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Kuźma Ł, Dąbrowski EJ, Kurasz A, Święczkowski M, Jemielita P, Kowalewski M, Wańha W, Kralisz P, Tomaszuk-Kazberuk A, Bachórzewska-Gajewska H, Dobrzycki S, Lip GY. Effect of air pollution exposure on risk of acute coronary syndromes in Poland: a nationwide population-based study (EP-PARTICLES study). Lancet Reg Health Eur 2024; 41:100910. [PMID: 38665621 PMCID: PMC11041836 DOI: 10.1016/j.lanepe.2024.100910] [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] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Background Air pollution (AP) is linked up to 20% of cardiovascular deaths. The aim of this nationwide study was to investigate subpopulations vulnerable to AP for non-ST- (NSTEMI) and ST-elevation myocardial infarction (STEMI) incidence. Methods We analysed short- (lags up to seven days) and mid-term (0-30 days moving average) influence of particulate matter (PM2.5), sulphur dioxide (SO2), nitrogen dioxide (NO2) and benzo(a)pyrene (BaP) on hospitalizations due NSTEMI and STEMI in 2011-2020. Data on AP concentrations were derived using GEM-AQ model. Study included residents of five voivodeships in eastern Poland, inhabited by over 8,000,000 individuals. Findings Higher NO2 and PM2.5 concentrations increased mid-term risk of NSTEMI in patients aged < 65 years by 1.3-5.7%. Increased SO2 and PM2.5 concentration triggered STEMI in the short- (SO2, PM2.5) and mid-term (PM2.5) amongst those aged ≥ 65 years. In the short- and mid-term, women were more susceptible to PM2.5 and BaP influence resulting in increased STEMI incidence. In rural regions, STEMI risk was triggered by SO2, PM2.5 and BaP. Income-based stratification showed disproportions regarding influence of BaP concentrations on NSTEMI incidence based on gross domestic product (up to 1.4%). Interpretation There are significant disparities in the influence of air pollution depending on the demographic and socio-economic factors. AP exposure is associated with the threat of a higher risks of NSTEMI and STEMI, especially to younger people, women, residents of rural areas and those with lower income. Funding National Science Center and Medical University of Bialystok, Poland.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Emil J. Dąbrowski
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Michał Święczkowski
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Piotr Jemielita
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, 137 Wołoska St., Warszawa 02-507, Poland
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Centre Maastricht (CARIM), P. Debyelaan 25, Maastricht 6229 HX, the Netherlands
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, 1 Via Tricomi, Palermo 90127, Italy
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 13/15 Jagiellońska St., Bydgoszcz 85-067, Poland
| | - Wojciech Wańha
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, 13/15 Jagiellońska St., Bydgoszcz 85-067, Poland
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 15 Poniatowskiego St., Katowice 40-055, Poland
| | - Paweł Kralisz
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, 14 Żurawia St., Białystok 15-540, Poland
| | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Białystok, 1 Kilinskiego St., Białystok 15-089, Poland
| | - Gregory Y.H. Lip
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, 14 Żurawia St., Białystok 15-540, Poland
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Egerton Court, 2 Rodney St, Liverpool L3 5UX, United Kingdom
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 7K, Aalborg 9220, Denmark
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Dąbrowski EJ, Kurasz A, Pasierski M, Pannone L, Kołodziejczak MM, Raffa GM, Matteucci M, Mariani S, de Piero ME, La Meir M, Maessen B, Meani P, McCarthy P, Cox JL, Lorusso R, Kuźma Ł, Rankin SJ, Suwalski P, Kowalewski M. Surgical Coronary Revascularization in Patients With Underlying Atrial Fibrillation: State-of-the-Art Review. Mayo Clin Proc 2024:S0025-6196(23)00606-7. [PMID: 38661599 DOI: 10.1016/j.mayocp.2023.12.005] [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] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 04/26/2024]
Abstract
The number of individuals referred for coronary artery bypass grafting (CABG) with preoperative atrial fibrillation (AF) is reported to be 8% to 20%. Atrial fibrillation is a known marker of high-risk patients as it was repeatedly found to negatively influence survival. Therefore, when performing surgical revascularization, consideration should be given to the concomitant treatment of the arrhythmia, the clinical consequences of the arrhythmia itself, and the selection of adequate surgical techniques. This state-of-the-art review aimed to provide a comprehensive analysis of the current understanding of, advancements in, and optimal strategies for CABG in patients with underlying AF. The following topics are considered: stroke prevention, prophylaxis and occurrence of postoperative AF, the role of surgical ablation and left atrial appendage occlusion, and an on-pump vs off-pump strategy. Multiple acute complications can occur in patients with preexisting AF undergoing CABG, each of which can have a significant effect on patient outcomes. Long-term results in these patients and the future perspectives of this scientific area were also addressed. Preoperative arrhythmia should always be considered for surgical ablation because such an approach improves prognosis without increasing perioperative risk. While planning a revascularization strategy, it should be noted that although off-pump coronary artery bypass provides better short-term outcomes, conventional on-pump approach may be beneficial at long-term follow-up. By collecting the current evidence, addressing knowledge gaps, and offering practical recommendations, this state-of-the-art review serves as a valuable resource for clinicians involved in the management of patients with AF undergoing CABG, ultimately contributing to improved outcomes and enhanced patient care.
