Publications by authors named "Sławomir Dobrzycki"

159 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).
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http://dx.doi.org/10.5603/CJ.a2021.0056DOI Listing
June 2021

Exposure to air pollution and renal function.

Sci Rep 2021 Jun 1;11(1):11419. Epub 2021 Jun 1.

Department of Invasive Cardiology, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24 A, 15-276, Bialystok, Poland.

Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed in respiratory, circulatory systems but also in renal function. We decide to investigate the hypothesis indicating that we can observe not only long- but also short-term impact of air pollution on kidney function. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO, SO, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration. 3554 patients (median age 66, men 53.2%) were included into final analysis. Chronic kidney disease (CKD) was diagnosed in 21.5%. The odds of CKD increased with increase in annual concentration of PM (OR for IQR increase = 1.07; 95% CI 1.01-1.15, P = 0.037) and NO (OR for IQR increase = 1.05; 95% CI 1.01-1.10, P = 0.047). The IQR increase in weekly PM concentration was associated with 2% reduction in expected eGFR (β = 0.02, 95% CI - 0.03; - 0.01). Medium- and short-term exposure to elevated air pollution levels was associated with a decrease in eGFR and development CKD. The main pollutants affecting the kidneys were PM and NO
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http://dx.doi.org/10.1038/s41598-021-91000-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169649PMC
June 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.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249698PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115813PMC
May 2021

Primary Takotsubo Syndrome as a Complication of Bladder Cancer Treatment in a 62-Year-Old Woman.

Am J Case Rep 2021 Apr 20;22:e930090. Epub 2021 Apr 20.

Department of Invasive Cardiology, Medical University in Białystok, Białystok, Poland.

BACKGROUND The main causes for takotsubo syndrome (TS) in oncological patients are stress related to cancer diagnosis and treatment, pain in the course of the disease, treatment complications, and paraneoplastic syndromes. CASE REPORT An obese 62-year-old female patient, with a 3-day history of chest pain, was admitted to the hospital with a suspected acute coronary event. She had been diagnosed with high-grade bladder cancer 6 months before. After the transurethral electroresection of the tumor 5 months before and subsequent chemotherapy (gemcitabine and cisplatin), the patient was qualified for the next cancer surgery. On admission, the patient remained without chest pain. The ECG record demonstrated inverted T waves in the leads from above the anterior and lateral wall. The coronarography demonstrated minor atherosclerotic changes in the coronary arteries. The left ventriculography presented akinesis of the apex and the apical and mid-segment of the anterior wall, and the ejection fraction (EF) was 38%. Takotsubo syndrome was diagnosed. Laboratory testing revealed elevated concentration of troponin and N-terminal pro-B-type natriuretic peptide. The subsequent ECG records demonstrated deeply inverted T waves and numerous ventricular premature beats and increased QTc (528 ms). A control echocardiography showed improved left ventricular contractive function (EF - 47%). On the 4th day of hospitalization, the patient was discharged and referred for further oncological treatment. CONCLUSIONS The diagnosis of TS in oncology patients is difficult, especially in the presence of atherosclerotic lesions in coronary arteries. Takotsubo syndrome in cancer patients delays the next stages of oncological treatment, which worsens the prognosis of these patients.
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http://dx.doi.org/10.12659/AJCR.930090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072183PMC
April 2021

Impact of short-term air pollution exposure on acute coronary syndrome in two cohorts of industrial and non-industrial areas: A time series regression with 6,000,000 person-years of follow-up (ACS - Air Pollution Study).

Environ Res 2021 Jun 17;197:111154. Epub 2021 Apr 17.

Department of Invasive Cardiology, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276, Białystok, Poland.

Background: There is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas.

Objectives: A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas.

Materials And Methods: The study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS.

Results: A total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM, PM, NO, SO, CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 μg/m of NO concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009-1.257; P = 0.034, lag-0) and an increase of 1 mg/m in CO concentration (RR = 1.055, 95%CI = 1.010-1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 μg/m in NO (OR = 1.062, 95%CI = 1.020-1.094; P = 0.005, lag-0), SO (OR = 1.061, 95%CI = 1.010-1.116; P = 0.018, lag-4), PM (OR = 1.010, 95%CI = 1.001-1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 μg/m in SO (OR = 1.094, 95%CI = 1.030-1.162; P = 0.002, lag-1), PM (OR = 1.041, 95%CI = 1.020-1.073; P < 0.001, lag-1), PM (OR = 1.030, 95%CI = 1.010-1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area.

Conclusion: The risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI.
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http://dx.doi.org/10.1016/j.envres.2021.111154DOI Listing
June 2021

Transcatheter transseptal mitral valve implantation with Edwards SAPIEN 3: the first experience of a single center.

Postepy Kardiol Interwencyjnej 2021 Mar 27;17(1):105-108. Epub 2021 Mar 27.

Department of Cardiosurgery, University Hospital, Bialystok, Poland.

