Jarosław Gorol

Platelet-to-lymphocyte ratio is a marker of poor prognosis in patients with diabetes mellitus and ST-elevation myocardial infarction

AIM Platelet-to-lymphocyte ratio (PLR) has emerged as a strong marker of worse outcomes. We determined the association between PLR and clinical outcomes in patients with diabetes mellitus and ST-elevation myocardial infarction. METHODS Five hundred and twenty three patients were enrolled. Low PLR (group 1, n = 349) was defined as ≤ 124 and high PLR (group 2, n = 174) as >124. RESULTS In-hospital and 1-year mortality was higher in group 2. Receiver operating characteristic analysis revealed moderate diagnostic value in predicting in-hospital (PLR cut-off >155) and long-term (PLR cut-off >146) death. PLR remained an independent risk factor of early and late mortality. CONCLUSION PLR proved to have good prognostic value for in-hospital and late mortality. PLR cut-off value for predicting in-hospital mortality was higher to that predicting late mortality. PLR remained an independent risk factor early and late mortality.

Prognostic significance of mean platelet volume in diabetic patients with ST-elevation myocardial infarction

PURPOSE Mean platelet volume (MPV) is a universally available parameter with routine blood counts. It has been linked to many cardiovascular risk factors. MPV is a marker of platelet size and activity and has been linked to poor prognosis following STEMI. There has been an increasing number of reports linking diabetes mellitus (DM) to platelet dysfunction. The aim of the study was to examine the association between admission MPV and clinical outcomes in patients with DM and STEMI undergoing primary percutaneous coronary intervention (PCI). The secondary objective of the study was to evaluate whether this index can be used to determine the long-term prognosis. METHODS A total of 1,557 patients with STEMI undergoing primary PCI were enrolled and divided into two groups depending on their diabetes mellitus status: Group 1 - patients with diabetes mellitus (N=539) and Group 2 - patients without diabetes mellitus (N=1018). RESULTS MPV and peak CK-MB concentration were higher in diabetic patients as compared to non-diabetic patients. In diabetic patients, MPV was positively correlated with admission Killip class and negatively correlated with time to death during follow-up, initial TIMI flow, final TIMI flow, and erythrocyte count. In non-diabetic patients, MPV was positively correlated with the number of diseased coronary arteries, admission Killip class, and negatively correlated with time to death during follow-up and initial TIMI flow. ROC analysis revealed high diagnostic value of MPV in predicting in-hospital and one-year mortality. MPV cut-off level was lower for diabetic patients compared to non-diabetic patients. CONCLUSIONS Diabetic patients had higher MPV than non-diabetic patients. Both in diabetic and non-diabetic patients MPV proved to have good prognostic value for in-hospital and late mortality. MPV cut-off value for predicting mortality was lower in diabetic patients. Mortality rate was the highest in the fourth quartiles of MPV in both study groups.

Complete percutaneous revascularisation feasibility in ischaemic heart failure is related to improved outcomes: insights from the COMMIT-HF registry

BACKGROUND AND AIM Heart failure (HF) is a major cause of death in cardiovascular disease. In a post-STICH landscape, we lack data on the role of percutaneous coronary intervention (PCI) in systolic HF patients. Complete revascularisation remains a key unanswered question in ischaemic HF. METHODS The COMMIT-HF is an ongoing systolic HF registry (inclusion criteria: HF with left ventricular ejection fraction ≤ 35%, exclusion: acute coronary syndrome). A total of 1798 patients were enrolled. A group of patients with multi-vessel coronary artery disease qualified for PCI were selected and divided into complete (n = 188) and incomplete revascularisation (n = 159) groups. Completeness of revascularisation was defined as successful PCI of every angiographically significant lesion in all arteries with a diameter of ≥ 2 mm without a patent surgical graft. Patients were followed up for a period of at least 12 months with all-cause mortality defined as the primary endpoint. RESULTS The study groups showed no significant differences in clinical status and echocardiographic parameters, with a lower comorbidity rate in the complete revascularisation group. Procedural characteristics were comparable. There were no significant differences in complication rates. All-cause mortality was significantly lower in the complete revascularisation group after 12-months (6.4% vs. 20.1%, p < 0.001). Multivariate analysis confirmed that achievement of complete revascularisation was an independent factor improving survival (HR 0.39; 95% CI 0.18-0.81, p = 0.01). CONCLUSIONS Percutaneous coronary intervention can be a safe and feasible method of revascularisation in ischaemic HF. Achievement of complete revascularisation with PCI was related to improved outcomes in the analysed patient population.

COnteMporary Modalities In Treatment of Heart Failure: a report from the COMMIT-HF registry.