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Affiliation(s)
- Emil J Dąbrowski
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Michał Pasierski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Michalina M Kołodziejczak
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department of Anesthesiology and Intensive Care, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Antoni Jurasz University Hospital No.1, Bydgoszcz, Poland
| | - Giuseppe M Raffa
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Matteo Matteucci
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Maria E de Piero
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Mark La Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bart Maessen
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Paolo Meani
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Patrick McCarthy
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Bluhm Cardiovascular Institute, Chicago, IL
| | - James L Cox
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Bluhm Cardiovascular Institute, Chicago, IL
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Scott J Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland; Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy; Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
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Muszyński P, Dąbrowski EJ, Pasławska M, Niwińska M, Kurasz A, Święczkowski M, Tokarewicz J, Kuźma Ł, Kożuch M, Dobrzycki S. Hyperuricemia as a Risk Factor in Hypertension among Patients with Very High Cardiovascular Risk. Healthcare (Basel) 2023; 11:2460. [PMID: 37685494 PMCID: PMC10486932 DOI: 10.3390/healthcare11172460] [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: 07/20/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Hypertension remains a global threat to public health, affecting the worldwide population. It is one of the most common risk factors for cardiovascular disease. Today's treatments focus on creating a hypotensive effect. However, there is a constant search for additional factors to reduce the potential of developing hypertension complications. These factors may act as a parallel treatment target with a beneficial effect in specific populations. Some studies suggest that uric acid may be considered such a factor. This study investigated the potential effect of uric acid concentrations over 5 mg/dL on the incidence of hypertension complications among patients with very high cardiovascular risk. A total of 705 patients with hypertension and very high cardiovascular risk were selected and included in the analysis. The patients were divided and compared according to serum uric acid levels. The study showed a higher occurrence of heart failure (OR = 1.7898; CI: 1.2738-2.5147; p = 0.0008), atrial fibrillation (OR = 3.4452; CI: 1.5414-7.7002; p = 0.0026) and chronic kidney disease (OR = 2.4470; CI: 1.3746-4.3558; p = 0.0024) among individuals with serum uric acid levels over 5 mg/dL, males and those with a BMI > 25 kg/m2. These findings suggest that even serum uric acid concentrations over 5 mg/dL may affect the prevalence of hypertension-related complications among patients with very high cardiovascular risk.
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Affiliation(s)
- Paweł Muszyński
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
- Department of General and Experimental Pathology, Medical University of Białystok, Mickiewicza 2C, 15-230 Białystok, Poland
| | - Emil Julian Dąbrowski
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
| | - Marta Pasławska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Białystok, J. Waszyngtona 17, 15-274 Białystok, Poland;
| | - Marta Niwińska
- Department of Family Medicine, Medical University of Białystok, Mieszka I 4B, 15-054 Białystok, Poland;
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
| | - Michał Święczkowski
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
| | - Justyna Tokarewicz
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
| | - Marcin Kożuch
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (P.M.); (A.K.); (M.Ś.); (J.T.); (Ł.K.); (M.K.)
