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Glądys K, Siudak Z, Trzeciak P, Siłka W, Skrzypek M, Chyrchel M, Gąsior M, Januszek R. Mortality of patients presented with acute ST-segment elevation myocardial infarction according to the status of standard modifiable cardiovascular risk factors. Am J Med Sci 2024; 367:328-336. [PMID: 38320673 DOI: 10.1016/j.amjms.2024.01.025] [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: 08/18/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Standard modifiable cardiovascular risk factors (SMuRFs) remain well-established elements of assessing cardiovascular risk scores. However, there is growing evidence that patients presented without known SMuRFs at admission demonstrate worse post-myocardial outcomes. The aim of the study was to assess the influence of the SMuRF status on short- and long-term mortality rates in patients with first-time ST-segment elevation myocardial infarction (STEMI). METHODS This observational, cross-sectional study covered 182,726 patients admitted between 2003-2020 to the CathLabs, according to data from the Polish Registry of Acute Coronary Syndrome. Both baseline characteristics and mortality (in-hospital, 30-day, and 12-month) were examined and stratified by SMuRF status. The predictors of mortality were assessed at selected time points by multivariable analysis. RESULTS The majority of STEMI patients had at least one SMuRF (88.7%), however, mortality rates of SMuRF-less individuals were greater at selected time points of the follow-up (p < 0.001), and persisted at a higher level during each year of the follow-up period compared to the SMuRF group and general population. Furthermore, the SMuRFs status constituted an independent predictor of mortality at the 30-day (OR: 1.345; 95% CI: 1.142-1.585, p < 0.001) and 12-month (OR: 1.174; 95% CI: 1.054-1.308, p < 0.001) follow-ups. CONCLUSIONS SMuRF-less individuals presented with STEMI are at an increased risk of all-cause mortality compared to those with at least one SMuRF. Consequently, further investigations regarding the recognition and treatment of risk factors, irrespective of SMuRF status, are indicated.
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Affiliation(s)
- Kinga Glądys
- Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Przemysław Trzeciak
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Michał Skrzypek
- Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia in Katowice, Poland
| | - Michał Chyrchel
- 2nd Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Rafał Januszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Kraków, Poland.
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Mamas MA, Martin GP, Grygier M, Wadhera RK, Mallen C, Curzen N, Wijeysundera HC, Banerjee A, Kontopantelis E, Rashid M, Sielski J, Siudak Z. Indirect impact of the war in Ukraine on primary percutaneous coronary interventions for ST-elevation myocardial infarction in Poland. Pol Arch Intern Med 2024:16737. [PMID: 38661123 DOI: 10.20452/pamw.16737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION The Russian invasion of Ukraine in February 2022 resulted in the displacement of approximately 12.5 million refugees to adjacent countries including Poland, that may have strained healthcare service delivery. OBJECTIVES Using the ST-elevation myocardial infarction (STEMI) data, we aimed to evaluate whether the Russian invasion of Ukraine has indirectly impacted the delivery of acute cardiovascular care in Poland. PATIENTS AND METHODS We analyzed all adult patients undergoing percutaneous coronary interventions (PCI) for STEMI across Poland between 25th February 2017 to 24th May 2022. Centers were allocated to regions of <100km and >100km of the Polish-Ukraine border. Mixed effect generalized linear regression models with random effects per hospital were used to explore the associations between the war in Ukraine starting with several outcomes of interest, and whether these associations differed across regions of >100km from the Polish-Ukraine border. RESULTS A total of 90,115 procedures were included in the analysis. The average number of procedures per-month was similar to predicted volume for centers in the >100km region, while the average number of PCI was higher than expected (by an estimated 15 (11-19)) for the <100km region. There was no difference in adjusted fatality rate or quality of care outcomes pre- vs. during-war in both <100 and >100 km regions, with no evidence of a difference-in-difference across regions. CONCLUSIONS Following the Russian invasion of Ukraine, there was only a modest and temporary increase in primary PCI predominantly in centers situated within 100km of the border, although no significant impact on in-hospital fatality rate.
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Pruc M, Kubica J, Banach M, Swieczkowski D, Rafique Z, Peacock WF, Siudak Z, Kurek K, Nanayakkara P, Szarpak Ł. Diagnostic and prognostic performance of the neutrophil-to-lymphocyte ratio in acute coronary syndromes: A meta-analysis of 90 studies including 45 990 patients. Kardiol Pol 2024; 82:276-284. [PMID: 38493452 DOI: 10.33963/v.phj.99554] [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: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Cardiovascular disease is a leading cause of mortality worldwide and is likely to rise. Acute coronary syndrome (ACS) is consequent on inflammation. As a common and cost-effective inflammatory biomarker, the neutrophil-to-lymphocyte ratio (NLR) may be beneficial in cardiovascular medicine. AIMS This meta-analysis examines the diagnostic and prognostic performance of the NLR in ACS. METHODS We systematically searched PubMed Central, Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrial.gov databases. The search spanned from databases inception to January 10, 2024. The findings were aggregated into normalized mean differences with 95% confidence intervals. RESULTS Ninety articles, with 45 990 participants, were included. Pooled analysis of the NLR varied and was higher in ST-segment elevation myocardial infarction (STEMI) vs. non-ST-segment elevation myocardial infarction patients (4.94 ± 3.24 vs. 3.24 ± 2.74), acute myocardial infarction vs. unstable angina (4.47 ± 3.43 vs. 2.97 ± 1.58), ACS vs. stable angina (SA) (5.45 ± 4.28 vs. 2.46 ± 2.15), and ACS vs. controls (5.31 ± 4.01 vs. 2.46 ± 2.45). The NLR also was associated with ACS mortality, with survivors having lower results (3.67 ± 2.72 vs. 5.56 ± 3.93). Subanalysis showed that differences in the NLR were observed in STEMI survivors (4.28 ± 3.24 vs. 6.79 ± 3.98). Of ACS patients with major cardiovascular events (MACE) vs. without MACE, the NLR was 6.29 ± 4.89 vs. 3.82 ± 4.12. In STEMI patients, the NLR differed between those with and without MACE (6.99 ± 5.27 vs. 4.99 ± 4.12). CONCLUSIONS The NLR is an effective tool for differentiating between different types of ACS. A high NLR is associated with ACS and increased MACE at 30 days. The NLR also appears to be a good predictor of MACE risk, at least in STEMI patients.
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Affiliation(s)
- Michał Pruc
- Department of Clinical Research and Development, LUXMED Group, Warszawa, Poland
- Department of Public Health, International European University, Kyiv, Ukraine
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łódź, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Góra, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódź, Poland
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Damian Swieczkowski
- Department of Clinical Research and Development, LUXMED Group, Warszawa, Poland
- Department of Toxicology, Faculty of Pharmacy, Medical University of Gdansk, Gdańsk, Poland
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - William Frank Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Zbigniew Siudak
- Department of Clinical Research and Development, LUXMED Group, Warszawa, Poland
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Krzysztof Kurek
- Department of Clinical Research and Development, LUXMED Group, Warszawa, Poland
| | - Prabath Nanayakkara
- Division of Acute Medicine, Department of Internal Medicine, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Łukasz Szarpak
- Department of Clinical Research and Development, LUXMED Group, Warszawa, Poland.
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States.
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Warszawa, Poland.
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Kaziród-Wolski K, Sielski J, Jóźwiak M, Wolska M, Bernardi M, Spadafora L, Biondi-Zoccai G, Siudak Z, Versaci F. Does PM 2.5 and PM 10-associated heavy metals affect short-term and long-term survival after out-of-hospital cardiac arrest? Four-year study based on regional registry. Minerva Med 2024; 115:14-22. [PMID: 38037701 DOI: 10.23736/s0026-4806.23.08979-6] [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: 12/02/2023]
Abstract
BACKGROUND This study aims to investigate the effect of arsenic (As), cadmium (Cd), nickel (Ni) and lead (Pb) suspended on particulate matters (PM) 2.5 and PM 10 taking into account clinical factors on 30-day and one-year survival after out-of-hospital cardiac arrest (OHCA). METHODS A retrospective 4-year study that involved patients hospitalized after OHCA. Patients' data were obtained from Emergency Medical Services dispatch cards and the National Health Fund. The concentration of air pollutants was measured by the Environmental Protection Inspectorate in Poland. RESULTS Among the 948 patients after OHCA, only 225 (23.7%) survived for 30 days, and 153 (16.1%) survived for 1 year. Survivors were more commonly affected by OHCA in urban areas (85 [55.6%] vs. 355 [44.7%]; P=0.013) and had slightly higher one-year mean concentration of As (0.78 vs. 0.77; P=0.01), Cd (0.34 vs. 0.34; P=0.012), and Pb (11.13 vs. 10.20; P=0.015) with no differences in daily mean concentration. Significant differences in mean concentrations of heavy metals and PM 2.5 and PM 10 were observed among different quarters. However, survival analysis revealed no differences in long-term survival between quarters. Heavy metals, PM 2.5, and PM 10 did not affect short-term and long-term survival in multivariable logistic regression. CONCLUSIONS The group of survivors showed slightly higher mean one-year concentrations of As, Cd and Pb, but they also experienced a higher incidence of OHCA in urban areas. There were no differences in long-term survival between patients who suffer OHCA in different quarters. Heavy metals did not independently affect survival.
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Affiliation(s)
- Karol Kaziród-Wolski
- Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland -
- Unit of Intensive Cardiac Care, Świętokrzyskie Cardiology Center, Kielce, Poland -
| | - Janusz Sielski
- Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Unit of Intensive Cardiac Care, Świętokrzyskie Cardiology Center, Kielce, Poland
| | | | | | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Zbigniew Siudak
- Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Francesco Versaci
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
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Doolub G, Mamas MA, Dziewierz A, Malinowski KP, Oleś I, Kuleta M, Zdzierak B, Siudak Z. Do two operators improve outcomes in left main percutaneous coronary intervention? Insights from the ORPKI Registry. Minerva Cardiol Angiol 2024; 72:79-86. [PMID: 37870423 DOI: 10.23736/s2724-5683.23.06364-0] [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: 10/24/2023]
Abstract
BACKGROUND Significant left main coronary artery (LMCA) disease is prevalent in 7% of patients undergoing angiography. Limited data exists on the impact of double scrubbing in LMCA PCI. We sought to assess periprocedural outcomes in two-operator LMCA percutaneous coronary intervention (PCI). METHODS Using data from the Polish National Registry of PCI (ORPKI), we collected data on 28,745 patients undergoing LMCA PCI from 154 centers. Patients were divided into two groups based on the number of operators performing PCI (one vs. two operators). RESULTS LMCA PCI was performed by a single operator in 86% of the cases and by two operators in 14% of cases. Patients treated by two operators had a greater comorbidity burden including diabetes mellitus, arterial hypertension, previous myocardial infarction, and previous revascularization. In addition, these were more likely to be treated in high-volume centers, by operators with higher volume of LMCA PCIs. The risk of periprocedural death (2.37% vs. 2.44%; P=0.78), as well as cardiac arrest, coronary artery perforation, no-reflow, and puncture site bleeding was comparable between the two groups. On multivariable analysis, we found that a two-operator strategy was an independent predictor of periprocedural death, with this effect being much more profound in an elective setting (OR=5.13 [1.37-19.26]; P=0.015), compared to an urgent (ACS) setting (OR=1.32 [1.00-1.73]; P=0.047). CONCLUSIONS Our study suggests that a two-operator approach is not necessarily routinely recommended for LMCA interventions, although it can be considered for more complex cases.
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Affiliation(s)
- Gemina Doolub
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
- Unit of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Mamas A Mamas
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Artur Dziewierz
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital of Krakow, Krakow, Poland
| | - Krzysztof P Malinowski
- Jagiellonian University Medical College, Department of Bioinformatics and Telemedicine, Krakow, Poland
- Jagiellonian University Medical College, Digital Medicine and Robotics Center, Krakow, Poland
| | - Izabela Oleś
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Martyna Kuleta
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Barbara Zdzierak
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland -
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Zaman M, Stevens C, Ludman P, Wijeysundera HC, Siudak Z, Sharp ASP, Kinnaird T, Mohamed MO, Ahmed JM, Rashid M, Mamas MA. Intracoronary imaging in PCI for acute coronary syndrome: Insights from British Cardiovascular Intervention Society registry. Cardiovasc Revasc Med 2023; 56:50-56. [PMID: 37357105 DOI: 10.1016/j.carrev.2023.05.020] [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: 03/10/2023] [Revised: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND While previous studies have demonstrated the superiority of ICI-guided PCI over an angiography-based approach, there are limited data on all-comer ACS patients. This study aimed to identify the characteristics and in-hospital outcomes of patients undergoing intracoronary imaging (ICI) guided percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). METHODS All patient undergoing PCI for ACS in England and Wales between 2006 and 2019 were retrospectively analyzed and stratified according to ICI utilization. The outcomes assessed were in-hospital all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE) using multivariable logistic regression models. RESULTS 598,921 patients underwent PCI for ACS, of which 41,716 (7.0 %) had ICI which was predominantly driven by IVUS use (5.6 %). ICI use steadily increased from 1.4 % in 2006 to 13.5 % in 2019. Adjusted odds of mortality (OR 0.69, 95%CI 0.58-0.83) and MACCE (OR 0.77, 95%CI 0.73-0.83) were significantly lower in the ICI group. The association between ICI and improved outcomes varied according to vessel treated with both left main stem (LMS) and LMS/left anterior descending (LAD) PCI associated with significantly lower odds of mortality (OR 0.34, 95%CI 0.27-0.44, OR 0.51 95%CI 0.45-0.56) and MACCE (OR 0.44 95%CI 0.35-0.54, OR 0.67 95%CI 0.62-0.72) respectively. CONCLUSIONS Although ICI use has steadily increased, less than one in seven patients underwent ICI-guided PCI. The association between ICI use and improved in-hospital outcomes was mainly observed in PCI procedures involving LMS and LAD.
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Affiliation(s)
- Mahvash Zaman
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Wythenshawe Hospital, Manchester Foundation Trust, Manchester, UK
| | - Chris Stevens
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Institute of Health Informatics, University College London, London, UK
| | - Javed M Ahmed
- Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Department of Academic Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Department of Academic Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
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Kaziród-Wolski K, Piotrowska A, Sielski J, Zając P, Malinowski KP, Zabojszcz M, Pytlak K, Wolska M, Kołodziej A, Mamas MA, Mizera P, Siudak Z. The Effect of Daylight-Saving Time on Percutaneous Coronary Intervention Outcomes in Acute Coronary Syndrome Patients-Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) in the Years 2014-2022. J Cardiovasc Dev Dis 2023; 10:375. [PMID: 37754804 PMCID: PMC10532136 DOI: 10.3390/jcdd10090375] [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: 07/06/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Many factors related to the switch to summer/winter time interfere with biological rhythms. OBJECTIVES This study aimed to analyze the impact of time change on clinical outcomes of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS Electronic data of 874,031 patients with ACS who underwent invasive procedures were collected from the Polish National Register of Interventional Cardiology Procedures (ORPKI) between 2014 and 2021. We determined the number of patients undergoing PCI and periprocedural mortality during the day of spring or autumn time change and within the first 3 and 7 days after the time change. RESULTS We demonstrated the impact of time changes on the periprocedural mortality of ACS patients within 1 day and the period of 3 and 7 days from the time change. We observed that the occurrence of all ACS and NSTEMI on the first day was lower for both time changes and higher in the case of UA and spring time change. The autumn time change significantly reduced the occurrence of all types of ACS. A significant decrease in the number of invasive procedures was found after autumn transition in the period from the first day to 7 days for ACS, NSTEMI, and UA. CONCLUSIONS The occurrence of ACS and the number of invasive procedures were lower for both changes over time. Autumn time change is associated with increased periprocedural mortality in ACS and a less frequent occurrence of UA and NSTEMI within 7 days.
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Affiliation(s)
- Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
- Intensive Cardiac Care Unit, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
| | - Aleksandra Piotrowska
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
- Intensive Cardiac Care Unit, Świętokrzyskie Cardiology Center, 25-736 Kielce, Poland
| | - Patrycja Zając
- The Rheumatology Department, The Province Hospital in Końskie, 26-200 Końskie, Poland;
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 30-688 Kraków, Poland;
| | - Michał Zabojszcz
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Kamil Pytlak
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Magdalena Wolska
- Outpatient Treatment Facility “CenterMed”, 25-314 Kielce, Poland;
| | - Agnieszka Kołodziej
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Mamas A. Mamas
- Keele Cardiac Research Group, Keele University, Keele ST5 5BG, UK;
| | - Paulina Mizera
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-317 Kielce, Poland; (K.K.-W.); (A.P.); (J.S.); (M.Z.); (K.P.); (A.K.); (P.M.)
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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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Kupisz-Urbańska M, Jankowski P, Topór-Mądry R, Chudzik M, Gąsior M, Gil R, Gryka P, Kalarus Z, Kubica J, Legutko J, Mitkowski P, Pinkas J, Sierpiński R, Stępińska J, Siudak Z, Teisseyre P, Witkowski A, Zielińska-Borkowska U, Zdrojewski T, Gellert R. Survival in nonagenarians with acute myocardial infarction in 2014-2020: A nationwide analysis. Kardiol Pol 2023; 81:1015-1017. [PMID: 37448218 DOI: 10.33963/kp.a2023.0155] [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] [Received: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Małgorzata Kupisz-Urbańska
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warszawa, Poland.
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warszawa, Poland
- Department of Epidemiology and Health Promotion, School of Public Health, Center of Postgraduate Medical Education, Warszawa, Poland
| | - Roman Topór-Mądry
- Agency for Health Technology Assessment and Tariff System, Warszawa, Poland
| | - Michał Chudzik
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warszawa, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Warszawa, Poland
| | - Patrycja Gryka
- Agency for Health Technology Assessment and Tariff System, Warszawa, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Division of Medical Sciences in Zabrze, Silesian Medical University, Zabrze, Poland
| | - Jacek Kubica
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
- SIRIO MEDICINE Research Network, Bydgoszcz, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Przemysław Mitkowski
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, Warszawa, Poland
| | | | - Janina Stępińska
- Department of Communication in Medicine, School of Public Health, Center of Postgraduate Medical Education, Warszawa, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Paweł Teisseyre
- Agency for Health Technology Assessment and Tariff System, Warszawa, Poland
- Institute of Computer Science, Polish Academy of Sciences, Warszawa, Poland
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warszawa, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Urszula Zielińska-Borkowska
- Department of Anaesthesiology and Intensive Care Medicine, Centre of Postgraduate Medical Education, Warszawa, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
| | - Ryszard Gellert
- Department of Nephrology and Internal Medicine, Medical Center for Postgraduate Education, Warszawa, Poland
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10
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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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11
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Siudak Z, Hawranek M, Kleczyński P, Bartuś S, Kusa J, Milewski K, Opolski MP, Pawłowski T, Protasiewicz M, Smolka G, Malinowski KP, Dudek D, Grygier M. Interventional cardiology in Poland in 2022. Annual summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and Jagiellonian University Medical College. Postepy Kardiol Interwencyjnej 2023; 19:82-85. [PMID: 37465633 PMCID: PMC10351074 DOI: 10.5114/aic.2023.129205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Michał Hawranek
- 3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Stanisław Bartuś
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Kusa
- Medical University of Silesia, Katowice, Poland
- Regional Specialist Hospital, Wroclaw, Poland
| | - Krzysztof Milewski
- University of Technology, Faculty of Medicine, Katowice, Poland
- American Heart of Poland SA, Katowice, Poland
| | - Maksymilian P. Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Pawłowski
- Department of Cardiology, Central Clinical Hospital of Internal Affairs, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marcin Protasiewicz
- Department of Cardiology, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Krzysztof P. Malinowski
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- Digital Medicine and Robotics Center, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Grygier
- 1 Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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12
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Zając P, Kaziród-Wolski K, Sielski J, Wolska M, Malinowski KP, Siudak Z. COVID-19 as an independent predictor of aspiration thrombectomy in STEMI. National data from the ORPKI register in the years 2020-2022. Postepy Kardiol Interwencyjnej 2023; 19:119-126. [PMID: 37465631 PMCID: PMC10351080 DOI: 10.5114/aic.2023.127893] [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: 12/28/2022] [Accepted: 03/06/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) exacerbates intravascular thrombosis that occurs in the coronary artery in ST-elevation myocardial infarction (STEMI). Aim To analyze the impact of COVID-19 on the application and effect of thrombectomy in STEMI patients. Material and methods 29915 STEMI patients were analyzed, of whom 3139 (10.5%) underwent thrombectomy. COVID-19 (+) was reported in 311 (10.8%). The clinical characteristics and management of STEMI in COVID-19 (+) and COVID-19 (-) patients were compared. A multivariable logistic regression analysis was performed in search of factors influencing thrombectomy. Results COVID-19 (+) patients had higher Killip class (IV class; n = 33 (12.31%) vs. n = 138 (5.84%); p < 0.0001) and cardiac arrest at baseline was more frequent in this group (n = 25 (8.04%) vs. n = 137 (4.84%); p = 0.016). Thrombolysis in myocardial infarction (TIMI) 3 after percutaneous coronary intervention was less frequent (n = 248 (80.52%) vs. n = 2388 (87.19%); p = 0.001) in the COVID-19 (-) group. Periprocedural mortality was similar in both groups (n = 28 (0.99%) vs. n = 4 (1.29%); p = 0.622). In multivariable regression analysis COVID-19 increased the risk of thrombectomy (OR = 1.23; 97.5% CI: 1.05-1.43; p = 0.001). Conclusions STEMI patients undergoing aspiration thrombectomy who were COVID-19 (+) were more likely to be in a severe clinical condition (higher Killip class, more frequent cardiac arrest before the procedure) than COVID-19 (-) patients. Despite more intensive antiplatelet and anticoagulant treatment, PCI procedures were less likely to result in an optimal TIMI 3 effect. COVID-19 is an independent strong predictor of patient qualification for aspiration thrombectomy in STEMI.
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Affiliation(s)
- Patrycja Zając
- Rheumatology Department of the Province Hospital, Końskie, Poland
| | | | - Janusz Sielski
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | | | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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13
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Dziewierz A, Vogel B, Zdzierak B, Kuleta M, Malinowski KP, Rakowski T, Piotrowska A, Mehran R, Siudak Z. Operator-patient sex discordance and periprocedural outcomes of percutaneous coronary intervention (from the ORPKI Polish National Registry). Postepy Kardiol Interwencyjnej 2023; 19:113-118. [PMID: 37465632 PMCID: PMC10351079 DOI: 10.5114/aic.2023.129208] [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: 05/06/2023] [Accepted: 05/06/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction A recent study suggested that sex discordance between surgeons and patients negatively affects the outcomes of patients undergoing common surgical procedures. Aim We sought to assess whether such an impact exists for periprocedural outcomes of percutaneous coronary intervention (PCI). Material and methods From 2014 to 2020, data on 581,744 patients undergoing single-stage coronary angiography and PCI from 154 centers were collected. Patients were divided into four groups based on the patient and operator sex. Operator-patient sex discordance was defined as the procedure done by a male operator on a female patient or by a female operator on a male patient. Results Of 581,744 patients treated by 34 female and 782 male operators, 194,691 patients were sex discordant with their operator (female operator with male patient 12,479; male operator with female patient 182,212) while 387,053 were sex concordant (female operator with female patient 6,068; male operator with male patient 380,985). Among female patients, no difference in the risk of periprocedural complications, including death (0.65% vs. 0.82%; p = 0.10), between patients discordant versus concordant with operators was observed. Among male patients the risk of death (0.55% vs. 0.43%; p = 0.037) and bleeding at the puncture site (0.13% vs. 0.08%; p = 0.046) was higher in patients discordant with operators. However, the differences were no longer significant after adjustment for covariates. Conclusions No detrimental effect of operator-patient sex discordance on periprocedural outcomes was confirmed in all-comer patients undergoing PCI. Some of the observed differences in outcomes were primarily related to the differences in baseline risk profile.
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Affiliation(s)
- Artur Dziewierz
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Martyna Kuleta
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | | | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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14
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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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15
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Terlecki M, Wojciechowska W, Klocek M, Drożdż T, Kocowska-Trytko M, Lis P, Pavlinec C, Pęksa JW, Kania M, Siudak Z, Januszewicz A, Kreutz R, Małecki M, Grodzicki T, Rajzer M. Prevalence and clinical implications of atrial fibrillation in patients hospitalized due to COVID-19: Data from a registry in Poland. Front Cardiovasc Med 2023; 10:1133373. [PMID: 36993999 PMCID: PMC10041565 DOI: 10.3389/fcvm.2023.1133373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundAtrial fibrillation (AF) is a common arrhythmia with increasing prevalence with respect to age and comorbidities. AF may influence the prognosis in patients hospitalized with Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis.Methods and resultsWe assessed the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis. Data of all COVID-19 patients hospitalized in the University Hospital in Krakow, Poland, between March 2020 and April 2021, were analyzed. The following outcomes: short-term (30-days since hospital admission) and long-term (180-days after hospital discharge) mortality, major cardiovascular events (MACEs), pulmonary embolism, and need for red blood cells (RBCs) transfusion, as a surrogate for major bleeding events during hospital stay were assessed. Out of 4,998 hospitalized patients, 609 had AF (535 pre-existing and 74 de novo). Compared to those without AF, patients with AF were older and had more cardiovascular disorders. In adjusted analysis, AF was independently associated with an increased risk of short-term {p = 0.019, Hazard Ratio [(HR)] 1.236; 95% CI: 1.035–1.476} and long-term mortality (Log-rank p < 0.001) as compared to patients without AF. The use of novel oral anticoagulants (NOAC) in AF patients was associated with reduced short-term mortality (HR 0.14; 95% CI: 0.06–0.33, p < 0.001). Moreover, in AF patients, NOAC use was associated with a lower probability of MACEs (Odds Ratio 0.3; 95% CI: 0.10–0.89, p = 0.030) without increase of RBCs transfusion.ConclusionsAF increases short- and long-term risk of death in patients hospitalized due to COVID-19. However, the use of NOACs in this group may profoundly improve prognosis.