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http://dx.doi.org/10.5114/aic.2021.104776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039921PMC
March 2021

Cardiac Rupture-The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review.

J Clin Med 2021 Mar 4;10(5). Epub 2021 Mar 4.

Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland.

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient.

Methods: In the years 2008-2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria.

Results: Cardiac rupture was observed in women with TS aged 74-88 years. Patients with TS and CR were older (82.20 vs. 64.84; = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III.

Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).
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http://dx.doi.org/10.3390/jcm10051066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962024PMC
March 2021

6-year results of BiOSS stents in coronary bifurcation treatment.

Eur J Clin Invest 2021 Mar 29:e13555. Epub 2021 Mar 29.

Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland.

Background: The wide variation in bifurcation anatomy has generated an ongoing search for stents explicitly designed for coronary bifurcations, and to date, results have been underachieved.

Methods: The POLBOS I and POLBOS II were international, multicentre, randomized, open-label, controlled trials. Patients were randomly assigned to BiOSS Expert (in POLBOS I, biodegradable polymer eluting paclitaxel)/BiOSS LIM (in POLBOS II, biodegradable polymer eluting sirolimus) stent implantation or regular drug-eluting stent (rDES) deployment. A provisional T-stenting strategy was the default treatment option. The primary endpoint of this pooled data study was the cumulative rate of major adverse cardiovascular events (MACE) consisting of cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR). Telephone follow-up was performed annually up to 72 months. (ClinicalTrials.gov Identifier: POLBOS I-NCT02192840, POLBOS II-NCT02198300).

Results: The total study population consisted of 445 patients, 222 patients in the BiOSS group and 223 patients in the rDES group. The follow-up rate was 93.7% in the BiOSS group and 91.9% in the rDES group. At 72 months, there was no significant difference between BiOSS and rDES groups regarding MACE (25.7% vs 25.1%, HR 1.06, 95% CI 0.73-1.52), cardiac death (3.1% vs 4.0%, HR 0.94, 95% CI 0.43-2.34), MI (3.6% vs 4.9%, HR 0.76, 95% CI 0.32-2.89), TLR (18.9% vs 16.1%, HR 1.17, 95% CI 0.75-1.83) and stent thrombosis rates (0.9% vs 0.5%, HR 1.21, 95CI 0.75-2.09).

Conclusions: At the 6-year follow-up, clinically significant clinical events did not differ between BiOSS stents and rDES.
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http://dx.doi.org/10.1111/eci.13555DOI Listing
March 2021

The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study.

Int Urol Nephrol 2021 Feb 18. Epub 2021 Feb 18.

Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland.

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS.

Methods: In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1-53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m; 29.8%) and group 2-125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m; 70.2%).

Results: In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG.

Conclusion: Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.
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http://dx.doi.org/10.1007/s11255-021-02794-xDOI Listing
February 2021

A Rare Case of Acute Pleuropericarditis as a Complication of Permanent Pacemaker Insertion.

Am J Case Rep 2021 Jan 10;22:e928188. Epub 2021 Jan 10.

Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland.

BACKGROUND Pleuropericarditis after pacemaker (IPG) implantation is a rare post-cardiac injury syndrome (PCIS) condition. Pericarditis is one of the complications following insertion of a IPG; it affects 2-5% of patients within 5-21 days after IPG implementation and is associated with screw-in (active fixation) atrial lead positioning. Usually, pericarditis following IPG implantation is benign and has a self-limiting course. The mechanism of this complication remains unclear. It could involve a direct irritation of pericardium by minimally protruding electrodes, low bleeding, and autoimmune and inflammatory responses. The frequency of pleuropericarditis is not well defined. The etiopathogenesis is presumed to be the same as for pericarditis, yet there are no standardized criteria for the diagnosis, and treatment is based on the empirical anti-inflammatory therapy used in pericarditis. CASE REPORT A 71-year-old woman was admitted due to syncope. Sinus arrests with escape atrioventricular rhythm were observed during hospitalization; therefore, a dual-chamber pacemaker (IPG) was implanted with 2 active fixation (screw-in) electrodes. On the first day after implantation, a slight pericardial hemorrhage occurred with resorption in the following days, and an inflammatory reaction with pericardial and left pleural effusion occurred later. The first-line treatment was ineffective. However, prednisolone with colchicines with longer use than suggested by pericarditis recommendations was effective. CONCLUSIONS Patients with even mild pericardial effusion after IPG insertion should be followed closely due to the risk of pleuropericarditis, with consideration of anti-inflammatory treatment for longer than in pericarditis.
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http://dx.doi.org/10.12659/AJCR.928188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810288PMC
January 2021

Effect of Sex on Outcomes of Coronary Rotational Atherectomy Percutaneous Coronary Intervention (From the European Multicenter Euro4C Registry).

Am J Cardiol 2021 03 5;143:29-36. Epub 2021 Jan 5.