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4
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Kuźma Ł, Roszkowska S, Święczkowski M, Dąbrowski EJ, Kurasz A, Wańha W, Bachórzewska-Gajewska H, Dobrzycki S. Exposure to air pollution and its effect on ischemic strokes (EP-PARTICLES study). Sci Rep 2022; 12:17150. [PMID: 36229478 PMCID: PMC9563068 DOI: 10.1038/s41598-022-21585-7] [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: 07/25/2022] [Accepted: 09/29/2022] [Indexed: 01/04/2023] Open
Abstract
It is well known that exceeded levels of particulate matter in the air and other air pollutants harmfully affect the cardiovascular system. Empirical analyses of the effects of these factors on stroke incidence and mortality are still limited. The main objective of our analyses was to determine the association between short-term exposure to air pollutants and stroke incidence in non-industrial areas, more specifically in north-eastern Poland. To achieve this aim, we used data from the National Health Fund on patients hospitalized for stroke between 2011 and 2020 in the largest city of the region described as the Green Lungs of Poland. The pollution levels and atmospheric conditions data were obtained from the Provincial Inspectorate for Environmental Protection and the Institute of Meteorology and Water Management. Using daily data on hospitalizations, atmospheric conditions, and pollution, as well as ordered logistic regression models the hypotheses on the impact of weather and air pollution conditions on ischemic strokes were tested. The study group included 4838 patients, 45.6% of whom were male; the average patient age was approximately 74 years. The average concentrations of PM2.5 were 19.09 µg/m3, PM10 26.66 µg/m3 and CO 0.35 µg/m3. Analyses showed that an increase in PM2.5 and PM10 concentrations by 10 µg/m3 was associated with an increase in the incidence of stroke on the day of exposure (OR = 1.075, 95% CI 0.999-1.157, P = 0.053; OR = 1.056, 95% CI 1.004-1.110, P = 0.035) and the effect was even several times greater on the occurrence of a stroke event in general (PM2.5: OR = 1.120, 95% CI 1.013-1.237, P = 0.026; PM10: OR = 1.103, 95% CI 1.028-1.182, P = 0.006). Furthermore, a short-term (up to 3 days) effect of CO on stroke incidence was observed in the study area. An increase of 1 μg/m3 CO was associated with a lower incidence of stroke 2 days after the exposure (OR = 0.976, 95% CI 0.953-0.998, P = 0.037) and a higher incidence 3 days after the exposure (OR = 1.026, 95% CI 1.004-1.049, P = 0.022).
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Affiliation(s)
- Łukasz Kuźma
- grid.48324.390000000122482838Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Sylwia Roszkowska
- grid.10789.370000 0000 9730 2769Faculty of Economics and Sociology, University of Lodz, Łódź, Poland ,grid.12847.380000 0004 1937 1290Faculty of Management, University of Warsaw, Warsaw, Poland
| | - Michał Święczkowski
- grid.48324.390000000122482838Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Emil Julian Dąbrowski
- grid.48324.390000000122482838Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Anna Kurasz
- grid.48324.390000000122482838Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Wojciech Wańha
- grid.411728.90000 0001 2198 0923Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Hanna Bachórzewska-Gajewska
- grid.48324.390000000122482838Department of Invasive Cardiology, Department of Clinical Medicine, Medical University of Bialystok, Białystok, Poland
| | - Sławomir Dobrzycki
- grid.48324.390000000122482838Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland
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Rogalska E, Kurasz A, Kuźma Ł, Bachórzewska-Gajewska H, Dobrzycki S, Koziński M, Sobkowicz B, Tomaszuk-Kazberuk A. Comparing Atrial-Fibrillation Validated Rapid Scoring Systems in the Long-Term Mortality Prediction in Patients Referred for Elective Coronary Angiography: A Subanalysis of the Białystok Coronary Project. Int J Environ Res Public Health 2022; 19:10419. [PMID: 36012052 PMCID: PMC9408630 DOI: 10.3390/ijerph191610419] [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: 07/24/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Rapid scoring systems validated in patients with atrial fibrillation (AF) may be useful beyond their original purpose. Our aim was to assess the utility of CHA2DS2-VASc, HAS−BLED, and 2MACE scores in predicting long-term mortality in the population of the Białystok Coronary Project, including AF patients. The initial study population consisted of 7409 consecutive patients admitted for elective coronary angiography between 2007 and 2016. The study endpoint was all-cause mortality, which occurred in 1244 (16.8%) patients during the follow-up, ranging from 1283 to 3059 days (median 2029 days). We noticed substantially increased all-cause mortality in patients with higher values of all compared scores. The accuracy of the scores in predicting all-cause mortality was also assessed using the receiver operator characteristic (ROC) curves. The greatest predictive value for mortality was recorded for the CHA2DS2-VASc score in the overall study population (area under curve [AUC] = 0.665; 95% confidence interval [95%CI] 0.645−0.681). We observed that the 2MACE score (AUC = 0.656; 95%CI 0.619−0.681), but not the HAS−BLED score, had similar predictive value to the CHA2DS2-VASc score for all-cause mortality in the overall study population. In AF patients, all scores did not differ in all-cause mortality prediction. Additionally, we found that study participants with CHA2DS2-VASc score ≥3 vs. <3 had a 3-fold increased risk of long-term all-cause mortality (odds ratio 3.05; 95%CI 2.6−3.6). Our study indicates that clinical scores initially validated in AF patients may be useful for predicting mortality in a broader population (e.g., in patients referred for elective coronary angiography). According to our findings, all compared scores have a moderate predictive value. However, in our study, the CHA2DS2-VASc and 2MACE scores outperformed the HAS−BLED score in terms of the long-term all-cause mortality prediction.