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Affiliation(s)
- Michał Terlecki
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Klocek
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Drożdż
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maryla Kocowska-Trytko
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jan W. Pęksa
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Reinhold Kreutz
- Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
- Correspondence: Reinhold Kreutz Marek Rajzer
| | - Maciej Małecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Correspondence: Reinhold Kreutz Marek Rajzer
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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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17
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Leone AM, Galante D, Siudak Z. Lipoprotein(a): the hidden side of the Moon? Prognostic role of lipoprotein(a) in PCI-AMI patients. Minerva Cardiol Angiol 2023:S2724-5683.22.06271-8. [PMID: 36645388 DOI: 10.23736/s2724-5683.22.06271-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Antonio M Leone
- Sacred Heart Catholic University, Rome, Italy - .,Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | | | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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18
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Kaziród-Wolski K, Sielski J, Gąsior M, Bujak K, Hawranek M, Pyka Ł, Gierlotka M, Pawłowski T, Siudak Z. Factors affecting short- and long-term survival of patients with acute coronary syndrome treated invasively using intravascular ultrasound and fractional flow reserve: Analysis of data from the Polish Registry of Acute Coronary Syndromes 2017-2020. Kardiol Pol 2023; 81:265-272. [PMID: 36404732 DOI: 10.33963/kp.a2022.0261] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are invasive procedures increasingly used in treating acute coronary syndrome (ACS). AIMS This study aimed to evaluate the frequency of IVUS and FFR use in patients with ACS in Poland and to assess the safety of these procedures as well as their impact on short- and long-term survival. METHODS AND RESULTS This retrospective study included 103849 patients enrolled in the Polish Registry of Acute Coronary Syndromes in 2017-2020. IVUS was performed in 1727 patients, FFR in 1537 patients, and both procedures in 37 patients. The frequency of performing FFR in ACS patients increased over the years from 1.3% to 1.8% (P <0.0001) and IVUS from 1.7% to 2.3% (P <0.0001). In the FFR and/or IVUS group, a similar incidence of stroke, reinfarction, target vessel revascularization, and major bleeding was observed while in-hospital mortality was lower (0% for IVUS + FFR vs. 0.9% for FFR vs. 2.3% for IVUS vs. 3.7 for no procedure; P <0.0001). FFR and IVUS did not affect the 30-day and one-year prognosis. CONCLUSION In recent years, the number of FFR and IVUS procedures performed in patients with ACS in Poland has increased. There was lower in-hospital mortality in the FFR and/or IVUS group in ACS patients, and no differences in the incidence of stroke, reinfarction, target vessel revascularization, and major bleeding were observed. Performing FFR and IVUS in ACS patients does not significantly affect 30-day or one-year mortality.
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Affiliation(s)
| | - Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Kamil Bujak
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Michał Hawranek
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Łukasz Pyka
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | | | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, Kielce, Poland
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19
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Kobo O, Abramov D, Davies S, Ahmed SB, Sun LY, Mieres JH, Parwani P, Siudak Z, Van Spall HG, Mamas MA. CKD-Associated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020. Kidney Med 2022; 5:100597. [PMID: 36814454 PMCID: PMC9939730 DOI: 10.1016/j.xkme.2022.100597] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 12/29/2022] Open
Abstract
Rationale & Objective Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular (CV) mortality, but there are limited data on temporal trends disaggregated by sex, race, and urban/rural status in this population. Study Design Retrospective observational study. Setting & Participants The Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research database. Exposure & Predictors Patients with CKD and end-stage kidney disease (ESKD) stratified according to key demographic groups. Outcomes Etiologies of CKD- and ESKD-associated mortality between 1999 and 2000. Analytical Approach Presentation of age-adjusted mortality rates (per 100,000 people) characterized by CV categories, ethnicity, sex (male or female), age categories, state, and urban/rural status. Results Between 1999 and 2020, we identified 1,938,505 death certificates with CKD (and ESKD) as an associated cause of mortality. Of all CKD-associated mortality, the most common etiology was CV, with 31.2% of cases. Between 1999 and 2020, CKD-related age-adjusted mortality increased by 50.2%, which was attributed to an 86.6% increase in non-CV mortality but a 7.1% decrease in CV mortality. Black patients had a higher rate of CV mortality throughout the study period, although Black patients experienced a 38.6% reduction in mortality whereas White patients saw a 2.7% increase. Hispanic patients experienced a greater reduction in CV mortality over the study period (40% reduction) compared to non-Hispanic patients (3.6% reduction). CV mortality was higher in urban areas in 1999 but in rural areas in 2020. Limitations Reliance on accurate characterization of causes of mortality in a large dataset. Conclusions Among patients with CKD-related mortality in the United States between 1999 and 2020, there was an increase in all-cause mortality though a small decrease in CV-related mortality. Overall, temporal decreases in CV mortality were more prominent in Hispanic versus non-Hispanic patients and Black patients versus White patients.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel,Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Simon Davies
- Department of Renal Medicine, School of Medicine, Keele University, David Weatherall Building, Keele, United Kingdom
| | - Sofia B. Ahmed
- Department of Medicine, University of Calgary, Alberta, Canada,Libin Cardiovascular Institute of Alberta, Calgary, Canada,Alberta Kidney Disease Network, Calgary, Canada
| | - Louise Y. Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer H. Mieres
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada,Research Institute of St. Joseph’s, Hamilton, Ontario, Canada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom,Address for Correspondence: Mamas A. Mamas, Professor of Cardiology, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK.
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20
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Tokarek T, Dziewierz A, Zeliaś A, Malinowski KP, Rakowski T, Dudek D, Siudak Z. Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest. Int J Environ Res Public Health 2022; 20:337. [PMID: 36612658 PMCID: PMC9819125 DOI: 10.3390/ijerph20010337] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Patients with ST-segment-elevation myocardial infarction (STEMI) treated during the COVID-19 pandemic might experience prolonged time to reperfusion. The delayed reperfusion may potentially aggravate the risk of out-of-hospital cardiac arrest (OHCA) in those patients. Limited access to healthcare, more reluctant health-seeking behaviors, and bystander readiness to render life-saving interventions might additionally contribute to the suggested change in the risk of OHCA in STEMI. Thus, we sought to explore the effects of the COVID-19 outbreak on treatment delay and clinical outcomes of patients with STEMI with OHCA. Overall, 5,501 consecutive patients with STEMI complicated by OHCA and treated with primary percutaneous coronary intervention with stent implantation were enrolled. A propensity score matching was used to obviate the possible impact of non-randomized design. A total of 740 matched pairs of patients with STEMI and OHCA treated before and during the COVID-19 pandemic were compared. A similar mortality and prevalence of periprocedural complications were observed in both groups. However, patients treated during the COVID-19 outbreak experienced longer delays from first medical contact to angiography (88.8 (±61.5) vs. 101.4 (±109.8) [minutes]; p = 0.006). There was also a trend toward prolonged time from pain onset to angiography in patients admitted to the hospital in the pandemic era (207.3 (±192.8) vs. 227.9 (±231.4) [minutes]; p = 0.06). In conclusion, the periprocedural outcomes in STEMI complicated by OHCA were comparable before and during the COVID-19 era. However, treatment in the COVID-19 outbreak was associated with a longer time from first medical contact to reperfusion.
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Affiliation(s)
- 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
| | - 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
| | - Aleksander Zeliaś
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, 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
| | - Dariusz Dudek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-317 Kielce, Poland
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21
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Dziewierz A, Zabojszcz M, Natorska J, Ślusarczyk-Dolecka M, Kuleta M, Siudak Z. Dapagliflozin reduces plasma concentration of plasminogen activator inhibitor-1 in patients with heart failure with preserved ejection fraction and type 2 diabetes. Pol Arch Intern Med 2022; 132. [PMID: 36520466 DOI: 10.20452/pamw.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland,Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Zabojszcz
- Department of Internal Medicine and Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Joanna Natorska
- Department of Thromboembolic Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland,Center for Research and Innovative Technology, John Paul II Hospital, Kraków, Poland
| | | | - Martyna Kuleta
- Department of Internal Medicine and Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Zbigniew Siudak
- Department of Internal Medicine and Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
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22
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Sielski J, Jóźwiak MA, Kaziród-Wolski K, Siudak Z, Jóźwiak M. Impact of Air Pollution and COVID-19 Infection on Periprocedural Death in Patients with Acute Coronary Syndrome. Int J Environ Res Public Health 2022; 19:16654. [PMID: 36554535 PMCID: PMC9778735 DOI: 10.3390/ijerph192416654] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/22/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
Air pollution and COVID-19 infection affect the pathogenesis of cardiovascular disease. The impact of these factors on the course of ACS treatment is not well defined. The purpose of this study was to evaluate the effects of air pollution, COVID-19 infection, and selected clinical factors on the occurrence of perioperative death in patients with acute coronary syndrome (ACS) by developing a neural network model. This retrospective study included 53,076 patients with ACS from the ORPKI registry (National Registry of Invasive Cardiology Procedures) including 2395 COVID-19 (+) patients and 34,547 COVID-19 (-) patients. The neural network model developed included 57 variables, had high performance in predicting perioperative patient death, and had an error risk of 0.03%. Based on the analysis of the effect of permutation on the variable, the variables with the greatest impact on the prediction of perioperative death were identified to be vascular access, critical stenosis of the left main coronary artery (LMCA) or left anterior descending coronary artery (LAD). Air pollutants and COVID-19 had weaker effects on end-point prediction. The neural network model developed has high performance in predicting the occurrence of perioperative death. Although COVID-19 and air pollutants affect the prediction of perioperative death, the key predictors remain vascular access and critical LMCA or LAD stenosis.