Department of Cardiology, Rangueil Toulouse University Hospital, University Paul Sabatier, Toulouse, France.

Data regarding the potential influence of gender on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of gender on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. In them, 267 (27.6%) were females. Female patients were older than males (77.7 years old ± 9.8 vs 73.3 ± 9.5 years old respectively, p < 0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p < 0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p = 0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p = 0.004). In-hospital major adverse cardiac event rate-defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization, and coronary artery bypass grafting surgery-was higher in the female group (7.1% vs 3.7%, p = 0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ in gender, neither did cardiovascular medications at discharge. At 1 year follow-up, rate of major adverse cardiac event was 18.4% in the female group vs 11.2% in the male group (adjusted Hazard Ratio 1.82 [1.24 to 2.67], p = 0.002). No significant bleeding differences were observed in gender, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at 1 year follow-up than did men.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.040DOI Listing
March 2021

The effect of serum uric acid levels on the long-term prognosis of patients with non-ST-elevation myocardial infarction.

Adv Clin Exp Med 2020 11;29(11):1255-1263

Department of Invasive Cardiology, Medical University of Bialystok, Poland.

Background: Cardiovascular diseases (CVD) are the leading cause of death worldwide. Many studies have reported an association between serum uric acid (sUA) and CVD, and its role as a risk marker for mortality.

Objectives: To assess the relationship between sUA levels and the long-term prognosis of patients with non-ST-elevation myocardial infarction (NSTEMI).

Material And Methods: The study was conducted at the Clinical Hospital of Białystok (Poland). Based on medical records, 9328 patients were hospitalized between 2011 and 2013, of which 726 had NSTEMI. The exclusion criteria were: any diagnosed neoplasms and estimated glomerular filtration rate (eGFR) <15 mL/min. The average observation time was 2324 days.

Results: A total of 549 patients were qualified for the analysis; men were in the majority (69.03%, n = 379), and the mean age was 68.42 years (standard deviation (SD) = 11.66). The sUA norm was exceeded in 137 of the patients (24.95%). Hyperuricemia is more likely to occur in women (risk ratio (RR) = 1.52, 95% confidence interval (95% CI) = 1.016-2.288, p = 0.042), in patients with chronic kidney disease (CKD) (RR = 3.452, 95% CI = 2.432-4.854, p < 0.001) and in patients with higher body mass index (BMI)s (RR = 1.048, 95% CI = 1.008-1.090, p = 0.018). In the whole study group, during the study, 178 of the patients died (32.41.9%), more often those with hyperuricemia: (60/137 patients (43.8%)) compared to patients with normal sUA values (118/412 values (28.64%)); p < 0.001). There was a significant correlation between an increase in sUA levels and an increase in mortality (p < 0.001). Independent risk factors of death were age (RR = 1.086, 95% CI = 1.065-1.108, p < 0.001), sUA (RR = 1.245, 95% CI = 1.131-1.370, p = 0.041), ejection fraction (EF) (RR = 0.928, 95% CI = 0.910-0.946, p < 0.001) and hemoglobin concentration (RR = 0.685, 95% CI = 0.611-0.768, p < 0.001).

Conclusions: Serum UA concentration is an independent risk factor of long-term mortality in patients who have undergone NSTEMI, and is associated with higher in-hospital death rates. Secondary prevention after NSTEMI should entail management of the patients' sUA levels.
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http://dx.doi.org/10.17219/acem/127145DOI Listing
November 2020

The 10-Year Study of the Impact of Particulate Matters on Mortality in Two Transit Cities in North-Eastern Poland (PL-PARTICLES).

J Clin Med 2020 Oct 27;9(11). Epub 2020 Oct 27.

Department of Invasive Cardiology, Medical University of Bialystok, 24A Sklodowskiej-Curie St, 15-276 Bialystok, Poland.

The detrimental influence of air pollution on mortality has been established in a series of studies. The majority of them were conducted in large, highly polluted cities-there is a lack of studies from small, relatively clean regions. The aim was to analyze the short-term impact of particulate matters (PMs) on mortality in north-eastern Poland. Time-stratified case-crossover design was performed for mortality in years 2008-2017. Daily concentrations of PM (28.4 µg/m, interquartile range (IQR) = 25.2) vs. (12.6 µg/m, IQR = 9.0) and PM (29.0 µg/m, IQR = 18.0) vs. (21.7 µg/m, IQR = 14.5) were higher in Łomża than Suwałki ( < 0.001). Impact of PM on mortality was recorded in Łomża (odds ratio (OR) for IQR increase 1.061, 1.017-1.105, = 0.06, lag 0) and Suwałki (OR for IQR increase 1.044, 1.001-1.089, = 0.004, lag 0). PM had an impact on mortality in Łomża (OR for IQR increase 1.028, 1.000-1.058, = 0.049, lag 1). Cardiovascular mortality was affected by increase of PM in Łomża (1.086, 1.020-1.156, = 0.01) and Suwałki (1.085, 1.005-1.171, = 0.04). PM had an influence on respiratory mortality in Łomża (1.163, 1.021-1.380, = 0.03, lag 1). In the whole studied region, despite differences in the air quality, the influence of PMs on mortality was observed.
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http://dx.doi.org/10.3390/jcm9113445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692125PMC
October 2020

Effectiveness of Levosimendan in an 84-Year-Old Patient with Takotsubo Syndrome Complicated by Acute Heart Failure.

Am J Case Rep 2020 Oct 20;21:e927081. Epub 2020 Oct 20.

Department of Invasive Cardiology, Medical University of Białystok, Białystok, Poland.

BACKGROUND Although takotsubo syndrome (TTS) is usually mild, severe complications such as acute heart failure may occur in the acute phase. Because of the etiology of TTS, typical catecholamines are not recommended; the use of inotropic drugs with a different mechanism of action is recommended, mainly levosimendan. CASE REPORT An 84-year-old patient with cardiovascular risk factors, hospitalized in a city hospital because of exacerbation of chronic obstructive pulmonary disease (COPD), was transferred to the clinic with suspected myocardial infarction. At the time of admission, the patient was hemodynamically stable. The coronarography indicated insignificant atherosclerotic lesions in the coronary arteries. The echocardiography revealed apical akinesis and hypokinesis of the apical and middle left ventricular segments (LV). The ejection fraction (EF) was 40%. TTS was diagnosed. After 12 h of hospitalization, the patient developed symptoms of acute heart failure, with deterioration of the LV systolic function (EF 30%). Levosimendan was included in the treatment, which led to an increased blood pressure and clinical improvement after several hours. Over the next few days, the patient's condition improved and he was transferred to the referral center, from which he was discharged to home. CONCLUSIONS In patients with COPD, exacerbation of the disease may be a trigger for TTS. In acute heart failure complicating TTS, administration of levosimendan improves the clinical condition of patients.
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http://dx.doi.org/10.12659/AJCR.927081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585457PMC
October 2020

Atrial fibrillation is more frequently associated with nonobstructive coronary lesions: the Bialystok Coronary Project.

Pol Arch Intern Med 2020 12 5;130(12):1029-1036. Epub 2020 Oct 5.

Introduction: Atrial fibrillation (AF) and chronic coronary syndrome (CCS) share common risk factors and frequently coexist. Additionally, AF symptoms may mimic CCS.

Objectives: The aim of the study was to investigate the hypothesis indicating absence of significant coronary lesions in patients with AF as compared with those with sinus rhythm.

Patients And Methods: We conducted a single‑center retrospective study including consecutive patients referred for elective coronary angiography between 2007 and 2016.

Results: The study population included 8288 patients out of whom 1674 had AF. There were substantial differences between groups with and without AF. Patients with AF were significantly older, more often were men and had diabetes, and more frequently were diagnosed with both chronic kidney disease and heart failure. On the other hand, they had history of hyperlipidemia less often. CCS was less frequently detected in patients with AF as compared with those with sinus rhythm (37.5% vs 41.1%; P <0.001). Additionally, the latter group more often underwent subsequent coronary angioplasty (19.2% vs 22.3%; P = 0.004). Multivariable analysis identified AF as an independent factor associated with absence of significant coronary lesions (odds ratio, 1.57; 95% CI, 1.32-1.87; P <0.001). Moreover, a comparison between patients with and without angiographically significant CCS revealed a higher prevalence of AF in the latter group (18.7% vs 21.2%; P = 0.006).

Conclusions: In our study, AF was associated with the absence of significant coronary lesions on angiography, reflecting difficulties with qualifying patients with AF for invasive CCS diagnostic workup. Our findings suggest the need for more efficacious noninvasive diagnostic approach for patients with AF and suspected CCS.
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http://dx.doi.org/10.20452/pamw.15635DOI Listing
December 2020

Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study.

Ren Fail 2020 Nov;42(1):881-889

Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.

Introduction: Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes.

Aim: The aim of our study was to assess renal function impact on mortality among patients with ACS.

Materials And Methods: The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009-2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m, hemodialysis. Mean observation time was 2296 days.

Results: Criteria were met by 2213 patients. CKD occurred in 24.1% ( = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196),  = .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53),  < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277),  < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567-5.721,  < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029-4.463,  = .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056-4.959,  = .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481-3.424,  < .001).

Conclusion: PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.
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http://dx.doi.org/10.1080/0886022X.2020.1810069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472470PMC
November 2020

Exposure to air pollution-a trigger for myocardial infarction? A nine-year study in Bialystok-the capital of the Green Lungs of Poland (BIA-ACS registry).

Int J Hyg Environ Health 2020 08 3;229:113578. Epub 2020 Aug 3.

Department of Invasive Cardiology, Medical University of Bialystok, The Medical University of Bialystok Clinical Hospital, ul. M. Skłodowskiej-Curie 24 A, 15-276, Bialystok, Poland.

