Publications by authors named "Mariusz Gąsior"

352 Publications

A new approach to ticagrelor-based de-escalation of antiplatelet therapy after acute coronary syndrome. A rationale for a randomized, double-blind, placebo-controlled, investigator-initiated, multicenter clinical study.

Cardiol J 2021 Jun 7. Epub 2021 Jun 7.

Department of Cardiology, Center for Heart Diseases, Military Hospital, Wroclaw, Poland.

The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome - a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and maintaining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up (ClinicalTrials.gov Identifier: NCT04718025; EudraCT number: 2020-005130-15).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.a2021.0056DOI Listing
June 2021

Managed care for acute myocardial infarction survivors in the Silesian agglomeration during the COVID-19 pandemic.

Kardiol Pol 2021 May 24. Epub 2021 May 24.

3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.a2021.0020DOI Listing
May 2021

Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: Multicentre CRACK registry.

PLoS One 2021 12;16(5):e0249698. Epub 2021 May 12.

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.

Background: Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation.

Methods: This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI).

Results: The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST].

Conclusions: The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249698PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115813PMC
May 2021

Metformin in patients with type 2 diabetes mellitus and heart failure: a review.

Endokrynol Pol 2021 ;72(2):163-170

3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland.

Diabetes mellitus is a major, global problem. Among the numerous complications of diabetes, there is increasing concern over the coexisting heart failure. Metformin is the most frequently used oral antidiabetic drug that is considered to be safe and effective in the management of type 2 diabetes mellitus. Since the publication of the UK Prospective Diabetes Study, it has been suggested that metformin might improve cardiovascular prognoses. Results from available studies have shown that metformin therapy in patients with type 2 diabetes mellitus and heart failure was associated with improved clinical outcomes when compared with other oral antidiabetic agents, insulin, or lifestyle management. However, there have been no randomized controlled trials evaluating the influence of metformin use on clinical outcomes in patients with type 2 diabetes mellitus and heart failure. New evidence from large cardiovascular outcome trials that showed a reduction in heart failure hospitalization for SGLT2 inhibitors caused changes in recommendations on the management of hyperglycaemia. Currently, the European Society of Cardiology recommends sodium-glucose co-transporter 2 inhibitors in patients with type 2 diabetes mellitus and heart failure or at high risk for heart failure, as a first choice in drug naïve patients, or as a second drug if the patient is already on metformin. The aim of our study is to review the current state of knowledge about the position of metformin in the treatment of patients with type 2 diabetes mellitus and heart failure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/EP.a2021.0033DOI Listing
January 2021

Acute Coronary Tree Thrombosis After Vaccination for COVID-19.

JACC Cardiovasc Interv 2021 05;14(9):e103-e104

3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia, Katowice, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcin.2021.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092130PMC
May 2021

Serum Sulfhydryl Groups, Malondialdehyde, Uric Acid, and Bilirubin as Predictors of Adverse Outcome in Heart Failure Patients due to Ischemic or Nonischemic Cardiomyopathy.

Oxid Med Cell Longev 2021 15;2021:6693405. Epub 2021 Apr 15.

Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia, 41-902 Bytom, Poland.

Oxidative stress plays a significant role in the pathogenesis of heart failure (HF). The aim of the study was to investigate the prognostic value of oxidation-reduction (redox) markers in patients with HF due to ischemic and nonischemic cardiomyopathy. The study included 707 patients of HF allocated into two groups depending on ethology: ischemic cardiomyopathy (ICM) ( = 435) and nonischemic cardiomyopathy (nICM) ( = 272), who were followed up for one year. The endpoint occurrence (mortality or heart transplantation) in a 1-year follow-up was similar in the ICM and nICM group. The predictive value of endpoint occurrence of oxidative stress biomarkers such as the serum protein sulfhydryl groups (PSH), malondialdehyde (MDA), uric acid (UA), bilirubin, and MDA/PSH ratio and other clinical and laboratory data were assessed in both groups (ICM and nICM) separately using univariate and multivariate Cox regression analyses. In multivariate analysis, the higher concentrations of UA ( = 0.015, HR = 1.024, 95% CI (1.005-1.044)) and MDA ( = 0.004, HR = 2.202, 95% CI (1.296-3.741)) were significantly associated with adverse prognosis in patients with ICM. Contrastingly, in patients with nICM, we observed that higher bilirubin concentration ( = 0.026, HR = 1.034, 95% CI (1.004-1.064)) and MDA/PSH ratio ( = 0.034, HR = 3.360, 95% CI (1.096-10.302)) were significantly associated with increased risk of death or HT. The results showed the association of different oxidative biomarkers on the unfavorable course of heart failure depending on etiology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2021/6693405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062185PMC
May 2021

Multivessel Intervention in Myocardial Infarction with Cardiogenic Shock: CULPRIT-SHOCK Trial Outcomes in the PL-ACS Registry.

J Clin Med 2021 Apr 22;10(9). Epub 2021 Apr 22.

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-752 Katowice, Poland.

Background: The aim of the study was a comparison of culprit-lesion-only (CL-PCI) with the multivessel percutaneous coronary intervention (MV-PCI) in terms of 30-day and 12-month mortality in a national registry.

Methods: Patients from the PL-ACS registry with MI and CS were analyzed. Patients meeting the criteria of the CULPRIT-SHOCK trial were divided into two groups: CL-PCI and MV-PCI groups.

Results: Of the 3265 patients in the PL-ACS registry with MI complicated by CS, the criteria of the CULPRIT-SHOCK trial were met by 2084 patients (63.8%). The CL-PCI was performed in 883 patients, and MV-PCI was performed in 1045 patients. After the propensity score matching analysis, 617 well-matched pairs were obtained. In a 30-day follow-up, death from any cause occurred in 49.3% in the CL-PCI group and 57.0% in the MV-PCI group (RR 0.86, 95% CI 0.58-0.92, = 0.0081). After 12 months, the rate of mortality was 62.5% in the CL-PCI group and 68.0% in the MV-PCI group (RR 0.92, 95% CI 0.84-1.01, = 0.066).

Conclusions: The results confirm the validity of CULPRIT-SHOCK findings in a national registry and current guideline-recommended strategy of revascularization limited to the infarct-related artery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10091832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122818PMC
April 2021

Idarucizumab for dabigatran reversal in cardiac tamponade complicating percutaneous intervention in ST elevation myocardial infarction.

Postepy Kardiol Interwencyjnej 2021 Mar 27;17(1):129-130. Epub 2021 Mar 27.

3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Disease in Zabrze, Poland.

An 83-year-old man with a history of permanent atrial fibrillation (AF) anticoagulated by dabigatran 150 b.i.d., type 2 diabetes mellitus, and hypertension was admitted to the hospital with a diagnosis of ST-elevation myocardial infarction (STEMI). The patient was loaded with 300 mg of aspirin , 5000 IU of unfractionated heparin and 600 mg of clopidogrel and was transferred to the catheterization laboratory. Coronary angiography demonstrated left anterior descending artery (LAD) occlusion. During the LAD angioplasty a dissection of a distal part of the LAD and the blood extravasation to the pericardium occurred (Figure 1 A). Idarucizumab 2 × 2.5 g was administered and the inflated balloon maintained at the site of coronary perforation. About 10 min after the end of idarucizumab infusion, the balloon was deflated and the patient presented with clinical symptoms of cardiac tamponade such as blood pressure decrease and tachycardia. The echocardiographic assessment revealed up to 16 mm accumulation of pericardial fluid (Figure 2 A). Immediately the covered stent was implanted (Papyrus, Biotronik) and the pericardiocentesis was carried out. 320 ml of blood was finally drained. Control contrast injection revealed a covered perforating zone with no contrast extravasation (Figure 1 B). The echocardiographic control revealed pericardial effusion less than 5 mm (Figure 2 B). The patient was stable with a blood pressure of 130/80 mm Hg, a heart rate of 100-130/min (AF), and without chest pain. No significant reduction in the red blood cell count was observed. Antiplatelet therapy was given consisting of aspirin and clopidogrel. In the following days enoxaparin was introduced and finally changed to dabigatran 110 mg b.i.d.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aic.2021.104784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039931PMC
March 2021

Comparison of the results of transcatheter aortic valve implantation in patients with bicuspid and tricuspid aortic valve.

Postepy Kardiol Interwencyjnej 2021 Mar 27;17(1):82-92. Epub 2021 Mar 27.

Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.

Introduction: Indications for transcatheter aortic valve implantation (TAVI) are constantly expanding, including younger patients. Bicuspid aortic valves (BAV) often occur in this group. In order to achieve optimal treatment results in younger patients, it is necessary to develop an effective method for selecting the size of implanted valves.

