Long-term outcomes of patients with multivessel coronary artery disease presenting non-ST-segment elevation acute coronary syndromes

Background: There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography. Methods: 3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics.  Results: After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20–0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31–0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19–0.69; p = 0.0020). Conclusions: In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.

Aterektomia rotacyjna — renesans metody

Advances in the diagnosis and treatment of cardiovascular diseases have contributed to the increase of number of elderly patients referred to cardiologists. Coronary artery calcification rate increases with age. Calcifications are the most common cause of the percutaneous coronary intervention failure. Revascularization of patients with heavily calcified coronary arteries can be a challenge for interventional cardiologists. The procedural success rate in these patients can be improved by using rotational atherectomy (RA), which is a technique to modify the atherosclerotic plaque and facilitate stent delivery and implantation. Even though, RA is not recommended before stenting, it may improve prognosis and the quality of life in many patients. Currently the role of RA increases, therefore we present the current state of this technique.Postępy w diagnostyce i leczeniu chorób układu sercowo-naczyniowego sprawiają, że pod opieką kardiologów znajdują się coraz starsi chorzy. Z wiekiem wzrasta także stopień uwapnienia tętnic wieńcowych. Uwapnione zmiany są najczęstszą przyczyną niepowodzeń zabiegów angioplastyki wieńcowej. Rewaskularyzacja pacjentów z uwapnionymi zmianami tętnic wieńcowych często stanowi wyzwanie dla kardiologa. Alternatywną metodą, która stanowi szansę na powodzenie zabiegu u takich chorych, jest aterektomia rotacyjna (RA), technika ta pozwala na modyfikację blaszki miażdżycowej i wprowadzenie stentu. Chociaż RA nie zaleca się jako rutynowej procedury przed implantacją stentu, to w wielu przypadkach umożliwia poprawę rokowania i jakości życia. W ostatnich latach rola rotablacji się zwiększa, dlatego w niniejszej pracy zaprezentowano aktualny stan wiedzy dotyczący tej metody

Compression Anastomosis Clips Versus a Hand-Sewn Technique for Intestinal Anastomosis in Pigs

Background. Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality. The ideal device to create anastomoses should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time. Objectives. The aim of this experimental study was to evaluate the safety and efficacy of a new compression anastomosis clip (CAC) for jejunojejunostomies and ileocolostomies by comparing CAC anastomoses with hand-sewn (HS) anastomoses in pigs in terms of healing, breaking strength and the time to create anastomoses. Material and Methods. The 11 pigs in the study underwent side-to-side CAC and HS jejunojejunostomies and ileocolostomies, for a total of 88 anastomoses. The pigs were sacrificed on postoperative day 5 (5 pigs) or 7 (6 pigs). Macroscopic, histopathological and breaking-strength examinations were performed. The time to create the anastomoses was recorded. Results. Neither group had anastomotic complications such as leakage or obstruction. Macroscopic examination showed no statistically significant differences between the groups. In the CAC group, the healing process was characterized by a lesser inflammatory reaction (p < 0.05) and very thin scar tissue at the anastomotic line (less collagen deposition and better epithelial regeneration), while the HS group had a much thicker anastomotic line. The breaking strength was significantly greater in the CAC group compared with the HS group (p < 0.05). The anastomosis time was shorter in the CAC group than in the HS group (p < 0.01). Conclusions. Anastomosis using a CAC appears to be safe and less time-consuming than HS; it was also characterized by a good healing process with little inflammatory reaction and a high breaking strength compared with HS anastomosis (Adv Clin Exp Med 2015, 24, 6, 000–000)

Spontaneous reperfusion before intervention improves immediate but not long-term prognosis in diabetic patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Background: The presence of normal thrombolysis in myocardial infarction (TIMI) fl owgrade 3 before percutaneous coronary intervention (PCI) is associated with better outcomes.The aim of this study was to evaluate the association of spontaneous reperfusion (SR) beforePCI and its effect on the immediate and long-term outcomes in diabetic patients.Methods: A total of 1,850 patients with myocardial infarction and multivessel coronary arterydisease undergoing primary PCI were enrolled and divided into 4 groups: (1) patients withdiabetes mellitus (DM) and initial TIMI &lt; 3 fl ow (n = 491), (2) patients with DM and initialTIMI 3 fl ow (n = 48), (3) patients without DM and with initial TIMI &lt; 3 fl ow (n = 1,196),(4) patients without DM and with initial TIMI 3 fl ow (n = 115).Results: SR before PCI was similar in diabetic and non-diabetic patients (8.9% vs. 8.8%,p = 0.8). DM was not an independent predictor of either pre-procedural or post-proceduralTIMI 3 fl ow. In-hospital mortality rate was the highest in group 1 and the lowest in group 4(p &lt; 0.0001). Death rates of patients from groups 2 and 3 were similar (approximately 8.3%each, p = 0.9). Non-diabetic patients had a higher 1-year survival rate than diabetic patients,irrespective of their initial TIMI fl ow.Conclusions: SR is associated with a similar post-PCI improvement in epicardial blood fl owboth in diabetic and non-diabetic patients. SR improves in-hospital survival of diabetic patients,which is similar to the survival of non-diabetic patients without SR. The benefi cial effectof SR in diabetic patients disappears during 1-year follow-up

Przezskórna rewaskularyzacja przewlekłej okluzji tętnicy wieńcowej jako terapia skrajnej niewydolności serca i pomost do transplantacji

Patients with end-stage, inotrope-dependent heart failure (HF) have extremely poor prognosis with one-year mortality rate above 70%. The most frequent cause of HF is left ventricular ischemic systolic dysfunction. In this category, most cases result from the end-stage coronary artery disease with a previous history of myocardial infarction (MI) and the presence of coronary artery disease without options for revascularization, with at least one chronic total occlusion (CTO). This report describes a percutaneous recanalization of CTO as a bridge-to-transplantation therapy in a patient with an end-stage, inotrope-dependent HF.Pacjenci w schyłkowym stadium niewydolności serca charakteryzują się bardzo złym rokowaniem z roczną śmiertelnością ponad 70%. Najczęstszą przyczyną wystąpienia niewydolności jest niedokrwienna dysfunkcja skurczowa. W tej grupie u większości pacjentów występują zaawansowana choroba wieńcowa lub przebyty zawału serca w wywiadzie, a także przewlekłe okluzje tętnic wieńcowych. W niniejszym artykule autorzy przedstawiają przypadek chorego w schyłkowym stadium niewydolności serca, zależnego od amin katecholowych, u którego wykonano angioplastykę przewlekle zamkniętej tętnicy wieńcowej w charakterze leczenia pomostowego przed przeszczepieniem serca

Rewaskularyzacja w skurczowej niedokrwiennej niewydolności serca — prezentacja przypadku i podsumowanie aktualnych wytycznych

Heart failure has become a global pandemic. Despite being identified as the main cause of heart failure, evidence based data on coronary heart disease treatment in this population is scarce. At the same time the clinical characteristics in this group of patients is often very complex and requires an “outside-the-EBM-box” approach. This article is an attempt to summarize the current guidelines. We also present a case of a patient, in whom percutaneous revascularization with support of mechanical circulatory support, despite high risk, has given a very satisfactory short-term result and a good long-term outcome.  Niewydolność serca (NS) stała się światową pandemią. Pomimo że choroba wieńcowa stanowi jej najczęstszą przyczynę, zasób wiedzy opartej na faktach dotyczącej kwalifikacji do diagnostyki inwazyjnej oraz rewaskularyzacji jest ograniczony. Ponadto, wobec często znacznie obciążonej charakterystyki klinicznej pacjentów z NS konieczne do podjęcia w codziennej praktyce decyzje diagnostyczno-terapeutyczne wymykają się wytycznym. Niniejsza praca stanowi próbę podsumowania aktualnych zaleceń oraz przedstawia przypadek kliniczny pacjenta, u którego przeprowadzenie zabiegu przezskórnej rewaskularyzacji z wykorzystaniem mechanicznego wspomagania krążenia, pomimo wysokiego ryzyka, przyniosło bardzo dobry efekt terapeutyczny i pozwoliło na długoterminową poprawę