The Impact of Complete Blood Count-Derived Indices (RDW, PDW and NLR) on 4 Years Outcomes in Patients after PCI with Sirolimus-Eluting Stent, including Complex High-Risk Index Procedure (CHIP) Patients

Background We analyzed red cell distribution width (RDW), platelet distribution width (PDW), and the neutrophil-to-lymphocyte ratio (NLR) as potential predicting factors of adverse outcomes in patients after percutaneous coronary intervention (PCI) at 48 months follow-up. Material and methods We gathered data on subjects who underwent PCI with a sirolimus-eluting Alex Plus stent (Balton, Poland). We characterized the rate of major adverse cardiovascular events (MACE) over a 4-year period, which encompassed cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR) depending on the RDW, PDW, and NLR values. Results We included 218 patients (256 stents), among which we also identified 77 complex, high-risk index procedure (CHIP) patients and 73 high bleeding risk (HBR) patients. We identified only RDW as having a significant impact on long-term outcomes and only in the total population and CHIP patients. The total population with RDW > 14.5% was characterized by higher age (67±11 vs. 73±10 years, p < 0.01) and higher incidence of chronic kidney disease (14% vs. 39%, p < 0.01) as well as chronic obstructive pulmonary disease (4% vs. 15%, p=0.024). Interestingly, this group had a lower rate of ACS (42% vs. 34%, p=0.049). At 48 months in the total population with RDW > 14.5% patients, the rates of MACE, cardiac death, MI, and TLR were 26.8%, 19.5%, 9.8%, and 12.2%, respectively. Conclusions RDW > 14.5% correlated with a higher risk of cardiac death in the total population and CHIP patients

Arterial hypertension as a risk factor for myocardial infarction with non-obstructive coronary arteries (MINOCA)

Myocardial infarction with non-obstructive coronary arteries (MINOCA) as a relatively new disease entity distinguished from the group of acute coronary syndromes (ACS) is not a rare clinical problem and it requires in-depth diagnostics. MINOCA accounts for 5–10% of all ACS cases. MINOCA is most common between the ages of 50–60 and predominates in females. Coronary microvascular dysfunction and coronary vasospasm are among the potential mechanisms. The latest guidelines for the treatment of ACS in patients presenting without persistent ST-segment elevation emphasize the importance of searching for the causes of angina in patients with insignificant lesions in the coronary arteries by extending invasive diagnostics (e.g., acetylcholine provocation test) and using noninvasive diagnostics (e.g., CMR or SPECT). In the context of MINOCA, among the typical risk factors for coronary artery disease, arterial hypertension (HTN) seems to be the most important by inducing coronary microcirculation remodeling (mostly hypertrophy) and hence the narrowing of the lumen. Studies comparing patients with MINOCA and obstructive coronary artery disease (MI-CAD) in the context of risk factors, in particular HTN, were analyzed. In five out of nine analyzed studies, HTN occurred significantly more often in patients with MINOCA compared to patients with MI-CAD. The current pharmacotherapy recommendations focus on slowing the progression of coronary microvascular dysfunction (CMD), i.e., adequate treatment of risk factors and comorbidities, such as HTN. Therefore, it seems reasonable to conduct studies directly analyzing the relationship between HTN and MINOCAin order to improve diagnostics and establish appropriate pharmacotherapy that will improve prognosis

Morbidity and mortality trends of the most common cancers in 1990–2019. Poland's position compared to other European countries

Introduction.The purpose of the study was to evaluate the trends in morbidity and mortality of the selected cancer sites in Poland against other European countries. Material and methods.Countries for analysis were selected based on geographical location. Estimates of age-adjusted incidence and mortality rates were calculated using the new European 2013 standard population. Lung, colorectal, breast, and prostate cancers were chosen. Time trends for age-standardized rates were  analyzed using Jointpoint Regression software. Results.Poland differed from other analyzed countries mainly in terms of cancer mortality. Poland is a country with one of the smallest amounts of current expenses on health care per capita, which translates into one of the highest levels of cancer mortality in both women and men. Conclusions.Compared to other countries, Poland's cancer outcomes on population level are unsatisfactory. The situation may improve with the introduction of educational and screening programs

