An interesting case of a self-apposing stent implantation in an aneurysmatically dilated artery in acute myocardial infarction with high quality optical coherence tomography images

56-Year-old man with non-ST-segment elevation myocardial infarction. Coronary angiography showed aneurysmatic changes of the left circumflex artery with near occlusion of this vessel. We have decided to implant a Self-Apposing® Coronary Stent Xposition S (Stentys SA, Paris, France). In optical coherence tomography a good stent apposition has been confirmed. A complete distal flow in the infarct-related artery was achieved. Implantation of DES in a large vessel, especially with aneurysmatic dilatation is limited due to difficulties in choosing a proper stent size. Undersizing may cause stent malapposition which carries an increased risk of late and very late stent thrombosis. Oversizing may lead to dissection or even vessel perforation. In presented case choosing a proper stent size was not so easy because of aneurysmatic changes of the artery. The vessel diameter in the aneurysm area was about 6 mm. Regular DES are commercially available in maximal sizes up to 4.5–5.0 mm. In this case we have chosen the largest Stentys stent size available (3.5–4.5 × 27 mm) which is designed to target vessels of diameter between 3.5 and 6.0 mm. Self-apposing stents present useful features which might have advantages over conventional drug-eluting stents in specific angiographic situations

CHA2DS2-VASc and R2-CHA2DS2-VASc scores predict in-hospital and post-discharge outcome in patients with myocardial infarction

Introduction: The CHA2DS2-VASc and R2-CHA2DS2-VASc scores were initially designed to evaluate the risk of cerebrovascular events in patients with atrial fibrillation. However, these scales consist of parameters which are well known as general risk factors for cardiovascular events. Aim: To assess the role of the CHA2DS2-VASc and R2-CHA2DS2-VASc scores in predicting outcome of patients with myocardial infarction (MI). Material and methods: We enrolled 212 consecutive patients with both ST-elevation and non-ST-elevation MI referred for primary percutaneous coronary intervention (PCI). Patients were divided into two groups depending on the CHA2DS2-VASc score: ≤ 3 (low score) and > 3 points (high score). Results: The group with a CHA2DS2-VASc score > 3 points consisted of 93 (44%) patients. Follow-up was available in 200 (94.3%) patients with median duration of 10 (Q1: 6; Q3: 13) months. During the follow-up all-cause mortality was greater in patients from the high score group (21%) compared to patients with lower scores (8%) (p = 0.009). Recurrent MI was found in 4% of patients from the low score group and in 13% of patients from the high score group (p = 0.024). The combined endpoint of cardiovascular mortality, recurrent non-fatal MI and non-fatal stroke occurred in 13% of lower score patients and in 30% of patients with a score > 3 points (p = 0.002). In a Cox regression model both scores were predictors of all-cause mortality with a hazard ratio of 1.31 per 1 point increase for the CHA2DS2-VASc score (p = 0.004) and 1.36 for the R2-CHA2DS2-VASc score (p < 0.001). Conclusions: The CHA2DS2-VASc and R2-CHA2DS2-VASc scores predict in-hospital and post-discharge outcome in patients with acute MI undergoing primary PCI

Direct Absorb bioresorbable scaffold implantation in acute coronary syndrome

Background: Direct stent implantation is a preferred technique for primary percutaneous coronary intervention (PCI). For the deployment of a bioresorbable vascular scaffold (BVS), the current guidelines recommend aggressive predilatation. Data about direct BVS implantation in patients with acute coronary syndrome (ACS) are scarce. Aim: We sought to assess procedural characteristics and immediate outcomes of direct Absorb BVS implantation in ACS patients. Methods: A total of 91 patients with acute myocardial infarction (MI) requiring urgent coronary revascularisation were enrolled. Among them, 50 patients underwent an attempt of direct Absorb implantation. The control group consisted of 41 patients treated with PCI with BVS deployment after elective predilatation. Results: In the direct group BVS deployment was successful in 91% of lesions, and in the remaining 9% of lesions direct implantation failed. In the control group scaffolds were successfully deployed after predilatation in 98% of lesions. In one case Absorb implantation failed even after balloon angioplasty. Type C lesions with severe tortuosity and angulation &gt; 90° were associated with failure in direct Absorb deployment. Quantitative coronary analysis showed similar final percentages of diameter stenosis in the study and control groups. Flow analyses did not show significant differences between both methods. During hospitalisation no recurrent MI, scaffold thrombosis, or target lesion revascularisation was reported in either group. Conclusions: Direct Absorb implantation in ACS patients may be feasible in a suitable lesion anatomy

Simulation of water turbine integrated with electrical generator

The paper presents the analysis of the small hydropower plant working at variable speed. The hydro-set that consists of the guide vanes and propeller turbine integrated with the permanent magnet synchronous generator is simulated by using Computational Fluid Dynamics (CFD) in Ansys Fluent v18.0. The k-ε and k-ω SST models, as well as the one-equation Spalart-Allmaras (SA) model, were tested. The comparison showed the significant divergence of the calculation results. The turbulence model selection influences the average value of the power and also the speed for which the power is maximal

Frailty as a predictor of in-hospital outcome in patients with myocardial infarction

(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay