Does the operator's sex matter? An analysis based on the national interventional cardiology registry.

BACKGROUND: A small number of female cardiologists work in the field of interventional cardiology. Such disparity is observed in most European countries. AIMS: We present the first national report on the practice patterns and outcomes regarding percutaneous coronary interventions (PCIs) performed by female operators (FOs) in Poland. METHODS: Data were collected from the National Registry of Invasive Cardiology Procedures (Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej [ORPKI]) between January 2014 and December 2017. RESULTS: A total of 31 FOs (4.1%) performed 12 935 PCIs (2.8%). The median (interquartile range [IQR]) number of PCIs performed by FOs per year was 75 (43-154), whereas that by male operators was 139 (67-216; P <0.01). Patients handled by FOs were characterized by a lower prevalence of cardiovascular risk factors and previous coronary artery interventions. Acute coronary syndrome was the main indication for treatment (74.66%). Compared with male operators, FOs handled significantly more patients with single­vessel disease (87.02% vs 84.72%; P <0.001). They used smaller contrast doses during PCIs (median [IQR], 170.36 [77.54] cm3 vs 173.48 [77.54] cm3; P <0.001) yet higher doses of radiation exposure (median [IQR], 843 [472-1409] mGy vs 815 [458-1390] mGy; P = 0.01). There was no difference in clinical outcomes (a composite of all­cause death, bleeding at the puncture site, or coronary artery perforation) associated with the operator's sex. CONCLUSIONS: Women represent a minority of operators in interventional cardiology and are responsible for a low percentage of PCIs. Nonetheless, the practice patterns and outcomes of PCIs performed by FOs are similar to those of male operators.

[The influence of the outpatient cardiologic rehabilitation on the physical fitness at patients after a STEMI]. / Wplyw ambulatoryjnej rehabilitacji kardiologicznej na wydolnosc fizyczna chorych po zawale miesnia serca z uniesieniem odcinka ST.

UNLABELLED: Myocardial infraction, sudden cardiac death next is one of the most serious clinical demonstrations of ischaemic heart diseases. It is characterized by an irreversible destruction (necrosis) of a part of cardiac muscle, caused by severe narrowing or blood clot (thrombosis) in the lumen of coronary arteries. The long-term, systematic and individually selected program of the physical rehabilitation has a beneficial effect to the improvement in the physical fitness at patients, after an myocardial infarction. The aim of this work was to examine the influence of the outpatient, cardiological rehabilitation on the physical fitness and the normalization of the arterial pressure at patients after STEMI, treated with methods of invasive cardiology, and determining effects of the rehabilitation. MATERIAL AND METHODS: The study included 108 patients (93 men and 15 women). An average age of patients was 53. Examined patients were divided into 2 groups: rehabilitated (55 people) and control (53 people). The program of the cardiologic rehabilitation included 24 forty-minute training sessions, for 2-3 times during the week. Every training session spread through 10 minutes of the general keep-fit exercise (warm-up), 24 minutes of the ride on cycloergometer (intervallic training) with submaximal load adjusted individually for every patient, under the constant electrocardiographic scrutiny of the action of the heart, and 6 minutes of respiratory exercises. The criterion of intensity of a physical effort was determined on the basis of a Bruce test according to on the level of the 70% of the maximum limit of the heart rate. The rehabilitation lasted about 3 months. RESULTS: Obtained findings show that the outpatient, cardiologic rehabilitation has a beneficial effect for the improvement in the physical fitness and the decrease in value of the rest arterial pressure at patients after STEMI. Examinations show the increase of the maximum load (max MET'S) and longer duration of the exercise test. CONCLUSIONS: Above findings confirm the effectiveness of the cardiological rehabilitation, although they are not spectacular. Perhaps if they increase the frequency and intensity and number of training sessions, the results would be more significant.

[Massive infective endocarditis treated with triple bioprostheses implantation]. / Masywne infekcyjne zapalenie wsierdzia leczone metoda implantacji trzech biologicznych protez zastawkowych.

A case of a 50-year-old man admitted to the cardiology department due to massive infective endocarditis is presented. Diagnosis was confirmed by further investigations and patient was referred to cardiosurgery department. The surgery revealed destruction of mitral, tricuspid and aortic valve, thus three bioprostheses were implanted. The treatment was successful and six months after surgery patient was in good overall condition.

Comparison of clinical results and life quality after myocardial infarction therapy with primary percutaneous coronary intervention and fibrinolytic angents.

INTRODUCTION: A correct and early diagnosis of ST-segment elevation myocardial infarction (STEMI) and implementation of treatment with the aim to regain patency of the infarct-related artery is crucial for prognosis and the ability to return to normal activities. OBJECTIVES: The aim of the current analysis was to compare two strategies of STEMI therapy in terms of decreasing the impairment level in patients undergoing treatment, expressed as the time to the return to normal social and professional life. PATIENTS AND METHODS: Two 100-patient groups of patients with STEMI were enrolled into the study. In the first group a fibrinolytic drug was used, while in the other primary percutaneous coronary intervention (PPCI) was performed. The material for the study was collected in the unique transitional period (2001-2002), when the 24-hour call schedule in the catheterization laboratories was introduced in the Ludwik Perzyna Complex Hospital in Kalisz. RESULTS: During the 6-month follow-up mortality in the fibrinolysis group was 18%, and in the PPCI group 1 death (1%). In both groups, there were recurrent chest pain (63% vs. 38.5%, p < 0.0001), the need for nitroglycerin use (73% vs. 37.4%, p < 0.0001), recurrent STEMI (7% vs. 0%, p = 0.02), and recurrent hospitalizations (35% vs. 15.2%, p = 0.003). Marked limitations of activity in family and social life were more commonly observed in the thrombolytic drugs-treated group (p <0.0001). A small percentage of patients who returned to work was observed, however in favor of the PPCI group (20% vs. 38%, p = 0.009). Differences between groups concerning professional status 6 months after STEMI were significant (p = 0.046; chi2). CONCLUSIONS: Treatment of STEMI with PPCI was associated with an earlier return of respondents to health and a significantly smaller limitation of their activity during the 6-month follow-up.

Short- and long-term mortality in patients with ST-elevation myocardial infarction treated with different therapeutic strategies. Results from WIelkopolska REgional 2002 Registry (WIRE Registry).

BACKGROUND: Although primary coronary angioplasty seems to be the best treatment in acute myocardial infarction (MI), thrombolytic therapy still remains the most common reperfusion strategy particularly in smaller centers. Nowadays, different regional networks are developed to improve the treatment of patients with MI. AIM: To analyse the effects of different therapeutic strategies on 30-day and long-term mortality (median time 18.3 months) after ST-elevation MI (STEMI) in a population of 3 350 000 people from the Wielkopolska Region. METHODS: In 2002, 3780 patients with STEMI entered the registry. Complete data were available for 3564 (94.3%) patients. Depending on therapeutic strategies, patients were divided into five groups: the PCI group--direct percutaneous coronary angioplasty (PCI) in small cathlab, 'selected patients', n=381 (10.7%); the PA group--aged <70, treated with tissue plasminogen activator (rt-PA) up to 4 hours from the onset of chest pain, n=479 (13.4%); the IS group - invasive strategy in every patient, 24-hour duty, setting of unselected patients with STEMI, n=989 (27.7%); the SK group--patients receiving standard streptokinase treatment up to 12 hours from the onset of chest pain, n=584 (16.4%); the NR group--no reperfusion therapy, n=1131 (31.7%). RESULTS: The 30-day mortality rate in the groups above was: 3.15, 4.38, 4.54, 9.25, and 12.5% respectively (p <0.001). Long-term mortality rate was: 4.2, 9.4, 9.4, 14.4, and 18.50% respectively (p <0.001). The rate of urgent PCI in the PA group was 25% and in the SK group--11% (p <0.001). CONCLUSIONS: Treatment with rt-PA in patients under 70 years of age and up to 4 hours from pain onset may be an alternative to an invasive strategy. However, a quarter of those patients require urgent PCI. In long-term observation the mortality benefit can be clearly seen only in patients with early PCI.

[Acute inferior myocardial infarction with right ventricular involvement complicated by interventricular septum rupture - a case report]. / Zawal serca sciany dolnej i prawej komory z peknieciem przegrody miedzykomorowej.

A case of a 62-year-old female with acute inferior myocardial infarction with right ventricular involvement is presented. The patient developed cardiogenic shock due to interventricular septum rupture. Pharmacological agents and intraaortic balloon counterpulsation restored normal circulation which enabled elective surgical treatment 14 days after the onset of symptoms.

Correlation between the extent of coronary atherosclerosis and lipid profile.

Increased concentration of low density lipoprotein (LDL) cholesterol or decreased level of high density lipoprotein (HDL) cholesterol are important risk factors for coronary atherosclerosis. However, an independent association of triglycerides (TG) with atherosclerosis is uncertain. The aim of this prospective study was to evaluate the relationship between serum lipid levels and the extent of coronary atherosclerosis in patients with suspected coronary artery disease (CAD) and no previous myocardial infarction who were not treated with lipids lowering therapy or low-lipid diet. The study was conducted in 141 patients (53.6 +/- 7.8 years old; 32 female) who underwent a routine coronary angiography for CAD diagnosis. A modified angiographic Gensini Score (GS) was used to reflect the extent of coronary atherosclerosis. Fasting serum lipid concentrations were determined using cholesterol esterase/peroxidase (CHOD/PAP) enzymatic method for total cholesterol and its fractions and lipase glycerol kinase (GPO/PAP) enzymatic method TG evaluation. The association of Gensini Score with variables characterising lipid profile was analysed with the use of Pearson correlation (r co-efficient; p value). GS was positively correlated with total cholesterol (r = 0.404; p < 0.001), LDL cholesterol (r = 0.484; p < 0.001 ) and TG (r = 0.235; p = 0.005). There was a negative correlation between Gensini Score and HDL cholesterol (r = -0.396; p < 0.001). In angina pectoris patients with no previous myocardial infarction, the extent of coronary atherosclerosis is positively correlated with pro-atherogenic lipids, i.e. total cholesterol, LDL cholesterol and TG and negatively correlated with antiatherogenic HDL cholesterol.