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Affiliation(s)
- Ewelina Rogalska
- Department of Cardiology, Medical University of Białystok, 24A Skłodowskiej-Curie, 15-276 Białystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Białystok, 24A Skłodowskiej-Curie, 15-276 Białystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Białystok, 24A Skłodowskiej-Curie, 15-276 Białystok, Poland
| | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Białystok, 24A Skłodowskiej-Curie, 15-276 Białystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Białystok, 24A Skłodowskiej-Curie, 15-276 Białystok, Poland
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, 9b Powstania Styczniowego, 81-519 Gdynia, Poland
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University of Białystok, 24A Skłodowskiej-Curie, 15-276 Białystok, Poland
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University of Białystok, 24A Skłodowskiej-Curie, 15-276 Białystok, Poland
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6
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Rogalska E, Kuźma Ł, Wojszel ZB, Kurasz A, Napalkov D, Sokolova A, Tomaszuk-Kazberuk A. Atrial fibrillation is a predictor of nonobstructive coronary artery disease in elective angiography in old age: a cross-sectional study in Poland and Russia. Aging Clin Exp Res 2022; 34:175-183. [PMID: 34117626 PMCID: PMC8794909 DOI: 10.1007/s40520-021-01895-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Significant changes in the coronary vessels are not confirmed in a large proportion of patients undergoing cardiac catheterization. AIMS The present study aimed to determine correlates and independent predictors of nonobstructive coronary artery disease (CAD) in older adults referred for elective coronary angiography. METHODS A cross-sectional study was conducted involving 2,214 patients referred to two medical centers (in Poland and Russia) between 2014 and 2016 for elective coronary angiography due to exacerbated angina, despite undergoing optimal therapy for CAD. The median age was 72 years (IQR: 68-76), and 49.5% patients were women. RESULTS Significant stenosis (defined as stenosis of 50% or more of the diameter of the left main coronary artery stem or stenosis of 70% or more of the diameter of the remaining major epicardial vessels) was diagnosed only in 1135 (51.3%) patients. Female sex (odds ratio [OR], 3.01; 95% confidence interval [CI], 2.44-3.72; p < 0.001) and atrial fibrillation (OR, 1.87; 95% CI 1.45-2.40; p < 0.001) were the main independent predictors of nonobstructive CAD. Significantly lower ORs were observed for diabetes (OR, 0.75; 95% CI 0.59-0.95; p = 0.02), chronic kidney disease (OR, 0.76; 95% CI 0.61-0.96; p = 0.02), and anemia (OR, 0.69; 95% CI 0.50-0.95; p = 0.02) after controlling for age, chronic heart failure, BMI, and study center. DISCUSSION AND CONCLUSIONS The results confirmed that nonobstructive CAD occurs in a high percentage of older patients referred for elective coronary angiography. This suggests the need to improve patient stratification for invasive diagnosis of CAD, especially for older women and patients with atrial fibrillation. Trial registration number and date of registration: NCT04537507, September 3, 2020.
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Affiliation(s)
- Ewelina Rogalska
- Department of Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland.
