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Orzech JW, Zatorska K, Grabowski M, Miłkowska M, Jaworska-Wilczyńska M, Kowalik I, Kukulski T, Lesiak M, Surdacki A, Hryniewiecki T. Preliminary results from the Polish Infective Endocarditis Registry (POL-ENDO): Time to change clinical practice? Kardiol Pol 2024:VM/OJS/J/100275. [PMID: 38644668 DOI: 10.33963/v.phj.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Jakub W Orzech
- Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland
| | - Karina Zatorska
- Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland
| | - Maciej Grabowski
- Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland
| | - Małgorzata Miłkowska
- Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland
| | | | - Ilona Kowalik
- Clinical Research Support Center, National Institute of Cardiology, Warszawa, Poland
| | - Tomasz Kukulski
- 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Andrzej Surdacki
- 2nd Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University, Medical College, Kraków, Poland
| | - Tomasz Hryniewiecki
- Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland.
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Roczniak J, Tarnawski A, Dziewierz A, Glanowski S, Pawlik A, Sabatowski K, Januszek R, Rzeszutko Ł, Surdacki A, Bartuś S, Chyrchel M. Radial artery spasms - angiographic morphology, risk factors and management. Postepy Kardiol Interwencyjnej 2024; 20:53-61. [PMID: 38616935 PMCID: PMC11008508 DOI: 10.5114/aic.2024.136936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Radial artery is the preferred access for coronary interventions. However, the procedure is sometimes interrupted by a spasm which causes pain, prolongs the procedure, and can force the access crossover. Aim To observe factors contributing to a symptomatic radial artery spasm. Material and methods In this prospective study, we present results of 103 consecutive patients regarding radial artery spasm and angiographic image of the punctured artery. Angiography of the radial artery was performed in 70 (68.0%) patients. Potential risk factors for radial artery spasm were evaluated. Results The overall incidence of the radial artery spasm was high - 25 (24.3%). Signs of spasm were present in 37.1% of radial artery angiographies before the procedure and 60.1% after, however, it did not always indicate a symptomatic spasm. Risk factors related to radial artery spasm included female sex (OR = 2.94, p = 0.02), failure of the first puncture attempt (OR = 3.12, p = 0.014) and use of non-hydrophilic sheath (OR = 9.56, p = 0.036). Radial artery narrowing at the tip of the sheath was also a risk factor for spasm (p = 0.022). No spasms were observed after hydrophilic sheath application (n = 13). The administration of a radial cocktail was not observed to significantly decrease the spasm odds. Conclusions Risk factors for radial artery spasm include female sex and multiple puncture attempts. Hydrophilic sheath coating protects against radial artery spasm. Overall signs of a spasm in the angiography are common and do not imply a symptomatic spasm, which can be predicted by a tight narrowing at the tip of the sheath.
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Affiliation(s)
- Jan Roczniak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | | | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Glanowski
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Pawlik
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Rafał Januszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Krakow, Poland
| | - Łukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Chyrchel M, Siłka W, Wylaź M, Wójcik W, Surdacki A. Electrocardiography versus Echocardiography in Severe Aortic Stenosis with the Consideration of Coexistent Coronary Artery Disease. J Clin Med 2024; 13:1013. [PMID: 38398326 PMCID: PMC10888567 DOI: 10.3390/jcm13041013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Coexistent coronary artery disease (CAD) might influence the ability of electrocardiogram (ECG) to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) in patients with aortic stenosis (AS). We aimed to assess the relation between ECG-LVH (by the Sokolov-Lyon or Cornell criteria) and ECHO-LVH considering coexistent CAD. (2) Methods: We retrospectively analyzed the medical records of 74 patients (36 males) with severe AS who were hospitalized in the University Hospital in Cracow from 2021 to 2022. (3) Results: ECHO-LVH was present in 49 (66%) patients, whereas 35 (47.3%) patients had ECG-LVH. There was no difference between the rate of ECG-LVH in patients with vs. without ECHO-LVH. Single-vessel and multi-vessel CAD were diagnosed by invasive coronary angiography in 18% and 11% of patients, respectively. The sensitivity of the classical ECG-LVH criteria with regard to ECHO-LVH was low, reaching at best 41% for the Sokolov-Lyon and Cornell criteria. The results were similar and lacked a pattern when considering patients without significant stenosis, with single- and multi-vessel disease separately. Correlations between the left ventricular mass index and ECG-derived parameters were weak and present solely for the Lewis index (r = 0.31), R wave's amplitude >1.1 mV in aVL (r = 0.36), as well as the Cornell (r = 0.32) and Sokolov-Lyon (r = 0.31) voltage criteria (p < 0.01). The presence, location of stenoses, and CAD extent were not associated with the presence of either ECHO-LVH or ECG-LVH, irrespective of individual ECG-LVH criteria. (4) Conclusions: The sensitivity of classical ECG criteria for echocardiographic LVH in severe AS is low, regardless of coexistent CAD or its angiographic extent.
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Affiliation(s)
- Michał Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.C.); (A.S.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Cracow, Poland
| | - Wojciech Siłka
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.W.); (W.W.)
| | - Mateusz Wylaź
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.W.); (W.W.)
| | - Wiktor Wójcik
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.W.); (W.W.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland; (M.C.); (A.S.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Cracow, Poland
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Węgiel M, Surmiak M, Malinowski KP, Dziewierz A, Surdacki A, Bartuś S, Rakowski T. In-Hospital Levels of Circulating MicroRNAs as Potential Predictors of Left Ventricular Remodeling Post-Myocardial Infarction. Medicina (Kaunas) 2024; 60:149. [PMID: 38256409 PMCID: PMC10819680 DOI: 10.3390/medicina60010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Biochemical and molecular regulation of both adaptive and pathological responses of heart tissue to ischemic injury is widely investigated. However, it is still not fully understood. Several biomarkers are tested as predictors of left ventricle (LV) remodeling after myocardial infarction (MI). The aim of this study was to assess the relationship between selected microRNAs (miRNAs) and LV function and morphology in patients after MI. Materials and Methods: Selected miRNAs related to heart failure were assessed in the acute phase of MI: miR-150-3p, miR-21-5p, miR-19b-3p, miR-155-5p, miR-22-5p. Echocardiography with 3D imaging was performed at baseline and after 6 months. Remodeling was defined as >20% increase in LV end-diastolic volume, whereas reverse remodeling was defined as >10% reduction in LV end-systolic volume. Results: Eighty patients entered the registry. Remodeling occurred in 26% and reverse remodeling was reported in 51% of patients. In the presented study, none of the analyzed miRNAs were found to be a significant LV remodeling predictor. The observed correlations between miRNAs and other circulating biomarkers of myocardial remodeling were relatively weak. Conclusions: Our analysis does not demonstrate an association between the analyzed miRNAs and LV remodeling in patients with MI.
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Affiliation(s)
- Michał Węgiel
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
| | - Marcin Surmiak
- Department of Internal Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Krzysztof Piotr Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
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Chyrchel M, Bartuś S, Piechocki M, Glądys K, Januszek R, Surdacki A, Rzeszutko Ł. Is single-catheter technique for coronary angiography an optimal tool for beginners in interventional cardiology?-randomized controlled study TRACT 2: Transradial Coronary Angiography Trial 2. Cardiovasc Diagn Ther 2023; 13:1019-1029. [PMID: 38162109 PMCID: PMC10753231 DOI: 10.21037/cdt-23-212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Background Transradial coronary angiography can be performed using a dual-catheter technique (DCT) or single-catheter technique (SCT). The current study aimed to compare DxTerity SCT Ultra and the Trapease curve SCT catheters with DCT catheters in procedures performed by young, less experienced, interventional cardiologists. Methods For this prospective, single-blinded, randomized study 107 were enrolled and assigned to 1 of 3 groups. They underwent planned coronary angiography at the Second Department of Cardiology Jagiellonian University in Kraków. In groups 1 (n=37) and 2 (n=35), DxTerity SCT Ultra catheters and the Trapease curve were used, respectively. In control group 3 (n=35), standard DCT Judkins catheters were applied. One patient was excluded from group 2, bringing the total number of cases analysed to 106. The study endpoints comprised the percentage of optimal stability, proper ostial artery engagement, a good quality angiogram, the duration of each procedure stage, the amount of contrast and the radiation dose. Results The highest percentage of optimal stability was observed in group 1 for the right coronary artery (RCA): 94%, and in group 3, for the left coronary artery (LCA): 85%. The necessity to change the catheter was most common in group 2. Group 1 was characterised by a shorter total procedural time. The contrast volume was higher in group 2, while there were no differences in radiation dose. Conclusions SCT is at least as adequate as DCT for young cardiologists. SCT was associated with lower necessity of catheter exchange during RCA visualization. The DxTerity Ultra curve catheter allows shortening the total procedure time.
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Affiliation(s)
- Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Piechocki
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Kinga Glądys
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Chyrchel M, Roczniak J, Surdacki A. Radial artery spasms impair invasive cardiological procedures' performance: a pharmacological approach to prevention and treatment. J Physiol Pharmacol 2023; 74. [PMID: 38345441 DOI: 10.26402/jpp.2023.6.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/31/2023] [Indexed: 02/15/2024]
Abstract
The radial artery (RA) access is currently the gold standard to perform cardiovascular interventions. One of the more common limitations is radial artery spasm which is an often complication interrupting the procedure. Common risk factors associated with spasm include female gender, periprocedural anxiety, multiple puncture attempts, distal radial access, diabetes, hypertension, and smoking. The mechanism of spasm is complex and includes calmodulin and rho-kinase pathways leading to the smooth muscle contraction. Proper hydration, anxiety management, and adequate local anesthesia should be applied to decrease the risk of spasms. Radial cocktail is often used to prevent spasm. Its composition differs between catheterization laboratories and the effect is attributed either to the verapamil or nitroglycerin, with contradictory results of different studies. Balbay maneuver is also an effective mean of prevention. Hydrophilic-coated devices can be used both to avoid spasms or reverse them. Radial angiography can be used to differentiate spasm from a tortuosity and choose proper method of management. Fasudil, a Rho-kinase inhibitor, has been reported as a pharmacological method to prevent spasm and reverse radial artery spasm.
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Affiliation(s)
- M Chyrchel
- Departament of Cardiology and Cardiovascular Interventions, University Hospital, Cracow, Poland.
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - J Roczniak
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - A Surdacki
- Departament of Cardiology and Cardiovascular Interventions, University Hospital, Cracow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland
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Gołąbek N, Jakubowski W, Król S, Kozioł M, Niewiara Ł, Kleczyński P, Legutko J, Dziewierz A, Surdacki A, Chyrchel M. ECG patterns suggestive of high-risk coronary anatomy in non-ST-segment elevation acute coronary syndrome - an analysis of real-world patients. Postepy Kardiol Interwencyjnej 2023; 19:326-332. [PMID: 38187480 PMCID: PMC10767565 DOI: 10.5114/aic.2023.132161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Electrocardiographic (ECG) patterns suggestive of high-risk coronary anatomy are indications for an urgent invasive approach in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Aim To estimate the frequency of the observed phenomenon and assess the clinical characteristics of NSTE-ACS subjects associated with Wellens syndrome, the de Winter sign, or ST-segment depressions by ≥ 1 mm in ≥ 6 classic ECG leads with simultaneous ST-segment elevation in aVR and/or V1. Material and methods Out of 207 pre-screened subjects diagnosed with NSTE-ACS, 64 patients (26 women and 38 men) with complete medical records (including admission ECG and coronary angiography during the index hospitalization), and significant culprit stenosis or occlusion of the left main coronary artery (LMCA) or the proximal/middle segment of the left anterior descending artery (LAD) entered the final analysis. Clinical characteristics of patients exhibiting any of the high-risk ECG patterns was compared to their counterparts with significant lesions in LMCA or proximal/middle LAD without any of the high-risk ECG patterns. Results Among 64 patients with significant culprit lesions in LMCA or LAD, 19 (29.69%) exhibited one of the high-risk ECG patterns: Wellens syndrome (n = 10), the de Winter sign (n = 0), or multiple ST-segment depressions (n = 9). Clinical characteristics were comparable in 19 NSTE-ACS patients with the high-risk ECG patterns and their 45 counterparts. Conclusions Because ECG patterns suggestive of high-risk coronary anatomy are relatively frequent in patients with NSTE-ACS and culprit lesions in LMCA or LAD, their early recognition is of clinical importance.
