European Society of Cardiology: Cardiovascular Disease Statistics 2017

Background: The European Society of Cardiology (ESC) Atlas has been compiled by the European Heart Agency to document cardiovascular disease (CVD) statistics of the 56 ESC member countries. A major aim of this 2017 data presentation has been to compare high income and middle income ESC member countries, in order to identify inequalities in disease burden, outcomes and service provision. Methods: The Atlas utilizes a variety of data sources, including the World Health Organization, the Institute for Health Metrics and Evaluation, and the World Bank to document risk factors, prevalence and mortality of cardiovascular disease and national economic indicators. It also includes novel ESC sponsored survey data of health infrastructure and cardiovascular service provision provided by the national societies of the ESC member countries. Data presentation is descriptive with no attempt to attach statistical significance to differences observed in stratified analyses. Results: Important differences were identified between the high income and middle income member countries of the ESC with regard to CVD risk factors, disease incidence and mortality. For both women and men, the age-standardised prevalence of hypertension was lower in high income countries (18.3% and 27.3%) compared with middle income countries (23.5% and 30.3%). Smoking prevalence in men (not women) was also lower (26% vs 41.3%), and together these inequalities are likely to have contributed to the higher CVD mortality in middle income countries. Declines in CVD mortality have seen cancer becoming a more common cause of death in a number of high income member countries, but in middle income countries declines in CVD mortality have been less consistent where CVD remains the leading cause of death. Inequalities in CVD mortality are emphasised by the smaller contribution they make to potential years of life lost in high income compared with middle income countries both for women (13% vs. 23%) and men (20% vs. 27%). The downward mortality trends for CVD may, however, be threatened by the emerging obesity epidemic that is seeing rates of diabetes increasing across all ESC member countries. Survey data from the National Cardiac Societies (n=41) showed that rates of cardiac catheterization and coronary artery bypass surgery, as well as the number of specialist centres required to deliver them, were greatest in the high income member countries of the ESC. The Atlas confirmed that these ESC member countries, where the facilities for the contemporary treatment of coronary disease were best developed, were often those in which declines in coronary mortality have been most pronounced. Economic resources were not the only driver for delivery of equitable cardiovascular healthcare, as some middle income ESC member countries reported rates for interventional procedures and device implantations that matched or exceeded the rates in wealthier member countries. Conclusion: In documenting national CVD statistics, the Atlas provides valuable insights into the inequalities in risk factors, healthcare delivery and outcomes of CVD across ESC member countries. The availability of these data will underpin the ESC’s ambitious mission “to reduce the burden of cardiovascular disease” not only in its member countries, but also in nation states around the world

The association of uncarboxylated matrix gla protein with mitral annular calcification in patients without significant coronary artery disease

Objective: Mitral annular calcification (MAC) is associated with systemic calcification and cardiovascular disease (CVD) events. Matrix Gla protein (MGP) is a strong inhibitor of vascular and soft-tissue calcification and reduced levels of its circulating precursor, uncarboxylated MGP (ucMGP), was found associated with vascular calcification in pilot studies. Methods and Results: In this study, which includes 86 outpatients with no significant coronary artery and chronic kidney diseases, we measured serum ucMGP levels and evaluated MAC using echocardiography. In participants with MAC (n = 44), serum ucMGP levels were lower than the control group (n = 42) (216.1 ± 154.1 vs. 390.2 ± 256.3, P = 0.001, respectively). The patients with MAC were divided into two groups: mild MAC group and moderate MAC group. Serum ucMGP levels were significantly lower in the moderate MAC group than the mild MAC group (139.0 ± 121.8 vs. 248.4 ± 156.3, P = 0.03, respectively). Conclusions: In patients with MAC, serum ucMGP level was significantly low, and this association has been detected for the first time in patients with no significant coronary artery disease (CAD)

ARTYKUŁ ORYGINALNYZwiązek pomiędzy zwrotem załamka T a klinicznymi i angiograficznymi parametrami u w ostrej fazie zawału serca

