Stanisław Bartuś

DETERMINATION OF NITRITE/NITRATE IN HUMAN BIOLOGICAL MATERIAL BY THE SIMPLE GRIESS REACTION

Since a number of pathological processes such as septic shock, inflammation, graft rejection, diabetes, etc. are associated with a release of nitric oxide (NO), rapid and accurate methods of monitoring of NO concentration are of interest. Various methods for measurement of nitrite and nitrate (NO2-, NO3- ) -- the stable metabolites of NO -- are commonly used for this purpose. In this paper we have shown that the proper Griess procedure for nitrite determination significantly increases the sensitivity of this method. This procedure, supplemented with deproteinization and reduction of nitrates to nitrites in the presence of NADPH-sensitive reductase, can be successfully applied for measurement of NOx levels in human body fluids (serum, urine and CSF). Deproteinization of samples with methanol/diethylether is required and does not influence the sensitivity of detection of NO metabolites. The recovery of the method is 88%+/-6% (n = 30). The NOx concentrations measured by this procedure ranged from 25.0 to 39.0 micromol/l in blood, 4.6 to 14.6 micromol/l in CSF and 0.37 to 2.52 mmol/l (adjusted to creatinine concentration) in urine. The coefficient of variation for this method was between 1.3-2.2%. This method can also be recommended for measurement of NOx produced by cells in tissue cell culture.

Facilitated percutaneous coronary intervention in patients with acute myocardial infarction transferred from remote hospitals

P percutaneous coronary intervention (PCI) is the preferred therapy for myocardial infarction (MI) in centers that have access to immediate invasive treatment because it confers higher patency rates, lower mortality, and lower intracranial hemorrhage rates than fibrinolysis alone.1–3 Current guidelines suggest that primary PCI could be offered as an alternative to thrombolytic therapy if performed by experienced operators within 90 30 minutes after admission.4 Recent studies have suggested that PCI for MI is superior to thrombolysis even if treatment is delayed by 120 minutes by transferring the patient to an interventional center.5,6 However, delay in restoring myocardial blood flow is known to adversely impact long-term outcome.7 If safe and feasible, restoration of myocardial blood flow by thrombolytic therapy during transfer would make longer transfer times to primary PCI acceptable without compromising myocardial salvage. In the present study we tested a combined therapy of a reduced dose of fibrinolytic drug and glycoprotein IIb/IIIa inhibitor during transfer of patients with acute MI from remote community hospitals to a routine emergency angiographic center and possible invasive treatment of MI. • • • The study was approved by the institutional review board and patients gave informed consent. Patients were enrolled at the community hospitals if: (1) they presented with an acute MI (onset of chest pain 12 hours earlier and ST elevation 1 mm in 2 contiguous electrocardiographic leads) to the emergency department of a hospital without a catheterization laboratory; (2) they had no contraindications to thrombolytic therapy and were 75 years of age; and (3) if anticipated transfer time to an interventional center was 90 minutes. Two hundred eligible patients received an IV bolus of 60 U/kg heparin (maximum 5,000), 15 mg alteplase, and 0.25 mg/kg abciximab at the remote center and were transferred, in the presence of a physician, to a single tertiary referral center for diagnostic angiography and possible PCI. Demographic data and time intervals between different stages of patient care are listed in Table 1. Infusion of alteplase (35 mg/60 min) was continued during transfer. Infusion of abciximab From the Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland. This study was financed entirely by the National Health Care Agency of Poland, Krakow Regional Division, as a part of the program to improve early detection and treatment of myocardial infarction in that region of Poland. Dr. Dudek’s address is: 2nd Department of Cardiology, Kopernika Str.17, 31-501 Krakow, Poland. E-mail: mcdudek@cyf-kr.edu.pl. Manuscript received July 8, 2002; revised manuscript received and accepted August 30, 2002. TABLE 1 Baseline Demographics, Risk Factors, Clinical Characteristics, and Time Intervals Between Different Stages of Patient Care

Long-term follow-up of mesh-covered stent implantation in patients with ST-segment elevation myocardial infarction