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Affiliation(s)
- Natalia Gołąbek
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Jakubowski
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Król
- Students’ Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Mateusz Kozioł
- Students’ Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Łukasz Niewiara
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Zdzierak B, Zasada W, Rakowski T, Krawczyk-Ożóg A, Bartuś S, Surdacki A, Dziewierz A. Influence of diabetes mellitus on the invasive assessment of myocardial ischemia in patients with coronary artery disease. Pol Arch Intern Med 2023; 133:16502. [PMID: 37227217 DOI: 10.20452/pamw.16502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Current guidelines recommend physiological evaluation of borderline coronary artery stenoses using hyperemic (fractional flow reserve [FFR]) and nonhyperemic (instantaneous wave‑free ratio [iFR] and resting full‑cycle ratio [RFR]) methods. However, comorbidities, such as diabetes mellitus (DM), may influence the results of the assessment. OBJECTIVES We sought to investigate the impact of DM and insulin treatment on the discordance between FFR and iFR/RFR. PATIENTS AND METHODS A total of 417 intermediate stenoses in 381 patients underwent FFR and iFR/RFR assessment. FFR lower than or equal to 0.8 and iFR/RFR lower than or equal to 0.89 indicated significant ischemia. The patients were categorized based on DM diagnosis and insulin treatment status. RESULTS Of the 381 patients, 154 (40.4%) had DM. Among these, 58 patients (37.7%) received insulin treatment. Diabetic patients had higher body mass index and glycated hemoglobin levels, and lower ejection fraction. FFR and iFR/RFR analyses were conducted in 417 vessels with available measurements for both tests. A good correlation between FFR and iFR/RFR was confirmed in both diabetic (R = 0.77) and nondiabetic (R = 0.74) patients. Discordance between FFR and iFR/RFR occurred in approximately 20% of cases, and the frequency of discordance was not affected by the diabetic status. However, insulin‑treated DM was independently associated with a higher risk of negative FFR and positive iFR/RFR discordance (odds ratio, 4.61; 95% CI, 1.38-15.4; P = 0.01). Also, the optimal cutoff value for FFR identifying significant ischemia in DM patients treated with insulin was higher (0.84) than the generally recommended value. CONCLUSIONS The rate of FFR and iFR/FFR discordance was similar regardless of the diabetes status, and insulin‑treated DM was associated with an increased risk of negative FFR and positive iFR/RFR discordance.
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Affiliation(s)
- Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- KCRI, Kraków, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Department of Anatomy, HEART – Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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Zasada W, Zdzierak B, Rakowski T, Bobrowska B, Krawczyk-Ożóg A, Surowiec S, Bartuś S, Surdacki A, Dziewierz A. The Impact of Age on the Physiological Assessment of Borderline Coronary Stenoses. Medicina (Kaunas) 2023; 59:1863. [PMID: 37893581 PMCID: PMC10608417 DOI: 10.3390/medicina59101863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Coronary angiography is the gold standard for diagnosing coronary artery disease (CAD). In the case of borderline changes, patients require further diagnosis through ischemia assessment via one of the recommended methods of invasive evaluation. This study aimed to assess whether clinical factors influence the risk of a positive result in invasive myocardial ischemia assessment and if these potential factors change with the patient's age and the consistency of ischemia assessment. Materials and Methods: Data were collected retrospectively on all consecutive patients hospitalized in the University Hospital in Krakow between 2020 and 2021, on whom physiological assessments of coronary circulation were performed. Patients were divided into two groups: patients aged 60 or younger and patients older than 60. Results: Despite the older patients having more risk factors for CAD, their physiological assessment results of borderline lesions were similar to those of the younger patients. Positive fractional flow reserve (FFR) assessments were obtained from almost 50% of vessels. In the younger patients, cigarette use and type 2 diabetes mellitus increased the risk of a positive FFR result by 3.5 and 2.5 times, respectively. In the older patients, male gender and peripheral vascular disease significantly increased the risk of a positive FFR by 2.5 and 2 times, respectively. Conclusions: Clinical characteristics of patients undergoing physiological assessment of borderline coronary stenosis varied significantly by age. Refining the definition of borderline lesions to include age, gender, and other factors may improve the identification of patients who would benefit from physiological assessment and coronary revascularization.
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Affiliation(s)
- Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- KCRI, 30-347 Krakow, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Beata Bobrowska
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- Department of Anatomy, HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Sławomir Surowiec
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
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10
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Maruszak N, Pilch W, Januszek R, Malinowski KP, Surdacki A, Chyrchel M. Risk Factors of Suboptimal Coronary Blood Flow after a Percutaneous Coronary Intervention in Patients with Acute Anterior Wall Myocardial Infarction. J Pers Med 2023; 13:1217. [PMID: 37623467 PMCID: PMC10455189 DOI: 10.3390/jpm13081217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/29/2023] [Accepted: 07/29/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND AND AIMS Primary percutaneous coronary intervention (PCI) is regarded as the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). Thrombolysis in Myocardial Infarction (TIMI) flow grade has been an important and cohesive predictor of outcomes in STEMI patients. We sought to evaluate potential variables associated with the risk of suboptimal TIMI flow after PCI in patients with anterior wall STEMI. METHODS We evaluated 107 patients admitted to our hospital between 1 January 2019 and 31 December 2021 with a diagnosis of anterior wall STEMI treated with primary PCI. RESULTS Suboptimal TIMI flow grade (≤2) after PCI occurred in 14 (13%) patients while grade 3 was found in 93 (87%) of them presenting with anterior wall STEMI. Failure to achieve optimal TIMI 3 flow grade after PCI was associated with lower TIMI grade prior to PCI (OR 0.5477, 95% CI 0.2589-0.9324, p = 0.02), greater troponin concentration before (OR 1.0001, 95% CI 1-1.0001, p = 0.0028) and after PCI (OR 1.0001, 95% CI 1-1.0001, p = 0.0452) as well as lower mean minimal systolic blood pressure (OR 0.9653, 95% CI 0.9271-0.9985, p = 0.04). CONCLUSIONS Among predictors of suboptimal TIMI flow grade after PCI, we noted lower TIMI grade flow pre-PCI, greater serum troponin concentrations in the periprocedural period and lower mean minimal systolic blood pressure.
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Affiliation(s)
- Natalia Maruszak
- Faculty of Medicine, Student Scientific Group at Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland; (N.M.); (W.P.)
| | - Weronika Pilch
- Faculty of Medicine, Student Scientific Group at Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland; (N.M.); (W.P.)
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland (M.C.)
| | - Krzysztof Piotr Malinowski
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kopernika 7E Str., 31-034 Kraków, Poland
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Medyczna 7 Str., 30-688 Kraków, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland (M.C.)
| | - Michał Chyrchel
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland (M.C.)
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11
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Januszek R, De Luca G, Siłka W, Bryniarski L, Malinowski KP, Surdacki A, Wańha W, Bartuś S, Piotrowska A, Bartuś K, Pytlak K, Siudak Z. Single versus Dual-Operator Approaches for Percutaneous Coronary Interventions within Chronic Total Occlusion-An Analysis of 27,788 Patients. J Clin Med 2023; 12:4684. [PMID: 37510798 PMCID: PMC10380720 DOI: 10.3390/jcm12144684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Since the treatment of chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) is associated with high procedural complexity, it has been suggested to use a multi-operator approach. This study was aimed at evaluating the procedural outcomes of single (SO) versus dual-operator (DO) CTO-PCI approaches. (2) Methods: This retrospective analysis included data from the Polish Registry of Invasive Cardiology Procedures (ORPKI), collected between January 2014 and December 2020. To compare the DO and SO approaches, propensity score matching was introduced with equalized baseline features. (3) Results: The DO approach was applied in 3604 (13%) out of 27,788 CTO-PCI cases. Patients undergoing DO CTO-PCI experienced puncture-site bleeding less often than the SO group (0.1% vs. 0.3%, p = 0.03). No differences were found in the technical success rate (successful revascularization with thrombolysis in myocardial infarction flow grade 2/3) of the SO (72.4%) versus the DO approach (71.2%). Moreover, the presence of either multi-vessel (MVD) or left main coronary artery disease (LMCA) (odds ratio (OR), 1.67 (95% confidence interval (CI), 1.20-2.32); p = 0.002), as well as lower annual and total operator volumes of PCI and CTO-PCI, could be noted as factors linked with the DO approach. (4) Conclusions: Due to the retrospective character, the findings of this study have to be considered only as hypothesis-generating. DO CTO-PCI was infrequent and was performed on patients who were more likely to have LMCA lesions or MVD. Operators collaboratively performing CTO-PCIs were more likely to have less experience. Puncture-site bleeding occurred less often in the dual-operator group; however, second-operator involvement had no impact on the technical success of the intervention.
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Affiliation(s)
- Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Giuseppe De Luca
- Division of Cardiology, AOU Policlinico G. Martino, University of Messina, 98166 Messina, Italy
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | - Wojciech Siłka
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Krzysztof Piotr Malinowski
- Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Aleksandra Piotrowska
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Kraków, Poland
| | - Kamil Pytlak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
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12
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Zdzierak B, Zasada W, Krawczyk-Ożóg A, Rakowski T, Bartuś S, Surdacki A, Dziewierz A. Influence of sex on the functional assessment of myocardial ischemia. Kardiol Pol 2023; 81:895-902. [PMID: 37448217 DOI: 10.33963/kp.a2023.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) and non-hyperemic resting pressure ratios, such as instantaneous wave-free ratio (iFR) and resting full-cycle ratio (RFR), are recommended for evaluating the significance of angiographically intermediate coronary stenoses. Despite their usefulness, approximately 20% of assessed lesions exhibit discordance between FFR and iFR/RFR. AIMS The role of sex in this discrepancy remains uncertain; thus, we aimed to investigate its impact on the discordance between FFR and iFR/RFR. METHODS We reviewed 417 consecutive intermediate stenotic lesions from 381 patients, stratified by sex and assessed with both FFR and iFR/RFR. FFR ≤0.80 and iFR/RFR ≤0.89 were considered positive for ischemia. RESULTS Of the 381 patients, 92 (24.1%) were women. Women were older, had a lower estimated glomerular filtration rate (eGFR), higher ejection fraction, and were more likely to have peripheral artery disease than men. Median FFR and iFR/RFR values were lower in men than in women (FFR 0.86 vs. 0.80; P <0.001; iFR 0.92 vs. 0.90; P = 0.049). However, overall discordance prevalence was similar for both sexes (20.6% vs. 15.1%; P = 0.22). In men, eGFR, insulin-treated diabetes mellitus, and arterial hypertension were predictors of positive FFR | negative iFR/RFR discordance, while eGFR, insulin-treated diabetes mellitus, atrial fibrillation, and chronic obstructive pulmonary disease were predictors of negative FFR | positive iFR/RFR discordance. No factors associated with either discordance were identified in women. CONCLUSIONS FFR and iFR/RFR results indicating significant ischemia were more common in men than women when assessing intermediate coronary stenoses. Nevertheless, sex did not predict discordant results.
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Affiliation(s)
- Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- KCRI, Kraków, Poland
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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13
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Chyrchel B, Kruszelnicka O, Wieczorek-Surdacka E, Surdacki A. Association of ADP-Induced Whole-Blood Platelet Aggregation with Serum Low-Density Lipoprotein Cholesterol in Patients with Coronary Artery Disease When Receiving Maintenance Ticagrelor-Based Dual Antiplatelet Therapy. J Clin Med 2023; 12:4530. [PMID: 37445565 DOI: 10.3390/jcm12134530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
The degree of platelet inhibition in patients undergoing dual antiplatelet therapy (DAPT) affects cardiovascular outcomes after acute coronary syndromes (ACS) and/or percutaneous coronary intervention. Our aim was to search for correlates of residual ex vivo platelet reactivity and circulating soluble P-selectin (sP-selectin), an index of in vivo platelet activation, in patients being treated by DAPT with ticagrelor. Adenosine diphosphate (ADP)-induced platelet aggregability (by multiple electrode aggregometry) and plasma sP-selectin were estimated in 62 stable post-ACS subjects (46 men and 16 women; mean age: 64 ± 10 years; 30 with type 2 diabetes (T2DM)) undergoing maintenance DAPT with ticagrelor and aspirin. These patients did not exhibit heart failure or other relevant coexistent diseases except for properly controlled T2DM, mild renal insufficiency, and hypertension. We also assessed this in 64 subjects on clopidogrel-based DAPT matched for age, sex, and T2DM status. ADP-induced platelet aggregation was below the optimal levels (190-460 arbitrary units (AU) * min) in most patients receiving ticagrelor-based DAPT, especially in those with below-median (<1.9 mmol/L) serum concentrations of low-density lipoprotein cholesterol (LDL-c) (128 ± 61 vs. 167 ± 73 AU * min for below-median and above-median LDL-c, respectively, p = 0.025). In contrast, platelet reactivity did not differ by LDL-c on clopidogrel-based DAPT (246 ± 101 vs. 268 ± 108 AU * min for below-median and above-median LDL-c, respectively, p > 0.4). Plasma sP-selectin was found to be unrelated to serum LDL-c when receiving DAPT with ticagrelor (p > 0.4) or clopidogrel (p > 0.8). In conclusion, our preliminary observational study suggests the association of lower residual ex vivo platelet aggregability with better LDL-c control in patients undergoing ticagrelor-based maintenance DAPT, which does not appear to be reflected by plasma sP-selectin. Whether the serum LDL-c level should be considered among the factors affecting the degree of platelet inhibition for those treated with ticagrelor-based DAPT needs to be investigated in larger studies.
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Affiliation(s)
- Bernadeta Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
| | - Olga Kruszelnicka
- Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka Street, 31-202 Cracow, Poland
| | - Ewa Wieczorek-Surdacka
- Center of Innovative Medical Education, Jagiellonian University Medical College, 7 Medyczna Street, 30-688 Cracow, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
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14
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Januszek R, Siudak Z, Malinowski KP, Wańha W, Surowiec S, Heba G, Pawlik A, Kameczura T, Wojakowski W, Jaguszewski M, Kołodziej A, Bryniarski L, Bartuś K, Surdacki A, Dobrzycki S, Legutko J, Bartuś S. Factors determining the frequency of optical coherence tomography and intravascular ultrasound use in patients treated with percutaneous coronary interventions in recent years: Analysis based on a large national registry. Kardiol Pol 2023; 81:969-977. [PMID: 37401576 DOI: 10.33963/kp.a2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/11/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have demonstrated improvement in the clinical outcome of patients undergoing percutaneous coronary intervention (PCI). AIMS We aimed to examine the frequency of implementing OCT and IVUS during coronary angiography (CA) and PCI in everyday practice in Poland. Factors related to the more common choice of these imaging techniques were determined. METHODS Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) were procured for analysis. Between January 2014 and December 2021, we extracted data on 1 452 135 CAs, 11 710 using IVUS (0.8%) and 1471 with OCT (0.1%) and 838 297 PCIs, 15 436 with IVUS (1.8%) and 1680 with OCT (0.2%). We assessed the determining factors for applying IVUS and OCT via multiple regression logistics models. RESULTS The frequency of applying IVUS during CAs and PCIs increased significantly between the years 2014 and 2021. In 2021, it reached 1.54% for CAs and 4.42% for PCIs, while for OCT, there was a rise regarding the CA group, namely 0.13% in 2021, and, in the PCI group, 0.43%. Age was one of the factors significantly associated with the frequency of using IVUS/OCT during CA/PCI, which was confirmed by multivariate analysis (Odds ratio: 0.981 for IVUS and 0.973 for OCT use with PCI). CONCLUSION The frequency at which IVUS and OCT were used has undergone a significant increase in previous years. This increase can be largely attributed to the current reimbursement policies. Further improvement is required for this frequency to be at a satisfactory level.
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Affiliation(s)
- Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Krzysztof Piotr Malinowski
- Jagiellonian University Medical College, Faculty of Medicine, Department of Bioinformatics and Telemedicine, Kraków, Poland
- Jagiellonian University Medical College, Centre for Digital Medicine and Robotics, Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sławomir Surowiec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Grzegorz Heba
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Artur Pawlik
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Tomasz Kameczura
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszów, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Miłosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Agnieszka Kołodziej
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Polan
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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15
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Bobrowska B, Zasada W, Zawada M, Surdacki A, Bartuś S, Rajtar-Salwa R. Autosomal recessive hypercholesterolemia: the first experience in Poland. Pol Arch Intern Med 2023; 133:16498. [PMID: 37171179 DOI: 10.20452/pamw.16498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Beata Bobrowska
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- KCRI, Kraków, Poland
| | - Magdalena Zawada
- Department of Hematology Diagnostics and Genetics, University Hospital, Kraków, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Renata Rajtar-Salwa
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
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16
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Tofilska A, Zięba K, Surdacki A, Rajzer M, Olszanecka A. Does the incidence of infectious endocarditis show seasonal patterns? - a single center retrospective study. Folia Med Cracov 2023; 63:39-44. [PMID: 37406275 DOI: 10.24425/fmc.2023.145428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
I n t r o d u c t i o n: Seasonal variation has been observed for bacterial and viral infections (e.g., COVID-19 [1]), but also for numerous cardiac problems. However, little information is available on the seasonality of infectious endocarditis (IE), a rare disease that is usually linked to a bacterial origin. Data from the Polish population are lacking. Materials and M e t h o d s: Our retrospective study focused on the identification of patients with IE, who were hospitalized at the University Hospital in Krakow between 2005-2022. For this purpose, we searched the medical records system using the ICD-10 code. We decided to divide our patients into four groups (winter, spring, summer, autumn), based on the date of admission to the hospital. Comparison of the distribution of IE incidents by season was performed with the ch2 test. R e s u l t s: One hundred and ten patients were included in the study (median age 62.5 years (range 20-94), 72 men (65.45%)). The left native valve IE was diagnosed in 49% of the patients, the prosthetic valve IE in 16%, the right valve IE in 27% and the implantable cardiac electronic devices IE in 12% of the subjects. The outcomes comprised of cardiac surgery (n = 53), embolism (n = 16), death (n = 15) and metastatic infections (n = 5). No differences in the incidence of IE by season were observed. C o n c l u s i o n s: In the preliminary observation of IE cases of patients admitted to the University Hospital in Krakow, Poland no seasonal pattern of IE was detected. Therefore, IE should be taken into account in the differential diagnosis at any time of the year.
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Affiliation(s)
- Anna Tofilska
- Students' Scientific Group at the First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Zięba
- Students' Scientific Group at the First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
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17
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Rakowski T, Węgiel M, Malinowski KP, Siudak Z, Zasada W, Zdzierak B, Tokarek T, Rzeszutko Ł, Dudek D, Bartuś S, Surdacki A, Dziewierz A. Thrombus containing lesions strategies during primary percutaneous coronary interventions in ST-segment elevation myocardial infarction: insights from ORPKI National Registry. J Thromb Thrombolysis 2023:10.1007/s11239-023-02811-z. [PMID: 37093352 DOI: 10.1007/s11239-023-02811-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/25/2023]
Abstract
In the era of potent P2Y12 inhibitors, according to current guidelines, treatment with glycoprotein IIb/IIIa inhibitors (GPIs) should be limited to bail-out and/or highly thrombotic situations. Similarly, the recommendation for aspiration thrombectomy (AT) is downgraded to very selective use. We examine the prevalence, and predictors of GPI and AT use in STEMI patients referred to primary percutaneous coronary intervention (PCI). Data on 116,873 consecutive STEMI patients referred to primary PCI in Poland between 2015 and 2020 were analyzed. GPIs were administered in 29.3%, AT was used in 11.6%, and combined treatment with both in 6.1%. There was a mild trend toward a decrease in GPI and AT usage during the analyzed years. On the contrary, there was a rapid growth of the ticagrelor/prasugrel usage rate from 6.5 to 48.1%. Occluded infarct-related artery at baseline and no-reflow during PCI were the strongest predictors of GPI administration (OR 2.3; 95% CI 2.22-2.38 and OR 3.47; 95% CI 3.13-3.84, respectively) and combined usage of GPI and AT (OR 4.4; 95% CI 4.08-4.8 and OR 3.49; 95% CI 3.08-3.95 respectively) in a multivariate logistic regression model. Similarly, the administration of ticagrelor/prasugrel was an independent predictor of both adjunctive treatment strategies. In STEMI patients in Poland, GPIs are selectively used in one in four patients during primary PCI, and the combined usage of GPI and AT is marginal. Despite the rapid growth in potent P2Y12 inhibitors usage in recent years, GPIs are selectively used at a stable rate during PCI in highly thrombotic lesions.
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Affiliation(s)
- Tomasz Rakowski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Węgiel
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Krzysztof P Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, Nowy Sacz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Andrzej Surdacki
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland.
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
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Kańtoch A, Chyrchel B, Surowiec S, Chyrchel M, Rzeszutko Ł, Surdacki A, Bartuś S, Bryniarski L. How multislice computed tomography (MSCT) of the coronary arteries can change the chronic total occlusion (CTO) recanalization procedure? Kardiol Pol 2023:VM/OJS/J/94734. [PMID: 36999724 DOI: 10.33963/kp.a2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Anna Kańtoch
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
| | - Bernadeta Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Sławomir Surowiec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Krawczyk-Ożóg A, Batko J, Koziej M, Tokarek T, Sorysz D, Siudak Z, Dudek D, Bartuś S, Surdacki A, Hołda MK. Computed tomography and transthoracic echocardiography for assessment of left ventricle geometry in patients with aortic valve stenosis. Postepy Kardiol Interwencyjnej 2023; 19:47-55. [PMID: 37090214 PMCID: PMC10114178 DOI: 10.5114/aic.2023.124406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/27/2022] [Indexed: 04/25/2023] Open
Abstract
Introduction Standard transthoracic echocardiography (TTE) often is not sufficient to properly visualize the geometry of the left ventricle. One of the clinical imaging modalities that can be used for this purpose is contrast-enhanced, electrocardiologically gated cardiac computed tomography (CT). Aim To compare cardiac CT and TTE as tools for assessing geometry and function of the left ventricle in patients with severe aortic stenosis. Material and methods We analyzed 58 consecutive patients (43.1% males, mean age 81.4 ±6.0 years) with severe aortic stenosis, who underwent both cardiac CT and TTE. Results Left ventricle major axis length is significantly longer in CT than in TTE (81.5 ±11.7 mm vs. 74.6 ±13.5 mm, p = 0.004). No difference was found in end-systolic left ventricle volume between the two imaging methods, while end-diastolic volume of the left ventricle was significantly larger when measured in CT than in both 2D biplane and 3D triplane TTE. The stroke volume was not different between the 2D biplane TTE and CT. No significant difference was found between CT and TTE in the calculation of ejection fraction and LV mass/indexed LV mass (p > 0.05). Conclusions The use of three-dimensional postprocessing provides a very accurate image of heart structures in CT, which in some aspects may significantly differ from the values estimated by TTE.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Jakub Batko
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Koziej
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tokarek
- Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, Nowy Sacz, Poland
| | - Danuta Sorysz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
| | - Dariusz Dudek
- Digital Medicine and Robotics Center, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K. Hołda
- HEART – Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Zdzierak B, Zasada W, Krawczyk-Ożóg A, Rakowski T, Bartuś S, Surdacki A, Dziewierz A. Comparison of Fractional Flow Reserve with Resting Non-Hyperemic Indices in Patients with Coronary Artery Disease. J Cardiovasc Dev Dis 2023; 10:jcdd10020034. [PMID: 36826530 PMCID: PMC9959762 DOI: 10.3390/jcdd10020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Guidelines recommend using hyperemic (FFR) and non-hyperemic (iFR/RFR) methods of evaluating coronary artery stenoses in patients with coronary artery disease. However, in some cases, achieved results indicating significant ischemia may differ between those methods. Thus, we sought to identify predictors of such a discrepancy. Data were collected on all consecutive patients with chronic coronary syndrome hospitalized between 2020 and 2021. For 279 patients (417 vessels), results for both FFR and iFR/RFR were available. Values of ≤0.80 for FFR and ≤0.89 for iFR/RFR were considered positive for ischemia. Discordant measurements of FFR and iFR/RFR were observed in 80 (19.2%) patients. Atrial fibrillation was the only predictor of the overall FFR and iFR/RFR discordance - OR (95%CI) 1.90 (1.02-3.51); p = 0.040. The chance of positive FFR and negative iFR/RFR decreased independently with age - OR (95%CI) 0.96 (0.93-0.99); p = 0.024. On the contrary, insulin-treated diabetes mellitus was the predictor of negative FFR and positive iFR/RFR discrepancy - OR (95%CI) 4.61 (1.38-15.40); p = 0.013. In everyday clinical practice, iFR/FFR correlates well with FFR. However, discordance between these methods is quite common. Physicians should be aware of the risk of such discordance in patients with atrial fibrillation, advanced age, and insulin-treated diabetes mellitus.
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Affiliation(s)
- Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- KCRI, 30-347 Krakow, Poland
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- Department of Anatomy, HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, 33-332 Krakow, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-2250
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Totoń-Żurańska J, Sulicka-Grodzicka J, Seweryn MT, Pitera E, Kapusta P, Konieczny P, Drabik L, Kołton-Wróż M, Chyrchel B, Nowak E, Surdacki A, Grodzicki T, Wołkow PP. MicroRNA composition of plasma extracellular vesicles: a harbinger of late cardiotoxicity of doxorubicin. Mol Med 2022; 28:156. [PMID: 36517751 PMCID: PMC9753431 DOI: 10.1186/s10020-022-00588-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The use of doxorubicin is associated with an increased risk of acute and long-term cardiomyopathy. Despite the constantly growing number of cancer survivors, little is known about the transcriptional mechanisms which progress in the time leading to a severe cardiac outcome. It is also unclear whether long-term transcriptomic alterations related to doxorubicin use are similar to transcriptomic patterns present in patients suffering from other cardiomyopathies. METHODS We have sequenced miRNA from total plasma and extracellular vesicles (EVs) from 66 acute lymphoblastic leukemia (ALL) survivors and 61 healthy controls (254 samples in total). We then analyzed processes regulated by differentially expressed circulating miRNAs and cross-validated results with the data of patients with clinically manifested cardiomyopathies. RESULTS We found that especially miRNAs contained within EVs may be informative in terms of cardiomyopathy development and may regulate pathways related to neurotrophin signaling, transforming growth factor beta (TGFβ) or epidermal growth factor receptors (ErbB). We identified vesicular miR-144-3p and miR-423-3p as the most variable between groups and significantly correlated with echocardiographic parameters and, respectively, for plasma: let-7g-5p and miR-16-2-3p. Moreover, vesicular miR-144-3p correlates with the highest number of echocardiographic parameters and is differentially expressed in the circulation of patients with dilated cardiomyopathy. We also found that distribution of particular miRNAs between of plasma and EVs (proportion between compartments) e.g., miR-184 in ALL, is altered, suggesting changes within secretory and miRNA sorting mechanisms. CONCLUSIONS Our results show that transcriptomic changes resulting from doxorubicin induced myocardial injury are reflected in circulating miRNA levels and precede development of the late onset cardiomyopathy phenotype. Among miRNAs related to cardiac function, we found vesicular miR-144-3p and miR-423-3p, as well as let-7g-5p and miR-16-2-3p contained in the total plasma. Selection of source for such studies (plasma or EVs) is of critical importance, as distribution of some miRNA between plasma and EVs is altered in ALL survivors, in comparison to healthy people, which suggests that doxorubicin-induced changes include miRNA sorting and export to extracellular space.