Aim: To compare the results of TAVI with use of a self-expanding prosthesis in patients with a BAV and a tricuspid aortic valve (TAV) with valve selection based on annular sizing.

Material And Methods: The diagnosis of BAV and TAV and measurements (annular sizing) were based on multi-slice computed tomography scans. Eighty-three patients received a self-expanding CoreValve or Evolut R prosthesis. In group I (BAV) there were 21 (25.3%) patients and in group II (TAV) there were 62 (74.7%) patients.

Results: The groups did not differ in terms of baseline clinical characteristics. Device success was achieved in 16 (76.2%) and 55 (88.7%) ( = NS) in group I and II respectively. Composite endpoints: early safety occurred in 5 (23.8%) and 11 (17.7%) patients ( =NS) in group I and II respectively; clinical efficacy occurred in 10 (47.6%) and 28 (45.2%) patients ( = NS) in group I and II respectively. 30-day mortality was 4.8% vs 9.7%, 1-year mortality was 28.6% vs 17.7% ( = NS) in group I and II respectively.

Conclusions: TAVI in patients with severe aortic stenosis and BAV is as effective as in patients with TAV using self-expanding prostheses if the valve selection is based on annular sizing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aic.2021.104773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039923PMC
March 2021

An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis.

Cardiol J 2021 Apr 12. Epub 2021 Apr 12.

3rd Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.

Background: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD) therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation did not change, it is worth noting that these findings significantly affected the daily practice of ICD implantation in Europe.

Methods: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non-ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the available carefully designed prospective randomized controlled trials. Only prospective randomized controlled trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH.

Results: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789 patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67-1.01); p = 0.06. The data from the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI 0.31-0.67); p < 0.001.

Conclusions: In comparison with optimal medical treatment, ICD implantation in patients with heart failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards all-cause mortality reduction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.a2021.0041DOI Listing
April 2021

ANalgesic Efficacy and safety of MOrphiNe versus methoxyflurane in patients with acute myocardial infarction: the rationale and design of the ANEMON-SIRIO 3 study: a multicentre, open-label, phase II, randomised clinical trial.

BMJ Open 2021 03 1;11(3):e043330. Epub 2021 Mar 1.

Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland.

Introduction: The unfavourable influence of morphine on the pharmacokinetics of ticagrelor resulting in weaker and retarded antiplatelet effect in patients with acute coronary syndrome (ACS) has been previously shown. Replacing morphine with methoxyflurane, a potent, non-opioid analgesic agent, that does not weaken or delay the effect of antiplatelet agents may improve the clinical efficacy of treatment of patients with ACS.

Methods: The ANEMON-SIRIO 3 study was designed as a multicentre, open-label, phase II, randomised clinical trial aimed to test the analgesic efficacy and safety of methoxyflurane in patients with ACS. The study population will comprise patients with ST-elevation myocardial infarction or non-ST-elevation ACS admitted to the study centres with typical chest pain requiring analgesic treatment. Before percutaneous coronary intervention (PCI) for the patients with index ACS will be randomly assigned in 1:1 ratio to receive methoxyflurane administered by inhalation, or to obtain morphine administered intravenously. Analgesic treatment will be followed by 300 mg loading dose of aspirin and 180 mg loading dose of ticagrelor. Patients will be assessed with regard to pain intensity according to the Numeric Pain Rating Scale at baseline, 3 min after study drug administration and immediately after PCI. Moreover, patients will be actively monitored with regard to the occurrence of side effects of evaluated therapies, as well as adverse events that may be related to insufficient platelet inhibition (no-reflow phenomenon assessed immediately after PCI, administration of GPIIb/IIIa inhibitors during PCI, acute stent thrombosis).

Ethics And Dissemination: The study will be conducted in six Polish clinical centres from the beginning of in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Trial Registration Details: ClinicalTrials.gov, NCT04476173.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-043330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098993PMC
March 2021

Female gender and the clinical and periprocedural profile and clinical outcomes of transcatheter aortic valve implantation: experiences of a tertiary Polish centre.

Postepy Kardiol Interwencyjnej 2020 Dec 29;16(4):436-443. Epub 2020 Dec 29.

3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.

Introduction: Despite the establishment of multiple factors influencing short- and mid-term outcomes in patients treated with transcatheter aortic valve implantation (TAVI), the real-world data on the association between gender and outcomes after TAVI remain conflicting.