| | - Zyta B Wojszel
- Department of Geriatrics, Medical University of Bialystok, Fabryczna Str. 27, 15-369, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
| | - Dmitry Napalkov
- Department of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19c1, Moscow, Russia, 119146
| | - Anastasiya Sokolova
- Department of Internal Diseases, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19c1, Moscow, Russia, 119146
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University of Bialystok, M. Sklodowska-Curie Str. 24A, 15-276, Bialystok, Poland
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Kuźma Ł, Tomaszuk-Kazberuk A, Kurasz A, Dobrzycki S, Koziński M, Sobkowicz B, Lip GYH. Predicting Mortality in Patients with Atrial Fibrillation and Obstructive Chronic Coronary Syndrome: The Bialystok Coronary Project. J Clin Med 2021; 10:jcm10214949. [PMID: 34768472 PMCID: PMC8584483 DOI: 10.3390/jcm10214949] [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: 10/07/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/25/2022] Open
Abstract
Over the next decades, the prevalence of atrial fibrillation (AF) is estimated to double. Our aim was to investigate the causes of the long-term mortality in relation to the diagnosis of atrial fibrillation (AF) and chronic coronary syndrome (CCS). The analysed population consisted of 7367 consecutive patients referred for elective coronary angiography enrolled in a large single-centre retrospective registry, out of whom 1484 had AF and 2881 were diagnosed with obstructive CCS. During follow-up (median = 2029 days), 1201 patients died. The highest all-cause death was seen in AF(+)/CCS(+) [194/527; 36.8%], followed by AF(+)/CCS(−) [210/957; 21.9%], AF(−)/CCS(+) [(459/2354; 19.5%)] subgroups. AF ([HR]AC = 1.48, 95%CI, 1.09–2.01; HRCV = 1.34, 95%CI, 1.07–1.68) and obstructive CCS (HRAC = 1.90, 95%CI, 1.56–2.31; HRCV = 2.27, 95%CI, 1.94–2.65) together with age, male gender, heart failure, obstructive pulmonary disease, diabetes were predictors of both all-cause and CV mortality. The main findings are as follow among patients referred for elective coronary angiography, both AF and obstructive CCS are strong and independent predictors of the long-term mortality. Mortality of AF without CCS was at least as high as non-AF patients with CCS. CV deaths were more frequent than non-CV deaths in AF patients with CCS compared to those with either AF or CCS alone.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Białystok, 15-089 Białystok, Poland; (Ł.K.); (A.K.); (S.D.)
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University of Białystok, 15-089 Białystok, Poland;
- Correspondence: ; Tel.: +48-600-044-992
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Białystok, 15-089 Białystok, Poland; (Ł.K.); (A.K.); (S.D.)
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Białystok, 15-089 Białystok, Poland; (Ł.K.); (A.K.); (S.D.)
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, 81-519 Gdynia, Poland;
| | - Bożena Sobkowicz
- Department of Cardiology, Medical University of Białystok, 15-089 Białystok, Poland;
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
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Kuzma L, Kurasz A, Dabrowski EJ, Swieczkowski M, Dobrzycki S, Bachorzewska-Gajewska H. Association between air pollution and case-specific mortality in north-eastern part of Poland. Case crossover study with 4,500,000 person-years of follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2655] [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
Recent studies have reported associations between air pollution and daily mortality. The majority of them are conducted in highly polluted areas. Taking into consideration the scarce number of surveys from cities with moderate air quality we decided to conduct a study in this type of region.
Purpose
To assess the short-term impact of air pollution on cardiovascular (CVD), coronary artery-related (CAD), and cerebrovascular-related (CbVD) mortality.
Methods
The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR).
Results
The analysed region was inhabited by almost 500,000 residents. From 2008 to 2017 in Bialystok, Lomza, and Suwalki we recorded 49,573 deaths – 34,005, 8,082, 7,486, respectively. The median daily concentrations of PM10 (23.8 μg/m3, IQR=16.9) was the highest in Lomza, Median daily concentration of PM2.5 was the highest in Bialystok (16.2 μg/m3, IQR=15.9). In the case of Suwalki, daily median PM2.5 concentration was 9.8 μg/m3 (IQR=8.7), and PM10 – 18.0 μg/m3 (IQR=14.3). The IQR increase in PM2.5 (OR 1.036, 95% CI 1.016–1.056, P<0.001) and PM10 concentration (OR 1.034, 95% CI 1.015–1.053, P<0.001) was associated with increased CVD mortality on lag 0 and this effect persisted on following days. The effects of PMs were more expressed in association with CAD-related mortality (OR for PM2.5 = 1.045, 95% CI 1.012–1.080, P=0.008), (OR for PM10 = 1.044, 95% CI 1.010–1.078, P=0.011) and CbVD mortality (OR for PM2.5 = 1.046, 95% CI 1.013–1.080, P=0.006), (OR=1.041 for PM10, 95% CI 1.002–1.082, P=0.038). Additionally, IQR increase in NO2 concentration was associated with increased CAD-related mortality at lag 0–1 (OR=1.055, 95% CI 1.004–1.108, P=0.032). The highest OR for PMs was noted in Suwalki compared to Bialystok and Lomza. The trend was noted regardless of the cause of death from lag 0 to lag 0–3. In a comparison of seasons, we noted higher CVD mortality OR in the cold season for PM10 in Suwalki (P=0.047) and Bialystok (p=0.001). However, the impact of NO2 (P=0.02) and PM10 (P=0.03) on CAD related mortality was higher in the warm season.
