Paweł Francuz

Prognostic Significance of Hyperuricemia in Patients with Different Types of Renal Dysfunction and Acute Myocardial Infarction Treated with Percutaneous Coronary Intervention

Aim: This study evaluated the impact of hyperuricemia (HUR) on outcome in patients with different types of impaired renal function (IRF) and acute myocardial infarction (AMI) treated invasively. Methods: Out of 3,593 consecutive AMI patients treated invasively, 1,015 IRF patients were selected. The IRF group consisted of patients with baseline kidney dysfunction (BKD group) and/or patients with contrast-induced nephropathy (CIN group). HUR was defined as a serum uric acid concentration (SUAC) >420 µmol/l (>7 mg/dl). Independent predictors of death and major adverse cardiovascular events (MACE) were selected by the multivariate Cox-regression model. Results: Remote mortality rates were higher in HUR patients: IRF (32.7 vs. 18.6%), BKD (41.3 vs. 25.9%), CIN (35.4 vs. 16.7%); all p < 0.001. HUR was an independent predictor of death in BKD (hazard ratio (HR) 1.38, p < 0.05). Each 100-µmol/l increase in SUAC was associated with a significant increase of HR for mortality: 1.087 in IRF patients, 1.108 in BKD patients, 1.128 in CIN patients; all p < 0.05. Remote major adverse cardiovascular event rates were higher in HUR patients: IRF (55.4 vs. 48.9%), CIN (56.8 vs. 48%); both p < 0.05. Conclusions: In AMI patients treated invasively, an increase in SUAC is an independent predictor of death within all types of renal dysfunction; HUR defined as SUAC >420 µmol/l (>7 mg/dl) is a predictor only in BKD patients.

Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities

Background Glucose abnormalities are frequent comorbidities influencing prognosis in patients with cardiovascular diseases. The objective of this study was to evaluate prognostic role of HbA1c in patients with acute myocardial infarction (AMI) treated invasively, who had newly detected glucose abnormalities. Design Single-centre registry encompassed 2146 survivors of AMI. In all patients without diabetes mellitus (DM), oral glucose tolerance test was performed before hospital discharge and interpreted according to the guidelines. Methods From the study population, two major groups with defined new glucose abnormalities and estimated HbA1c were selected: 457 patients with impaired glucose tolerance (IGT) and 306 patients with newly detected DM (newDM). In each of these groups, the median value of HbA1c was calculated and established as the cut-off point for further analysis. The median HbA1c for IGT group was 5.9% and for newDM was 7.0%. Results Patients with IGT and HbA1c ≤ 5.9% had significantly lower posthospital mortality (4.5%) than those with HbA1c >5.9% (25.0%; p<0.001). Similarly, patients with newDM and HbA1c ≤7.0% had lower mortality (6.4%) than those with HbA1c >7.0% (14.3%; p<0.05). Multivariate regression analysis revealed that increase of HbA1c was one of the strongest independent risk factors of death among IGT patients (HR 2.9, 95% CI 2.7–3.1; p < 0.001) and newDM (HR 1.53, 95% CI 1.39–1.66; p<0.05). Conclusions Increase of HbA1c in patients with newly detected glucose abnormalities was associated with significantly reduced survival after AMI treated invasively. Moreover, increase of HbA1c in patients with IGT and newDM was one of the strongest independent risk factors of death in these populations.

Platelet count and volume indices in patients with contrast-induced acute kidney injury and acute myocardial infarction treated invasively.