Objectives: This study aimed to assess the effect of air pollution and weather conditions on the frequency of hospital admissions due to acute coronary syndrome (ACS) in the population of Bialystok, known as the capital of the Green Lungs of Poland.

Materials And Methods: The study analyzed the medical records of 2,645 patients living within the borders of Bialystok who were treated for ACS between 2009 and 2017 and the data on air pollutants-nitrogen dioxide (NO), sulfur dioxide (SO), and particulate matter with a diameter of 2.5 μm or less (PM) and 10 μm or less (PM)-and the basic meteorological factors (temperature, humidity, and atmospheric pressure). A time-stratified case-crossover study design was applied to assess the effects of particulate matter, the concentration of gases, and weather conditions on ACS.

Results: The number of patients admitted for ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA) was 791, 999, and 855, respectively. The daily concentration norm for PM recommended by the World Health Organization (WHO) was exceeded in 692 days (i.e., 24.58% of the observation period). The significant increase in the number of ACS hospitalizations was associated with an interquartile-range increase in NO concentration, with an odds ratio of 1.08 (95% confidence interval (CI): 1.02-1.15, P = 0.01), 1.09 (95% CI: 1.01-1.18, P = 0.03), and 1.11 (95% CI: 1.00-1.22, P = 0.048) for patients with ACS, NSTEMI, and UA, respectively.

Conclusion: The study showed that the effects of air pollution and weather conditions on the number of ACS hospitalizations are also observed in cities with moderately polluted or good air quality. NO was identified as the main air pollutant affecting the incidence of ACS.
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http://dx.doi.org/10.1016/j.ijheh.2020.113578DOI Listing
August 2020

Gender Differences in Association between Air Pollution and Daily Mortality in the Capital of the Green Lungs of Poland-Population-Based Study with 2,953,000 Person-Years of Follow-Up.

J Clin Med 2020 Jul 23;9(8). Epub 2020 Jul 23.

Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland.

(1) Introduction: air pollution is considered to be one of the main risk factors for public health. According to the European Environment Agency (EEA), air pollution contributes to the premature deaths of approximately 500,000 citizens of the European Union (EU), including almost 5000 inhabitants of Poland every year. (2) Purpose: to assess the gender differences in the impact of air pollution on the mortality in the population of the city of Bialystok-the capital of the Green Lungs of Poland. (3) Materials and Methods: based on the data from the Central Statistical Office, the number-and causes of death-of Białystok residents in the period 2008-2017 were analyzed. The study utilized the data recorded by the Provincial Inspectorate for Environmental Protection station and the Institute of Meteorology and Water Management during the analysis period. Time series regression with Poisson distribution was used in statistical analysis. (4) Results: A total of 34,005 deaths had been recorded, in which women accounted for 47.5%. The proportion of cardiovascular-related deaths was 48% ( = 16,370). An increase of SO concentration by 1-µg/m (relative risk (RR) 1.07, 95% confidence interval (CI) 1.02-1.12; = 0.005) and a 10 °C decrease of temperature (RR 1.03, 95% CI 1.01-1.05; = 0.005) were related to an increase in the number of daily deaths. No gender differences in the impact of air pollution on mortality were observed. In the analysis of the subgroup of cardiovascular deaths, the main pollutant that was found to have an effect on daily mortality was particulate matter with a diameter of 2.5 μm or less (PM2.5); the RR for 10-µg/m increase of PM2.5 was 1.07 (95% CI 1.02-1.12; = 0.01), and this effect was noted only in the male population. (5) Conclusions: air quality and atmospheric conditions had an impact on the mortality of Bialystok residents. The main air pollutant that influenced the mortality rate was SO, and there were no gender differences in the impact of this pollutant. In the male population, an increased exposure to PM2.5 concentration was associated with significantly higher cardiovascular mortality. These findings suggest that improving air quality, in particular, even with lower SO levels than currently allowed by the World Health Organization (WHO) guidelines, may benefit public health. Further studies on this topic are needed, but our results bring questions whether the recommendations concerning acceptable concentrations of air pollutants should be stricter, or is there a safe concentration of SO in the air at all.
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http://dx.doi.org/10.3390/jcm9082351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464921PMC
July 2020

Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects.

Int Urol Nephrol 2020 Nov 14;52(11):2161-2170. Epub 2020 Jul 14.

Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.

Introduction: Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy.

Aim: Analysis impact of CKD on long-term prognosis in patients with VHD.

Material And Methods: The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days.

Results: The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00-1.03, p < 0.001), creatinine (OR:1.27, 95% CI: 1.12-1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17-1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97-0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04-1.35, p = 0.01).

Conclusions: Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage.
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http://dx.doi.org/10.1007/s11255-020-02561-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575476PMC
November 2020

Angiographic Restenosis in Coronary Bifurcations Treatment with Regular Drug Eluting Stents and Dedicated Bifurcation Drug-Eluting BiOSS Stents: Analysis Based on Randomized POLBOS I and POLBOS II Studies.

Cardiovasc Ther 2020 21;2020:6760205. Epub 2020 Jan 21.

Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Aim: The marked variation in bifurcation anatomy has brought about an ongoing search for stents specifically constructed for coronary bifurcations. This study aimed to analyze the angiographic restenosis prevalence and patterns and predictors of different patterns in dedicated bifurcation BiOSS® vs. current generation drug-eluting stents implanted in coronary bifurcation lesions based on data from two clinical trials POLBOS I and II.

Methods: Dedicated bifurcation BiOSS® stents were compared with drug-eluting stents (DES) in patients with stable coronary artery disease (CAD) or nonST elevation acute coronary syndrome (NSTE-ACS) (POLBOS I: paclitaxel eluting BiOSS® Expert vs. DES; POLBOS II: sirolimus eluting BiOSS® LIM vs. DES). Provisional T-stenting was the default treatment. Morphological pattern of in-stent restenosis according to the modified Mehran classification adopted for bifurcation lesions was assessed with bifurcation dedicated quantitative coronary angiographic software (CAAS 5.11, Pie Medical Imaging BV, the Netherlands).

Results: In total, 445 patients (222 patients in BiOSS group and 223 patients in DES group) were included into the analysis. In BiOSS group 24 cases of angiographic restenosis (10.8%) were recorded, and in DES group-17 cases (7.6%) at 12 months follow-up (angiographic control rate at follow-up-90.3%). In the BiOSS group most frequent medina classification in restenotic cases was 0.0.1 (25%), whereas in DES-0.0.1 and 0.1.1 (23.5% each). In multivariate regression analysis proximal optimization technique was associated with the lowest chance for restenosis (OR 0.15, 95% CI 0.06-0.33), whereas diabetes on insulin was associated with the highest risk of restenosis (OR 4.21, 95% CI 1.48-11.44).

Conclusions: The angiographic restenosis pattern and rate was similar between BiOSS stents and DES in coronary bifurcation lesions.
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http://dx.doi.org/10.1155/2020/6760205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204374PMC
July 2020

The GRACE Scale in the Prognosis of Patients with Takotsubo Syndrome.

J Interv Cardiol 2020 24;2020:4340930. Epub 2020 Apr 24.

Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland.

Background: The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy.

Methods: 101 patients with TTS hospitalized in four centers of invasive cardiology in Podlaskie Voivodeship during the period 2008-2012 were included in the study. The patients were divided into two groups: I-52 patients (GRACE ≤ 140 points) and II-49 patients (GRACE > 140 points).

Results: The mean GRACE score in the study group was 138.66. The in-hospital stay of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36.7% vs 7.69%, =0.0004), rhythm abnormalities (17.3% vs 3.85%, =0.026), and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30.6% vs 5.77%, =0.001). The mean observation period was 7.2 years. A significantly higher risk of 6-month (18.37% vs 3.85%, =0.019), 1-year (22.45 vs 3.85%, =0.005), 3-year (40.82 vs 3.85%, < 0.0001), 5-year (42.86% vs 3.85%, < 0.0001), and 7-year mortalities (53.06% vs 9.62%, < 0.0001) was observed in the group of patients with a GRACE score ≥140. At multivariate analysis including low BMI, low eGFR, and a higher GRACE score, all these factors were independent predictor of death (=0.042; =0.010; =0.041). The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognostication. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI: 0.718-0.892, < 0.0001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS.

Conclusion: The GRACE scale is highly valuable for the prognostication of death risk in patients with TTS in the early and long-term observation.
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http://dx.doi.org/10.1155/2020/4340930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197005PMC
November 2020

Radial versus femoral access in patients treated with percutaneous coronary intervention and rotational atherectomy.

Kardiol Pol 2020 06 8;78(6):529-536. Epub 2020 Apr 8.

Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland

Background: The association between periprocedural complications and the type of vascular access in patients treated with percutaneous coronary intervention (PCI) and rotational atherectomy (RA) has not been investigated as frequently as in an overall group of patients treated with PCI.

Aims: The aim of this study was to assess the associations between the type of vascular access and selected periprocedural complications in a group of patients treated with PCI and RA.

Methods: ased on a nationwide Polish registry (National Registry of Percutaneous Coronary Interventions [ORPKI]), we analyzed 536 826 patients treated with PCI between the years 2014 and 2018. The study included 2713 patients (0.5% of the overall group of patients treated with PCI [n = 536 826]) treated with PCI and RA. Among them, 1018 (37.5%) were treated via femoral access, and 1653 (60.9%) via radial access. Subsequently, these patients were subject to comparison, which was proceeded by propensity score matching.