Conclusions
The impact of air pollution on CVD mortality is also observed in moderately polluted areas. PMs and NO2 had the greatest impact on CAD-related mortality. Differences in effect size and seasonality may depend on the source of air pollution.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Kuzma
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
| | - A Kurasz
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
| | - E J Dabrowski
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
| | - M Swieczkowski
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
| | - S Dobrzycki
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
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Kuzma L, Dabrowski EJ, Kurasz A, Swieczkowski M, Bachorzewska-Gajewska H, Dobrzycki S. Impact of air pollution on mortality due to cerebrovascular diseases. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.177] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The short-term effect of air pollution on cardiovascular mortality is well-documented but a scarce number of studies focus on cause-specific mortality in low-polluted areas.
Purpose
We decided to distinguish deaths due to cerebrovascular disease (CbVD) from a region widely known as the Green Lungs of Poland to assess the short-term effect of air pollution on CbVD mortality.
Methods
The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR) of air pollution.
Results
In the overall analysis of the studied region PM2.5 had an impact on increased CbVD mortality at LAG 0 (OR 1.046, 95% CI 1.013 – 1.080, P = 0.006), LAG 0-1 (1.048, 1.002-1.082, P = 0.040), and LAG 0-3 (1.052, 1.015-1.090, P = 0.006). The influence of PM10 was noted at LAG 0 (1.041, 1.002-1.082, P = 0.040). CbVD mortality in Bialystok was increased by exposure to PM10 at LAG 0 (1.05, 1.00-1.09, P = 0.048) and CO at LAG 1 (1.07, 1.00-1.14, P = 0.04). Additionally, an effect of CO was observed in cold season at LAG 1 (1.09, 1.02-1.17, P = 0.02), LAG 0-1 (1.08, 1.00-1.016, P = 0.04), and LAG 0-3 (1.09, 1.01-1.18, P = 0.04). In Suwalki, an impact of PM2.5 was also observed.
Conclusions
A short-term increase in air pollutants concentrations, especially in PM2.5 and CO, had an influence on CbVD mortality. Mortality rates were significantly increased in cold season. We also found heterogeneity in the influence of major contributors on mortality between analyzed cities.
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Affiliation(s)
- L Kuzma
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
| | - EJ Dabrowski
- Medical University of Bialystok, Bialystok, Poland
| | - A Kurasz
- Medical University of Bialystok, Bialystok, Poland
| | | | | | - S Dobrzycki
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
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Kuzma L, Malyszko J, Kurasz A, Bachorzewska-Gajewska H, Dobrzycki S. Exposure to air pollution and renal function - an underestimated threat? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.178] [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: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed not only in respiratory, circulatory, and nervous systems but also in renal function.
Purpose
Our goal was to investigate the hypothesis indicating that we can observe the long-term and also short-term impact of air pollution on kidney function.
Methods
We reviewed medical notes of patients hospitalized between 2007-2016. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO2, SO2, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration with 95% confidence intervals (CI).
Results
3,554 patients were included into the final analysis. The median age was 66 (IQR 15) and men were in the majority (53.2%, N = 1891). Chronic kidney disease (CKD) was diagnosed in 21.5% (N = 764). The long-term increase in annual average concentration of PM2.5 (OR for IQR increase = 1.07; 95% CI 1.01 – 1.15, P = 0.037) and NO2 (OR for IQR increase = 1.05;95% CI 1.01 – 1.10, P = 0.047) resulted in an increased number of patients with CKD. In short-term observation the IQR increase in weekly PM2.5 concentration was associated with a 2% reduction in eGFR (OR = 0.98, 95%CI 0.97 – 0.99, P = 0.03)
Conclusions
The effects of air pollution on renal function were observed. Long- and short–term exposure to elevated air pollution levels was associated with a decrease in eGFR. The main pollutant affecting the kidneys was PM2.5.