Aim: To evaluate the association of female gender with the clinical and periprocedural characteristics along with in-hospital, short- and medium-term outcomes of patients treated with TAVI in comparison with male patients.

Material And Methods: Data from the prospective, single-centre registry of consecutive patients with severe AS referred for TAVI from 26 November 2008 to 31 December 2018 were analysed retrospectively. The study population comprised 275 patients who were divided by gender. The primary endpoint of the study was all-cause mortality at 1 year.

Results: Women constituted 132 (48.0%) of the overall population. Women were significantly older, but had a significantly higher left ventricular ejection fraction (LVEF) and had less frequently undergone coronary artery bypass grafting (CABG) before TAVI. The implantation success rate was comparable between genders, but women less frequently required implantation of a pacemaker after TAVI, although they more frequently required blood transfusion due to severe bleeding. The primary endpoint occurred in 13.6% of women and 7.7% of men ( = 0.12).

Conclusions: Despite advanced age and prevalence of cardiovascular risk factors, the overall short- and medium-term mortality in patients treated with TAVI in our analysis of the real-world population remains relatively low. Although women seemed to have a slightly better clinical baseline profile, their in-hospital, 30-day, 6-month and 12-month outcomes did not differ significantly from the male patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aic.2020.101769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863829PMC
December 2020

Acute circumflex artery total occlusion during ablation of septal premature ventricular contraction with radiofrequency energy.

Postepy Kardiol Interwencyjnej 2020 Sep 2;16(3):352-353. Epub 2020 Oct 2.

rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aic.2020.99276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863806PMC
September 2020

Simultaneous multivessel percutaneous coronary intervention and transfemoral transcatheter aortic valve implantation with ACURATE neo.

Postepy Kardiol Interwencyjnej 2020 Sep 2;16(3):349-351. Epub 2020 Oct 2.

Division of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Disease, Zabrze, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aic.2020.99275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863808PMC
September 2020

Polymorphisms of genes coding for telomerase reverse transcriptase and telomerase RNA component and the need for target lesion revascularization after percutaneous coronary intervention.

Pol Arch Intern Med 2021 03 11;131(3):299-301. Epub 2021 Feb 11.

Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20452/pamw.15810DOI Listing
March 2021

Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission.

Medicine (Baltimore) 2021 Jan;100(4):e24360

Department of Cardiology and Cardiovascular Interventions, University Hospital.

Abstract: The relationship regarding time of percutaneous coronary intervention (PCI) and clinical outcomes in patients with acute myocardial infarction (AMI) treated within the left main coronary artery (LMCA) is less investigated compared to the overall group of patients with AMI.Therefore, we aimed to assess the relationship between time of PCI (day- vs night-time) and overall mortality rate in patients treated due to AMI within the LMCA.This cross-sectional study included 443,805 AMI patients hospitalized between 2006 and 2018 enrolled in the Polish Registry of Acute Coronary Syndromes. We extracted 5,404 patients treated within the LMCA. The number of patients were treated during daytime hours (7:00 am-10:59 pm) was 2809 while 473 patients underwent treatment during night-time hours (11:00 pm-6:59 am). Differences in cardiac mortality rates between night- and day-hours among patients treated with PCI during the follow-up period were assessed via the Kaplan-Meier method.The 30-day (20.3% vs 14.9%, P = .003) and 12-month (31.7% vs 26.2%, P = .001) overall mortality rates were significantly greater among patients treated during night-time, which was confirmed by comparison using Kaplan-Maier survival curves (P = .001). The time of PCI was not found among predictors of survival in multiple regression analysis (hazard ratio: 1.22; 95% confidence interval: 0.96-1.55, P = .099).Patients treated during night-time in comparison to the day-time are related to higher in-hospital, 30-day and 12-month mortality. This is probably largely a consequence that the night-time, in comparison to the day-time, of treatment of patients with AMI with PCI within the LMCA is and indicator of higher comorbidity and clinical acuity of patients undergoing therapy. Therefore, the night-time was not found to be an independent predictor of greater mortality rate during the 12-months follow-up period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000024360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850639PMC
January 2021

Glasgow Coma Scale score of more than four on admission predicts in-hospital survival in patients after out-of-hospital cardiac arrest.

Am J Emerg Med 2021 04 15;42:90-94. Epub 2021 Jan 15.

3rd Department of Cardiology, Silesian Center for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.

