis and to highlight its key assumptions and aims. Despite its recent beginnings, the POL-TAVI Registry has already demonstrated its value and usability in monitoring and assessment of TAVI procedures, leading to further improvement and development of this new method in Poland. It constitutes an important and valuable tool for patients, the medical community and the payer.