BACKGROUND AND AIM Heart failure (HF) has become a global health problem and is a significant burden for health-care systems worldwide. It is reported as the reason for 1-4% of all hospital admissions in developed countries. The prognosis in HF remains unfavourable. Having at our disposal a large group of patients with systolic HF at a high-volume reference cardiovascular centre with the possibility to implement complete diagnostics and therapy we decided to analyse the clinical data, administered therapies, and prognosis in HF patients. METHODS The COMMIT-HF is a single-centre observational study that is underway in the Third Chair and Department of Cardiology of the Silesian Centre for Heart Diseases in Zabrze. The study population is a cohort of adult HF patients with left ventricular ejection fraction (LVEF) ≤ 35%. Patients with acute coronary syndromes are excluded from the analysis. Complete patient demographics: medical history, hospitalisation data (diagnostic and therapeutic), and in-hospital results are collected. Twelve-month follow-up is based on the information acquired from the national health-care provider. RESULTS As of 31 December 2013 a group of 1798 patients have been enrolled (mean age 60.9 ± 12.8 years, 20.3% of subjects female, mean LVEF 26.06 ± 6.09, ischaemic aetiology 64.5%, atrial fibrillation 33.2%, diabetes mellitus 41.2%, chronic kidney disease stage ≥ III 29%). A significant proportion of patients underwent invasive procedures (ICD/CRT-D implantation 61.1%, coronary angiography 56.2%, PCI 19.6%, CABG 5.1%, heart transplantation qualification 5.5%, IABP 2.5%). All-cause 12-month morality was 12.5%. HF-related rehospitalisation rate was 28.9%. CONCLUSIONS The COMMIT-HF study will provide valuable information on the HF patient population. Initial analyses show that in this difficult patient population satisfactory long-term results can be achieved.

Safety and efficacy of self-apposing Stentys drug-eluting stent in left main coronary artery PCI: Multicentre LM-STENTYS registry

There is a paucity of data on left main (LM) percutaneous coronary intervention (PCI) therapy with dedicated DES platforms. The LM‐STENTYS is a multicenter registry aimed at evaluating clinical outcome after PCI of LM performed with a self‐apposing Stentys DES implantation.

Comparison of outcomes in patients undergoing rotational atherectomy after unsuccessful coronary angioplasty versus elective rotational atherectomy

Introduction Revascularization of patients with heavily calcified coronary arteries can be a challenge for interventional cardiologists. The procedural success rate in these patients can be improved by using rotational atherectomy (RA). Aim To compare in-hospital outcomes and those at 12-month follow-up between patients who underwent RA as a bailout procedure secondary to failed conventional angioplasty or as an elective procedure. Material and methods This is a retrospective analysis of 156 consecutive patients hospitalized at a high-volume percutaneous coronary intervention (PCI) center who underwent RA. In 43 (27.6%) patients, RA was performed on an elective basis (group 1). In 113 (72.4%) patients RA was carried out after unsuccessful traditional angioplasty (group 2). Results Patients in group 1 more often had a history of peripheral vascular disease (32.6% vs. 15.9%; p = 0.03). Group 1 was dominated by patients with multivessel disease (62.8% vs. 33.6%; p < 0.001). The left main coronary artery was more often treated in group 1 (25.6% vs. 2.7%; p < 0.001). Success rates in the two groups were similar: 93.0% for group 1 and 91.2% for group 2 (p = 0.71). The rate of in-hospital complications did not significantly differ between the groups. Twelve-month MI, TLR, and TVR rates were similar in both groups. There was no difference in the 12-month survival rate (86.1% vs. 92.0% in group 2; p = 0.27) or MACE (16.3% vs. 15.0%; p = 0.8). Conclusions Rotational atherectomy is associated with high efficacy and a relatively low risk of complications, with no significant differences in outcomes between patients treated with primary and secondary RA procedures.

Bivalirudin: treatment effect versus side effect.

Alexopoulos et al. [1] presented interesting data showing that in “real-life” scenario, there are no differences in one-month outcome between bivalirudinand no bivalirudin-treated patients. When talking about bivalirudin efficacy, we have to consider two distinct features: treatment effect (antithrombotic action) and side effect (bleeding events). In HORIZONS-AMI trial, there was a reduction in cardiac mortality in the bivalirudin group that can only partly be attributed to prevention of bleeding [2]. Notwithstanding, in EUROMAX trial, there was a substantial decline in bleeding events which did not transfer into survival benefit [3]. Repeatedly, however, there was a higher incidence of stent thrombosis and a trend toward a higher incidence of myocardial infarction [3,4], despite investigators’ attempts to prevent it by prolonging bivalirudin infusion to 4 h following PCI. So actually, in terms of treatment effect, the study proved the drug not to be so efficacious. Bleeding events are independently associated with a worse long-term prognosis across a wide spectrum of patients with coronary artery disease and the risk of death progresses with increasing severity of bleeding [5,6]. However, in this instance, it would seem that we have decreased the risk of side effects (excellent safety profile) at the trade-off of increasing the risk of thrombotic events – events that, one would expect, should decline using antithrombotic agent [7]. In addition, the cost of bivalirudin far exceeds that of standard treatment, thereby calling into question the ancillary benefits of the drug that would justify its use in place of the conventional regimen. Accordingly, we emphasize caution when talking about therapeutic effect. Until then, findings should be considered signals warranting further investigation.