BACKGROUND The MGuard stent (a bare-metal stent wrapped externally in a polymer mesh sleeve) was introduced to reduce the risk of distal embolisation and no-reflow phenomenon during percutaneous coronary intervention (PCI) in thrombus containing lesions, including ST-segment elevation myocardial infarction (STEMI). However, data on the long-term performance of the MGuard stent is limited. AIM To assess the long-term safety and efficacy of MGuard stent implantation during primary PCI for STEMI. METHODS AND RESULTS In this multicentre study, a total of 60 patients with STEMI ≤12 h treated with the MGuard stent were enrolled. Angiographic success of PCI was achieved in 96.7%, with the final TIMI grade 3 flow in 90.0% of patients. At six months, the overall rate of major adverse cardiac and cerebrovascular events (MACCE; composite of cardiac death, nonfatal target vessel reinfarction, target lesion revascularisation, and stroke) was 1.7%. A long-term follow-up of the study was successfully performed in 57 patients (mean follow-up of 38.7 ± 3.1 months). The long-term cardiac mortality was 7.0%, with a MACCE rate of 8.8%. There was no decrease in the left ventricular ejection fraction and no enlargement of the left ventriclebetween index and long-term follow-up echocardiogram. CONCLUSIONS The early safety and efficacy of the MGuard stent was maintained during the long-term follow-up. However, comparative data from ongoing randomised clinical trials are still required to confirm the long-term efficacy of MGuard stent implantation in patients with STEMI.

No long‐term clinical benefit from manual aspiration thrombectomy in ST‐elevation myocardial infarction patients. Data from NRDES registry

Current STEMI guidelines recommend thrombectomy should be considered during primary PCI. Multiple data from randomized clinical trials, registries, and metanalysis have confirmed the efficacy of thrombectomy in terms of surrogate endpoints like better myocardial perfusion, less pronounced distal embolization, and conflicting results on lower all‐cause mortality. Our aim was to analyze long‐term outcome of STEMI patients treated with manual thrombectomy during primary PCI in a contemporary national registry.

Percutaneous interventions in cardiology in Poland in the year 2014. Summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society AISN PTK.

Introduction The Board of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) publishes annual data from the National PCI Registry (ORPKI) operated by the Jagiellonian University Medical College in Krakow. Aim For the first time the AISN PTK report is based on the new electronic database implemented in Poland on January 1st, 2014. Material and methods In 2014, there were 155 invasive cardiology centers registered in the ORPKI database (an increase by 1 center in comparison to 2013) and 92% of them had 24/7 percutaneous (PCI) duty. For the first time the number of catheterization laboratories (cath labs) in Poland remained stable, and even though there was an increase by 1 in absolute numbers, 2 cath labs ceased to admit patients in 2014. This means that the number of active cath labs per 1 million inhabitants is similar to last year and equals 4. Results In comparison to 2013, there was a significant increase in the total number of coronary angiographies. There were 226 713 angiographies in 2014. The total number of PCI procedures was 126 241, which is 5.1% more than in 2013. Conclusions There was a significant increase in the overall number of coronary angiographies and PCIs in Poland in 2014. The use of attributes of modern interventional cardiology such as drug-eluting stents and bioabsorbable vascular stents is growing as well as more frequent choice of a radial access site by PCI operators even in ST-elevation myocardial infarction patients. One should also note a significant rise in the use of additional imaging or diagnostic tools such as fractional flow reserve, intravascular ultrasound and optical coherent tomography.

Borderline trend towards long-term mortality benefit from drug eluting stents implantation in ST-elevation myocardial infarction patients in Poland-data from NRDES registry.

To analyze long‐term outcome of ST‐Elevation Myocardial Infarction (STEMI) and non‐STEMI (NSTEMI) patients treated with Drug Eluting Stents (DES) stents with regard to mortality and stent thrombosis rates based on the national Polish PCI registry database.