Results: Following propensity score matching, multiple regression analysis revealed that patients undergoing PCI via femoral access experienced coronary artery perforation significantly less frequently than those managed via radial access (odds ratio, 0.29; 95% CI, 0.08-0.92; P = 0.04). We did not observe any significant associations between the type of vascular access and the periprocedural mortality rate (P = 0.99), cardiac arrest (P = 0.41), puncture‑site bleeding (P = 0.99), allergic reaction (P = 0.32), myocardial infarction (P = 0.48), no‑reflow phenomenon (P = 0.82), or the overall complication rate (P = 0.31).

Conclusion: In patients treated with PCI and RA, femoral access is associated with a lower rate of coronary artery perforations as compared with radial access.
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http://dx.doi.org/10.33963/KP.15286DOI Listing
June 2020

Clinical outcomes of PCI with rotational atherectomy: the European multicentre Euro4C registry.

EuroIntervention 2020 Jul 17;16(4):e305-e312. Epub 2020 Jul 17.

Department of Cardiology, Rangueil Toulouse University Hospital, Toulouse, France.

Aims: Despite the use of rotational atherectomy (RA) in interventional cardiology for over three decades, data regarding factors affecting the clinical outcomes of the RA procedure remain scarce. The aim of the present study was to describe the contemporary use and outcomes of RA in Europe.

Methods And Results: We conducted, for the first time, a prospective international registry in 8 European countries and 19 centres and included patients treated by percutaneous coronary intervention with RA. Between October 2016 and July 2018, 966 patients with complete data were recruited. Mean age was 74.5 years, 72.4% were male and 43.4% had diabetes. Initial presentation was an acute coronary syndrome (ACS) for 25.1% of the patients. Clinical success was observed in 91.9% of the procedures. The rate of in-hospital major adverse cardiac events (MACE) - defined as cardiovascular death, myocardial infarction, target lesion revascularisation, stroke and coronary artery bypass grafting - was 4.7%. At one year, the rate of MACE was 13.2%. Factors independently associated with the occurrence of MACE at one year were female gender, renal failure, ACS at admission, depressed left ventricular ejection fraction (LVEF) and presence of a significant left main coronary artery (LMCA) lesion.

Conclusions: Despite the high level of complexity of the studied population, RA turned out to be an effective procedure with a low rate of in-hospital complications and demonstrated good immediate and midterm results.
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http://dx.doi.org/10.4244/EIJ-D-19-01129DOI Listing
July 2020

Takotsubo syndrome - fatal prognosis of patients with low body mass index in 5-year follow-up.

Arch Med Sci 2020 8;16(2):282-288. Epub 2019 Aug 8.

Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.

Introduction: The clinical courses of takotsubo syndrome (TS) and of acute coronary syndromes (ACS) seem to be very similar. However, there is limited knowledge about risk factors of poor outcomes. Low body mass index worsens the prognosis of patients with cardiovascular diseases, especially those undergoing surgical treatment. The aim of the study was to evaluate the influence of the body mass index (BMI) on the prognosis in patients diagnosed with TS.

Material And Methods: Eighty patients aged 15-89 (mean: 67.9 years), 74 women and 6 men with TS diagnosis according to Mayo Clinic diagnostic criteria were divided into 3 groups: low body mass (BMI < 18.5 kg/m), normal body mass (18.5 ≥ BMI < 25 kg/m) and excessive body mass (BMI ≥ 25 kg/m).

Results: Patients with low BMI were older, but with less prevalent risk factors such as hypertension, hypercholesterolemia and positive family history of coronary artery disease and more frequent risk factors such as cigarette smoking, chronic obstructive pulmonary disease (COPD), depressive and anxiety disorders as well as malignancy. They also had higher haemoglobin, lower troponin, creatine kinase, C-reactive protein and lipid fractions. The highest annual, 3-year and 5-year mortality was observed in the group with BMI < 18.5 kg/m. None of the patients with low BMI survived the 5-year follow-up period (100% vs. 25% vs. 15.2%; < 0.0001). In group III, mortality among overweight patients (25 ≥ BMI < 30 kg/m) was 8.3%, and in obese people (BMI ≥ 30 kg/m) 1 out 5 patients died during follow-up.

Conclusions: The majority of typical cardiovascular risk factors are less frequently observed in patients with TS and low body mass. Early prognosis for TS patients and low BMI is relatively favourable, whereas the 5-year follow-up is associated with extremely high mortality. Overweight patients have the best prognosis in the long-term follow-up.
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http://dx.doi.org/10.5114/aoms.2019.87082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069448PMC
August 2019

Acute coronary syndromes and atherosclerotic plaque burden distribution in coronary arteries among patients with valvular heart disease (BIA-WAD registry).

Postepy Kardiol Interwencyjnej 2019 8;15(4):422-430. Epub 2019 Dec 8.

Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.

Introduction: Valvular heart diseases (VHD) are a significant problem in the Polish population. Coexistence of coronary artery disease (CAD) in patients with VHD increases the risk of death and affects the further therapeutic strategy.