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Affiliation(s)
- Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | | | - Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | - Marek Jóźwiak
- Institute of Geography and Environmental Sciences, Jan Kochanowski University in Kielce, Uniwersytecka 7, 25-406 Kielce, Poland
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23
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De Luca G, Silverio A, Verdoia M, Siudak Z, Tokarek T, Kite TA, Gershlick AH, Rodriguez-Leor O, Cid-Alvarez B, Jones DA, Rathod KS, Montero-Cabezas JM, Jurado-Roman A, Nardin M, Galasso G. Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies. Eur J Intern Med 2022; 105:69-76. [PMID: 35999094 PMCID: PMC9385833 DOI: 10.1016/j.ejim.2022.08.021] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The characteristics and outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) are still poorly known. METHODS The PANDEMIC study was an investigator-initiated, collaborative, individual patient data (IPD) meta-analysis of registry-based studies. MEDLINE, ScienceDirect, Web of Sciences, and SCOPUS were searched to identify all registry-based studies describing the characteristics and outcome of SARS-CoV-2-positive STEMI patients undergoing PPCI. The control group consisted of SARS-CoV-2-negative STEMI patients undergoing PPCI in the same time period from the ISACS-STEMI COVID 19 registry. The primary outcome was in-hospital mortality; the secondary outcome was postprocedural reperfusion assessed by TIMI flow. RESULTS Of 8 registry-based studies identified, IPD were obtained from 6 studies including 941 SARS-CoV-2-positive patients; the control group included 2005 SARS-CoV-2-negative patients. SARS-CoV-2-positive patients showed a significantly higher in-hospital mortality (p < 0.001) and worse postprocedural TIMI flow (<3, p < 0.001) compared with SARS-CoV-2-negative subjects. The increased risk for SARS-CoV-2-positive patients was significantly higher in males compared to females for both the primary (pinteraction = 0.001) and secondary outcome (pinteraction = 0.023). In SARS-CoV-2-positive patients, age ≥ 75 years (OR = 5.72; 95%CI: 1.77-18.5), impaired postprocedural TIMI flow (OR = 11.72; 95%CI: 2.64-52.10), and cardiogenic shock at presentation (OR = 11.02; 95%CI: 2.84-42.80) were independent predictors of mortality. CONCLUSIONS In STEMI patients undergoing PPCI, SARS-CoV-2 positivity is independently associated with impaired reperfusion and with a higher risk of in-hospital mortality, especially among male patients. Age ≥ 75 years, cardiogenic shock, and impaired postprocedural TIMI flow independently predict mortality in this high-risk population.
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, Azienda Ospedaliero-Universitaria Sassari, Viale S. Pietro, 43/B, Sassari 07100, Italy; Division of Clinical and Interventional Cardiology, Istituto Clinico Sant'Ambrogio, Milano, Italy.
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy
| | | | - Tomasz Tokarek
- Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, Kraków 31-501, Poland; 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Thomas A Kite
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Oriol Rodriguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; CIBER de Enfermedades CardioVasculares (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Belen Cid-Alvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Krishnaraj S Rathod
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, Brescia, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
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24
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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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Zając P, Kaziród-Wolski K, Oleś I, Sielski J, Siudak Z. Role of Fibrinolysis in the Management of Patients with COVID-19 and Thromboembolic Complications: A Review. J Cardiovasc Dev Dis 2022; 9:jcdd9100356. [PMID: 36286308 PMCID: PMC9604283 DOI: 10.3390/jcdd9100356] [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: 09/14/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
An impaired fibrinolytic process has been demonstrated in patients infected with SARS-CoV-2, including those in severe or critical condition. Disruption of fibrinolysis leads to fibrin deposition, which exacerbates inflammation and fibrosis and damages the pulmonary surfactant. Numerous authors point out the different course of coagulopathy in patients with COVID-19. It is reported that they may have a state of secondary hyperfibrinolysis, which may explain, at least in part, the increased incidence of venous thromboembolism, even among those patients already receiving appropriate anticoagulant treatment. This raises the question of whether current guidelines for the prevention and treatment of embolic–thrombotic complications, among patients with severe COVID-19, are sufficient. Some studies show evidence of clinical improvement in patients who have received fibrinolytic therapy, beyond the current indications for its implementation. However, when considering the inclusion of systemic fibrinolytic therapy, the benefits of such treatment should always be weighed over the risk of adverse effects. Thromboelastography and rotational thromboelastometry can be helpful in making such decisions. The purpose of this study was to review the current knowledge regarding fibrinolysis and its role in the treatment of patients with severe COVID-19, including those with thromboembolic complications.
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Affiliation(s)
- Patrycja Zając
- The Reumatology Department, Province Hospital in Konskie, Poland ul. Gimnazjalna 41B, 26-200 Końskie, Poland
| | - Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | - Izabela Oleś
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | - Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
- Correspondence:
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
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Januszek R, Bryniarski L, Siudak Z, Malinowski KP, Surowiec S, Wanha W, Wojakowski W, Bryniarski K, Legutko J, Kambis M, Di Mario C, Bartus K, Bartus S. Procedural outcomes and annual operator volume among patients treated with percutaneous coronary intervention of chronic total occlusions – analysis based on a large national registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2070] [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: 11/13/2022] Open
Abstract
Abstract
Background
It has been demonstrated that low operator and institutional volume is associated with poorer procedural and long-term clinical outcomes in general population of patients treated with percutaneous coronary interventions (PCI).
Purpose
The aim of the current study was to assess the relationship between operator volume and procedural outcomes of patients treated with PCI within chronic total occlusion (CTO).
Methods
Data for conducting the current analysis were obtained from the national registry of percutaneous coronary interventions (ORPKI) maintained in cooperation with the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The study covered data obtained from the registry from January 2014 to December 2020. To investigate the association between operator and all periprocedural complications, coronary artery perforation (CAP) and TIMI flow grade 2/3 after PCI in the presence of confounding and clustering effects, we used multivariable, mixed effects logistic regression modelling.
Results
During the investigated period, there were 162 active CathLabs, at which 747,033 PCI procedures were performed during the time of observation. Of those 14,924 were CTO-PCI procedures. Considering the number of CTO-PCIs performed annually by individual operators during the analyzed 7 years we assessed differences between four groups (≤10; >10≤20; >20≤30 and >30 procedures). We demonstrated by nonlinear relationship with annualised CTO-PCI operator volume that operators performing more than 40 PCI with CTO per year have lower number of the overall periprocedural complications (Fig. 1) including CAP, as well greater procedural success rates (Fig. 2) compared to operators performing less procedures (p<0.0001).
Conclusions
High-volume CTO operators achieve a greater procedural success with a lower frequency of periprocedural complications. This study suggests that the cut-off of 50 CTO-PCIs per year recommended in the EuroCTO Consensus remains a reasonable compromise to optimize outcome and maintain local availability. Special CTO training programs and a higher annual case load might increase the overall quality of CTO PCI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Januszek
- University Hospital of Krakow , Krakow , Poland
| | | | - Z Siudak
- The Jan Kochanowski University in Kielce , Kielce , Poland
| | | | - S Surowiec
- University Hospital of Krakow , Krakow , Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland
| | | | - J Legutko
- Jagiellonian University , Krakow , Poland
| | - M Kambis
- University Heart Center Freiburg-Bad Krozingen , Bad Krozingen , Germany
| | - C Di Mario
- Careggi University Hospital , Florence , Italy
| | - K Bartus
- Jagiellonian University , Krakow , Poland
| | - S Bartus
- Jagiellonian University , Krakow , 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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Terlecki M, Wojciechowska W, Klocek M, Olszanecka A, Bednarski A, Drożdż T, Pavlinec C, Lis P, Zając M, Rusinek J, Siudak Z, Bartuś S, Rajzer M. Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography. Front Cardiovasc Med 2022; 9:917250. [PMID: 36211554 PMCID: PMC9536466 DOI: 10.3389/fcvm.2022.917250] [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: 04/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI). Methods There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained. Results Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14–18) vs. 12 (12–14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79–18.14; p < 0.001). Conclusion Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.
