Survival benefit from recent changes in management of men and women with ST-segment elevation myocardial infarction treated with percutaneous coronary interventions

Background: Nowadays, the majority of patients with myocardial infarction with ST-segment elevation (STEMI) are treated with primary percutaneous coronary interventions (PCI). In recent years, there have been ongoing improvements in PCI techniques, devices and concomitant pharmacotherapy. However, reports on further mortality reduction among PCI-treated STEMI patients remain inconclusive. The aim of this study was to compare changes in management and mortality in PCI-treated STEMI patients between 2005 and 2011 in a real-life setting. Methods: Data on 79,522 PCI-treated patients with STEMI from Polish Registry of Acute Coronary Syndromes (PL-ACS) admitted to Polish hospitals between 2005 and 2011 were analyzed. First, temporal trends of in-hospital management in men and women were presented. In the next step, patients from 2005 and 2011 were nearest neighbor matched on their propensity scores to compare in-hospital, 30-day and 1-year mortality rates and in-hospital management strategies and complications. Results: Some significant changes were noted in hospital management including shortening of median times from admission to PCI, increased use of drug-eluting stents, potent antiplatelet agents but also less frequent use of statin, beta-blockers and angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. There was a strong tendency toward preforming additional PCI of non-infarct related arteries, especially in women. After propensity score adjustment there were significant changes in inhospital but not in 30-day or 1-year mortality rates between 2005 and 2011. The results were similar in men and women. Conclusions: There were apparent changes in management and significant in-hospital mortality reductions in PCI-treated STEMI patients between 2005 and 2011. However, it did not result in 30-day or 1-year survival benefit at a population level. There may be room for improvement in the use of guideline-recommended pharmacotherapy

Bradykardia u pacjenta z jadłowstrętem psychicznym — opis przypadku

Zaburzenia rytmu pod postacią bradykardii w przebiegu jadłowstrętu psychicznego (anorexianervosa) są zjawiskiem częstym, ale w większości przypadków niegroźnym i odwracalnym. Ponadto mogą im towarzyszyć inne nieprawidłowości z zakresu układu sercowo-naczyniowego. W praktyce bradykardia < 40/min, a nawet < 30/min może budzić niepokój i wymaga wykluczenia innych, poważniejszych przyczyn. Zwykle obserwowane zaburzenia rytmu wracają do normy w ciągu kilku tygodni od normalizacji masy ciała. Niekiedy jednak mogą utrzymywać się znacznie dłużej, pomimo skutecznego leczenia choroby podstawowej. W pracy przedstawiono przypadek pacjenta z wywiadem zaburzeń odżywiania o typie anoreksji–bulimii, u którego pomimo normalizacji masy ciała i braku dowodów na chorobę węzła zatokowego, jeszcze przez wiele miesięcy występowała bezobjawowa zatokowa bradykardia, która stopniowo zmniejszała się na przestrzeni 2-letniej obserwacji

AAI – the forgotten pacing mode

For a long time the AAI pacing mode was commonly used in patients with sick sinus syndrome, who were treated with pacemaker. After the guideline recommendations were updated in 2013 the AAI mode was displaced by the DDDR mode, especially with atrioventricular delay management. The most important argument for this change was the risk of the development of advanced atrioventricular block in long-term observation. This situation may require changing the pacing mode to DDD and implanting a ventricular lead. However, the AAI pacing mode has many forgotten advantages and it could still be successfully used in well selected patients with sick sinus syndrome

Interruption of anticoagulation in patients undergoing elective surgical procedures

Interruption of long-term therapy with oral anticoagulants in patients undergoing elective surgical procedures is a common problem in clinical practice. A large number of patients are receiving oral anticoagulants due to atrial fibrillation, mechanical prosthetic valves, or thromboembolic disease. Each year many of these patients will undergo an invasive procedure. The most important aspect is the risk-benefit assessment: the general risk of bleeding related to the procedure, additional risk of bleeding during the procedure related to anticoagulants, and on the other hand the risk of thrombotic complications such as ischaemic stroke or coronary stent thrombosis, associated with discontinuation of the antithrombotic therapy. The aim of the article is to present the management of anticoagulant therapy in patients undergoing elective surgical procedures

Sudden cardiac death – what do we know and how do we prevent it?

Sudden cardiac death (SCD) is an important clinical problem with a complex and multifactor background. Trends in its prevention have been dynamically developing over the last decades. Patients with ischemic heart disease, especially after myocardial infarction, represent the largest group at an elevated risk of SCD. Many congenital and hereditary diseases are associated with an increased risk of SCD, particularly among young people. Although far from perfect, left ventricular ejection fraction remains the only widely recognized, relatively objective and credible method of assessing the risk of SCD among patients with heart failure. Other methods for assessing the risk are waiting for the final confirmation of their usefulness in clinical trials. The implantable cardioverter-defibrillator (ICD) and its newer version – totally subcutaneous S-ICD – remain the most effective methods of SCD prevention. The only class of drugs with well-proven efficiency in most patients at risk of SCD is β-blockers

Pulmonary arterial hypertension: diagnosis and treatment

Pulmonary arterial hypertension is one of the clinical groups of arterial hypertension. It is a rare, chronic disease with a very poor prognosis. Diagnostic procedures ruling out different causes of present symptoms and other forms of pulmonary hypertension are difficult and specific. Current European guidelines recommend combined treatment with endothelin receptor antagonist, prostanoids, and phosphodiesterase type 5 inhibitors

Is the time between onset of pain and restoration of patency of infarct-related artery shortened in patients with myocardial infarction? The effects of the Kielce Region System for Optimal Management of Acute Myocardial Infarction

Introduction : The importance of delay in the restoration of infarct-related artery patency in patients with myocardial infarction was discussed, and actions were undertaken in the Kielce Region aimed at shortening this time within the System for Optimal Management of Acute Myocardial Infarction. Aim of the research: To evaluate the effectiveness of shortening time delays during transport of patients and diagnostics of myocardial infarction in the Kielce Region. Material and methods: Time delays were analysed in 5,934 patients with ST-segment elevation myocardial infarction (STEMI), hospitalised in cardiology wards with interventional cardiology on 24-hour duty, during the period 2008–2012. Time delays were analysed between the onset of myocardial infarction pain and undertaking treatment – T1 and T2 time – within which a patient with myocardial infarction, after admission to hospital, has intervention performed on infarct-related coronary artery. Results : During the period 2008–2012, the median T1 time was successfully shortened from 355 to 203 min, and the T2 time from 101 to 48 min. Conclusions: The effectiveness of the system was confirmed, and the necessity for further improvement of the system indicated

ST-segment elevation myocardial infarction with non-obstructive coronary arteries : score derivation for prediction based on a large national registry

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 (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