BACKGROUND The aetiology of contrast-induced acute kidney injury (CI-AKI) is not well understood. We hypothesised that the pathophysiology of CI-AKI and impaired coronary reperfusion (IR), observed after invasive treatment of acute myocardial infarction (AMI), could be similar and might be related to platelet count (PC) and platelet volume indices (PVI). AIM To evaluate the relation between PC, PVI, IR, and CI-AKI in patients with AMI treated invasively. METHODS A single-centre study evaluated 607 consecutive AMI-patients treated invasively. Comparative analyses were performed between patients with CI-AKI and without CI-AKI for the total study population (CI-AKI, n = 156; 25.7% vs. nCI-AKI, n = 451; 74.3%), for patients with diabetes mellitus (CI-AKI-DM, n = 56; 9.2% vs. nCI-AKI-DM, n = 123; 20.3%), and for patients with baseline kidney dysfunction (CI-AKI-BKD, n = 31; 5.1% vs. nCI-AKI-BKD, n = 67; 11.0%). Subjects with IR, who developed CI-AKI, were compared to the remaining patients with respect to platelet parameters (CI-AKI-IR, n = 47; 7.7% vs. controls, n = 560; 92.3%). For total population, as well as studied subgroups, multivariate logistic regression analyses were performed to reveal independent factors associated with CI-AKI. The results of the models were reported as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS PC was higher in CI-AKI-DM-patients (224.8 ± 62.8 × 10(9)/L vs. 197.9 ± 63.3 × 10(9)/L; p = 0.014) and in CI-AKI-BKD-patients (248.9 ± 86.5 × 10(9)/L vs. 202.5 ± 59.3 × 10(9)/L; p = 0.004) than in appropriate controls. Within the studied groups, there were no differences between CI-AKI and nCI-AKI patients with respect to PVI. Comparing CI-AKI-IR-patients with controls, no differences in PC or PVI were found. IR was observed more often in CI-AKI-patients than in nCI-AKI-patients only among diabetics (48.2% vs. 27.6%; p = 0.008). Increase in admission PC was independently associated with CI-AKI in patients with diabetes (per one unit increase OR 1.006; CI 1.0-1.01; p = 0.04) as well as with baseline kidney dysfunction (per one unit increase OR 1.01; CI 1,0-1,02; p = 0.02). CONCLUSIONS Any similarities in the pathophysiology of CI-AKI and IR were not reflected in platelet parameters. CI-AKI development was not related to PVI; however, higher PC was an independent risk factor for CI-AKI in patients with diabetes or baseline kidney dysfunction.

Prognostic Significance of Complex Ventricular Arrhythmias Complicating ST-Segment Elevation Myocardial Infarction.

The aim of the study was to assess the clinical significance of complex ventricular arrhythmias (VAs) (sustained ventricular tachycardia [sVT] and ventricular fibrillation [VF]) in patients with ST-segment elevation myocardial infarction (STEMI) depending on timing of arrhythmia. We analyzed 4,363 consecutive patients with STEMI treated invasively between 2004 and 2014. The median follow-up was 69.6 months (range: 0 to 139.8 months). The study population was divided into 2 main groups; VA group encompassed 476 patients (10.91%) with VAs, whereas 3,887 subjects (89.09%) without VT or VF were included into the control group. In VA population, prereperfusion VA (34.24%; n = 163) was the most common arrhythmia, whereas reperfusion-induced, early postreperfusion, and late postreperfusion VAs were diagnosed in 103 (21.64%), 103 (21.64%), and 107 (22.48%) patients, respectively. Every type of sVT or VF complicating STEMI portended significantly worse in-hospital prognosis, however a late onset arrhythmia was associated with the highest (over fivefold) and reperfusion-induced VA with the lowest (less than threefold) increase in mortality risk compared with the control group. On the contrary, long-term mortality was significantly increased only in subjects with late postreperfusion and prereperfusion VAs compared with VA-free population (43.93% and 36.81%, respectively vs 22.58%; p <0.001). Apart from cardiogenic shock on admission, late postreperfusion (hazard ratio 3.39) and prereperfusion VAs (hazard ratio 2.76) were the strongest independent predictors of death in the analyzed population. In conclusion, 1 in 10 patients with STEMI treated invasively was affected by sVT or VF. The clinical impact of VAs was strongly dependent on timing of arrhythmia.

