Survival rate after acute myocardial infarction in patients treated with percutaneous coronary intervention within the left main coronary artery according to time of admission

The relationship regarding time of percutaneous coronary intervention (PCI) and clinical outcomes in patients with acute myocardial infarction (AMI) treated within the left main coronary artery (LMCA) is less investigated compared to the overall group of patientswith AMI. Therefore, we aimed to assess the relationship between time of PCI (day- vs night-time) and overall mortality rate in patients treated due to AMI within the LMCA. This cross-sectional study included 443,805 AMI patients hospitalized between 2006 and 2018 enrolled in the Polish Registry of Acute Coronary Syndromes. We extracted 5,404 patients treated within the LMCA. The number of patients were treated during daytime hours (7:00 am-10:59 pm) was 2809 while 473 patients underwent treatment during night-time hours (11:00 pm-6:59 am). Differences in cardiac mortality rates between night- and day-hours among patients treated with PCI during the follow-up period were assessed via the Kaplan-Meier method. The 30-day (20.3% vs 14.9%, P = .003) and 12-month (31.7% vs 26.2%, P=.001) overall mortality rates were significantly greater among patients treated during night-time, which was confirmed by comparison using Kaplan-Maier survival curves (P=.001). The time of PCI was not found among predictors of survival in multiple regression analysis (hazard ratio: 1.22; 95% confidence interval: 0.96-1.55, P=.099). Patients treated during night-time in comparison to the day-time are related to higher in-hospital, 30-day and 12-month mortality. This is probably largely a consequence that the night-time, in comparison to the day-time, of treatment of patients with AMI with PCI within the LMCA is and indicator of higher comorbidity and clinical acuity of patients undergoing therapy. Therefore, the night-time was not found to be an independent predictor of greater mortality rate during the 12-months follow-up period

Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry

Background: Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD. Methods: Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively. Results: There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi­fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1–3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0–3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01–5.5; p < 0.0001) LVSD. Conclusions: The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD

Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Background: Time delays to reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) still remain a considerable drawback in many healthcare systems. Emergency medical service (EMS) has a critical role in the early management of STEMI. Under investigation herein, was whether the use of physician-staffed ambulances leads to shorter pre-hospital delays in STEMI patients.Methods: This was an observational and retrospective study, using data from the registry of the Silesianregional EMS system in Katowice, Poland and the Polish Registry on Acute Coronary Syndromes(PL-ACS) for a study period of January 1, 2013 to December 31, 2016. The study population (n = 717)was divided into two groups: group 1 (n = 546 patients) — physician-staffed ambulances and group 2(n = 171 patients) — paramedic-staffed ambulances.Results: Responses during the day and night shifts were similar. Paramedic-led ambulances moreoften transmitted 12-lead electrocardiogram (ECG) to the percutaneous coronary intervention centers.All EMS time intervals were similar in both groups. The type of EMS dispatched to patients (physicianstaffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.79–1.95;p = 0.4). However, service time exceeding 42 min was an independent predictor of in-hospital mortality(OR 4.19; 95% CI 1.27–13.89; p = 0.019). In-hospital mortality rate was higher in the two upperquartiles of service time in the entire study population.Conclusions: These findings suggest that both physician-led and paramedic-led ambulances meet thecriteria set out by the Polish and European authorities. All EMS time intervals are similar regardlessof the type of EMS unit dispatched. A physician being present on board did not have a prognostic impacton outcomes

Średnia objętość płytek krwi i wskaźnik dużych komórek jako czynniki prognostyczne choroby wieńcowej i zawału serca