Aim: The aim of the study was to assess the usefulness of the Glasgow Coma Scale (GCS) score assessed by EMS team in predicting survival to hospital discharge in patients after out-of-hospital cardiac arrest (OHCA).

Methods: Silesian Registry of OHCA (SIL-OHCA) is a prospective, population-based regional registry of OHCAs. All cases of OHCAs between the 1st of January 2018 and the 31st of December 2018 were included. Data were collected by EMS using a paper-based, Utstein-style form. OHCA patients aged ≥18 years, with CPR attempted or continued by EMS, who survived to hospital admission, were included in the current analysis. Patients who did not achieve return of spontaneous circulation (ROSC) in the field, with missing data on GCS after ROSC or survival status at discharge were excluded from the study.

Results: Two hundred eighteen patients with OHCA, who achieved ROSC, were included in the present analysis. ROC analysis revealed GCS = 4 as a cut-off value in predicting survival to discharge (AUC 0.735; 95%CI 0.655-0.816; p < 0.001). Variables significantly associated with in-hospital survival were young age, short response time, witnessed event, previous myocardial infarction, chest pain before OHCA, initial shockable rhythm, coronary angiography, and GCS > 4. On the other hand, epinephrine administration, intubation, the need for dispatching two ambulances, and/or a physician-staffed ambulance were associated with a worse prognosis. Multivariable logistic regression analysis revealed GCS > 4 as an independent predictor of in-hospital survival after OHCA (OR of 6.4; 95% CI 2.0-20.3; p < 0.0001). Other independent predictors of survival were the lack of epinephrine administration, previous myocardial infarction, coronary angiography, and the patient's age.

Conclusion: The survival to hospital discharge after OHCA could be predicted by the GCS score on hospital admission.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajem.2021.01.018DOI Listing
April 2021

Comparison of clinical characteristics, in-hospital course, and 12-month prognosis in women and men with chronic coronary syndromes.

Kardiol Pol 2021 04 15;79(4):393-400. Epub 2021 Jan 15.

3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland

Background: The prognosis of men and women with chronic coronary syndromes (CCS) remains ambiguous.

Aims: This study aimed to compare the clinical characteristics and 12‑month prognosis of women and men with CCS included in the prospective single‑center registry.

Methods: The study was based on the Prospective Registry of Stable Angina Management and Treatment (PRESAGE) including 11 021 patients with CCS hospitalized between 2006 and 2016 and subjected to coronary angiography. The composite endpoint included all‑cause death, nonfatal myocardial infarction, acute coronary syndrome with revascularization, unstable coronary artery disease, or stroke.

Results: Women were older than men (mean [SD] age, 66.6 [9] vs 63.5 [9.6] years; P <0.001). Arterial hypertension (85.8% vs 79%; P <0.001) and type 2 diabetes (38.2% vs 33.7%; P <0.001) were more often diagnosed in women compared with men. Multivessel disease or left main disease were more frequent in men. Percutaneous coronary intervention and coronary artery bypass grafting were more often performed in men than in women (47.1% vs 36%, P <0.001 and 10.6% vs 6.1%, P <0.001, respectively). At 12‑month follow‑up, the composite endpoint was more frequently reached in men (7.4% vs 10.2%; P <0.001), including death (3.3% vs 4.5%; P = 0.002). In multivariable analysis, sex was not an independent predictor of the composite endpoint (hazard ratio, 1.08; 95% CI, 0.89-1.31, P = 0.45).

Conclusions: Women and men with CCS differ in terms of the incidence of risk factors and revascularization treatments received. In men, a higher frequency of death and the composite endpoint was noted at 12‑month follow‑up. However, sex was not an independent predictor of patient outcomes at 12 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15749DOI Listing
April 2021

The CTGF gene -945 G/C polymorphism is associated with target lesion revascularization for in-stent restenosis.

Exp Mol Pathol 2021 02 23;118:104598. Epub 2020 Dec 23.

Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; 2nd Department of Cardiology and Angiology, Silesian Center for Heart Diseases, Zabrze, Poland.

Background And Aims: Previous studies have shown that transforming growth factor β (TGF-β) and vascular endothelial growth factor A (VEGF-A) pathways are involved in the in-stent restenosis (ISR) process. The present study aimed to assess the relationship between single-nucleotide polymorphisms (SNPs) in genes encoding downstream proteins of TGF-β and VEGF-A pathways and the risk of target lesion revascularization (TLR) for in-stent restenosis.