Long-term prognosis is related to mid-term changes of glucometabolic status in patients with acute myocardial infarction treated invasively

BACKGROUND Glucometabolic status (GS) in patients with acute myocardial infarction (AMI) has an impact on prognosis, but it may change over time. AIM To evaluate the prognosis after AMI treated invasively with respect to changes in GS assessed by oral glucose tolerance test at discharge and at mid-term follow-up visit (FU-visit). METHODS Glucometabolic status was assessed by two-hour post-load glycaemia and defined as abnormal glucose tolerance (AGT) or normal glucose tolerance (NGT). Out of 454 in-hospital AMI survivors, 368 (81%) patients completed an FU-visit and were divided into four groups with respect to GS at discharge and FU-visit: group 1 - AGT at discharge and FU-visit (n = 101); group 2 - AGT at discharge and NGT at FU-visit (n = 48); group 3 - NGT at discharge and AGT at FU-visit (n = 114); and group 4 - NGT at discharge and FU-visit (n = 105). All-cause mortality was compared between groups with log-rank test. RESULTS Median time from AMI to FU-visit was seven months. Median remote follow-up duration after AMI was 31 months. Two-hour post load glycaemia was significantly higher in patients with confirmed AGT at FU-visit than in other groups. Mortality was higher in group 1 (11.9%) than in group 2 (2.1%; p = 0.034) and group 4 (2.9%; p = 0.009). Mortality rates between group 2 and 4 were similar (2.1% vs. 2.9%; p = 0.781). There was no significant difference in mortality between group 1 and group 3 (11.9% vs. 6.1%; p = 0.114). Mortality in group 3 was over two-fold higher than in group 4; however, this difference was statistically non-significant (6.1% vs. 2.9%; p = 0.247). CONCLUSIONS Prognosis for patients with confirmed AGT was unfavourable; however, patients with AGT at discharge, in whom GS improved, had similar mortality to subjects with persistent NGT. The major clinical implication from this study is the finding that reassessment of GS by repeated oral glucose tolerance test has significant prognostic value and makes initial risk stratification performed at discharge more reliable.

Gender-related differences in long-term outcome among high-risk patients with myocardial infarction treated invasively

Introduction Treating acute myocardial infarction (AMI) with percutaneous coronary intervention (PCI) has an impact on improving long-term outcome. However, patients with other comorbidities are challenging, and are considered as a high-risk population. Aim To assess gender-related differences in long-term prognosis after AMI among high-risk patients. Material and methods The single-center registry encompassed 4375 AMI patients treated with PCI. The following high-risk groups were selected: age > 70 group (n = 1081), glomerular filtration rate (GFR ) < 60 group (n = 848), diabetes mellitus (DM) group (n = 782), low ejection fraction (EF) group (n = 560) defined as EF < 35%, and incomplete coronary revascularization (ICR) group (n = 2008). Within each group, comparative analysis of long-term mortality with respect to gender and age was performed. Results There were no significant differences in long-term mortality with respect to gender among groups with age > 70 (29.0% vs. 30.3%) and GFR < 60 (37.2% vs. 42.3%) (both p = NS respectively for men vs. women). In the DM group (24.8% vs. 30.8%; p = 0.06) and EF < 35% group (36.3% vs. 44.5%; p = 0.07) there was a trend towards significance. The ICR group showed a higher mortality rate with respect to gender (19.7% vs. 27.3%; p < 0.001). Differences in survival assessed by the log-rank test were significant among ICR and EF < 35% groups. Conclusions Female gender is related to higher long-term mortality among high-risk groups, but a statistically significant difference was observed only in patients with ICR and those with EF < 35%. Female gender may be associated with worse prognosis in diabetic patients, but it needs evaluation. However, worse prognosis in women was not independent and was associated mainly with other comorbidities and worse clinical characteristics.