Platelets represent an important link between inflammation and thrombosis and play an important role in all stages of atherosclerotic lesion formation. Increased platelet activity and their tendency to clot formation favour the incidence of thrombotic complications, such as unstable angina pectoris (UA), myocardial infarction (MI) and sudden cardiac death, in the course of coronary artery disease (CAD). Mean platelet volume (MPV) reflects the average size of platelets and, under normal circumstances, ranges between 7.5 fL to 10.5 fL. Platelet-large cell ratio (P-LCR) is defined as the percentage of platelets that exceed the normal value of platelet volume of 12 fL in the total platelet count. Platelet size has been shown to reflect platelet activity; therefore MPV and P-LCR are a simple and easy method of indirect assessment of platelet stimulation. In general population, higher MPV values are associated with increased risk of CAD. Higher MPV and P-LCR values are observed in CAD patients compared to patients without coronary atherosclerosis. In acute coronary syndromes (ACS) the MPV value is higher in patients with myocardial infarction than in patients with unstable CAD. In cases of stable CAD, elevated MPV correlates with the severity of coronary artery involvement and is a predictive factor of ACS. In patients with acute MI high MPV value has been reported to have impact on the no-reperfusion phenomenon following a percutaneous coronary intervention (PCI). Therefore, MPV and P-LCR indices, combined with other prognostic parameters, may be an important element of various scoring systems used in long-term prognosis in both stable CAD and ACS.Płytki krwi są ważnym ogniwem łączącym zapalenie i zakrzepicę oraz odgrywają istotną rolę na wszystkich etapach powstawania zmian miażdżycowych. Zwiększona aktywność płytek krwi powodująca nasiloną krzepliwość krwi przyczynia się do większej liczby powikłań zakrzepowych, takich jak niestabilna dławica piersiowa (UA), zawał serca (MI) i nagły zgon sercowy w przebiegi choroby wieńcowej (CAD). Średnia objętość płytki krwi (MPV) odpowiada przeciętnej wielkości płytek i w normalnych warunkach mieści się w zakresie od 7,5 fl do 10,5 fl. Wskaźnik płytkowy dużych komórek (P-LCR) jest definiowany jako odsetek płytek krwi przekraczających zakres prawidłowej objętości płytek wynoszący powyżej 12 fl. Wykazano, że wielkość płytek odzwierciedla ich aktywność, dlatego oznaczenie MPV i P-LCR to proste i łatwe metody pośredniej oceny stopnia stymulacji płytek krwi. W populacji ogólnej wyższe wartości MPV wiążą się ze zwiększonym ryzykiem CAD. U chorych z CAD obserwuje się wyższe wartości MPV i P-LCR niż u osób bez zmian miażdżycowych tętnic wieńcowych. W grupie chorych z ostrymi zespołami wieńcowymi (ACS) wartość MPV jest wyższa u osób z rozpoznaniem zawału serca niż u osób z niestabilną CAD. W przypadku stabilnej CAD wielkość MPV koreluje z ciężkością zmian w tętnicach wieńcowych i jest czynnikiem predykcyjnym ACS. Opisywano wpływ wysokich wartości MPV u chorych z ostrym MI na występowanie zjawiska braku reperfuzji po przezskórnej interwencji wieńcowej (PCI). Dlatego wskaźniki MPV i P-LCR w połączeniu z innymi prognostycznymi parametrami mogą być ważnym elementem różnych systemów oceny ryzyka w perspektywie długookresowej zarówno w stabilnej CAD, jak i ACS

The Silesian Registry of Out-of-Hospital Cardiac Arrest: Study design and results of a three-month pilot study

Background: Despite the introduction of the concept known as “Chain of Survival” has significantly increased survival rates in patients with out-of-hospital cardiac arrest (OHCA), short-term mortality in this group of patients is still very high. Epidemiological data on OHCA in Poland are limited. The aim of this study was to create a prospective registry on OHCA covering a population of 2.7 million inhabitants of Upper Silesia in Poland. Presented herein is the study design and results of a 3-monthpilot study.Methods: The Silesian Registry of Out-of-Hospital Cardiac Arrest (SIL-OHCA) is a prospective, population-based registry of OHCA, of minimum duration which was planned for 12 months; from January 1st, 2018 to December 31st, 2018. The first 3 months of the study constituted the pilot phase. The inclusion criterion is the occurrence of OHCA in the course of activity of the Voivodeship Rescue Service in Katowice, Poland.Results: During the 3-month pilot phase of the study there were 390 cases of OHCA in which cardiopulmonary resuscitation was undertaken. Estimated frequency of OHCA in the population analyzed was 57 per 100,000 population per year. Shockable rhythm was present in 25.8% of cases. Return of spontaneous circulation was achieved in 35.1% of the whole cohort. 28.7% of patients were admitted to the hospital, including 2.8% of patients, who were admitted during an ongoing cardiopulmonary resuscitation.Conclusions: Prehospital survival of patients with OHCA in Poland is still unsatisfactory. It is believed that data collected in SIL-OHCA registry will allow identification factors, which require improvement in order to reduce short- and long-term mortality of patients with OHCA

From red to green luminescence via surface functionalization. Effect of 2-(5-mercaptothien-2-yl)-8-(thien-2-yl)-5-hexylthieno[3,4-c]pyrrole-4,6-dione ligands on the photoluminescence of alloyed Ag-In-Zn-S nanocrystals

A semiconducting molecule containing a thiol anchor group, namely 2-(5-mercaptothien-2-yl)-8-(thien-2-yl)-5-hexylthieno- [3,4-c]pyrrole-4,6-dione (abbreviated as D-A-D-SH), was designed, synthesized, and used as a ligand in nonstoichiometric quaternary nanocrystals of composition Ag1.0In3.1Zn1.0S4.0(S6.1) to give an inorganic/organic hybrid. Detailed NMR studies indicate that D-AD- SH ligands are present in two coordination spheres in the organic part of the hybrid: (i) inner in which the ligand molecules form direct bonds with the nanocrystal surface and (ii) outer in which the ligand molecules do not form direct bonds with the inorganic core. Exchange of the initial ligands (stearic acid and 1-aminooctadecane) for D-A-DSH induces a distinct change of the photoluminescence. Efficient red luminescence of nanocrystals capped with initial ligands (λmax = 720 nm, quantum yield = 67%) is totally quenched and green luminescence characteristic of the ligand appears (λmax = 508 nm, quantum yield = 10%). This change of the photoluminescence mechanism can be clarified by a combination of electrochemical and spectroscopic investigations. It can be demonstrated by cyclic voltammetry that new states appear in the hybrid as a consequence of D-A-D-SH binding to the nanocrystals surface. These states are located below the nanocrystal LUMO and above its HOMO, respectively. They are concurrent to deeper donor and acceptor states governing the red luminescence. As a result, energy transfer from the nanocrystal HOMO and LUMO levels to the ligand states takes place, leading to effective quenching of the red luminescence and appearance of the green one

The platelet-to-lymphocyte ratio as a predictor of all-cause mortality in patients with coronary artery disease undergoing elective percutaneous coronary intervention and stent implantation

AbstractBackgroundThere is no data regarding the association between the platelet-to-lymphocyte ratio (PLR) and long-term mortality in patients with stable coronary artery disease (SCAD). The aim of this study is to evaluate the utility of the pre-procedural PLR for predicting long-term, all-cause mortality in patients with SCAD undergoing percutaneous coronary intervention (PCI) and stent implantation.MethodsWe analyzed a total of 2959 consecutive patients with SCAD who underwent PCI (balloon angioplasty followed by stent implantation or direct stenting) between July 2006 and December 2011 at our institution. The patients were stratified into tertiles according to their admission PLR. The association between the PLR value and the outcomes was assessed using Cox proportional regression analysis after adjusting for clinical angiographic and laboratory data.ResultsDuring median follow-up of 1124days, mortality was highest in patients with PLR within the 3rd tertile as compared to the 2nd and the 1st tertile (11.0% vs 8.7% vs. 9.6%, respectively, p=0.03). PLR remained associated with mortality in multivariable analysis including clinical variables, ejection fraction and angiographic parameters HR (per 10 units increase)=1.02 [95%CI,1.01÷1.04, p=0.006]. After adjustment for the eGFR and hemoglobin levels, PLR was however no longer significantly associated with mortality.ConclusionPLR has potential predictive value in patients with SCAD, which has not been reported previously, but statistical significance disappears after adjusting for estimated glomerular filtration rate (eGFR) and hemoglobin levels as a potential confounding variable

The association of functional polymorphisms in genes encoding growth factors for endothelial cells and smooth muscle cells with the severity of coronary artery disease

Associations of genotype with the Gensini score among patients without previous MI. (DOCX 14 kb