Compliance with pharmacological treatment among patients after minimally invasive coronary bypass grafting

Background: We sought to evaluate patients’ adherence to optimal pharmacotherapy as recommended by the European Society of Cardiology, together with the assessment of potential clinical determinants of medical non-compliance in a large cohort of patients after endoscopic atraumatic coronary artery bypassing (EACAB).Methods: This cross sectional study was conducted in a group of 706 individuals who underwent EACAB between April 1998 and December 2010. Data covering current pharmacological treatment with antiplatelet agents, beta-blockers (BB) (or heart rate lowering calcium channel blockers [CCB] in case of intolerance and/or poor efficacy of beta-blockade), angiotensin-converting enzyme (ACE) inhibitors (or angiotensin receptor blockers [ARB]) and statins was acquired. Mean duration of observation after the surgery was 2132 ± 1313 days.Results: Complete follow-up data has been obtained from 415 living patients (341 males). Amongst them, 353 (85%) received antiplatelet agents, while BB or CCB were routinely ingested by 349 (84%) patients. Statins were used by 310 (74.7%) individuals and 274 (66%) subjects took ACE inhibitors or ARB. Baseline demographic and clinical features, including major co-morbidities had no impact on patients’ compliance with all investigated medications. There was no clear association between adherence to treatment and risk of rehospitalization or occurrence of major cerebral and cardiovascular events.Conclusions: EACAB patients’ compliance with pharmacotherapy guidelines is insufficient and is unrelated to demographic and clinical features of the subjects. Multidisciplinary approach involving health education, enhancement in prescription drug affordability and a better rapport between doctors and patients should be incorporated into clinical practice to overcome therapeutic disobedience

Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis

Background: To perform a retrospective analysis of patients who underwent endoscopic atraumaticcoronary artery off-pump bypass grafting (EACAB) in a single center over a period of 11 years.Methods: Data was acquired from the hospital registry and patient medical records. In order to determine changes in clinical profile, patients were subdivided into three groups regarding year of surgery: 1998–2002 (group 1), 2003–2005 (group 2), 2006–2009 (group 3). In-hospital analysis up to 30 days and long-term observation were conducted.Results: The study cohort consisted of 714 patients (581 male). Procedural success accounted for 99%of all patients. No mortality was observed up to 30 days. Complications in the early period includedpleural effusion (7.6%), cardiac arrhythmias (3.6%), bleeding related revision (2.7%) and woundinfection (1.6%). Mean follow-up was 6 years (2132 ± 1313 days; median: 1918.5). Nineteen (2.7%)patients died, of which 52.6% (10 patients) were due to heart related conditions. Overall frequency ofmajor adverse cerebral and cardiovascular events (MACCE) was 10.8% (77 patients). The Kaplan-Meyer analysis defined survival rate and event-free survival in long-term observation of 96.1% and85.3%, respectively. Ejection fraction (EF) < 50% was the only independent factor of mortality (OR:3.35). Regarding cumulative MACCE, older age (OR: 1.72), lower EF (OR: 3.03), the history of percutaneous coronary intervention (OR: 2.13) and higher New York Heart Association class (OR: 2.63)influenced the incidence rate.Conclusions: The presented short and very long-term results confirm that EACAB is an efficient alternative for patients requiring revascularization of the left anterior descending artery. The eliminationof cardiopulmonary bypass significantly reduces the number of complications

Impact of air pollution on hospital patients admitted with ST- and non-ST-segment elevation myocardial infarction in heavily polluted cities within the European Union