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Affiliation(s)
- Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Klocek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Drożdż
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- *Correspondence: Marek Rajzer
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Kaziród-Wolski K, Zając P, Zabojszcz M, Kołodziej A, Sielski J, Siudak Z. The Effect of COVID-19 on the Perioperative Course of Acute Coronary Syndrome in Poland: The Estimation of Perioperative Prognosis and Neural Network Analysis in 243,515 Cases from 2020 to 2021. J Clin Med 2022; 11:jcm11185394. [PMID: 36143039 PMCID: PMC9506468 DOI: 10.3390/jcm11185394] [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: 06/13/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 12/03/2022] Open
Abstract
COVID-19 causes thromboembolic complications that affect the patient’s prognosis. COVID-19 vaccines significantly improve the prognosis for the course of the infection. The aim of this study was to evaluate the impacts of patient characteristics, including COVID-19 vaccinations, on perioperative mortality in acute coronary syndrome in Poland during the pandemic. We analyzed the data of 243,515 patients from the National Registry of Invasive Cardiology Procedures (Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej [ORPKI]). In this group, 7407 patients (21.74%) had COVID-19. The statistical analysis was based on a neural network that was verified by the random forest method. In 2020, the most significant impact on prognosis came from a diagnosis of unstable angina, a short period (<2 h) from pain occurrence to first medical contact, and a history of stroke. In 2021, the most significant factors were pre-hospital cardiac arrest, female sex, and a short period (<2 h) from first medical contact to coronary angiography. After adjusting for a six-week lag, a diagnosis of unstable angina and psoriasis were found to be relevant in the data from 2020, while in 2021, it was the time from the pain occurrence to the first medical contact (2−12 h) in non-ST segment elevation myocardial infarction and the time from first contact to balloon inflation (2−12 h) in ST-segment elevation myocardial infarction. The number of vaccinations was one of the least significant factors. COVID-19 vaccination does not directly affect perioperative prognosis in patients with acute coronary syndrome.
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Affiliation(s)
- Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
- Correspondence:
| | - Patrycja Zając
- The Reumatology Department of the Province Hospital in Konskie, ul. Gimnazjalna 41B, 26-200 Konskie, Poland
| | - Michał Zabojszcz
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | - Agnieszka Kołodziej
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | - Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, al. IX Wieków Kielc 19A, 25-369 Kielce, 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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Piątek Ł, Piątek K, Kurzawski J, Sadowski M, Malinowski K, Cecha P, Bartuś S, Siudak Z. Predictors and periprocedural outcomes of access crossover during primary percutaneous coronary interventions - a contemporary report from the Polish ORPKI registry. Kardiol Pol 2022; 80:799-805. [PMID: 35521715 DOI: 10.33963/kp.a2022.0121] [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 The radial artery became preferable access for percutaneous coronary interventions (PCI). The latest European Society of Cardiology guidelines strongly recommended transradial access in patients with ST-segment elevation myocardial infarction (STEMI). Though, in a significant portion of the coronary artery, invasive procedure crossover to femoral is necessary. AIMS This study aimed to determine the ratio, risk factors, and periprocedural outcomes of crossover from radial to femoral access during PCI in a contemporary STEMI registry. METHODS Based on data from the Polish registry ORPKI, we analyzed 90245 patients with a diagnosis of STEMI that were intended to be treated invasively via transradial access between 2014 and 2019. RESULTS In 1484 (1.6 %) individuals, a switch to femoral access was necessary during the procedure. The most important independent predictors of vascular crossover were female sex, previous coronary artery bypass graft, class 3 and 4 of the Killip scale, left main disease, as well as any complications during coronary angiography. In that cohort, the risk of bleeding at the puncture site was over 20-fold higher. Major disparities in periprocedural outcomes (death during procedure, cardiac arrest during PCI, Thrombolysis In Myocardial Infarction (TIMI) after PCI, and no-reflow) between these groups resulted from disparities in initial characteristics, and they were not associated with crossover itself. CONCLUSIONS Even though the risk of crossover to femoral is currently low, it appears to be indispensable to sustain operators' experience both in radial and femoral approaches to achieve the best outcomes in these patients.
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Affiliation(s)
- Łukasz Piątek
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
| | - Karolina Piątek
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Jacek Kurzawski
- 2nd Department of Cardiology, Świętokrzyskie Cardiology Center, Kielce, Poland
| | - Marcin Sadowski
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Krzysztof Malinowski
- 2nd Department of Cardiology, Collegium Medicum, Jagiellonian University in Krakow, Kraków, Poland
| | - Patrycja Cecha
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Collegium Medicum, Jagiellonian University in Krakow, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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Januszek R, Wańha W, Siudak Z, Malinowski K, Wojakowski W, Reczuch K, Dobrzycki S, Lesiak M, Gil R, Witkowski A, Bartuś S. TCTAP A-036 Annual Operator Volume Among Patients Treated Using Percutaneous Coronary Interventions With Rotational Atherectomy and Procedural Outcomes - Analysis Based on a Large National Registry. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Januszek R, Siudak Z, Malinowski KP, Wańha W, Wojakowski W, Reczuch K, Dobrzycki S, Lesiak M, Hawranek M, Gil RJ, Witkowski A, Lekston A, Gąsior M, Chyrchel M, Jędrychowska M, Bartuś K, Zajdel W, Legutko J, Bartuś S. Annual operator volume among patients treated using percutaneous coronary interventions with rotational atherectomy and procedural outcomes: Analysis based on a large national registry. Catheter Cardiovasc Interv 2022; 99:1723-1732. [PMID: 35318789 DOI: 10.1002/ccd.30155] [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] [Received: 11/08/2021] [Revised: 01/31/2022] [Accepted: 03/05/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low operator and institutional volume are associated with poorer procedural and long-term clinical outcomes in the general population of patients treated with percutaneous coronary interventions (PCI). AIM To assess the relationship between operator experience and procedural outcomes of patients treated with PCI and rotational atherectomy (RA). METHODS Data for conducting the current analysis were obtained from the national registry of percutaneous coronary interventions (ORPKI) maintained in cooperation with the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The study covers data from January 2014 to December 2020. RESULTS During the investigated period, there were 162 active CathLabs, at which 747,033 PCI procedures were performed by 851 operators (377 RA operators [44.3%]). Of those, 5188 were PCI with RA procedures; average 30 ± 61 per site/7 years (Me: 3; Q1-Q3: 0-31); 6 ± 18 per operator/7 years (Me: 0; Q1-Q3: 0-3). Considering the number of RA procedures annually performed by individual operators during the analyzed 7 years, the first quartile totaled (Q1: < =2.57), the second (Q2: < =5.57), and the third (Q3: < =11.57), while the fourth quartile was (Q4: > 11.57). The maximum number of procedures was 39.86 annually per operator. We demonstrated, through a nonlinear relationship with annualized operator volume and risk-adjusted, that operators performing more PCI with RA per year (fourth quartile) have a lower number of the overall periprocedural complications (p = 0.019). CONCLUSIONS High-volume RA operators are related to lower overall periprocedural complication occurrence in patients treated with RA in comparison to low-volume operators.
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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, Department of Internal Medicine, Jan Kochanowski University, Kielce, Poland
| | - Krzysztof P Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Faculty of Medicine, Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Sławomir Dobrzycki
- Department of Invasive Cardiology, State Teaching Hospital, Medical University of Białystok, Białystok, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznań 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 J Gil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, 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
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Wojciech Zajdel
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, 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
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Wahler S, Birkemeyer R, Alexopoulos D, Siudak Z, Müller A, von der Schulenburg JM. Cost-effectiveness of a photopethysmographic procedure for screening for atrial fibrillation in 6 European countries. Health Econ Rev 2022; 12:17. [PMID: 35218421 PMCID: PMC8882287 DOI: 10.1186/s13561-022-00362-2] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/10/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Strokes cause an estimated annual health care burden of 170 billion euros across Europe. Atrial fibrillation is one of the major risk factors for stroke and increases the individual risk 4.2-fold. But prevention with anticoagulants may reduce this risk by 70%. Screening methods are employed to detect previously undetected atrial fibrillation. Screening studies in various European countries show a high degree of undetected atrial fibrillation. This study aims to assess the cost-effectiveness of systematic screening with a smartphone application, named Preventicus Heartbeats. It is a hands-on screening tool for use on smartphone to diagnose AF with high sensitivity and specificity. METHODS A previously published model for calculating screening cost-effectiveness was extended to 6 European countries covering a wide range in terms of treatment costs and epidemiologic parameters. RESULTS The use of screening lowers the cost per case in countries with comparatively high levels of health care costs (Switzerland: -€75; UK: -€7). Moderate higher costs per case were observed in 4 countries (Greece: €6; Netherlands: €15). Low levels of health care costs result in less or no potential for further cost reduction (Poland: €20; Serbia: €33). In all countries considered, the model showed an increase in effectiveness measures both in the number of strokes avoided and the quality adjusted life years. The number of strokes avoided per 1000 participants ranged from 2.52 (Switzerland) to 4.44 (Poland). Quality-adjusted life-years per case gained from screening ranged from 0.0105 (Switzerland) to 0.0187 (Poland). The screening procedure dominated in two countries (Switzerland, UK). For the remaining countries, the incremental cost effectiveness ratio ranged from €489/QALY (Greece) to €2548/QALY (Serbia). CONCLUSION The model results showed a strong dependence of the results on the country-specific costs for stroke treatment. The use of the investigated screening method is close to cost-neutral or cost-reducing in the Western European countries and Greece. In countries with low price levels, higher cost increases due to AF screening are to be expected. Lower costs of anticoagulation, which are expected due to the upcoming patent expiry of direct anticoagulants, have a positive effect on the cost result.