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Affiliation(s)
- Justyna Totoń-Żurańska
- grid.5522.00000 0001 2162 9631Center for Medical Genomics OMICRON, Jagiellonian University Medical College, ul. Kopernika 7C, 31-034 Krakow, Poland
| | - Joanna Sulicka-Grodzicka
- grid.5522.00000 0001 2162 9631Department of Rheumatology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał T. Seweryn
- grid.5522.00000 0001 2162 9631Center for Medical Genomics OMICRON, Jagiellonian University Medical College, ul. Kopernika 7C, 31-034 Krakow, Poland ,grid.261331.40000 0001 2285 7943Department of Cancer Biology and Genetics, Center for Pharmacogenomics, College of Medicine, The Ohio State University, Columbus, OH USA
| | - Ewelina Pitera
- grid.5522.00000 0001 2162 9631Center for Medical Genomics OMICRON, Jagiellonian University Medical College, ul. Kopernika 7C, 31-034 Krakow, Poland
| | - Przemysław Kapusta
- grid.5522.00000 0001 2162 9631Center for Medical Genomics OMICRON, Jagiellonian University Medical College, ul. Kopernika 7C, 31-034 Krakow, Poland
| | - Paweł Konieczny
- grid.5522.00000 0001 2162 9631Center for Medical Genomics OMICRON, Jagiellonian University Medical College, ul. Kopernika 7C, 31-034 Krakow, Poland
| | - Leszek Drabik
- grid.5522.00000 0001 2162 9631Medical College and John Paul II Hospital, Jagiellonian University, Krakow, Poland ,grid.5522.00000 0001 2162 9631Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Kołton-Wróż
- grid.5522.00000 0001 2162 9631Center for Medical Genomics OMICRON, Jagiellonian University Medical College, ul. Kopernika 7C, 31-034 Krakow, Poland
| | - Bernadeta Chyrchel
- grid.5522.00000 0001 2162 9631Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Ewelina Nowak
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Surdacki
- grid.5522.00000 0001 2162 9631Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- grid.5522.00000 0001 2162 9631Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł P. Wołkow
- grid.5522.00000 0001 2162 9631Center for Medical Genomics OMICRON, Jagiellonian University Medical College, ul. Kopernika 7C, 31-034 Krakow, Poland ,grid.5522.00000 0001 2162 9631Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
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Chyrchel B, Kruszelnicka O, Surdacki A. Endothelial biomarkers and platelet reactivity on ticagrelor versus clopidogrel in patients after acute coronary syndrome with and without concomitant type 2 diabetes: a preliminary observational study. Cardiovasc Diabetol 2022; 21:249. [PMID: 36397167 PMCID: PMC9670560 DOI: 10.1186/s12933-022-01685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pleiotropic effects have been implicated in clinical benefits of ticagrelor compared to thienopyridine P2Y12 antagonists. There are conflicting data regarding effects of ticagrelor vs. thienopyridine P2Y12 blockers on endothelial function. Our aim was to compare endothelial biomarkers and their relations with platelet reactivity in real-world patients after acute coronary syndrome (ACS) on maintenance dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel stratified by diabetes status. METHODS Biochemical indices of endothelial dysfunction/activation and platelet reactivity by multiple electrode aggregometry were compared in 126 stable post-ACS subjects (mean age: 65 ± 10 years, 92 men and 34 women), including patients with (n = 61) or without (n = 65) coexistent type 2 diabetes (T2DM) on uneventful maintenance DAPT with either ticagrelor (90 mg b.d.) or clopidogrel (75 mg o.d.) in addition to low-dose aspirin. Exclusion criteria included a complicated in-hospital course, symptomatic heart failure, left ventricular ejection fraction < 40% and relevant coexistent diseases except for well-controlled diabetes, mild renal insufficiency or hypertension. RESULTS Clinical characteristics were similar in patients on ticagrelor (n = 62) and clopidogrel (n = 64). The adenosine diphosphate-induced platelet aggregation and circulating soluble P-selectin (sP-selectin) were decreased in ticagrelor users irrespective of T2DM status (p < 0.001 and p < 0.01 for platelet reactivity and sP-selectin, respectively). Plasma levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) were lower in T2DM subjects on ticagrelor vs. clopidogrel (758 ± 162 vs. 913 ± 217 µg/L, p < 0.01). In contrast, plasma sVCAM-1 was similar in non-diabetic patients on ticagrelor and clopidogrel (872 ± 203 vs. 821 ± 210 µg/L, p > 0.7). The concentrations of sE-selectin, monocyte chemoattractant protein-1 and asymmetric dimethylarginine did not differ according to the type of P2Y12 antagonist regardless of T2DM status. Platelet reactivity was unrelated to any endothelial biomarker in subjects with or without T2DM. CONCLUSIONS Our preliminary findings may suggest an association of ticagrelor-based maintenance DAPT with favorable endothelial effects compared to clopidogrel users in stable post-ACS patients with T2DM. If proven, this could contribute to more pronounced clinical benefits of ticagrelor in diabetic subjects.
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Affiliation(s)
- Bernadeta Chyrchel
- grid.5522.00000 0001 2162 9631Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland ,grid.412700.00000 0001 1216 0093Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
| | - Olga Kruszelnicka
- grid.5522.00000 0001 2162 9631Department of Coronary Artery Disease and Heart Failure, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka Street, 31-202 Cracow, Poland
| | - Andrzej Surdacki
- grid.5522.00000 0001 2162 9631Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland ,grid.412700.00000 0001 1216 0093Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
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Dziewierz A, Zdzierak B, Malinowski KP, Siudak Z, Zasada W, Tokarek T, Zabojszcz M, Dolecka-Ślusarczyk M, Dudek D, Bartuś S, Surdacki A, Rakowski T. Diabetes Mellitus Is Still a Strong Predictor of Periprocedural Outcomes of Primary Percutaneous Coronary Interventions in Patients Presenting with ST-Segment Elevation Myocardial Infarction (from the ORPKI Polish National Registry). J Clin Med 2022; 11:jcm11216284. [PMID: 36362512 PMCID: PMC9657628 DOI: 10.3390/jcm11216284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
The impact of diabetes mellitus (DM) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was confirmed by several studies. However, it is unclear whether this effect is still present in large groups of unselected patients undergoing up-to-date treatment. Thus, we sought to assess the impact of DM on periprocedural outcomes of primary PCI in STEMI using data from the Polish National Registry of PCI. Data on 150,782 STEMI patients undergoing primary PCI were collected. Of them, 26,360 (17.5%) patients had DM. Patients with DM were higher-risk individuals who experienced longer reperfusion delays and were less likely to have closed infarct-related artery at baseline (TIMI 0 + 1 flow: 73.2% vs. 72.0%; p < 0.0001) and achieve optimal reperfusion after PCI (TIMI 3 flow: 91.8% vs. 88.5%; p < 0.0001). The periprocedural mortality (1.1% vs. 1.9%; p < 0.0001) was higher in patients with DM and DM was identified as an independent predictor of periprocedural death. In conclusion, despite continuous progress in STEMI treatment, DM remains a strong predictor of periprocedural mortality. However, this detrimental effect of DM may be partially explained by the overall higher risk profile of diabetic patients.
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Affiliation(s)
- Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Barbara Zdzierak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Wojciech Zasada
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Michał Zabojszcz
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | | | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Andrzej Surdacki
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-22-50
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24
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Chyrchel M, Gallina T, Januszek R, Szafrański O, Gębska M, Surdacki A. The Reduction of Left Ventricle Ejection Fraction after Multi-Vessel PCI during Acute Myocardial Infarction as a Predictor of Major Adverse Cardiac Events in Long-Term Follow-Up. Int J Environ Res Public Health 2022; 19:ijerph192013160. [PMID: 36293739 PMCID: PMC9603361 DOI: 10.3390/ijerph192013160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Revascularisation strategy in patients with multi-vessel coronary disease and acute myocardial infarction (AMI) remains challenging. One of the potential treatment options is complete percutaneous revascularisation during index hospitalisation. This strategy could positively influence left ventricle ejection fraction (LVEF). AIM To investigate the long-term changes in LVEF and clinical outcome among patients with AMI after complete coronary revascularisation (CCR). METHODS Records of 171 patients with a diagnosis of AMI and multi-vessel coronary artery disease (CAD) on index angiography, in whom CCR was performed as a staged procedure during initial hospitalisation, were analysed. Clinical data were collected from in-hospital medical records and discharge letters. Cardiac ultrasound (CU), with particular assessment of LVEF, was performed one day before discharge. Follow-up (FU) CU was collected from the out-patient department at least six months ± one week after discharge. Follow-up data, including major adverse cardiac events (MACE), were collected during follow-up visits by telephone. Depending on the LVEF change during the follow-up period, patients were divided into two groups. Patients with a decrease in the LVEF (D-LVEF group) were compared with patients with no changes (preserved) or improvement regarding LVEF (P/I-LVEF). RESULTS The median duration of the follow-up was 19 months (14-24 months). The median change in LVEF during observation was -5.0p% (IQR (-7.0)-(-2.75p.%)) in the D-LVEF group and +4.0% (IQR 1.0-5.0p%) in the P/I-LVEF group. Among patients in the P/I-LVEF group, there was a sub-group of patients with no change in LVEF (28 patients), and one demonstrating improvement in LVEF (104 patients). In the subgroup of patients with improved LVEF, the median change in LVEF was 4.5p% (IQR 2-6.25p%). Among patients with decreasing LVEF, there was a significantly higher risk of MACE (15 vs. 2.3%, p = 0.031), especially non-fatal AMI (10 vs. 0%, p = 0.017). We found the following among predictors concerning increased risk of MACE occurrence: urgent PCI (p = 0.004), hospitalisations regardless of cause (p = 0.028), EF worsening (p = 0.025), fasting glucose serum concentration (p = 0.024) and fasting triglyceride serum concentration (p = 0.027). CONCLUSIONS Complete revascularisation (CR) at baseline (one stage) in patients with AMI and multi-vessel disease is associated with LVEF improvement and MACE rate reduction. Patients with worse LVEF have poor clinical outcome and a higher rate of MACE.
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Affiliation(s)
- Michał Chyrchel
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Tomasz Gallina
- Student Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Oskar Szafrański
- Student Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
| | - Monika Gębska
- Department of Cardiology, District Hospital, ul. Jagiellońska 36, 97-500 Radomsko, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688 Kraków, Poland
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Rakowski T, Wegiel M, Malinowski K, Siudak Z, Zasada W, Tokarek T, Rzeszutko L, Dudek D, Bartus S, Surdacki A, Dziewierz A. Contemporary approach to thrombus containing lesions during primary percutaneous coronary interventions in ST-segment elevation myocardial infarction (from the ORPKI National Registry in Poland). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the era of potent P2Y12 inhibitors, according to current guidelines on ST-segment elevation myocardial infarction (STEMI), treatment with glycoprotein IIb/IIIa inhibitors (GPI) should be limited to selected bail-out or highly thrombotic situations. Similarly, aspiration thrombectomy (AT) is downgraded in current guidelines for very selective but not routine usage. Both recommendations make the treatment of thrombus containing lesions somewhat defensive, underlining the need for an individualized approach to STEMI patients. However, data concerning current clinical practice of such approach are limited.
Purpose
We examined the prevalence, procedural characteristics, and predictors of GPI administration and AT usage in all-comers contemporary STEMI patients referred to primary PCI in Poland.
Methods
We focused on 116,873 consecutive STEMI patients undergoing primary PCI in Poland between 2015 and 2020.
Results
GPIs were administered in 29.3% of patients and AT was used in 11.6%, with combined treatment with GPI and AT in 6.1% of patients. There was a slight trend towards a decrease in GPI and AT usage during the analyzed years. On the opposite, there was a rapid growth of the ticagrelor/prasugrel usage rate from 6.5% in 2015 to 48.1% in 2020 (Figure 1). Patients with periprocedural GPI administration and combined strategy with GPI and AT were younger, more often men, with history of smoking and presented with cardiogenic shock on admission. They were less likely to have diabetes, chronic kidney disease and previous stroke. Occluded infarct-related artery in baseline angiography and no-reflow during PCI were the strongest independent predictors of GPI administration and combined usage of GPI and AT in a multivariate logistic regression model. Similarly, administration of ticagrelor/prasugrel was an independent predictor of both adjunctive treatment strategies (see table for details).