Background: Restoration of a positive T-wave in the chronic stage of myocardial infarction (MI) is usually seen in patients with a non-Q-wave (non-transmural) MI, where a viable tissue is present. The causes and significance of a positive T-wave in the early phase of acute MI are not clear. Aim: To investigate angiographic and clinical characteristics of patients with a positive T-wave in the early stage of acute MI. Methods: We evaluated the clinical and angiographic data in relation to T-wave polarity in 188 patients with acute MI. Coronary risk factors, pre-infarction angina, CK-MB level, left ventricular ejection fraction and angiographic findings were analysed. Death, cardiogenic shock, ventricular tachycardia/fibrillation and high-degree atrioventricular block were regarded as in-hospital complications. All electrocardiograms were divided into two groups, according to the shape of the T-wave, as exhibiting a positive T-wave or negative T-wave. Results: A positive T-wave was present in 30 (15.9%) patients. None of the patients with a positive T-wave had three-vessel disease compared with 21.5% of patients with a negative T-wave (pWstęp: Powrót dodatnich załamków T po przebyciu ostrej fazy zawału serca (MI) obserwuje się zwykle u chorych, którzy przebyli MI bez załamka Q i mają zachowaną żywotność mięśnia sercowego. Mechanizmy prowadzące do występowania dodatnich załamków T już we wczesnej fazie MI i znaczenie tego zjawiska nie zostały jeszcze dokładnie wyjaśnione. Cel: Ocena parametrów angiograficznych i klinicznych u chorych z dodatnim załamkiem T stwierdzanym w ostrej fazie MI. Metodyka: Grupę badaną stanowiło 188 chorych z ostrym MI. Analizowano czynniki ryzyka choroby wieńcowej, obecność bólów wieńcowych przed MI, stężenie CK-MB, frakcję wyrzutową lewej komory i wyniki koronarografii. Podczas obserwacji wewnątrzszpitalnej oceniano występowanie następujących powikłań sercowo-naczyniowych: zgon, wstrząs kardiogenny, częstoskurcz komorowy, migotanie komór lub zaawansowany blok przedsionkowo-komorowy. Chorzy zostali podzieleni na dwie grupy w zależności od dodatniego lub ujemnego wychylenia załamka T. Wyniki: Dodatnie załamki T w ostrej fazie MI stwierdzono u 30 (15.9%) chorych. Chorobę trzech naczyń stwierdzono u 21.5% chorych z ujemnym załamkiem T i u żadnego chorego z grupy z dodatnim załamkiem T (

Akut koroner sendromlu diyabetik hastalarda aort-koroner bypass cerrahisi ile yeni nesil ilaç salınımlı stentlerle uygulanan perkütan koroner girişimin erken ve uzun dönem sonuçlarının karşılaştırılması

Purpose: The aim of this study was to determine the difference between patients undergoing coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) (with new generation drug-eluting stents) who had diabetes mellitus during the course of an acute coronary syndrome (ACS). Materials and Methods: We carried out a retrospective evaluation of 405 diabetic patients admitted with an ACS during the period of 2 years in a single-center. Patients were followed for 5 years. All clinical incidents, such as death, cardiac death, myocardial infarction, stroke, revascularization, and stent thrombosis were recorded Results: We examined 405 patients with diabetes out of 1643 patients with ACS. of these, 183 (45.1%) were included in the PCI group and 222 (54.8%) were in the CABG group. During 5-years follow-up, primary endpoints including death, MI, and stroke were observed in 31 patients (16.9%) in the PCI group and in 33 patients (14.9%) in the CABG group. There was no difference between the two groups in terms of primary endpoints. All-cause mortality during 5-years was observed in 17 patients (9.8%) in the PCI, 20 (9.1%) in the CABG group. Conclusion: There was no difference in all-cause mortality between the PCI and the CABG groups during 5-year follow-up. Repeated revascularization and myocardial infarction were higher in the PCI group and the stroke rates were higher in the CABG group

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) : The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate

2019 ESC guidelines for the dignosis and management of acute pulmonary embolism developed in collaboration with the european respiratory society (ERS)

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription