Prognostic significance of new onset atrial fibrillation in acute coronary syndrome patients treated conservatively

Background: The purpose of this study was to assess the association between new onset of atrial fibrillation (AF) and in-hospital management and mortality in acute coronary syndrome patients admitted to hospitals without on-site invasive facilities. Methods: We assessed data concerning in-hospital management and mortality of 24 patients with, and 977 patients without, new onset of AF from the Krakow Registry of Acute Coronary Syndromes database. Results: Patients with new onset of AF were older and more likely to have diabetes, chronic obstructive pulmonary disease, cardiogenic shock and chest pain on admission, and a shorter time from the onset of symptoms to admission. These patients more frequently received glycoprotein IIb/IIIa inhibitors, thrombolytics, and were less likely to be treated with statins during their hospital stay. Risk of AF occurrence was lower in patients treated with statins (1.9% vs 5.2%; p = 0.021). Among patients treated conservatively, in-hospital mortality was higher in patients with new onset of AF (8.1% vs 33.3%; p = 0.001). Independent predictors of inhospital death in this group of patients were: new onset of AF, age, cardiogenic shock, chronic obstructive pulmonary disease, history of renal insufficiency, and discharge diagnosis. Conclusions: New onset of AF is associated with excessive in-hospital mortality in acute coronary syndrome patients staying on conservative treatment in community hospitals without on-site invasive facilities. (Cardiol J 2010; 17, 1: 57-64

Age-related gap in the management of heart failure patients. The National Project of Prevention and Treatment of Cardiovascular Diseases — POLKARD

Background: Heart failure (HF) is strongly associated with aging. It affects 10&#8211;12% of patients older than 80 years, with five-year overall mortality after first hospitalization for HF being as high as 81%. The main objective of this study was to assess the diagnosis and treatment of HF in hospitalized octogenarians compared to younger subjects. Methods: The survey was performed among a random sample of all Polish hospitals and in all academic centers, as part of the National Project of Prevention and Treatment of Cardiovascular Diseases in Poland &#8212; POLKARD. Using a questionnaire-based method, hospital documentation of the last five patients with diagnosed HF was reviewed. Eventually, in 2005, HF patients of 259 internal medicine and cardiology hospital wards, including 260 very elderly patients, were selected to the study. Results: The mean age of the 1,289 studied patients was 69.8 &#177; 11.4 years (age range: 26&#8211;96 years), 57.8% were males, and 80.1% were in NYHA class III or IV. Echocardiography was performed in 41.7% of octogenarians in comparison with 58.7% of those categorized as younger elderly, i.e. 60&#8211;79 years, and 75.2% of patients aged below 60 years (p < 0.0001). The most prescribed drugs in very elderly patients were diuretics (86.9%, p = 0.005) and ACE-I (81.9%), while only 61.5% used beta-blockers (p < 0.0001). In stepwise logistic regression analysis, hypertension, history of myocardial infarction and admission to cardiology ward were positively associated with beta-blocker and ACE-I (or ARB) therapy, while older age and pulmonary diseases (COPD or asthma) were related to their non-prescription. Conclusions: Despite significant progress in HF management, there is still a need for an improvement in the medical care of very elderly patients. The major obstacles seem to be advanced age and the presence of coexistent pulmonary diseases. Therefore, the participation of geriatricians and pulmonologists should be recommended in caring for octogenarians with HF. (Cardiol J 2012; 19, 2: 146&#8211;152

Impact of smoking status on outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

There are some data showing lower mortality of smokers comparing to non-smokers in patients with ST-segment elevation myocardial infarction (STEMI) when treated with thrombolysis or without reperfusion therapy. However, the role of smoking status is less established in patients with STEMI undergoing mechanical reperfusion. We evaluate the influence of smoking on outcome in patients with STEMI treated with primary percutaneous coronary intervention (PCI). A total of 1,086 patients enrolled into EUROTRANSFER Registry were included into present analysis. Patients were divided according to smoking status during STEMI presentation into those who were current smokers (391 patients, 36 %) and non-smokers (695 patients, 64 %). Current smokers were younger and more often men and less frequently had high-risk features as previous myocardial infarction, history of chronic renal failure, previous PCI, diabetes mellitus, anterior wall STEMI, and multivessel disease. Unadjusted mortality at 1 year was lower in current smokers comparing to non-smokers (3.3 vs. 9.5 %; OR 0.33 CI 0.18–0.6; p = 0.0001). However, after adjustment for age and gender by logistic regression, there was no longer significant difference between groups (OR 0.7; CI 0.37–1.36; p = 0.30). In conclusion, current smokers with STEMI treated with primary PCI have lower mortality at 1 year comparing to non-smokers, but this result may be explained by differences in baseline characteristics and not by smoking status itself. Current smokers developed STEMI more than 10 years earlier than non-smokers with similar age and sex-adjusted risk of death at 1 year. These results emphasize the role of efforts to encourage smoking cessation as prevention of myocardial infarction

Age-related differences in treatment strategies and clinical outcomes in unselected cohort of patients with ST-segment elevation myocardial infarction transferred for primary angioplasty

Data concerning the benefits and risks of primary PCI in the elderly patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Thus, the objective of the study was to assess age-dependent differences in the treatment and outcomes of STEMI patients transferred for primary PCI. Data were gathered on 1,650 consecutive STEMI patients from hospital networks in seven countries of Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Patients <65, 65 to 74, 75 to 84, and ≥85 years of age comprised 49.3, 27.5, 20.2, and 3 % of the registry population, respectively. Elderly patients were higher risk individuals and have experienced longer delays to reperfusion than their younger counterparts and were more likely to be treated conservatively after coronary angiography. Despite similar frequency of TIMI 3 flow before PCI, elderly patients were less likely to achieve TIMI 3 flow and ST-segment resolution >50 % after PCI, and were more likely to have PCI complications. The rates of death at 30 days, as well as at 1 year were increased with age. In the Cox regression analysis model age was an independent predictor of 30-day mortality. A trend toward higher risk of major bleeding requiring transfusion was observed. Age was an important determinant of treatment strategies selection and clinical outcomes in the group of consecutive STEMI patients transferred for primary PCI. Further efforts should be made to reduce delays and to optimize treatment of STEMI, regardless of patients’ age

Percutaneous left atrial appendage closure with Watchman LAA occluder device in a patient with persistent atrial fibrillation

We present a case of a 74-year-old male with persistent atrial fibrillation and ischaemic stroke despite vitamin-K antagonist treatment who underwent successful left atrial appendage closure with Watchman device

Analysis of the origin of birth defects in pregnant women from the Kujawy-Pomerania Region

Objectives: The aim of the study was to analyze the origin of birth defects in pregnant women from the Kujawy-Pomerania Region, and to identify factors affecting the formation of developmental disorders in the Province. Material and methods: The correlation between maternal age and fetal defects was investigated. We also attempted to determine whether environmental or family factors play a role in the formation of fetal abnormalities. Results: The analysis confirmed a correlation between the incidence of chromosomal aberrations and maternal age. Conclusions: Higher rates of neural tube defects were observed in fetuses born to mothers who did not take folic acid. The influence of other factors on developmental anomalies was not confirmed