Conclusions
Despite the rapid growth of potent P2Y12 inhibitors usage in Poland in recent years, GPI and AT are selectively used at a stable level during primary PCI in highly thrombotic STEMI lesions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Rakowski
- Jagiellonian University Medical College , Krakow , Poland
| | - M Wegiel
- Jagiellonian University Medical College , Krakow , Poland
| | - K Malinowski
- Jagiellonian University Medical College , Krakow , Poland
| | - Z Siudak
- Jan Kochanowski University , Kielce , Poland
| | - W Zasada
- Jagiellonian University Medical College , Krakow , Poland
| | - T Tokarek
- Jagiellonian University Medical College , Krakow , Poland
| | - L Rzeszutko
- Jagiellonian University Medical College , Krakow , Poland
| | - D Dudek
- Jagiellonian University Medical College , Krakow , Poland
| | - S Bartus
- Jagiellonian University Medical College , Krakow , Poland
| | - A Surdacki
- Jagiellonian University Medical College , Krakow , Poland
| | - A Dziewierz
- Jagiellonian University Medical College , Krakow , Poland
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Chyrchel M, Siudak Z, Rzeszutko Ł, Roczniak J, Piechocki M, Koziołek W, Malinowski KP, Januszek R, Bartuś S, Surdacki A. Culprit plaque location within the left circumflex coronary artery predicts clinical outcomes in patients experiencing acute coronary syndromes with percutaneous coronary intervention: Data from the ORPKI registry. Kardiol Pol 2022; 80:926-936. [DOI: 10.33963/kp.a2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022]
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Bartuś S, Siłka W, Kasprzycki K, Sabatowski K, Malinowski KP, Rzeszutko Ł, Chyrchel M, Bryniarski L, Surdacki A, Bartuś K, Januszek R. Experience with Optical Coherence Tomography Enhanced by a Novel Software (Ultreon™ 1.0 Software)-The First One Hundred Cases. Medicina (Kaunas) 2022; 58:medicina58091227. [PMID: 36143904 PMCID: PMC9505439 DOI: 10.3390/medicina58091227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022]
Abstract
Introduction: Optical coherence tomography (OCT) intravascular imaging including the latest version Ultreon™ 1.0 Software (Abbott Vascular, Santa Clara, CA, USA), not only improve patients prognosis, but also facilitates improved percutaneous coronary intervention (PCI). Objectives: The aim of the study was to compare procedure related decision making, procedural indices, clinical outcomes according to the extent of stent expansion and assess risk factors of underexpansion in patients treated with PCI using OCT. Methods: The study comprised 100 patients, which were divided in groups according to the extent of stent expansion: <90 (29 patients) and ≥90% (71 patients). Comparison of OCT parameters, selected clinical and procedural characteristics was performed between groups. We assessed clinical outcomes during the follow-up: major adverse cardiovascular events and risk factors of stent underexpansion. Results: Patients from the stent underexpansion group were treated more often in the past with percutaneous peripheral interventions (p=0.02), no other significant differences being noted in general characteristics, procedural characteristics or clinical outcomes comparing both groups. Significant predictors of stent underexpansion assessed by simple linear univariable analysis included: hypercholesterolemia, obstructive bronchial diseases and treatment with inhalators, family history of cardiovascular disease, PCI of other than the left main coronary artery, stent and drug-eluting stent implantation, PCI without drug-eluting balloon, paclitaxel antimitotic agent, greater maximal stent diameter and lower mean Euroscore II value. Univariable logistic regression analysis revealed a correlation between stent underexpansion and greater creatinine serum concentration before [OR: 0.97, 95%CI: 0.95-0.99, p=0.01] and after PCI [OR: 0.98, 95%CI: 0.96-0.99, p=0.02]. Conclusions: Based on the presented analysis, the degree of stent expansion is not related to the selected procedural, OCT imaging indices and clinical outcomes. Logistic regression analysis confirmed such a relationship for creatinine level.
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Affiliation(s)
- Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
| | - Wojciech Siłka
- Students’ Scientific Group, the Second Department of Cardiology, Jagiellonian University Medical College, 31-034 Kraków, Poland
| | - Karol Kasprzycki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
| | - Krzysztof Piotr Malinowski
- Faculty of Medicine, Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 31-530 Kraków, Poland
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, 31-530 Kraków, Poland
| | - Łukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Institute of Cardiology, Jagiellonian University Medical College, 31-202 Kraków, Poland
| | - Krzysztof Bartuś
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, 31-530 Kraków, Poland
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland
- Correspondence:
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Długosz D, Surdacki A, Zawiślak B, Bartuś S, Chyrchel B. Impaired Left Ventricular Circumferential Midwall Systolic Performance Appears Linked to Depressed Preload, but Not Intrinsic Contractile Dysfunction or Excessive Afterload, in Paradoxical Low-Flow/Low-Gradient Severe Aortic Stenosis. J Clin Med 2022; 11:2873. [PMID: 35628998 PMCID: PMC9144151 DOI: 10.3390/jcm11102873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Paradoxical low-flow/low-gradient aortic stenosis (P-LFLG-AS) occurs in about one-third of patients with severe AS and preserved left ventricular (LV) ejection fraction (EF). Our aim was to differentiate between altered LV loading conditions and contractility as determinants of subtle LV systolic dysfunction in P-LFLG-AS. We retrospectively analyzed medical records of patients with isolated severe degenerative AS and preserved EF (30 subjects with P-LFLG-AS and 30 patients with normal-flow/high-gradient severe AS (NFHG-AS)), without relevant coexistent diseases (e.g., diabetes, coronary artery disease and chronic kidney disease) or any abnormalities which could account for a low-flow state. Patients with P-LFLG-AS and NFHG-AS did not differ in aortic valve area index and most clinical characteristics. Compared to NFHG-AS, subjects with P-LFLG-AS exhibited smaller LV end-diastolic diameter (LVd) (44 ± 5 vs. 54 ± 5 mm, p < 0.001) (consistent with lower LV preload) with pronounced concentric remodeling, higher valvulo-arterial impedance (3.8 ± 1.1 vs. 2.2 ± 0.5 mmHg per mL/m2, p < 0.001) and diminished systemic arterial compliance (0.45 ± 0.11 vs. 0.76 ± 0.23 mL/m2 per mmHg, p < 0.001), while circumferential end-systolic LV midwall stress (cESS), an estimate of afterload at the LV level, was similar in P-LFLG-AS and NFHG-AS (175 ± 83 vs. 198 ± 69 hPa, p = 0.3). LV midwall fractional shortening (mwFS) was depressed in P-LFLG-AS vs. NFHG-AS (12.3 ± 3.5 vs. 14.7 ± 2.9%, p = 0.006) despite similar EF (61 ± 6 vs. 59 ± 8%, p = 0.4). By multiple regression, the presence of P-LFLG-AS remained a significant predictor of lower mwFS compared to NFHG-AS upon adjustment for cESS (β ± SEM: −2.35 ± 0.67, p < 0.001); however, the significance was lost after further correction for LVd (β = −1.10 ± 0.85, p = 0.21). In conclusion, the association of P-LFLG-AS with a lower cESS-adjusted mwFS, an index of afterload-corrected LV circumferential systolic function at the midwall level, appears secondary to a smaller LV end-diastolic cavity size according to the Frank−Starling law. Thus, low LV preload, not intrinsic contractile dysfunction or excessive afterload, may account for impaired LV circumferential midwall systolic performance in P-LFLG-AS.
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Affiliation(s)
- Dorota Długosz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (D.D.); (A.S.); (S.B.)
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (D.D.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University, 2 Jakubowskiego Street, 30-688 Cracow, Poland
| | - Barbara Zawiślak
- Intensive Care Unit, Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (D.D.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University, 2 Jakubowskiego Street, 30-688 Cracow, Poland
| | - Bernadeta Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (D.D.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University, 2 Jakubowskiego Street, 30-688 Cracow, Poland
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Rakowski T, Dziewierz A, Węgiel M, Siudak Z, Zasada W, Jąkała J, Dykla D, Matysek J, Surdacki A, Bartuś S, Dudek D, Wojdyła R. Risk factors of contrast-induced nephropathy in patients with acute coronary syndrome. Kardiol Pol 2022; 80:760-764. [PMID: 35521717 DOI: 10.33963/kp.a2022.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization, higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed. AIMS We aimed to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment. METHODS A total of 2638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 μmol/l) increase in the absolute value. RESULTS Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referred for other treatment strategies (P < 0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was an independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P < 0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN. CONCLUSIONS Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation, and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.
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Affiliation(s)
- Tomasz Rakowski
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Artur Dziewierz
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Węgiel
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Zasada
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Jacek Jąkała
- Krakow Center of Invasive Cardiology, Electrotherapy and Angiology, Kraków, Poland
| | - Dominika Dykla
- Center of Invasive Cardiology, Electrotherapy and Angiology in Nowy Sącz, Nowy Sącz, Poland
| | - Jerzy Matysek
- Krakow Center of Invasive Cardiology, Electrotherapy and Angiology, Kraków, Poland
| | - Andrzej Surdacki
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Roman Wojdyła
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
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Węgiel M, Kleczyński P, Dziewierz A, Rzeszutko Ł, Surdacki A, Bartuś S, Rakowski T. Frailty as a Predictor of In-Hospital Outcome in Patients with Myocardial Infarction. J Cardiovasc Dev Dis 2022; 9:jcdd9050145. [PMID: 35621856 PMCID: PMC9145424 DOI: 10.3390/jcdd9050145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay.
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Affiliation(s)
- Michał Węgiel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland;
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland;
| | - Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Łukasz Rzeszutko
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Stanisław Bartuś
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Tomasz Rakowski
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
- Correspondence: ; Tel.: +48-12-4002200
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Felkle D, Korman MŁ, Surdacki A. The growing need for reliable online health information during lockdown in Europe: An infodemiologic analysis of myocardial infarction management in the COVID-19 era. Folia Med Cracov 2022; 62:71-92. [PMID: 36256896 DOI: 10.24425/fmc.2022.141701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
I n t r o d u c t i o n: The COVID-19 pandemic has put healthcare systems worldwide under huge strain, resulting in a significant loss of their capacity and availability. Patients have become more reluctant to contact their doctors or call an ambulance in case of myocardial infarction (MI) symptoms onset. It has been accompanied by a significant decrease in the number of coronary angiography and PCI procedures performed. O b j e c t i v e s: The aim of the study is to evaluate the role of online health information in the patient- dependent phase of MI management during the COVID-19 lockdown in Europe. Methods: We analyzed Google Trends data on the popularity of phrases related to MI symptoms, respiratory tract infection, urological complaints, and terms unrelated to health, for the period of the first COVID-19 lockdown, along with the data from the corresponding weeks from 2017-2019 in seven European countries. R e s u l t s: The search volume for particular symptoms of myocardial infarction increased in all studied countries, compared to the analogous period from 2017-2019, with a significant increase in for chest pain, shortness of breath, fear, and palpitations in most countries. These changes have not been accompanied by increased interest in terms related to respiratory tract infection symptoms and urological complaints. C o n c l u s i o n s: Our findings suggest that during lockdown, patients with MI symptoms may have tried to manage their complaints on their own, using information from the Internet. This demonstrates the growing role of the Internet in the patient's decision-making process in the emergency situation, indicating a growing need for reliable and freely available online information provided by healthcare professionals.
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Affiliation(s)
- Dominik Felkle
- Students' Scientific Group at Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Michał Ł Korman
- Students' Scientific Group at Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Węgiel M, Wojtasik-Bakalarz J, Malinowski K, Surmiak M, Dziewierz A, Sorysz D, Tokarek T, Dudek D, Bartuś S, Surdacki A, Rakowski T. Mid-regional pro-adrenomedullin and lactate dehydrogenase as predictors of left ventricular remodeling in patients with myocardial infarction treated with percutaneous coronary intervention. Pol Arch Intern Med 2021; 132. [PMID: 34846110 DOI: 10.20452/pamw.16150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The main impact of myocardial infarction (MI) is shifting from acute mortality to adverse remodeling, chronic left ventricle (LV) dysfunction and heart failure. OBJECTIVES The aim of this study was to assess relationships between levels of circulating biomarkers and function of LV after MI. PATIENTS AND METHODS Prospective study of 80 patients with MI treated with percutaneous coronary interventions (PCI). Novel biomarkers including mid-regional pro-adrenomedullin (MR-proADM), Notch-1, syndecan-4, myeloperoxidase, S-100 protein, soluble ST-2, as well as markers of inflammatory response and tissue injury: galectin-3, C-reactive protein (CRP), lactate dihydrogenase (LDH) and interleukin-6 (IL-6) were assessed in the acute phase of MI. Echocardiography was performed at baseline and 6 months. RESULTS Adverse remodeling, defined as >20% increase in LV end-diastolic volume occurred in 26% of patients. Reverse remodeling (>10% reduction in LV end-systolic volume) was observed in 52% of patients. In a univariable analysis higher levels of MR-proADM and LDH were predictors of adverse remodeling and higher levels of MR-proADM, LDH, CRP and Il-6 were negative predictors of reverse remodeling. In a multivariable model LDH remained an independent predictor of adverse remodeling (OR: 3.13; 95%CI: 1.42-8.18; P=0.003) and negative predictor of reverse remodeling (OR: 0.37; 95%CI: 0.17-0.8; P=0.005). CONCLUSIONS LDH and MR-proADM seem to be promising biomarkers of adverse remodeling. On the other hand, higher levels of these biomarkers were associated with reduced chance of occurrence of favorable reverse remodeling in MI patients. However, further studies on larger groups of patients are necessary to confirm this data.
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Affiliation(s)
- Michał Węgiel
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof Malinowski
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Surmiak
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Sorysz
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, Kraków, Poland
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, Kraków, Poland
- Center for Intensive Care and Perioperative Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, Kraków, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Rakowski
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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Januszek RA, Bryniarski L, Siudak Z, Malinowski KP, Surowiec S, Bryniarski K, Jędrychowska M, Wańha W, Bartuś K, Wojakowski W, Wójcik J, Legutko J, Surdacki A, Bartuś S. Predictors and trends of contrast use and radiation exposure in a large cohort of patients treated with percutaneous coronary interventions: Chronic total occlusion analysis based on a national registry. Cardiol J 2021; 30:VM/OJS/J/74257. [PMID: 34642921 PMCID: PMC10713226 DOI: 10.5603/cj.a2021.0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/19/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim herein, was to assess predictors and current trends of radiation exposure and total contrast amount use in patients treated with percutaneous coronary intervention within chronic total occlusion (CTO PCI) and non-CTO PCI. METHODS Based on a nationwide registry (ORPKI), 535,857 patients treated with PCI between 2014 and 2018 were analysed. The study included 12,572 (2.34%) patients treated with CTO PCI. The CTO PCI and non-CTO PCI groups were compared before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of contrast amount use and radiation exposure. RESULTS The mean total contrast dose and radiation exposure decrease reached statistical significance in following years for the CTO PCI (p = 0.002 and p < 0.001) and non-CTO PCI groups (p < 0.001 and p < 0.001). Multifactorial analysis revealed that non-CTO PCI was a strong independent predictor of lower total contrast dose (estimate: -17.41; 95% confidence interval [CI]: -18.45 to -16.49, p < 0.001) and radiation exposure (estimate: -264.28; 95% CI: -273.75 to -254.81, p < 0.001). After PSM, it was confirmed that CTO PCI was an independent predictor of greater radiation exposure (estimate: 328.6; 95% CI: 289.1-368.1; p < 0.001) and total contrast dose (estimate: 30.5; 95% CI: 27.28-33.74; p < 0.001). CONCLUSIONS Contrast dose and radiation exposure have decreased in previous years with regard to the CTO PCI and non-CTO PCI groups. CTO PCI was found to be an independent predictor of greater total contrast dose and radiation exposure in the overall group of patients treated with PCI.