Background: Air pollution triggered diseases have become a leading health problem worldwide. The main adverse effects of air pollutants on human health are related to the cardiovascular system and particularly show an increasing prevalence of myocardial infarct and stroke. The aim of the study was to evaluate the influence of main air pollutants on non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) admissions to local interventionalcardiology centers.Methods: Between 2014 and 2015, a multicenter registry of 1957 patients with acute myocardial infarction (STEMI, NSTEMI) admitted to interventional cardiology departments in three Polish cities were under investigation. The air pollution (PM2.5, PM10, NO2, SO2, O3) and weather conditions (temperature, barometric pressure, humidity) data for each city were collected as daily averages. The case-crossover design and conditional logistic regression were used to explore the association between acute myocardial infarctions and short-term air pollution exposure.Results: Occurrence of NSTEMI on the day of air pollution was triggered by PM2.5 (OR = 1.099, p = 0.01) and PM10 (OR = 1.078, p = 0.03). On the following day after the air pollution was recorded, NSTEMI was induced by: PM2.5 (OR = 1.093, p = 0.025), PM10 (OR = 1.077, p = 0.025) and SO2 (OR = 1.522, p = 0.009). For STEMI, events that occurred on the day in which air pollution was triggered by: PM2.5 (OR = 1.197, p < 0.001), PM10 (OR = 1.163, p < 0.001), SO2 (OR = 1.670, p = 0.001) and NO2 (OR = 1.287, p = 0.011). On the following day after air pollution was recorded, STEMI was induced by: PM2.5 (OR = 1.172, p < 0.001), PM10 (OR = 1.131, p = 0.001), SO2 (OR = 1.550, p = 0.005) and NO2 (OR = 1.265, p = 0.02). None of the weather conditions indicated were statistically significant for acute myocardial infarction occurrence.Conclusions: The most important pollutants triggering acute myocardial infarction occurrence in the population of southern Poland, both on the day of air pollution and the following day are particulate matters (PM2.5, PM10) and gaseous pollutants including NO2 and SO2. These pollutants should be regarded as modifiable risk factors and thus, their reduction is a priority in order to decrease total morbidity and mortality in Poland

Low molecular weight heparin in surgical valve procedures: When and how much for an optimal prophylaxis?

Background: Periprocedural antithrombotic prophylaxis in patients undergoing surgical valve procedures (SVP) is insufficiently investigated. Low molecular weight heparin (LMWH) has been considered as an alternative to unfractionated heparin (UFH). However, safety and efficacy of this prophylaxis strategy is unknown. This study aimed to investigate safety and efficacy of periprocedural LMWH prophylaxis and determine optimal dosage and timing for periprocedural cessation and initiation.Methods: The present study is a retrospective, single-center observational analysis of 388 patients who underwent SVP (valve replacement or valvuloplasty) between 2015 and 2016. In-hospital endpoints were bleeding, transfusions, reoperation due to bleeding, and thromboembolic events. Results: Giving the first dose of LMWH on the day of SVP was a risk factor for bleeding (OR 1.07; 95% CI 1.04–1.10; p < 0.001), transfusions (OR 1.04; 95% CI 1.01–1.07; p = 0.008) and reoperation due to bleeding (OR 1.20; 95% CI 1.12–1.28; p < 0.001), with > 40 mg/day as a predictor. A higher dosage of LMWH premedication was an independent risk factor for bleeding (OR 1.02; 95% CI 1.00–1.04; p = 0.03) and transfusion (OR 1.03; 95% CI 1.01–1.05; p = 0.01), with > 60 mg/day as a predictor for these events. LMWH dosed within 24 h prior to SVP increased the risk of transfusion (AUC 0.636; 95% CI 0.496–0.762; p = 0.04).Conclusions: Bleeding is an important early concern after surgical valve procedures. Safety and efficacy of periprocedural prophylaxis with LMWH depends on dosage and the timing of its administration. The most optimal periprocedural prophylaxis in the SVP population appears to be LMWH in dosage of 40–60 mg/day, which is recommended for deep vein thrombosis prophylaxis, ceased at least one day before SV

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)

BackgroundAccording to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians.ObjectivesThe aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data.MethodsAll octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery.ResultsOctogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013).ConclusionOn the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians

Safety and feasibility of minimally invasive coronary artery bypass surgery early after drug eluting stent implantation due to acute coronary syndrome

Background: The evidence of performing minimally invasive coronary artery surgery early after drug eluting stent (DES) implantation due to acute coronary syndrome (ACS) is limited. Aim: The aim of the study is to determine the safety and feasibility of this approach. Methods: This registry includes 115  (78% male) patients from 2013‒2018, who underwent non-LAD percutaneous coronary intervention (PCI) due to ACS with contemporary DES implantation (39% diagnosed with myocardial infarction at baseline), followed by endoscopic atraumatic coronary artery bypass (EACAB) surgery within 180 days, after temporary P2Y12 inhibitor discontinuation. Primary composite endpoint of MACCE (Major Adverse Cardiac and Cerebrovascular Events), defined as death, myocardial infarction (MI), cerebrovascular incident and repeat revascularization was evaluated in long- term follow-up. The follow-up was collected via telephone survey and with National Registry for Cardiac Surgery Procedures. Results: Median (interquartile range [IQR]) time interval separating both procedures was 100.0 (62.0‒136.0) days. Median (IQR) follow-up duration was 1338.5 (753.0‒2093.0) days and was completed from all patients with regard to mortality. Eight patients (7%) died; 2 (1.7%) had a stroke; 6 (5.2%) suffered from MI and 12 (10.4%) required repeat revascularization. Overall, the incidence of MACCE was 20 (17.4%). Conclusions: EACAB is a safe and feasible method of LAD revascularization in patients who received DES for ACS within 180 days prior to surgery, despite early dual antiplatelet therapy discontinuation. The adverse event rate is low and acceptable