Morbidity and mortality trends of the most common cancers in 1990–2019. Poland’s position compared to other European countries

Introduction. The purpose of the study was to evaluate the trends in morbidity and mortality of the selected cancer sites in Poland against other European countries. Material and methods. Countries for analysis were selected based on geographical location. Estimates of age-adjusted incidence and mortality rates were calculated using the new European 2013 standard population. Lung, colorectal, breast, and prostate cancers were chosen. Time trends for age-standardized rates were analyzed using Joinpoint Re­gression software. Results. Poland differed from other analyzed countries mainly in terms of cancer mortality. Poland is a country with one of the smallest amounts of current expenditures on health care per capita, which translates into one of the highest levels of cancer mortality in both women and men. Conclusions. Compared to other countries, Poland’s cancer outcomes on population level are unsatisfactory. The si­tuation may improve with the introduction of educational and screening programs

Coronary slow flow is not an adverse prognostic factor in MINOCA patients in the 5-year follow-up

Introduction: The research aimed to compare the characteristics and outcomes of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients with coronary slow flow (CSF) vs. normal coronary flow (no CSF) in a 5-year follow-up. Material and methods: Between 2010–2015 were identified 111 patients as having final MINOCA diagnosis and available calculated corrected TIMI frame count (cTFC). CSF was defined as cTFC greater than 27 frames per second in any of the three coronary arteries. The primary endpoint was the 5-year major adverse cardiovascular events rate, defined as cardiac death, myocardial infarction, or hospitalization due to angina. Results: The mean cTFC was 28.9 ± 6.1 frames per second (median: 28, IQR 24–33; min-max: 19–58). 62 (55.9%) patients had normal coronary flow, and 49 (44.1%) had CSF. Patients did not differ in sex (females no CSF vs. CSF: 58% vs. 61%, p = 0.7) or age (63 ± 15 years vs. 63 ± 13 years, p = 0.8). Patients with CSF characterized higher rates of chronic kidney disease (0 vs. 8.2%, p = 0.035). No statistically significant difference was observed for any of the analysed points. MACE rates for no CSF vs. CSF were 9.6% vs. 14.3% (HR 0.80, 95% CI 0.28–2.96, p = 0.7), respectively. Conclusions: CSF was not associated with a higher risk of adverse events among MINOCA patients at five years

The predictive value of complete blood count-derived indices for major adverse cardiovascular events in MINOCA patients at 5-year follow-up

Introduction: The authors analysed the potential of red blood cell and platelet indices such as red cell distribution width (RDW), mean corpuscular volume (MCV), and mean platelet volume (MPV) as predicting factors in myocardial infarction with non-obstructive coronary arteries (MINOCA) patients of 5-year outcomes. Material and methods: Between 2010–2015 were identified 112 patients who had final MINOCA diagnosis and available laboratory findings. The primary endpoint was the 5-year major adverse cardiovascular events rate, defined as cardiac death, myocardial infarction, or hospitalization due to angina. Results: Only RDW had a significant impact on long-term outcomes. 93 (83%) patients had RDW ≤ 14.5 (group 1), and 19 (17%) patients had RDW > 14.5 (group 2). The mean RDW value was 13.58 ± 1.11%. In group 1 and group 2, mean RDW values were 13.18 ± 0.55%, and 15.54 ± 1.06% (p < 0.001), respectively. Patients with abnormal RDW values (group 2) characterized lower value of left ventricular eject fraction (60 ± 8% vs. 53 ± 13%, p = 0.024), and higher NT-proBNP values (3,170 ± 5,285 pg/mL vs. 6,200 ± 4,223 pg/mL, p = 0.013) as well as troponin levels (501–2500 ng/mL: 31% vs. 53%, p = 0.02). A statistically significant difference was observed only for all-cause death. All-cause death rates for no RDW ≤ 14.5% vs. RDW > 14.5% were 2.2% vs. 21.1% (HR 5.09, 95% CI 1.03–25.2, p = 0.046), respectively. Conclusions: RDW was significantly associated with the increased risk of all-cause mortality in MINOCA patients at 5 years