Methods: A total of 657 patients (with 781 treated lesions) who underwent percutaneous coronary intervention (PCI) with stent implantation at our center between 2007 and 2012 and completed a 4-year follow-up for clinically-driven TLR, were included. SNPs in CTGF (rs6918698), TGFBR2 (rs2228048), SMAD3 (rs17293632), KDR (rs2071559), CCL2 (rs1024610) were genotyped using TaqMan assay.

Results: Major allele carriers of CTGF gene -945 G/C polymorphism (rs6918698) were significantly less likely to underwent clinically-driven TLR during follow-up than minor allele carriers. After adjustment for clinical, angiographic, and procedural covariates, CTGF polymorphism was significantly associated with TLR, and minor allele (C) carriers had nearly two times higher risk of developing ISR requiring TLR (HR of 1.93, 95%CI 1.15-3.24) compared to patients with major (GG) genotype. No significant relationship was found between other analyzed polymorphisms and cumulative incidence of TLR at 4-years.

Conclusions: Our results suggest that functional -945 G/C polymorphism in the gene encoding connective tissue growth factor is associated with the need for TLR in patients who underwent PCI for stable coronary artery disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.yexmp.2020.104598DOI Listing
February 2021

Out-of-hospital cardiac arrest in dialysis patients.

Int Urol Nephrol 2021 Mar 18;53(3):563-569. Epub 2020 Dec 18.

Department of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland.

Purpose: The aim of the study was to assess whether a history of dialysis is related to cardiopulmonary resuscitation (CPR) attempts and survival to hospital admission in patients with out-of-hospital cardiac arrest (OHCA).

Methods: The databases of the POL-OHCA registry and of emergency medical calls in the Command Support System of the State of Emergency Medicine (CSS) were searched to identify patients with OHCA and a history of dialysis. A total of 264 dialysis patient with OHCA were found: 126 were dead on arrival of emergency medical services (EMS), and 138 had OHCA with CPR attempts. Data from the POL-OHCA registry for patients with CPR attempts, including age, sex, place of residence, first recorded rhythm, defibrillation during CPR, and priority dispatch codes, were collected and compared between patients with and without dialysis.

Results: CPR attempts by EMS were undertaken in 138 dialyzed patients (52.3%). The analysis of POL-OHCA data revealed no differences in age, sex, place of residence, first recorded rhythm, and priority dispatch codes between patients with and without dialysis. Defibrillation was less frequent in dialysis patients (P = 0.04). A stepwise logistic regression analysis revealed no association between survival to hospital admission and a history of hemodialysis (odds ratio = 1.12; 95% CI 0.74-1.70, P = 0.60).

Conclusions: A history of dialysis in patients with OHCA does not affect the rate of CPR attempts by EMS or a short-term outcome in comparison with patients without dialysis. Defibrillation during CPR is less common in patients on dialysis than in those without.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11255-020-02694-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907018PMC
March 2021

Radiation therapy in patients with cardiac implantable electronic devices.

Kardiol Pol 2021 02 8;79(2):156-160. Epub 2020 Dec 8.

Background: The number of patients with cardiac implantable electronic devices (CIEDs) treated with radiation therapy (RT) as an oncological treatment is expected to increase.

Aims: The aim of the study was to assess whether cancer treatment with radiation therapy is associated with any device dysfunctions and device‑related threats in patients with CIEDs.

Methods: The risk of all patients with CIEDs undergoing RT was assessed according to guidelines. Device interrogations were performed before the first and after the last RT session. In patients at high risk and/or with an implantable cardioverter‑defibrillator or cardiac resynchronization therapy with defibrillator (CRT‑D), all sessions were supervised by a cardiologist, and device interrogations were performed before and after every single RT session. Device parameters and events were monitored during thewhole treatment.

Results: The study included 157 patients with CIEDs who had palliative (n = 71) or radical (n = 86) RT. Pacemakers were implanted in 113 patients, implantable cardioverter‑defibrillators in 36, and CRT‑D in 8. During the 2396 RT sessions (median [interquartile range], 5 [5-28] per patient) with cumulative dose up to 78 Gy per patient for the whole RT treatment and maximum energy beam up to 20 MV, 2 events potentially related to radiation were recorded.