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Affiliation(s)
- Rafał A Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
- Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland.
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | - Sławomir Surowiec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Krzysztof Bryniarski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jarosław Wójcik
- Department of Cardiology, Hospital of Invasive Cardiology IKARDIA, Nałęczów, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Sabatowski K, Malinowski KP, Siudak Z, Reczuch K, Dobrzycki S, Lesiak M, Hawranek M, Gil RJ, Witkowski A, Wojakowski W, Lekston A, Gąsior M, Wańha W, Legutko J, Ekkert M, Jędrychowska M, Chyrchel M, Surdacki A, Bartuś S, Januszek R. Sex-related differences and rotational atherectomy - analysis of 5 177 percutaneous coronary interventions based on a large national registry from between 2014 and 2020. Kardiol Pol 2021; 79:1320-1327. [PMID: 34643261 DOI: 10.33963/kp.a2021.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients undergoing percutaneous coronary interventions (PCI) with rotational atherectomy (RA) have massively calcified coronary arteries and differ according to sex. AIMS To assess trends in sex-related percentage shares in following years, to compare demographic characteristics between men and women, and to identify factors associated with the risk of periprocedural complications and death. METHODS Based on the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), we analyzed 751 113 patients treated with PCI between 2014 and 2020. We extracted 5 177 (0.7%) patients treated with RA, 3 552 of them (68.6%) being men. To determine risk factors of periprocedural complications and death, multivariable analysis was performed. RESULTS The proportion of PCIs involving RA increase between 2014 and 2020 (P < 0.001). Almost twice as many RA procedures pertain to men (68.55%), while the percentage share did not change in following years. Data are reported as mean (standard deviation). The female patients were older (75.2 [8.3] vs 70.5 [9.2] years; P < 0.001). When considering periprocedural complications, their overall rate (3.45% vs 2.31%; P = 0.01) and death rate (0.68% vs 0.17%; P = 0.006) were greater among women. Also, via multivariable analysis, female sex was found to be a risk factor of greater periprocedural mortality (P = 0.02) and overall complication rate (P = 0.007). CONCLUSIONS The majority of patients treated with RA are men and sex-related distribution was stable during the analyzed period of time. Female sex is a risk factor of greater periprocedural complications and mortality in patients treated with RA.
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Affiliation(s)
- Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Krzysztof Piotr Malinowski
- Jagiellonian University Medical College, Faculty of Medicine, Department of Bioinformatics and Telemedicine, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | - Sławomir Dobrzycki
- Department of Invasive Cardiology, State Teaching Hospital, Medical University of Bialystok, Białystok, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Michał Hawranek
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Robert Julian Gil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Warszawa, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warszawa, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lekston
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases in Zabrze, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Michał Ekkert
- Faculty of Medicine, Katowice School of Technology, Katowice, Poland
| | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Faculty of Medicine, Katowice School of Technology, Katowice, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Department of Clinical Rehabilitation, University of Physical Education, Kraków, Poland
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35
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Staszczak B, Malinowski KP, Siudak Z, Wanha W, Surdacki A, Wojakowski W, Legutko J, Bartus K, Bartus S, Januszek R. Frequency and predictors of coronary angiography and percutaneous coronary intervention related stroke. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, although potentially life-threatening and often leading to serious disability, characterised by high morbidity and mortality rate. However, particular data on periprocedural complications, predictors, prognosis and the type of coronary intervention has not yet been adequately investigated.
Aim
The aim of the present study was to assess the relationship between the type of coronary procedure [coronary angiography (CA) and PCI] and incidence of stroke as well as predictors of stroke.
Material and methods
This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2019 and included 1,177,161 coronary procedures. Among them, 650,674 patients underwent isolated CA and 526,487 underwent PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) refers to patients admitted for CA and 57 (0.011%) in patients qualified for PCI. Subsequently, the mentioned groups were analysed for similarities and compared. Multivariate analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI.
Results
The amount of patients with periprocedural stroke was higher in a group treated with isolated CA during the analysed time. The mean age of the patients, who developed cerebral stroke, was significantly higher in the overall group (71.4±10.6 vs. 66.7±10.8; p<0.001). Patients with stroke, in comparison to non-stroke group, were treated more often from femoral access for CA (p<0.001) and PCI (p=0.04), they had a history of prior stroke for CA (p<0.001) and PCI (p<0.001) more often, and acute myocardial infarction at admission for CA (p<0.001) and PCI (p=0.01). They were also more frequently transported directly to the catheterisation laboratory for CA (p<0.001) and PCI (p=0.002). Predictors of periprocedural stroke, assessed by multivariate analysis for CA, are presented at Fig. 1 and for PCI at Fig. 2.
Conclusions
Based on the large national registry, PCI is associated with fewer risk factors and lower rate of periprocedural strokes than isolated CA.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- B Staszczak
- University Hospital of Krakow, Krakow, Poland
| | | | - Z Siudak
- The Jan Kochanowski University in Kielce, Kielce, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Surdacki
- University Hospital of Krakow, Krakow, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - J Legutko
- Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - K Bartus
- Jagiellonian University, Krakow, Poland
| | - S Bartus
- Jagiellonian University, Krakow, Poland
| | - R Januszek
- University Hospital of Krakow, Krakow, Poland
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36
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Jarczewski J, Jarczewska A, Boryczko A, Poniatowski A, Furgała A, Surdacki A, Gil K. Microvascular angina (Cardiac Syndrome X) from a historical overview, epidemiology, pathophysiology to treatment recommendations - a minireview. Folia Med Cracov 2021; 61:95-114. [PMID: 34882667 DOI: 10.24425/fmc.2021.138954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Microvascular angina (MVA) is a condition characterized by the presence of angina-like chest pain, a positive response to exercise stress tests, and no significant stenosis of coronary arteries in coronary angiography, with absence of any other specific cardiac diseases. The etiology of this syndrome is still not known and it is probably multifactorial. Coronary microvascular dysfunction is proposed as the main pathophysiological mechanism in the development of MVA. Altered somatic and visceral pain perception and autonomic imbalance, in addition to myocardial ischemia, has been observed in subjects with MVA, involving dynamic variations in the vasomotor tone of coronary microcirculation with consequent transient ischemic episodes. Other theories suggest that MVA may be a result of a chronic inflammatory state in the body that can negatively influence the endothelium or a local imbalance of factors regulating its function. This article presents the latest information about the epidemiology, diagnostics, etiopathogenesis, prognosis, and treatment of patients with MVA.
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Affiliation(s)
- Jarosław Jarczewski
- Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Jarczewska
- Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Boryczko
- Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Adrian Poniatowski
- Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Furgała
- Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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37
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Staszczak B, Malinowski KP, Wańha W, Siudak Z, Jędrychowska M, Susuł M, Surowiec S, Darocha S, Surdacki A, Kurzyna M, Wojakowski W, Legutko J, Bartuś K, Bartuś S, Januszek R. Frequency and predictors of diagnostic coronary angiography and percutaneous coronary intervention related to stroke. Kardiol Pol 2021; 79:1099-1106. [PMID: 34472076 DOI: 10.33963/kp.a2021.0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, which can be potentially life-threatening and can lead to serious disability. AIMS This study aimed to assess the relationship between the type of coronary procedure and incidence of stroke, as well as its predictors. METHODS This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) between January 2014 and December 2019 and included 1177 161 coronary procedures. Among them, 650 674 patients underwent isolated diagnostic coronary angiography (DCA), and 526 487 PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) happened during DCA and 57 (0.011%) during PCI. Multivariable logistic regression analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI. RESULTS The percentage of patients with periprocedural stroke was higher in the group treated with isolated DCA during the analyzed time. Among predictors of stroke in patients undergoing DCA, we confirmed prior stroke (P <0.001), contrast amount (P = 0.007), femoral access (P = 0.002), unfractionated heparin use (P = 0.01), direct transport to the catheterization laboratory (P = 0.04), older age (P <0.001) and multi-vessel disease (P <0.001). While for PCI ± DCA, these were prior stroke (P <0.001), thrombolysis (P = 0.003), treatment with bivalirudin (P <0.001), and acetylsalicylic acid loading during PCI (P = 0.003). CONCLUSIONS Based on the large national registry, PCI ± DCA is associated with fewer risk factors and a lower rate of periprocedural strokes than isolated DCA.
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Affiliation(s)
- Bartłomiej Staszczak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | | | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Susuł
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Sławomir Surowiec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland. .,Department of Clinical Rehabilitation, University of Physical Education, Kraków, Poland.
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38
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Zasada W, Bobrowska B, Plens K, Dziewierz A, Siudak Z, Surdacki A, Dudek D, Bartuś S. Acute myocardial infarction in young patients. Kardiol Pol 2021; 79:1093-1098. [PMID: 34472075 DOI: 10.33963/kp.a2021.0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is an incredibly destructive disease when it occurs in a young patient. Thus, the investigation of the disease presentation and treatment options seem to be particularly important in young patients with AMI. AIMS The study objective was to investigate the differences between young and older patients diag-nosed with AMI in terms of clinical characteristics and treatment strategies. METHODS The patient data comes from the National Registry of Procedures of Invasive Cardiology (ORPKI). Between 2014 and 2017, data of more than 230 000 patients with a diagnosis of AMI were collected in that registry. Young patients were defined as under 40 years old. RESULTS Young patients with AMI (n = 3208, 1.3%) compared with older patients with AMI were more often men (86.3% vs. 65.8%; P <0.001) with higher body weight (mean 85.9 vs. 79.7 kg; P <0.001). Typical risk factors of coronary heart disease were less frequent in younger patients than in older patients. However, in the under-40 group, there was a significantly higher number of current smokers (37.5% vs. 23.0%; P <0.001). Young patients with AMI were more often diagnosed with ST-segment elevation myocardial infarction (STEMI; 62.0% vs. 50.0%; P <0.001). Moreover, they had more frequently non-significant ste-nosis in coronary arteries diagnosed (14.4% vs. 6.8%; P <0.001). The left anterior descending artery was more frequently an infarct-related artery in young patients (51.3% vs. 36.3%; P <0.001). Bioresorbable vascular scaffolds were more commonly implanted in young patients with AMI than in the older ones (5.6% vs. 0.9%; P <0.001). The relative number of AMI in the young patients increased from 1.20% in 2014 to 1.43% in 2017. CONCLUSIONS Smoking is the most common risk factor in young adults. The relative number of AMI in young patients is growing.
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Affiliation(s)
- Wojciech Zasada
- KCRI, Kraków, Poland. .,Department of Cardiology, University Hospital, Kraków, Poland.
| | - Beata Bobrowska
- Department of Cardiology, University Hospital, Kraków, Poland
| | | | - Artur Dziewierz
- KCRI, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Andrzej Surdacki
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Department of Cardiology, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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39
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Zawadzka K, Dziedzic R, Surdacki A, Chyrchel B. Thyroid Hormones-An Underestimated Player in Dilated Cardiomyopathy? J Clin Med 2021; 10:jcm10163618. [PMID: 34441915 PMCID: PMC8397026 DOI: 10.3390/jcm10163618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is the most prevalent cardiomyopathy, typified by left ventricular dilation and systolic dysfunction. Many patients with DCM have altered thyroid status, especially lower levels of free triiodothyronine (T3) and elevated levels of thyroid-stimulating hormone. Moreover, growing evidence indicates that even subtle changes in thyroid status (especially low T3) are linked with a worse long-term prognosis and a higher risk of mortality. Notably, recent discoveries have shown that not only local myocardial thyroid hormones (THs) bioavailability could be diminished due to impaired expression of the activating deiodinase, but virtually all genes involved in TH biosynthesis are also expressed in the myocardium of DCM patients. Importantly, some studies have suggested beneficial effects of TH therapy in patients suffering from DCM. Our aim was to discuss new insights into the association between TH status and prognosis in DCM, abnormal expression of genes involved in the myocardial synthesis of TH in DCM, and the potential for TH use in the future treatment of DCM.
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Affiliation(s)
- Karolina Zawadzka
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (K.Z.); (R.D.)
| | - Radosław Dziedzic
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (K.Z.); (R.D.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
- Correspondence: ; Tel.: +48-12-400-2250
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Staszczak B, Siudak Z, Malinowski KP, Jędrychowska M, Zabojszcz M, Dolecka-Ślusarczyk M, Janion-Sadowska A, Susuł M, Tokarek T, Bartuś J, Pawlik A, Socha S, Surdacki A, Bartuś S, Januszek R. Clinical outcomes in patients with acute myocardial infarction treated with primary percutaneous coronary intervention stratified according to duration of pain-to-balloon time and type of myocardial infarction. Cardiol J 2021; 30:734-746. [PMID: 34240403 PMCID: PMC10635712 DOI: 10.5603/cj.a2021.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/30/2020] [Accepted: 02/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Based on the clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), treated with primary percutaneous coronary intervention (pPCI), this study intended to assess mortality and major adverse cardiac and cerebrovascular event (MACCE) rates according to duration of pain-to-balloon (PTB) time and type of MI. METHODS This is a retrospective cohort study based on the prospectively collected ORPKI registry which covers PCIs performed in Poland chosen between January 2014 and December 2017. Under assessment were 1,994 STEMI and 923 NSTEMI patients. Study endpoints included mortality and MACCE rates (in-hospital, 30-day, 12- and 36-month). Predictors of all-cause mortality in the overall group, STEMI and NSTEMI were assessed by multivariable analysis. RESULTS Kaplan-Meier survival curve analysis did not reveal significant differences between the STEMI and NSTEMI group for all-cause mortality or MACCE at the 36-month follow-up. While in the long PTB time group, MACCE rate was significantly greater in STEMI patients when compared to NSTEMI (p = 0.004). Among STEMI patients, the short, medium and long PTB time groups differed significantly in the rate of all-cause mortality (p = 0.006) and MACCE (p = 0.04) at 1,095 days of follow-up, which were the greatest in the long PTB time group. CONCLUSIONS Before considering the length of PTB time, there were no statistically significant differences in mortality or MACCE frequency between the STEMI and NSTEMI group at 36-month follow-up. Longer PTB times are related to significantly greater mortality at the 36-month follow-up in the STEMI, but not in the NSTEMI group.
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Affiliation(s)
- Bartłomiej Staszczak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | | | | | | | - Michał Susuł
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Joanna Bartuś
- Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Artur Pawlik
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Sylwia Socha
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Andrzej Surdacki
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
- University of Physical Education, Department of Clinical Rehabilitation, Krakow, Poland.
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Gamrat A, Trojanowicz K, Surdacki MA, Budkiewicz A, Wąsińska A, Wieczorek-Surdacka E, Surdacki A, Chyrchel B. Diagnostic Ability of Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criterion in Severe Aortic Stenosis. J Clin Med 2021; 10:jcm10132864. [PMID: 34203345 PMCID: PMC8268163 DOI: 10.3390/jcm10132864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022] Open
Abstract
Traditional electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), introduced in the pre-echocardiographic era of diagnosis, have a relatively low sensitivity (usually not exceeding 25–40%) in detecting LVH. A novel Peguero-Lo Presti ECG-LVH criterion was recently shown to exhibit a higher sensitivity than the traditional ECG-LVH criteria in hypertension. Our aim was to test the diagnostic ability of the novel Peguero-Lo Presti ECG-LVH criterion in severe aortic stenosis. We retrospectively analyzed 12-lead ECG tracings and echocardiographic records from the index hospitalization of 50 patients with isolated severe aortic stenosis (mean age: 77 ± 10 years; 30 women and 20 men). Exclusion criteria included QRS > 120 ms, bundle branch blocks or left anterior fascicular block, a history of myocardial infarction, more than mild aortic or mitral regurgitation, and significant LV dysfunction by echocardiography. We compared the agreement of the novel Peguero-Lo Presti criterion and traditional ECG-LVH criteria with echocardiographic LVH (LV mass index > 95 g/m2 in women and >115 g/m2 in men). Echocardiographic LVH was found in 32 out of 50 study patients. The sensitivity of the Peguero-Lo Presti criterion in detecting LVH was improved (55% vs. 9–34%) at lower specificity (72% vs. 78–100%) in comparison to 8 single traditional ECG-LVH criteria. Additionally, the positive predictive value (77% vs. 72%), positive likelihood ratio (2.0 vs. 1.5), and odds ratio (3.2 vs. 2.4) were higher for the Peguero-Lo Presti criterion versus the presence of any of these 8 traditional ECG-LVH criteria. Cohen’s Kappa, a measure of concordance between ECG and echocardiography with regard to LVH, was 0.24 for the Peguero-Lo Presti criterion, −0.01–0.13 for single traditional criteria, and 0.20 for any traditional criterion. However, by the receiver operating characteristics (ROC) curve analysis, the overall ability to discriminate between patients with and without LVH was insignificantly lower for the Peguero-Lo Presti versus Cornell voltage as a continuous variable (area under the ROC curve: 0.65 (95% CI, 0.48–0.81) vs. 0.71 (0.55–0.86), p = 0.5). In conclusion, our preliminary results suggest a slightly better, albeit still low, agreement of the novel Peguero-Lo Presti ECG criterion compared to the traditional ECG-LVH criteria with echocardiographic LVH in severe aortic stenosis.
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Affiliation(s)
- Aleksandra Gamrat
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Katarzyna Trojanowicz
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Michał A. Surdacki
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Aleksandra Budkiewicz
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Adrianna Wąsińska
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.G.); (K.T.); (M.A.S.); (A.B.); (A.W.)
| | - Ewa Wieczorek-Surdacka
- Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
- Correspondence: ; Tel.: +48-12-400-2250
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Więckowski K, Gallina T, Surdacki A, Chyrchel B. Diagonal Earlobe Crease (Frank's Sign) for Diagnosis of Coronary Artery Disease: A Systematic Review of Diagnostic Test Accuracy Studies. J Clin Med 2021; 10:2799. [PMID: 34202100 PMCID: PMC8268092 DOI: 10.3390/jcm10132799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 02/01/2023] Open
Abstract
Coronary artery disease is a global challenge for healthcare systems. Early diagnosis is a key issue to improve quality of life and reduce morbidity and mortality. Diagonal earlobe crease, a wrinkle extending obliquely across the earlobe, was linked by many authors to various atherosclerotic diseases. This systematic review aimed at summarizing the diagnostic accuracy of diagonal earlobe crease for diagnosis of chronic and acute coronary syndromes in adults. Cochrane's recommendations for systematic reviews of diagnostic test accuracy studies were followed. The protocol was registered on PROSPERO. Seven electronic databases were searched up to April 2021. The risk of bias and applicability were assessed using the QUADAS-2 tool. Meta-analysis was not performed. Finally, 13 cross-sectional studies evaluating 3951 patients were analyzed, all of which focused on chronic coronary syndromes defined as anatomically significant coronary stenosis. Invasive coronary angiography was used as a reference in most studies, except one which utilized computed tomography angiography. Sensitivity ranged from 26% to 90%, and specificity from 32% to 96%. Positive likelihood ratios varied from 1.11 to 7.03, but most results were below 2. Negative likelihood ratios were from 0.84 to 0.30, but most values exceeded 0.5. Diagnostic accuracy of diagonal earlobe crease for the detection of chronic coronary syndromes is insufficient. It only slightly changes pre-test probability, and its mere presence or absence should not affect the clinical management of the patients. However, for its feasibility and easy interpretation, Frank's sign could be considered as a part of physical examination.
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Affiliation(s)
- Krzysztof Więckowski
- Students’ Scientific Group at Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Tomasz Gallina
- Students’ Scientific Group at Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego, 30-688 Cracow, Poland; (A.S.); (B.C.)
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego, 30-688 Cracow, Poland; (A.S.); (B.C.)
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Roczniak J, Koziołek W, Piechocki M, Tokarek T, Surdacki A, Bartuś S, Chyrchel M. Comparison of Access Site-Related Complications and Quality of Life in Patients after Invasive Cardiology Procedures According to the Use of Radial, Femoral, or Brachial Approach. Int J Environ Res Public Health 2021; 18:ijerph18116151. [PMID: 34200250 PMCID: PMC8201254 DOI: 10.3390/ijerph18116151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 11/16/2022]
Abstract
The radial approach (RA) is the most common in invasive cardiology, but depending on the clinical situation, the femoral approach (FA) and brachial approach (BA) are also used. The BA is associated with the highest odds of complications so it is used mainly if a first-choice approach fails. The aim of the study was to assess clinical outcomes after invasive cardiology procedures stratified by the use of the RA, FA, and BA, with a focus on access site-related complications, quality of life (QoL), and patients' perspective. A total of 250 procedures (RA: 98; FA: 99; BA: 53) performed between 2013 and 2020 were retrospectively analyzed. Puncture site-related complications, vascular events, patient preferences, and QoL were assessed by the analysis of medical records and telephone follow-up using a proprietary questionnaire and the modified EQ-5D-3L questionnaire. Patients from the RA group received the smallest volume of contrast during a percutaneous coronary interventions (PCI) procedure (RA vs. FA vs. BA: 180 (150-240) mL vs. 200 (180-270) mL vs. 190 (100-200) mL, p = 0.045). The access site was changed most frequently in the procedures initiated from the RA (p < 0.04). Overall puncture site-related complications, especially local hematomas, occurred most commonly in the BA group (7.1, 14.1, and 24.5% for RA, FA, and BA, respectively, p = 0.01). During the index procedure, the access site was changed most frequently in procedures initiated from the RA (19.7, 8.5 and 0%, p = 0.04). The RA was indicated as an approach preferred by the patient for a hypothetical next procedure (87.9, 55.4, and 70.0% for subjects preferring the same approach out of patients who underwent a procedure by the RA, FA, and BA, respectively, p < 0.001). For the RA and FA, the prevalence of moderate or extreme access site-related problems in self-care decreased significantly (RA: p < 0.01, FA: p < 0.05) within 1 month after the index procedure (RA: 18.1, 4.2, and 1.4%; FA: 20.7, 11.1, and 9.6% periprocedurally, after 1 and 6 months, respectively). In contrast, for the BA these percentages were higher and a significant improvement (p < 0.05) was delayed until 6 months (54.6, 36.4, and 18.2% periprocedurally, after 1 and 6 months, respectively). In conclusion, compared to the BA and FA, the RA appears to be not only the safest, mainly due to the lowest risk of puncture site-related complications after coronary procedures but also represents a preferable approach from the patient's perspective. Although overall post-procedural QoL outcomes did not differ significantly according to the access site, nevertheless, the BA was associated with more frequent self-care problems whose improvement was delayed until more than one month after the index procedure.
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Affiliation(s)
- Jan Roczniak
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Wojciech Koziołek
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Marcin Piechocki
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.R.); (W.K.); (M.P.)
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Center for Intensive Care and Perioperative Medicine, Faculty of Medicine, Jagiellonian University Medical College, 30-901 Cracow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.T.); (A.S.); (S.B.)
- Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland
- Correspondence: ; Tel.: +48-12-400-2250
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Budkiewicz A, Surdacki MA, Gamrat A, Trojanowicz K, Surdacki A, Chyrchel B. Electrocardiographic Versus Echocardiographic Left Ventricular Hypertrophy in Severe Aortic Stenosis. J Clin Med 2021; 10:jcm10112362. [PMID: 34072214 PMCID: PMC8198672 DOI: 10.3390/jcm10112362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Although ECG used to be a traditional method to detect left ventricular hypertrophy (LVH), its importance has decreased over the years and echocardiography has emerged as a routine technique to diagnose LVH. Intriguingly, an independent negative prognostic effect of the "electrical" LVH (i.e., by ECG voltage criteria) beyond echocardiographic LVH was demonstrated both in hypertension and aortic stenosis (AS), the most prevalent heart valve disorder. Our aim was to estimate associations of the ECG-LVH voltage criteria with echocardiographic LVH and indices of AS severity. We retrospectively manually analyzed ECG tracings of 50 patients hospitalized in our center for severe isolated aortic stenosis, including 32 subjects with echocardiographic LVH. The sensitivity of single traditional ECG-LVH criteria in detecting echocardiographic LVH was 9-34% and their respective specificity averaged 78-100%. The ability to predict echocardiographic LVH was higher for S-waves than R-waves (mean area under the receiver operating curve (AUC): 0.62-0.70 vs. 0.58-0.65). Among combinations of R- and S-waves, the discriminating ability was highest for the Cornell voltage (AUC: 0.71) compared to the Sokolow-Lyon, Romhilt and Gubner-Ungerleider voltage (AUC: 0.62-0.68). By multiple regression, peak aortic pressure gradient was positively related to the Sokolow-Lyon (β = 1.7 ± 0.5, p = 0.002) and Romhilt voltage (β = 1.3 ± 0.5, p = 0.01), but not Cornell (0.5 ± 0.3, p = 0.2) or Gubner-Ungerleider voltage (β = 0.0 ± 0.5, p > 0.9), regardless of LV mass index. In conclusion, echocardiographic LVH and stenosis severity appear to have distinct associations with traditional ECG-LVH criteria in AS. A moderate diagnostic superiority of the Cornell voltage criterion with regard to anatomic LVH might result from its unique ability to include depolarization vectors in both the frontal and horizontal plane with consequent lesser sensitivity to the confounding effect of obesity.