A new version of cardiovascular risk assessment system and risk charts calibrated for Polish population

1Zakład Prewencji i Dydaktyki, Gdański Uniwersytet Medyczny, Gdańsk 2I Klinika Kardiologii i Elektrokardiologii Interwencyjnej oraz Nadciśnienia Tętniczego, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 3II Klinika Kardiologii oraz Interwencji Sercowo-Naczyniowych, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 4Klinika Neurologii Dorosłych, Gdański Uniwersytet Medyczny, Gdańsk 5Katedra Medycyny Społecznej i Zapobiegawczej, Uniwersytet Medyczny w Łodzi, Łódź 6Zakład Epidemiologii, Prewencji Chorób Układu Krążenia i Promocji Zdrowia, Instytut Kardiologii, Warszawa 7Katedra i Klinika Chorób Wewnętrznych, Nadciśnienia Tętniczego i Angiologii, Warszawski Uniwersytet Medyczny, Warszawa 8Klinika Wad Wrodzonych Serca, Instytut Kardiologii, Warszawa 9Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii, Śląski Uniwersytet Medyczny, Katowice 10Klinika Kardiologii, Pomorski Uniwersytet Medyczny, Szczecin 11Klinika Chorób Serca i Naczyń, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 12III Klinika Chorób Wewnętrznych i Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 13I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa 14Zakład Epidemiologii i Badań Populacyjnych, Instytut Zdrowia Publicznego, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński, Collegium Medicum, Kraków 15Klinika Rehabilitacji Kardiologicznej i Elektrokardiologii Nieinwazyjnej, Instytut Kardiologii, Warszawa 16Katedra Kardiologii i Kardiochirurgii, Uniwersytet Warmińsko-Mazurski, Olsztyn 17Klinika Kardiologii Dziecięcej, I Katedra Pediatrii, Uniwersytet Medyczny im. K. Marcinkowskiego, Poznań 18Klinika Intensywnej Terapii Kardiologicznej, Instytut Kardiologii, Warszawa 19Zakład Medycyny Rodzinnej, Katedra Chorób Wewnętrznych i Gerontologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków 20Narodowy Instytut Zdrowia Publicznego — Państwowy Zakład Higieny, Warszawa

Denervation (ablation) of nerve terminalis in renal arteries: early results of interventional treatment of arterial hypertension in Poland

BACKGROUND Arterial hypertension is one of the main causes of cardiovascular disease morbidity and overall mortality. AIM To report the single centre experiences with changes in arterial blood pressure (BP) in patients after intra-arterial application of radiofrequency (RF) energy to cause renal sympathetic efferent and somatic afferent nerve and report vascular and kidney safety in a six month follow up. METHODS Twenty-eight patients, with hypertension despite medical therapy (median age 52.02 years, range 42-72 years) consented to therapeutic renal nerve ablation. SIMPLICITY RF catheters and generator provided by Ardian (currently Medtronic Inc., USA) were used to perform renal artery angiography and ablation. RESULTS The mean BP at baseline, and after one month, three months and six months were measured [mm Hg]: systolic 176.6; 162.3 (p = 0.004); 150.6 (p < 0.001); 147.2 (p < 0.001); diastolic 100.2; 90.3 (p < 0.001); 91.79 (p = 0.03); 88.5 (p < 0.001); pulse pressure 76.57; 75.18 (p = NS); 65.80 (p < 0.001); 62.15 (p < 0.001). Neither procedure-related nor therapy-related complications were reported in the six month follow up. CONCLUSIONS In our cohort of patients, intra-arterial renal nerve denervation was not associated with either vascular or renal complications out to six months. Nerve ablation of renal arteries led to significant reduction of mean values of arterial systolic, diastolic BP and significant reduction of pulse pressure. The Polish experience is not significantly different compared to that reported in the Symplicity I and Symplicity II international cohorts. The long term durability of this therapy and its application to earlier stages of hypertension or other disease states will require further investigation.