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Affiliation(s)
- Steffen Wahler
- St. Bernward GmbH, Friedrich-Kirsten-Straße 40, D-22391, Hamburg, Germany.
| | | | - Dimitrios Alexopoulos
- Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Tetrapoleos 18, GR-115 27, Athens, Greece
| | - Zbigniew Siudak
- Department of Internal Medicine and Cardiology, Jan Kochanowski University, Stefana Żeromskiego 5, PL-25-369, Kielce, Poland
| | - Alfred Müller
- Analytic Services GmbH, Jahnstr. 34c, D-80469, Munich, Germany
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36
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Sielski J, Kaziród-Wolski K, Jurys K, Wałek P, Siudak Z. The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019. J Clin Med 2021; 10:jcm10235716. [PMID: 34884418 PMCID: PMC8658305 DOI: 10.3390/jcm10235716] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. Methods: The observational cohort study group consisted of 118,601 participants recruited from the National Registry of Invasive Cardiology Procedures (ORPKI). Results: Procedure-related death occurred in 802 (1.0%) men and in 663 (1.7%) women. The odds of procedure-related death among women were significantly higher than among men (OR, 1.76; 95% CI, 1.59–1.95; p < 0.001). The probability of procedure-related mortality was highest in both men and women with cardiac arrest in the cath lab, critical stenosis of the left main coronary artery, and direct transfer to the cath lab. The factors that reduced the probability of procedure-related mortality in both men and women were thrombolysis in myocardial infarction (TIMI) flow grade and the use of P2Y12 inhibitors in the peri-infarct period. Psoriasis was associated with increased odds of procedure-related death among men, whereas cigarette smoking reduced the odds among women. Conclusions: Procedure-related deaths occurred more frequently in women than men with STEMI. Additional scrutiny needs to be undertaken to identify factors influencing survival regarding gender differences.
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Affiliation(s)
- Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
| | - Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
| | - Karolina Jurys
- Hospital Emergency Department, Provincial Hospital, 25-736 Kielce, Poland;
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
- Correspondence: ; Tel.: +48-41-3671-493
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, Żeromskiego 5 St., 25-600 Kielce, Poland; (J.S.); (K.K.-W.); (Z.S.)
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Kaziród-Wolski K, Sielski J, Sidło J, Januszek R, Siudak Z. The Most Relevant Factors Affecting the Perioperative Death Rate in Patients with Acute Coronary Syndrome and COVID-19, Based on Annual Follow-Up in the ORPKI Registry. Biomedicines 2021; 9:biomedicines9121813. [PMID: 34944629 PMCID: PMC8698975 DOI: 10.3390/biomedicines9121813] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 01/14/2023] Open
Abstract
Background: The COVID-19 pandemic is significantly affecting the functioning of the entire healthcare system. The disease itself may be associated with thromboembolic complications. The purpose of this study is to compare patients with acute coronary syndrome (ACS) and patients with ACS who were diagnosed with COVID-19 in terms of their clinical profile, management, treatment complications, and prognosis. Methods: We analyzed 47,940 cases of patients treated for ACS in 2020, including 44,952 patients (93.8%) who were not diagnosed with COVID-19 and 2988 patients (6.2%) who tested positive for COVID-19. Results: Patients with COVID-19 were significantly more likely to experience out-of-hospital sudden cardiac arrest (7.9 vs. 1.1%; p < 0.0001) and be transported directly to a catheterization laboratory (21.3% vs. 8.1%; p < 0.0001). Mortality was significantly higher in this group (0.9% vs. 0.4%; p < 0.0001). The risk of perioperative death was increased by age over 65 years, use of glycoprotein IIb/IIIa inhibitors (GPI IIb/IIIa), femoral access, critical left main stem coronary artery (LMCA) vascular lesions, ST elevation myocardial infarction (STEMI), and no-reflow phenomenon. Conclusions: Despite the pandemic, patients with COVID-19 were treated equally to healthy patients. Efficient organization of the healthcare system allowed the prompt transportation of patients to catheterization laboratories. The study group was characterized by a worse prognosis that was affected by multiple factors.
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Affiliation(s)
- Karol Kaziród-Wolski
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland; (K.K.-W.); (J.S.); (Z.S.)
| | - Janusz Sielski
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland; (K.K.-W.); (J.S.); (Z.S.)
- Correspondence:
| | - Jacek Sidło
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland; (K.K.-W.); (J.S.); (Z.S.)
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Krakow, Poland;
- Second Department of Cardiology, Faculty of Medicine, Institute of Cardiology, Medical College, Jagiellonian University, 30-688 Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University in Kielce, 25-369 Kielce, Poland; (K.K.-W.); (J.S.); (Z.S.)
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Januszek R, Zabojszcz M, Cyran-Stemplewska S, Kręcisz B, Bartuś S, Siudak Z. Impact of psoriasis on ticagrelor platelet activity versus clopidogrel in patients with chronic coronary syndromes treated via percutaneous coronary intervention. Pol Arch Intern Med 2021; 131. [PMID: 34612030 DOI: 10.20452/pamw.16105] [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: 11/23/2022]
Affiliation(s)
- Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Department of Clinical Rehabilitation, University of Physical Education, Kraków, Poland.
| | | | | | - Beata Kręcisz
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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Sielski J, Kaziród-Wolski K, Siudak Z. Risk of perioperative death and sudden cardiac arrest: A study of 113 456 cases from the National Registry of Invasive Cardiology Procedures (ORPKI) for estimation of the perioperative prognosis. Kardiol Pol 2021; 79:1328-1334. [PMID: 34643263 DOI: 10.33963/kp.a2021.0133] [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: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite optimizing treatment of ST-segment elevation myocardial infarction (STEMI), a number of patients die during the invasive procedure or experience sudden cardiac arrest (SCA) that complicates further hospitalization. AIMS This study aimed to identify the most important risk factors leading to SCA and death in the cath lab among STEMI patients. METHODS We used data from the National Registry of Invasive Cardiology Procedures (ORPKI) collected between 2014 and 2019. The study population consisted of 113 465 patients. Descriptive statistics, univariate and multiple logistic regression analysis of factors affecting perioperative mortality (PM) and SCA in the cath lab were performed. RESULTS Death and SCA occurred in 1549 (1.4%) and 945 (0.8%) patients, respectively. Diabetes (odds ratio [OR], 1.76; P <0.0001), previous brain stroke (OR, 2.26; P <0.0001), prior myocardial infarction (OR, 1.81; P <0.0001), psoriasis (OR, 1.79; P = 0.04), and chronic renal failure (OR, 2.79; P <0.0001) were the strongest predictors of PM. The occurrence of SCA was dependent mainly on diabetes (OR, 1.37; P = 0.0001), previous brain stroke (OR, 2.23; P <0.0001), prior myocardial infarction (OR, 1.73; P <0.0001), psoriasis (OR, 2.03; P = 0.04), and chronic renal failure (OR, 2.79; P <0.0001). Of the pre-hospital factors, the Killip-Kimball class showed the strongest relationship with the two endpoints (OR 3.53; P <0.0001 and OR 2.65; P <0.0001, respectively). CONCLUSIONS Diabetes, previous brain stroke, myocardial infarction, psoriasis, chronic renal failure, and the Killip-Kimball class were the strongest predictors of PM and SCA in the cath lab among STEMI patients.
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Affiliation(s)
- Janusz Sielski
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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40
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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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41
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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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Tokarek T, Dziewierz A, Malinowski K, Rakowski T, Bartus S, Dudek D, Siudak Z. Treatment delay and clinical outcomes in patients with ST-elevation myocardial infarction during the COVID-19 pandemic. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1470] [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
The COVID-19 pandemic negatively affected access to health-care system and timeline of treatment. The fear of contamination might potentially forbear from accessing the emergency system.mFurthermore, pandemic-specific protocols require additional time to prepare medical stuff and catheterization laboratory before procedure. Thus, patients with ST-segment elevation myocardial infarction (STEMI) might be exposed to a longer delay for revascularization and higher risk of mortality.
Purpose
The aim of this study was to evaluate treatment delay and clinical outcomes in COVID-19 positive and negative patients with STEMI treated with percutaneous coronary intervention (PCI) during on- and off hours.
Methods
All consecutive patients with STEMI treated with PCI and stent implantation between 1st March 2020 and 31st December 2020 were enrolled into analysis. To overcome potential bias related to the non-randomized design a propensity score match (PSM) was used to compare COVID-19 positive and negative patients for both working frames hours. The study group consisted of 877 matched pairs treated during regular hours (everyday 7:00AM-16:59PM) and 418 matched pairs with PCI performed during off-hours (everyday 17:00PM and 06:59AM) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry).
Results
After PSM there were no differences between COVID-19 positive and negative patients in baseline characteristics during both on- and off-hours. However, patients diagnosed with COVID-19 were admitted with cardiac arrest more frequently as compared to COVID-19 negative patients during regular working hours (180 (20.5%) vs. 64 (7.30%); p=0.001). There were no differences in radiation doses and total amount of contrast between both groups. Similarly, no differences in rate of periprocedural complications were observed despite of time of intervention, including stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. Furthermore, there were no differences in periprocedural mortality between both groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%),p=0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%),p=0.5). However, COVID-19 positive patients were exposed to longer time from first medical contact to angiography during both on-hours (133.76 (±137.10) vs. 117.14 (±135.83) [min]; p=0.001) and off-hours (148.08 (±201.56) vs. 112.19 (±138.72) [min]; p=0.003). Time from pain to first medical contact remained similar during both working frame hours (On-hours and off-hours, respectively: p=0.7 and p=0.9).
Conclusions
Patients diagnosed with COVID-19 might experience a longer time from first medical contact to revascularization. There was no impact of COVID-19 diagnosis on rate of periprocedural mortality or periprocedural complication, irrespective of time of intervention. System-level changes might be crucial to improve health-care during COVID-19 pandemic.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Tokarek
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - A Dziewierz
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - K Malinowski
- Jagiellonian University Medical College, Cracow, Poland
| | - T Rakowski
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - S Bartus
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - D Dudek
- Jagiellonian University Medical College, Cracow, Poland
| | - Z Siudak
- The Jan Kochanowski University in Kielce, Kielce, Poland
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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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Cecha P, Chromik A, Piotrowska I, Zabojszcz M, Dolecka-Ślusarczyk M, Siudak Z. Assessment of application of the new 2019 European Society of Cardiology/ European Atherosclerosis Society Guidelines for the Management of Dyslipidaemias in daily clinical practice - one center study. Folia Med Cracov 2021; 61:43-54. [PMID: 34882663 DOI: 10.24425/fmc.2021.138950] [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
B a c k g r o u n d: Cardiovascular diseases are the first cause of death globally. Hypercholester- olemia is the most important factor responsible for atherosclerotic plaque formation and increasing cardiovascular risk. Reduction of LDL-C level is the most relevant goal for reduction of cardiovascular risk. A i m s: Real life adherence to guidelines concerning statin therapy in one center study population. M e t h o d s: We analyzed data collected in the Department of Internal Diseases from September 2019 to February 2020, obtained from 238 patients hospitalized in this time period. We assessed application of the new 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias in daily clinical practice and compared effectiveness of LLT according to 2016 and 2019 guidelines. R e s u l t s: Only 1 in 5 patients with dyslipideamia achieve the 2019 ESC/EAS guideline-recommended levels of LDL-C with relation to their TCVR. We noticed that 20 of patients who did not achieve proper 2019 LDL level, meet new therapy targets established in year 2016. We observed that higher patient TCVR resulted in better compliance with guidelines and ordination of proper LLT. Most patients were on monotherapy with statins. C o n c l u s i o n s: It could be beneficial to start treatment with double or even triple therapy especially in group with the highest LDL-C levels.
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Affiliation(s)
- Patrycja Cecha
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
| | - Anna Chromik
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | | | | | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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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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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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47
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Tokarek T, Dziewierz A, Malinowski KP, Rakowski T, Bartuś S, Dudek D, Siudak Z. Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic. J Clin Med 2021; 10:jcm10173920. [PMID: 34501369 PMCID: PMC8432080 DOI: 10.3390/jcm10173920] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 02/02/2023] Open
Abstract
Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%); p = 0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%); p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min); p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min); p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention.
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Affiliation(s)
- Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-22-62
| | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Krzysztof Piotr Malinowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Tomasz Rakowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-369 Kielce, Poland;
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Jędrychowska M, Siudak Z, Malinowski KP, Zandecki Ł, Zabojszcz M, Kameczura T, Mika P, Bartuś K, Wańha W, Wojakowski W, Legutko J, Bartuś S, Januszek R. ST-segment elevation myocardial infarction with non-obstructive coronary arteries: Score derivation for prediction based on a large national registry. PLoS One 2021; 16:e0254427. [PMID: 34351919 PMCID: PMC8341573 DOI: 10.1371/journal.pone.0254427] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute myocardial infarction with ST-segment elevation (STEMI) and obstructive coronary arteries (MI-CAD) are treated with primary percutaneous coronary interventions (pPCI), while patients with STEMI and non-obstructive coronary arteries (MINOCA), usually require non-invasive therapy. The aim of the study is to design a score for predicting suspected MINOCA among an overall group of STEMI patients. MATERIALS AND METHODS Based on the Polish national registry of PCIs, we evaluated patients between 2014 and 2019, and selected 526,490 subjects treated with PCI and 650,728 treated using only coronary angiography. These subjects were chosen out of 1,177,218 patients who underwent coronary angiography. Then, we selected 124,663 individuals treated with pPCI due to STEMI and 5,695 patients with STEMI and MINOCA. The score for suspected MINOCA was created using the regression model, while the coefficients calculated for the final model were used to construct a predictive model in the form of a nomogram. RESULTS Patients with MINOCA differ significantly from those in the MI-CAD group; they were significantly younger, less often males and demonstrated smaller burden of concomitant diseases. The model allowed to show that patients who scored more than 600 points had a 19% probability of MINOCA, while for those scoring more than 650 points, the likelihood was 71%. The other end of the MINOCA probability scale was marginal for patients who scored less than 500 points (< .2%). CONCLUSIONS Based on the created MINOCA score presented in the current publication, we are able to distinguish MINOCA from MI-CAD patients in the STEMI group.
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Affiliation(s)
- Magdalena Jędrychowska
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | - Łukasz Zandecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | - Tomasz Kameczura
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Piotr Mika
- Department of Clinical Rehabilitation, University School of Physical Education, Kraków, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, 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
| | - Stanisław Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Januszek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Department of Clinical Rehabilitation, University School of Physical Education, Kraków, Poland
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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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50
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Terlecki M, Wojciechowska W, Dudek D, Siudak Z, Plens K, Guzik TJ, Drożdż T, Pęksa J, Bartuś S, Wojakowski W, Grygier M, Rajzer M. Impact of acute total occlusion of the culprit artery on outcome in NSTEMI based on the results of a large national registry. BMC Cardiovasc Disord 2021; 21:297. [PMID: 34126930 PMCID: PMC8204478 DOI: 10.1186/s12872-021-02099-y] [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: 12/02/2020] [Accepted: 05/31/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The impact of acute total occlusion (TO) of the culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate the clinical and angiographic phenotype and outcome of NSTEMI patients with TO (NSTEMITO) compared to NSTEMI patients without TO (NSTEMINTO) and those with ST-segment elevation and TO (STEMITO). METHODS Demographic, clinical and procedure-related data of patients with acute myocardial infarction who underwent percutaneous coronary intervention (PCI) between 2014 and 2017 from the Polish National Registry were analysed. RESULTS We evaluated 131,729 patients: NSTEMINTO (n = 65,206), NSTEMITO (n = 16,209) and STEMITO (n = 50,314). The NSTEMITO group had intermediate results compared to the NSTEMINTO and STEMITO groups regarding mean age (68.78 ± 11.39 vs 65.98 ± 11.61 vs 64.86 ± 12.04 (years), p < 0.0001), Killip class IV on admission (1.69 vs 2.48 vs 5.03 (%), p < 0.0001), cardiac arrest before admission (2.19 vs 3.09 vs 6.02 (%), p < 0.0001) and death during PCI (0.43 vs 0.97 vs 1.76 (%), p < 0.0001)-for NSTEMINTO, NSTEMITO and STEMITO, respectively. However, we noticed that the NSTEMITO group had the longest time from pain to first medical contact (median 4.0 vs 5.0 vs 2.0 (hours), p < 0.0001) and the lowest frequency of TIMI flow grade 3 after PCI (88.61 vs 83.36 vs 95.57 (%), p < 0.0001) and that the left circumflex artery (LCx) was most often the culprit lesion (14.09 vs 35.86 vs 25.42 (%), p < 0.0001). CONCLUSIONS The NSTEMITO group clearly differed from the NSTEMINTO group. NSTEMITO appears to be an intermediate condition between NSTEMINTO and STEMITO, although NSTEMITO patients have the longest time delay to and the worst result of PCI, which can be explained by the location of the culprit lesion in the LCx.
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Affiliation(s)
- Michał Terlecki
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Wiktoria Wojciechowska
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Dariusz Dudek
- Jagiellonian University Medical College, 2nd Department of Cardiology, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | - Tomasz J Guzik
- Jagiellonian University Medical College, Department of Internal and Agricultural Medicine, Kraków, Poland
| | - Tomasz Drożdż
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Jan Pęksa
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland
| | - Stanisław Bartuś
- Jagiellonian University Medical College, 2nd Department of Cardiology, Kraków, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Grygier
- 1St Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Rajzer
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jakubowskiego St. 2, 30-688, Kraków, Poland.
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