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Affiliation(s)
- Aleksandra Budkiewicz
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Michał A. Surdacki
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Aleksandra Gamrat
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Katarzyna Trojanowicz
- Students’ Scientific Group, Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (A.B.); (M.A.S.); (A.G.); (K.T.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Jakubowskiego Street, 30-688 Cracow, Poland;
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Jakubowskiego Street, 30-688 Cracow, Poland;
- Correspondence: ; Tel.: +48-12-400-2250
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Sulicka-Grodzicka J, Surdacki A, Seweryn M, Mikołajczyk T, Rewiuk K, Guzik T, Grodzicki T. Low-grade chronic inflammation and immune alterations in childhood and adolescent cancer survivors: A contribution to accelerated aging? Cancer Med 2021; 10:1772-1782. [PMID: 33605556 PMCID: PMC7940211 DOI: 10.1002/cam4.3788] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/07/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background The long‐term consequences of chemotherapy and radiotherapy result in a high prevalence and early onset of age‐related chronic diseases in survivors. We aimed to examine whether childhood and adolescent cancer survivors (CS) demonstrate biomarkers of accelerated aging. Methods We evaluated 50 young adult CS at 11 [8–15] years after cancer diagnosis, and 30 healthy, age and sex‐matched controls, who were unexposed to cancer therapy. Using a machine‐learning approach, we assessed factors discriminating CS from controls and compared selected biomarkers and lymphocyte subpopulations with data from the Framingham Heart Study (FHS) cohort and the Genotype Tissue Expression (GTEx) project. Results Survivors compared with controls had higher levels of C‐reactive protein and fibrinogen. The surface expression of CD38 on T cells was increased, and there was an increase in the percentage of memory T cells in survivors, compared with the unexposed group. The relationships between above cell subpopulations and age were consistent in CS, FHS, and GTEx cohorts, but not in controls. Conclusions Young pediatric cancer survivors differ from age‐related controls in terms of activation of the adaptive immune system and chronic, low‐grade inflammation. These changes resemble aging phenotype observed in older population. Further research in biomarkers of aging in young, adult childhood cancer survivors is warranted, as it may facilitate screening and prevention of comorbidities in this population.
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Affiliation(s)
| | - Andrzej Surdacki
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Seweryn
- Center for Medical Genomics, OMICRON, Jagiellonian University Medical College, Krakow, Poland.,Department of Cancer Biology and Genetics, Center for Pharmacogenomics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Tomasz Mikołajczyk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Rewiuk
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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Chyrchel M, Gębska M, Dziewierz A, Rzeszutko Ł, Surdacki A. Recurrent stent thrombosis in a patient with neurofibromatosis type 1. Kardiol Pol 2020; 79:91-92. [PMID: 33394578 DOI: 10.33963/kp.15722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Januszek R, Siudak Z, Malinowski KP, Wojdyła R, Mika P, Wańha W, Kameczura T, Surdacki A, Wojakowski W, Legutko J, Bartuś S. Aspiration Thrombectomy in Patients with Acute Myocardial Infarction-5-Year Analysis Based on a Large National Registry (ORPKI). J Clin Med 2020; 9:E3610. [PMID: 33182436 PMCID: PMC7698028 DOI: 10.3390/jcm9113610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
Blood flow restoration after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction (AMI) may not always be achieved and could be complicated by the no-reflow phenomenon (NRP). The aim of the current study was to assess the frequency of thrombus aspirations (TAs) and NRPs in patients with AMI and treated with pPCI based on the data collected during a 5-year period in the national ORPKI registry, as well as the frequency of periprocedural strokes and predictors of TA and NRP. This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2018, and included 200,991 patients treated due to AMI out of 535,857 patients treated using PCI. Among them, 16,777 patients underwent TA. TA was mainly used in the STEMI subgroup of 14,207 patients (84.8%). The frequency of NRP among AMI patients in the thrombectomy group was 2.75% and in the non-thrombectomy group 0.82%. Predictors of TA and NRP were also assessed using multivariate analysis. The percentage of patients treated with pPCI and with PCI alone increased significantly in all of the three selected groups of patients from 88.7% to 94.3% in the AMI group (p < 0.001), from 82.3% to 90.3% in the STEMI subgroup (p < 0.001), and from 96.3% to 98.2% in the NSTEMI subgroup (p < 0.001) during the analysed period. NRP occurred more often in the thrombectomy group for the NSTEMI (0.58% vs. 3.07%, p < 0.05) and STEMI (1.06% vs. 2.69%, p < 0.05) subgroups. Periprocedural stroke occurred more often in the thrombectomy group in comparison to the non-thrombectomy group with AMI (0.03% vs. 0.01%, p < 0.05) and the NSTEMI (0.16% vs. 0.02%, p < 0.05). In conclusion, the frequency of TA has been experiencing a steady decline in recent years, regardless of AMI type, among patients treated with pPCI.
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Affiliation(s)
- Rafał Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland; (R.W.); (A.S.); (S.B.)
- Department of Clinical Rehabilitation, University of Physical Education, 31-571 Kraków, Poland;
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland;
| | - Krzysztof P. Malinowski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Roman Wojdyła
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland; (R.W.); (A.S.); (S.B.)
| | - Piotr Mika
- Department of Clinical Rehabilitation, University of Physical Education, 31-571 Kraków, Poland;
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (W.W.); (W.W.)
| | - Tomasz Kameczura
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, 35-310 Rzeszow, Poland;
| | - Andrzej Surdacki
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland; (R.W.); (A.S.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; (W.W.); (W.W.)
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, 31-202 Kraków, Poland;
| | - Stanisław Bartuś
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland; (R.W.); (A.S.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland;
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Tsikas D, Surdacki A. Biotransformation of organic nitrates by glutathione S-transferases and other enzymes: An appraisal of the pioneering work by William B. Jakoby. Anal Biochem 2020; 644:113993. [PMID: 33080215 DOI: 10.1016/j.ab.2020.113993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Organic nitrates (R-ONO2; R, organic residue) such as nitroglycerin are used as drugs in part for more than a century. Their pharmacological use is associated with clinically relevant tolerance which is reportedly known since 1888. The underlying mechanisms of both, the mechanisms of action and the main pharmacological effect, which is vasodilatation and reduction of blood pressure, and the development of tolerance, which means increasing need of drug amount in sustained long-term therapy, are still incompletely understood. William B. Jakoby and associates were the first to report the biotransformation of organic nitrates, notably including nitroglycerin (i.e., glycerol trinitrate; GTN), by glutathione S-transferase (GST)-catalyzed conjugation of glutathione (GSH) to the nitrogen atom of one of the three nitrate groups of GTN to generate glutathione sulfenyl nitrite (glutathione thionitrate, S-nitroglutathione; GSNO2). Jakoby's group was also the first to suggest that GSNO2 reacts with a second GSH molecule to produce inorganic nitrite (ONO-) and glutathione disulfide (GSSG) without the catalytic involvement of GST. This mechanism has been adopted by others to the biotransformation of GTN by mitochondrial aldehyde dehydrogenase (mtALDH-(CysSH)2) which does not require GSH as a substrate. The main difference between these reactions is that mtALDH forms an internal thionitrate (mtALDH-(CysSH)-CysSNO2) which releases inorganic nitrite upon intra-molecular reaction to form mtALDH disulfide (mtALDH-(CysS)2). Subsequently, ONO- and GSNO2 are reduced by several proteins and enzymes to nitric oxide (NO) which is a very potent activator of soluble guanylyl cyclase to finally relax the smooth muscles thus dilating the vasculature. GSNO2 is considered to rearrange to GSONO which undergoes further reactions including GSNO and GSSG formation. The present article is an appraisal of the pioneering work of William B. Jakoby in the area of the biotransformation of organic nitrates by GST. The two above mentioned enzymatic reactions are discussed in the context of tolerance development to organic nitrates, still a clinically relevant pharmacological concern.
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Affiliation(s)
- Dimitrios Tsikas
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, Hannover, Germany.
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical Colleague and University Hospital, Cracow, Poland
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49
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Jędrychowska M, Januszek R, Wańha W, Malinowski KP, Kunik P, Trznadel A, Bartuś J, Staszczak B, Januszek SM, Kameczura T, Wojakowski W, Surdacki A, Bartuś S. Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries. Medicina (Kaunas) 2020; 56:E432. [PMID: 32867290 PMCID: PMC7557849 DOI: 10.3390/medicina56090432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Background and Objectives: A topic already widely investigated is the negative prognostic value regarding the extent of high sensitive troponin I (hs-TnI) increases among patients with myocardial infarction (MI) and obstructive coronary atherosclerosis compared to a group of patients with MI and non-obstructive coronary atherosclerosis (MINOCA). Thus, the aim of this study was to evaluate the prognostic value concerning the extent of hs-TnI increase on clinical outcomes among patients with a MINOCA working diagnosis. Materials and Methods: We selected 337 consecutive patients admitted to hospital with a working diagnosis of MINOCA. The patients were divided in three groups according to the extent of hs-TnI increase during hospitalization (increase ≤5-times above the limit of the upper norm, >5 and ≤20-times, and >20-times). The study endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE; cerebral stroke and transient ischemic attacks, MI, coronary artery revascularization, either percutaneous coronary intervention or coronary artery bypass grafting and all-cause mortality). Results: During the mean follow-up period of 516.1 ± 239.8 days, using Kaplan-Meier survival curve analysis, significantly higher mortality rates were demonstrated among patients from the group with the greatest hs-TnI increase compared to the remaining groups (p = 0.01) and borderline values for MACCE (p = 0.053). Multivariable cox regression analysis did not confirm hs-TnI among factors related to increased MACCE or all-cause mortality rates. Conclusion: While a relationship between clinical outcomes and the extent of the hs-TnI increase among patients with a MINOCA working diagnosis remains, it does not seem to be not as strong as it is in patients with obstructive coronary atherosclerosis.
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Affiliation(s)
- Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland;
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland;
- Department of Clinical Rehabilitation, University of Physical Education, 31-571 Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Krzysztof Piotr Malinowski
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Piotr Kunik
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Agata Trznadel
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Joanna Bartuś
- Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland;
| | | | | | - Tomasz Kameczura
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, 35-310 Rzeszow, Poland;
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Andrzej Surdacki
- Department of Cardiology, Jagiellonian University Medical College, 40-055 Kraków, Poland; (A.S.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 40-055 Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology, Jagiellonian University Medical College, 40-055 Kraków, Poland; (A.S.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 40-055 Kraków, Poland
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50
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Chyrchel M, Gallina T, Szafrański O, Rzeszutko Ł, Surdacki A, Bartuś S. Comparison of the Characteristics of Coronary Interventions Performed During Day and Night Shifts in Patients with Acute Myocardial Infarction. Int J Environ Res Public Health 2020; 17:ijerph17155378. [PMID: 32722586 PMCID: PMC7432738 DOI: 10.3390/ijerph17155378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022]
Abstract
Therapeutic percutaneous coronary intervention (PCI) is the treatment of choice in acute myocardial infarction (AMI). If optimally performed, PCI reduces myocardial injury and improves the likelihood of a positive clinical outcome. Therefore, the equal quality of PCI throughout both day and night shifts is of paramount importance. Our aim was to compare urgent diagnostic and therapeutic coronary interventions performed during day and night shifts. We retrospectively analyzed the medical records of 144 patients who underwent coronary angiography for AMI over six months in a tertiary referral center working in 24/7 mode. The patients' characteristics, procedural data and the operator's experience in interventional cardiology were compared according to the time of intervention during a day shift (8 a.m. until 8 p.m., group A, n = 106) and night shift (from 8 p.m. until 8 a.m. next day, group B, n = 36). The baseline characteristics of the subjects of groups A and B were similar, except for a higher proportion of AMI without persistent ST-segment elevation (NSTEMI) in patients who underwent coronary angiography during regular working hours compared to off-hours (58% vs. 34%, p < 0.05). The average time of diagnostic coronary angiography was longer by about 5 min during the day shift (28.5 ± 12.2 vs. 23.8 ± 8.9 min, p < 0.05), while other procedural data, including the arterial access route, the number of catheters needed and the contrast-medium volume, were similar. The use of additional diagnostic tools for coronary lesion assessment (intracoronary ultrasound or fractional flow reserve measurement) was almost twice as frequent during regular working hours (15% vs. 8%). Urgent therapeutic PCI on the culprit artery was performed in 79% and 89% of group A and B patients, respectively. The groups did not differ in procedural characteristics regarding the total interventional session, including both diagnostic angiography and therapeutic PCI, such as total procedure duration, fluoroscopy time, radiation dose, stenting technique and total stent length. Coronary thrombectomy or rotational atherectomy were more frequently used in group A (27% vs. 15%, p = 0.16). The percentage of doctors with the least experience in interventional cardiology was, albeit insignificantly, lower during day shifts (31% vs. 42%). In conclusion, the majority of clinical and periprocedural characteristics appeared to be independent of intervention time, except for a longer duration of diagnostic coronary angiography during daytime. This finding could probably result from a higher proportion of NSTEMI patients frequently requiring additional angiographic projections and special techniques to properly identify the infarct-related artery during the day shift. Whether a tendency of less frequent use of additional tools at off-hours may also be due to a lower percentage of NSTEMI interventions at night, or whether this can be linked to lower availability of experienced operators, remains to be validated in a large study. The latter possibility, if confirmed, might encourage public health authorities and healthcare organizers to improve off-hours cathlab staffing with experienced interventionalists. Finally, additional obligatory training in special diagnostic and therapeutic invasive techniques might be advisable for the least experienced operators scheduled to work night shifts.
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Affiliation(s)
- Michał Chyrchel
- Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (M.C.); (Ł.R.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
| | - Tomasz Gallina
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.G.); (O.S.)
| | - Oskar Szafrański
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (T.G.); (O.S.)
| | - Łukasz Rzeszutko
- Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (M.C.); (Ł.R.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (M.C.); (Ł.R.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
- Correspondence:
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland; (M.C.); (Ł.R.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland
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