Aim: Analysis of atherosclerotic plaque burden distribution in coronary arteries and long-term prognosis among patients with VHD.

Material And Methods: Inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ±1454 days.

Results: Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CAD with severe angiographic stenoses was noted in 42.3% ( = 434). Among patients with severe MVI, CAD was noted in 47.1% of cases, and prior acute coronary syndromes (ACS) in 27.1% of patients ( = 58). In severe AVS patients, significant angiographic atherosclerotic changes were observed in 29.6% ( = 86), and prior ACS in 7.6% ( = 22) of patients. During the observation 52.7% of patients died, including 62.9% of patients with severe MVI and 51.6% of those with severe AVS. Age (OR = 1.038; 95% CI: 1.005-1.072; = 0.022) and coexisting aortic valve insufficiency (AVI) (OR = 2.39, 95% CI: 5.370-11.065, = 0.035) increased the mortality rate.

Conclusions: Severe AVS is starting to be the most prevalent VHD. CAD is one of the most significant factors deteriorating prognosis of patients with VHD. AVI and age were significant risk factors for mortality. The worst prognosis was observed in severe MVI, which may result from more frequent occurrence of CAD in this group. A lesser burden of CAD and ACS in the group of patients with severe AVS did not affect survival.
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http://dx.doi.org/10.5114/aic.2019.90216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956465PMC
December 2019

Effect of air pollution on the number of hospital admissions for acute coronary syndrome in elderly patients.

Pol Arch Intern Med 2020 01 19;130(1):38-46. Epub 2019 Nov 19.

Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland; Department of Clinical Medicine, Medical University of Bialystok, Białystok, Poland

Introduction: Air pollution is a documented risk factor for cardiovascular diseases.

Objectives: The aim of the study was to assess the effect of air pollution on the number of hospital admissions for acute coronary syndrome (ACS) in elderly patients.

Patients And Methods: The medical records of 26 695 patients hospitalized for ACS between 2008 and 2017 were examined. Weather conditions and the following components of air pollution were analyzed: sulfur dioxide, nitrogen dioxide, and particulate matter with a diameter of 2.5 μm or less (PM2.5) and a diameter of 10 μm or less (PM10).

Results: The study included 1618 inhabitants of Białystok in Poland (mean [SD] age, 75 [6.4] years; men, 52.6%). The norm for PM2.5 was exceeded on 23.5% of days, while for PM10, on 5.3% of days. Elevated PM10 levels were associated with a higher number of hospitalizations for ACS on the day of exposure (mean [SD], 0.61 [0.78] vs 0.44 [0.69]; P <0.001), and this effect persisted in the subsequent days (mean [SD], 1.07 [1.07] vs 0.88 [1.00]; P = 0.02). An increase of PM10 concentrations by 10 μg/m3 was associated with an increase in the number of hospitalizations due to unstable angina, and significant effects were observed even after 6 days (rate ratio, 1.16; 95% CI, 1.03-1.32; P = 0.02).

Conclusions: Increased exposure to air pollution, in particular, elevated PM10 levels, is associated with a higher incidence of ACS both on the day of exposure and over the following days.
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http://dx.doi.org/10.20452/pamw.15064DOI Listing
January 2020

Current trends and procedural outcomes in the era of rotational atherectomy expansion in Poland in the period 2014-2017 (based on the nationwide ORPKI registry).

Postepy Kardiol Interwencyjnej 2019 18;15(2):158-166. Epub 2019 Jan 18.

2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Introduction: The availability of rotational atherectomy (RA) has recently increased in Poland, which was followed by an increase in the rate of RA procedures and catheterization laboratories performing RA.

Aim: To assess current trends regarding the rapid increase in the number of RA procedures and catheterization laboratories performing RA.

Material An Methods: We analyzed patients treated with percutaneous coronary intervention (PCI) in the years 2014-2017 available in the nationwide ORPKI dataset. From the overall 431,467 patients treated with PCI, we extracted 1,873 treated with RA. We analyzed the relationship between frequency of RA usage, its distribution between low and high volume centers and procedural outcomes, procedural-related complications and the PCI effectiveness expressed as the target vessel patency rate after PCI.

Results: The number of RA procedures increased from 181 in 2014 (0.19%) to 698 in 2017 (0.61%), with an over two-fold increase in the number of catheterization laboratories performing RA from 25 (15.5%) in 2014 to 55 (34.1%) in 2017. Besides the fact that patient characteristics have changed in the most recent years, the rate of procedural success expressed as procedure-related complications remained stable in the 3 years 2015-2017 and was around 3%, while the procedural effectiveness expressed as patent target coronary artery after PCI was stable and over 98% in all of the analyzed years.

Conclusions: Along with the increasing number of RA procedures and catheterization laboratories performing RA in Poland, the procedural effectiveness remained stable during an observational period of 4 years.
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http://dx.doi.org/10.5114/aic.2019.81387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6727224PMC
January 2019