Conclusions: Radiation therapy in patients with CIEDs is not associated with substantial risk to the patients assuming the patients' management follows current guidelines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.33963/KP.15705DOI Listing
February 2021

Factors Associated with Ineffectiveness of Sildenafil Treatment in Patients with End-Stage Heart Failure and Elevated Pulmonary Vascular Resistance.

J Clin Med 2020 Nov 2;9(11). Epub 2020 Nov 2.

3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.

Introduction: Elevated pulmonary vascular resistance (PVR) unresponsive to vasodilator treatment is a marker of heart failure (HF) severity, and an important predictor of poor results of heart transplantation (HT).

Objective: We sought to analyze factors associated with ineffectiveness of sildenafil treatment in end-stage HF patients with elevated PVR with particular emphasis placed on tenascin-C (TNC) serum concentrations.

Patients And Methods: The study is an analysis of 132 end-stage HF patients referred for HT evaluation in the Cardiology Department between 2015 and 2018. TNC was measured by sandwich enzyme-linked immunosorbent assay (Human TNC, SunRedBio Technology, Shanghai, China). The endpoint was PVR > 3 Wood units after the six-month sildenafil therapy.

Results: The median age was 58 years, and 90.2% were men. PVR >3 Wood units after 6 months of sildenafil treatment were found in 36.6% patients. The multivariable logistic regression analysis confirmed that TNC (OR = 1.004 (1.002-1.006), = 0.0003), fibrinogen (OR= 1.019 (1.005-1.033), = 0.085), creatinine (OR =1.025 (1.004-1.047), = 0.0223) and right ventricular end-diastolic dimension (RVEDd) (OR = 1.279 (1.074-1.525), = 0.0059) were independently associated with resistance to sildenafil treatment. Area under the ROC curves indicated an acceptable power of TNC (0.9680 (0.9444-0.9916)), fibrinogen (0.8187 (0.7456-0.8917)) and RVEDd (0.7577 (0.6723-0.8431)), as well as poor strength of creatinine (0.6025 (0.4981-0.7070)) for ineffectiveness of sildenafil treatment.

Conclusions: Higher concentrations of TNC, fibrinogen and creatinine, as well as a larger RVEDd are independently associated with the ineffectiveness of sildenafil treatment. TNC has the strongest predictive power, sensitivity and specificity for evaluation of resistance to sildenafil treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9113539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692635PMC
November 2020

Long-term outcomes of 11 021 patients with chronic coronary syndromes and after coronary angiography: the PRESAGE registry.

Pol Arch Intern Med 2020 12 4;130(12):1043-1052. Epub 2020 Nov 4.

Introduction: There is a paucity of real‑world registries concerning patients with chronic coronary syndromes (CCS).

Objectives: We aimed to assess the long‑term outcomes of patients with CCS and after coronary angiography performed in accordance with the treatment strategy.

Patients And Methods: The analysis involved 11 021 patients treated in a single center between 2006 and 2016 who were enrolled into the ongoing PRESAGE registry. Based on the results of coronary angiography and the treatment strategy adopted, patients were classified into 4 groups: with nonsignificant lesions (n = 3637), undergoing percutaneous coronary intervention (n = 4678), undergoing coronary artery bypass grafting (CABG; n = 997), and receiving conservative treatment (notwithstanding significant lesions on an angiogram; n = 1709). All‑cause death, assessed in every study group at 1-, 3-, and 5‑year follow‑up, was regarded as the primary outcome measure.

Results: The mean (SD) age of the study patients was 64.6 (9.5) years, and women constituted 35% of the cohort. Patients treated conservatively were the oldest (mean [SD] age, 64.9 [9.3] years) in the group and showed the highest prevalence of previous myocardial infarction (50.5%), CABG (31.8%), diabetes (40.3%), chronic total occlusion (65.5%), and left ventricular ejection fraction below 35% (24.4%). Death from any cause in patients with nonsignificant lesions, undergoing percutaneous coronary intervention, undergoing CABG, and receiving conservative treatment occurred 5 years following the index hospitalization in 11.2%, 16.2%, 9.7%, and 21% of those patients, respectively.

Conclusions: The PRESAGE registry provides valuable information about the clinical characteristics and long‑term outcomes of patients with CCS. The population of CCS patients is heterogeneous, and long‑term prognosis is also varied. The poorest characteristics and outcomes were reported in patients with significant lesions and ineligible for revascularization procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20452/pamw.15675DOI Listing
December 2020