Piotr Desperak

Prognostic implications of mean platelet volume on short- and long-term outcomes among patients with non-ST-segment elevation myocardial infarction treated with percutaneous coronary intervention: A single-center large observational study

Abstract Background: Mean platelet volume (MPV) is a simple and reliable indicator of platelet size that correlates with platelet activation and their ability to aggregate. We studied the predictive value of MPV in patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated with percutaneous coronary intervention (PCI). Methods: We analyzed the consecutive records of 1001 patients who were hospitalized due to NSTEMI at our center. The primary end point was a composite end point that included the rates of all-cause death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) driven revascularization at 12 months. The enrolled patients were stratified according to the quartile of the MPV level at admission. Results: Along with the increasing quartile of MPV, the 12-month composite end point increased significantly (p = 0.010), and this association remained significant after the risk-adjusted analyses (per 1 fL higher MPV; adjusted hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.02–1.27; p = 0.026). In the multivariate analysis, the MPV was also an independent factor of all-cause mortality (per 1 fL increase; adjusted HR 1.34; 95% CI 1.12–1.61; p = 0.0014) and death or non-fatal myocardial infarction (per 1 fL increase; adjusted HR 1.16; 95% CI 1.03–1.31; p = 0.017). Conclusion: In patients with NSTEMI treated with PCI, a high MPV value was associated with a significantly increased incidence of long-term adverse events, particularly for all-cause mortality.

Proximal LAD atherosclerosis: milking-like effect of the septal perforator branches.

involved in the genesis of atherosclerosis, we have come to the conclusion that the proximal LAD segment susceptibility to atherosclerosis can be attributed to the milking effect of septal perforators (Fig. 1). Numerous studies have shown that the myocardial bridge is associated with the development of atherosclerosis proximal to the tunneled artery. In fact, retrograde blood flow observed in the segment proximal to myocardial bridge is the result of intramural vessel compression during systole. It may lead to time-varying bidirectional flow formations generating oscillatory endothelial shear stress responsible of the pro-atherogenic gene expression. In conclusion, we proposed the hypothesis the septal perforators, similarly to myocardial bridge, may be considered as a risk factor for LAD atherosclerosis location (myocardial bridging effect) [3, 4].

Clinical characteristics, and in-hospital and long-term outcomes of stable angina treatment in patients below and over 40 years of age (from the PRESAGE registry)

BACKGROUNDnThere is a paucity of data concerning young patients with stable angina (SA).nnnAIMnThe study aimed to compare the characteristics, as well as in-hospital one-, two-, and five-year outcomes of patients aged ≤ 40 and > 40 years with SA.nnnMETHODSnThe analysis involved 80 patients aged ≤ 40 years and 9299 patients aged > 40 years with SA treated in the 3rd Department of Cardiology in Zabrze between 2006 and 2014, and enrolled in the ongoing PRESAGE Registry. Propensity scores matching was used to adjust for differences in patients baseline characteristics. The composite endpoint involved death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) or ACS-driven unplanned revascularisation within one-, two-, and five-year follow-up periods.nnnRESULTSnIn comparison to older patients, the younger ones had a higher incidence of smoking (58.3% vs. 35.2%, p < 0.0001) and previous percutaneous angioplasty (45% vs. 33.7%, p = 0.033). There was no significant difference in in-hospital outcomes. The composite endpoint incidence did not differ significantly between the young and old group within one year (1.3% vs. 8.1%, p = 0.068), two years (5.8% vs. 12.9%, p = 0.08), and five years (23.1% vs. 25.7%, p = 0.71) after discharge. Young patients had a borderline lower mortality rate (0% vs. 4.5%, p = 0.053) after a one-year follow-up and a significantly lower mortality rate within two and five years after index hospitalisation (0% vs. 7.8%, p = 0.02 and 5.1% vs. 17.1%, p = 0.04, respectively). After propensity score matching analysis, a significantly lower two-year mortality was observed in the ≤ 40 age group (0% vs. 8.1%; p = 0.016), without significant difference during five-year follow-up (5.1% vs. 13.5%; p = 0.21).nnnCONCLUSIONSnThe younger and older groups of patients with SA differed in clinical characteristics, with no significant difference in the in-hospital outcomes and composite endpoint incidence in the follow-up period. However, younger patients had a borderline lower mortality rate one year after discharge and a significantly lower mortality rate two and five years after the index hospitalisation.

Medium platelet volume as a noninvasive predictor of chronic total occlusion in non-infarct artery in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease

BACKGROUNDnChronic total occlusion (CTO) in a noninfarct-related artery (non-IRA) is an independent predictor of mortality in non-ST elevation myocardial infarction (NSTEMI). Mean platelet volume (MPV) is associated with cardiovascular events in NSTEMI. Little is known about the predictors of non-IRA-CTO in patients with NSTEMI. The purpose of this study was to evaluate the relationship between the presence of non-IRA-CTO with MPV level in patients with NSTEMI and multivessel coronary artery disease (MVCAD).nnnMETHODSnData of consecutive patients with NSTEMI and MVCAD treated in high-volume PCI center between 2006 and 2012 and included in the prospective registry were divided according to the presence of CTO and analyzed.nnnRESULTSnIn the group of 685 patients fulfilling the inclusion criteria, 308 (45%) patients had CTO (CTO+), and in 377 (55%) patients CTO was not observed (CTO-). The MPV level on admission was significantly higher in the CTO+ group than in the CTO- group (P<0.0001). In the multivariate analysis of the entire study population, independent predictors of occurrence of CTO were medium platelet volume (MPV; per 1fL more; odds ratio [OR] 1.34; 95% confidence interval [CI] 1.15-1.57; P=0.0002) together with left ventricular ejection fraction and prior MI.nnnCONCLUSIONSnMPV at admission is independently associated with more frequent occurrence of non-IRA CTO in patients with NSTEMI and MVCAD.