Zrównoważony rozwój, systemy informacyjne i zarządzanie bezpieczeństwem w perspektywie długoterminowej przedsiębiorstw

Z wprowadzenia: "Pojęcie zrównoważonego rozwoju jest szeroko opisywane w literaturze przedmiotu, często również kojarzone z pojęciem sustainability. Dotyczy harmonijnego rozwoju organizacji, w tym także biznesowych, które w swych założeniach są nastawione na równoczesną realizacje celów ekonomicznych, społecznych i ekologicznych. Aspekty społeczne będą się przejawiać m.in. w realizacji założeń CSR. Zrównoważenie może być zakłócane występowaniem różnego rodzaju zagrożeń, także wynikających ze skrajnej turbulencji otoczenia. Skutki takich zakłóceń (w tym w ujęciu ekologicznym) mogą wywoływać stany kryzysowe w przedsiębiorstwach. Oczekiwane są zatem zachowania o charakterze rezylientnym (o różnym stopniu odporności i zdolności dostosowawczych wobec zmiennych warunków), pozwalającym na przezwyciężenie sytuacji kryzysowych. Mając na uwadze realizację założeń rozwoju zrównoważonego, podkreślić należy rolę polityki informacyjnej przedsiębiorstw odnośnie do ochrony środowiska naturalnego, a także znaczenie systemów zarządzania środowiskowego czy funkcjonowania łańcuchów dostaw. Zróżnicowanie zagrożeń – w tym występowanie tych o charakterze pandemicznym – powoduje konieczność właściwego ukierunkowania działań społecznie odpowiedzialnych. W ramach szeroko pojętej koncepcji zrównoważonego rozwoju dokonano między innymi wstępnej analizy wykonalności konkretnego, proekologicznego i innowacyjnego projektu hydrologicznego, umożliwiającego wytwarzanie energii elektrycznej. Powyższe tematy zostały podjęte w części pierwszej monografii pod tytułem: Zarządzanie zrównoważonym rozwojem organizacji. Strategie proekologiczne przedsiębiorstw. Część druga monografii nosi tytuł: Systemy informacyjne i zarządzanie bezpieczeństwem w strategiach rozwoju organizacji. Z jednej strony naświetlone zostały tu problemy zarządzania bezpieczeństwem organizacji rozumiane jako możliwości ciągłego, efektywnego funkcjonowania głównie firm produkcyjnych przy wsparciu m.in. współczesnych systemów informatycznych. Z drugiej – zwrócono uwagę na wzrost znaczenia bezpieczeństwa opisywanego jako bezpieczeństwo publiczne. Ten nurt w zarządzaniu zyskuje na znaczeniu wobec narastających, nieoczekiwanych zagrożeń, również pandemicznych. Także na znaczeniu zyskują działania zarządcze w przedsiębiorstwach świadczących usługi dla szerokich rzesz społeczeństwa. Problem, ten omówiono na przykładzie bezpieczeństwa ruchu kolejowego. Poruszono różne ważne kwestie szczegółowe, między innymi skuteczność narzędzi informatycznych w zakresie komunikowania istotnych informacji biznesowych, wspomaganie procesów biznesowych z wykorzystaniem systemów informatycznych klasy ERP, wsparcie sprzedaży, zarządzanie bezpieczeństwem danych produkcyjnych, uwarunkowania prawne doręczeń elektronicznych, formy komunikacji w zarządzaniu kryzysowym (przykład pandemii). Rozpatrując systemy zarządzania bezpieczeństwem w transporcie kolejowym, oparto się na założeniach funkcjonowania organizacji wysokiej niezawodności . Publikacja ukazuje wybrane aspekty dorobku naukowego i obszary zainteresowań badawczych zarówno pracowników Wydziału Zarządzania i Komunikacji Społecznej Krakowskiej Akademii im. Andrzeja Frycza Modrzewskiego, jak i pracowników innych uczelni i wydziałów, w szczególności deklarujących dyscyplinę nauki o zarządzaniu i jakości."(...