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Affiliation(s)
- L Kuzma
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
| | - J Malyszko
- Medical University of Warsaw, Department of Nephrology, Dialysis and Internal Disease, Warsaw, Poland
| | - A Kurasz
- Medical University of Bialystok, Bialystok, Poland
| | | | - S Dobrzycki
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
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Kuzma L, Kurasz A, Niwinska M, Dabrowski EJ, Swieczkowski M, Bachorzewska-Gajewska H, Dobrzycki S. Does climate change affect the chronobiological trends in occurrence of acute coronary syndromes? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.106] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Acute coronary syndromes (ACS) are the leading cause of death all over the world, in the last years chronobiology of their occurrence has been changing.
Purpose
The aim of this study was to assess the influence of climate change on hospital admissions due to ACS.
Methods
Medical records of 10,529 patients hospitalized for ACS in 2008–2017 were examined. Weather conditions data were obtained from the Institute of Meteorology.
Results
Among the patients, 3537 (33.6%) were hospitalized for STEMI, 3947 (37.5%) for NSTEMI, and 3045 (28.9%) for UA. The highest seasonal mean for ACS was recorded in spring (N = 2782, mean = 2.52, SD = 1.7; OR 1.07; 95% CI 1.0-1.2; P = 0.049) and it was a season with the highest temperature changes day to day (Δ temp.=11.7). On the other hand, every 10ºC change in temperature was associated with an increased admission due to ACS by 13% (RR 1.13; 95% CI 1.04-1.3; P = 0.008). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (N = 1703, mean = 2.7, SD = 1.9; OR 1.16; 95% CI 1.0-1.23; P = 0.004), in STEMI subgroup it was Monday (N = 592, mean = 0.9, SD = 1.6, OR 1.2; 95% CI 1.1-1.4; P = 0.002). Sunday was associated with decreased admissions due to all types of ACS (N = 1098, mean = 1.7, SD = 1.4; OR 0.69; 95% CI 0.6-0.8, P < 0.001). In the second half of the study period (2013-2018) the relative risks of hospital admissions due to ACS were 1.043 (95%CI: 1.009-1.079, P = 0.014, lag 0) and 0.957 (95%CI: 0.925-0.990, P = 0.010, lag 1) for each 10ºC decrease in temperature; 1.049 (95% CI: 1.015-1.084, P = 0.004, lag 0) and 1.045 (95%CI: 1.011-1.080, P = 0.008, lag 1) for each 10 hPa decrease in atmospheric pressure and 1.180 (95% CI: 1.078-1.324, P = 0.007, lag 0) for every 10ºC change in temperature. For the first half of the study the risk was significantly lower.
Conclusion
We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuation associated with climate change in this season. The lowest frequency of ACS took place on weekends. Atmospheric changes had a much more pronounced effect on admissions due to ACS in the second half of the analyzed period, which is in line with the dynamics of global climate change.
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Affiliation(s)
- L Kuzma
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
| | - A Kurasz
- Medical University of Bialystok, Bialystok, Poland
| | - M Niwinska
- Medical University of Bialystok, Bialystok, Poland
| | - EJ Dabrowski
- Medical University of Bialystok, Bialystok, Poland
| | | | | | - S Dobrzycki
- Medical University of Bialystok, Department of Invasive Cardiology, Bialystok, Poland
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Kuźma Ł, Małyszko J, Bachórzewska-Gajewska H, Niwińska MM, Kurasz A, Zalewska-Adamiec M, Kożuch M, Dobrzycki S. Impact of chronic kidney disease on long-term outcome of patients with valvular heart defects. Int Urol Nephrol 2020; 52:2161-2170. [PMID: 32661631 PMCID: PMC7575476 DOI: 10.1007/s11255-020-02561-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/29/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. AIM Analysis impact of CKD on long-term prognosis in patients with VHD. MATERIAL AND METHODS The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days. RESULTS The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00-1.03, p < 0.001), creatinine (OR:1.27, 95% CI: 1.12-1.43, p < 0.001), CKD (OR: 1.30, 95% CI: 1.17-1.44, p < 0.001), reduced ejection fraction (EF) (OR: 0.98, 95% CI: 0.97-0.99, p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04-1.35, p = 0.01). CONCLUSIONS Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Małyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland.
| | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Marta Maria Niwińska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Marcin Kożuch
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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Kuźma Ł, Kulikowska A, Kurasz A, Niwińska MM, Zalewska-Adamiec M, Dobrzycki S, Bachórzewska-Gajewska H. The effect of serum uric acid levels on the long-term prognosis of patients with non-ST-elevation myocardial infarction. ADV CLIN EXP MED 2020; 29:1255-1263. [PMID: 33269811 DOI: 10.17219/acem/127145] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) are the leading cause of death worldwide. Many studies have reported an association between serum uric acid (sUA) and CVD, and its role as a risk marker for mortality. OBJECTIVES To assess the relationship between sUA levels and the long-term prognosis of patients with non-ST-elevation myocardial infarction (NSTEMI). MATERIAL AND METHODS The study was conducted at the Clinical Hospital of Białystok (Poland). Based on medical records, 9328 patients were hospitalized between 2011 and 2013, of which 726 had NSTEMI. The exclusion criteria were: any diagnosed neoplasms and estimated glomerular filtration rate (eGFR) <15 mL/min. The average observation time was 2324 days. RESULTS A total of 549 patients were qualified for the analysis; men were in the majority (69.03%, n = 379), and the mean age was 68.42 years (standard deviation (SD) = 11.66). The sUA norm was exceeded in 137 of the patients (24.95%). Hyperuricemia is more likely to occur in women (risk ratio (RR) = 1.52, 95% confidence interval (95% CI) = 1.016-2.288, p = 0.042), in patients with chronic kidney disease (CKD) (RR = 3.452, 95% CI = 2.432-4.854, p < 0.001) and in patients with higher body mass index (BMI)s (RR = 1.048, 95% CI = 1.008-1.090, p = 0.018). In the whole study group, during the study, 178 of the patients died (32.41.9%), more often those with hyperuricemia: (60/137 patients (43.8%)) compared to patients with normal sUA values (118/412 values (28.64%)); p < 0.001). There was a significant correlation between an increase in sUA levels and an increase in mortality (p < 0.001). Independent risk factors of death were age (RR = 1.086, 95% CI = 1.065-1.108, p < 0.001), sUA (RR = 1.245, 95% CI = 1.131-1.370, p = 0.041), ejection fraction (EF) (RR = 0.928, 95% CI = 0.910-0.946, p < 0.001) and hemoglobin concentration (RR = 0.685, 95% CI = 0.611-0.768, p < 0.001). CONCLUSIONS Serum UA concentration is an independent risk factor of long-term mortality in patients who have undergone NSTEMI, and is associated with higher in-hospital death rates. Secondary prevention after NSTEMI should entail management of the patients' sUA levels.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Poland
| | - Agata Kulikowska
- Department of Anesthesiology and Intensive Therapy, Medical University of Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, Poland
| | | | | | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Poland
| | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Poland
- Department of Clinical Medicine, Medical University of Bialystok, Poland
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Kuźma Ł, Małyszko J, Kurasz A, Niwińska MM, Zalewska-Adamiec M, Bachórzewska-Gajewska H, Dobrzycki S. Impact of renal function on patients with acute coronary syndromes: 15,593 patient-years study. Ren Fail 2020; 42:881-889. [PMID: 32862755 PMCID: PMC7472470 DOI: 10.1080/0886022x.2020.1810069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. Aim The aim of our study was to assess renal function impact on mortality among patients with ACS. Materials and methods The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009–2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR <15 ml/min/1.73 m2, hemodialysis. Mean observation time was 2296 days. Results Criteria were met by 2213 patients. CKD occurred in 24.1% (N = 533) and more often affected those with NSTEMI (26.2 (337) vs. 21.2 (196), p = .006). STEMI patients had higher incidence of post-contrast acute kidney injury (PC-AKI) (5 (46) vs. 4.1 (53), p < .001). During the study, 705 people died (31.9%), more often with NSTEMI (33.2% (428) vs. 29.95% (277), p < .001). However, from a group of patients suffering from PC-AKI 57.6% died. The risk of PC-AKI increased with creatinine concentration (RR: 2.990, 95%CI: 1.567–5.721, p < .001), occurrence of diabetes mellitus (RR: 2.143, 95%CI: 1.029–4.463, p = .042), atrial fibrillation (RR: 2.289, 95%CI: 1.056–4.959, p = .036). Risk of death was greater with an increase in postprocedural creatinine concentration (RR: 2.254, 95%CI: 1.481–3.424, p < .001). Conclusion PC-AKI is a major complication in patients with ACS, occurs more frequently in STEMI and may be a prognostic marker of long-term mortality in patients undergoing percutaneous coronary intervention (PCI). More attention should be given to the prevention and diagnosis of PC-AKI but necessary PCI should not be withheld in fear of PC-AKI.
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Affiliation(s)
- Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Małyszko
- Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Anna Kurasz
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marta Maria Niwińska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | | | - Hanna Bachórzewska-Gajewska
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.,Department of Clinical Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
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