Is right coronary artery chronic total vessel occlusion impacting the surgical revascularization results of patients with multivessel disease? A retrospective study

Introduction Chronic total occlusion (CTO) is common in the presence of other significantly narrowed coronary arteries. The impact of total occlusion and its association with completeness of revascularization on patients with multivessel disease undergoing coronary artery bypass graft (CABG) remains largely unknown. Aim The aim of our study was to compare CABG operation characteristics, as well as 30-day mortality, incidence of post-operative major adverse cardiac and cerebrovascular events (MACCE) between patients with and without CTO in right coronary artery (RCA). Materials and Methods A total of 156 consecutive patients were included in the analysis. CTO of RCA or right posterior descending artery (RPD) was diagnosed in 57 patients (CTO-RCA group). Coronary stenosis without CTO in RCA was diagnosed in 99 patients (nonCTO-RCA group). Baseline characteristics were comparable in both groups. Results The majority of patients had class II (49.1% vs. 46%, p = 0.86) or class III (42.1% vs. 43%, p = 1.0) Canadian Cardiovascular Society grading system symptoms. Patients in the CTO-RCA group had in average 2.2 grafts implanted, as opposed to 2.4 grafts in patients in the nonCTO-RCA group (p = 0.003). Graft to the RCA was performed in 40.3% patients in the CTO-RCA group and in 81% patients in the nonCTO-RCA group (p = 0.001). The 30-day mortality from any cause or cardiac cause did not differ between groups (7% vs. 2%, p = 0.14 and 3.5% vs. 2%, p = 0.57 respectively). In a multivariate analysis CTO in RCA or RPD and peripheral artery disease were independent predictors of post-operative MACCE (7.9 (1.434-43.045) p = 0.02; 18.8 (3.451-101.833) p < 0.01, respectively). Conclusions Chronic total occlusion of RCA was found to be associated with smaller number of grafts performed during the CABG procedure. Although mortality between patients in the CTO-RCA and nonCTO-RCA groups did not differ, patients in the CTO-RCA group had higher incidence of post-operative MACCE.

The network of invasive cardiology facilities in Poland in 2016 (data from the ORPKI Polish National Registry)

INTRODUCTION Despite significant advancements in cardiac care, cardiovascular diseases (CVDs) are the main cause of mortality in Poland. Thus, they should be a priority in the national health policy. In addition, further optimisation of medical care requires maintenance of an effective, integrated, and networked structure of the treatment of CVDs. In Poland, treatment of coronary artery disease, including acute coronary syndrome (ACS), is currently provided complimentarily by a network of highand low-volume percutaneous coronary intervention (PCI) centres. Importantly, the network has been organised and developed by Polish cardiologists for almost 20 years. During that period, multiple strategies have been introduced to improve the safety and efficacy of national care for patients with ACS. These have included a reduction of the time from first medical contact to reperfusion through an increase in the availability of primary-PCI centres, direct transfer, bypassing non-PCI-capable hospitals or emergency departments, and early cath lab activation after electrocardiogram teletransmission from the field [1–5]. Despite this, approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) are still not transferred directly to the appropriate facility and may experience an unnecessary delay to reperfusion [3, 4]. Thus, regional and countrywide systems of care face an ongoing challenge of determining the best policies for geographical distribution of cath labs and time frames of transferring the patients from referring centres to primary-PCI hospitals. Data on the current activity and geographical distribution of cath labs may be helpful to refine the network. Thus, we sought to evaluate the current number, performance, and localisation of PCI facilities in Poland, based on data from the Polish National PCI Registry (ORPKI). METHODS The ORPKI Registry is operated by the Jagiellonian University Medical College in Krakow, Poland (https://www.orpki.cm-uj. krakow.pl/) and is endorsed by the Polish Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) [6]. The registration in the ORPKI database is voluntary; however, as much as 98% of all catheterisation laboratories in Poland have joined the registry. For this study, complete data for 2016 collected from 157 cath labs were extracted. The centres were divided into high-volume (≥ 400 PCIs/year) and low-volume (< 400 PCIs/year), depending on the total number of all PCIs performed in a particular cath lab in 2016. A cut-off value of 400 PCIs/year was selected, as recommended by the European Society of Cardiology (ESC) guidelines on myocardial revascularisation [6]. In addition, data from the highest-volume centres, according to a cut-off value of 1000 PCIs/year, were assessed. Subsequently, data concerning numbers of PCIs were stratified by the initial diagnosis.