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Background: The coronavirus disease-2019 (COVID-19) pandemic is surging across Poland, leading to many direct deaths and underestimated collateral damage. We aimed to compare the influence of the COVID-19 pandemic on hospital admissions and in-hospital mortality in larger vs. smaller cardiology departments (i.e., with ≥ 2000 vs. < 2000 hospitalizations per year in 2019). Methods: We performed a subanalysis of the COV-HF-SIRIO 6 multicenter retrospective study including all patients hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, focusing on patients with acute heart failure (AHF) and COVID-19. Results: Total number of hospitalizations was reduced by 29.2% in larger cardiology departments and by 27.3% in smaller cardiology departments in 2020 vs. 2019. While hospitalizations for AHF were reduced by 21.8% and 25.1%, respectively. The length of hospital stay due to AHF in 2020 was 9.6 days in larger cardiology departments and 6.6 days in smaller departments (p < 0.001). In-hospital mortality for AHF during the COVID-19 pandemic was significantly higher in larger vs. smaller cardiology departments (10.7% vs. 3.2%; p < 0.001). In-hospital mortality for concomitant AHF and COVID-19 was extremely high in larger and smaller cardiology departments accounting for 31.3% vs. 31.6%, respectively. Conclusions: During the COVID-19 pandemic longer hospitalizations and higher in-hospital mortality for AHF were observed in larger vs. smaller cardiology departments. Reduced hospital admissions and extremely high in-hospital mortality for concomitant AHF and COVID-19 were noted regardless of department size.
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OBJECTIVES: The aim of this study was to assess prospectively the effectiveness and safety profile of distal left main stem (LMS) stenosis treatment with dedicated bifurcation paclitaxel-eluting stent BiOSS Expert®. BACKGROUND: Angioplasty of distal LMS stenosis is always a high-risk procedure, and optimal treatment is uncertain. METHODS: This was a prospective international 2-center study, which enrolled patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) or stable angina with distal left main stenosis. All patients were treated with the dedicated bifurcation stent BiOSS Expert®. Provisional T-stenting was the obligatory strategy. Angiographic control was performed after 12 months. The primary end-point was cumulative rate of death, myocardial infarction (MI), and target lesion revascularization (TLR) at 12 months. Angiographic end-points included late lumen loss, percent diameter stenosis, and binary restenosis rate. RESULTS: A total of 54 patients with distal LMS stenosis were enrolled. Seven patients (13%) were enrolled during NSTE-ACS, 77.8% were hypertensive, 27.8% were diabetic, 51.9% had previous MI, 53.7% underwent prior percutaneous coronary intervention, and 16.7% coronary artery bypass graft. The mean SYNTAX score was 21.52 ± 6.50. The device success rate was 100%. The mean BiOSS Expert stent parameters were as follows: 4.07 ± 0.26 mm × 3.36 ± 0.26 mm × 16.61 ± 1.72 mm and in side branch the other stent (classical drug-eluting stent) was implanted in 25.9% of cases. The overall TLR was 9.3%. There were no death, stent thrombosis, or acute MI. In the univariate regression analysis, the only factor associated with higher risk for TLR was the SYNTAX score value. CONCLUSIONS: The dedicated bifurcation stent BiOSS Expert® proved to be a feasible device, with promising safety and long-term clinical effectiveness in the treatment of distal LMS stenosis.
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Angina Estável , Angioplastia Coronária com Balão , Estenose Coronária , Stents Farmacológicos , Paclitaxel/uso terapêutico , Idoso , Angina Estável/etiologia , Angina Estável/terapia , Angioplastia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Antineoplásicos Fitogênicos/uso terapêutico , Angiografia Coronária/métodos , Estenose Coronária/complicações , Estenose Coronária/diagnóstico , Estenose Coronária/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. METHODS: The present research is a subanalysis of a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). RESULTS: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). CONCLUSIONS: A greater reduction in hospital admissions in 2020 vs. 2019, higher rates of patients brought by ambulance together with lower rates of self-referrals and higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths were observed in cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones.
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COVID-19 , Cardiologia , Insuficiência Cardíaca , Humanos , COVID-19/epidemiologia , Pandemias , Estudos Retrospectivos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Mortalidade HospitalarRESUMO
AIMS: The coronavirus disease-2019 (COVID-19) pandemic has changed the landscape of medical care delivery worldwide. We aimed to assess the influence of COVID-19 pandemic on hospital admissions and in-hospital mortality rate in patients with acute heart failure (AHF) in a retrospective, multicentre study. METHODS AND RESULTS: From 1 January 2019 to 31 December 2020, a total of 101 433 patients were hospitalized in 24 Cardiology Departments in Poland. The number of patients admitted due to AHF decreased by 23.4% from 9853 in 2019 to 7546 in 2020 (P < 0.001). We noted a significant reduction of self-referrals in the times of COVID-19 pandemic accounting 27.8% (P < 0.001), with increased number of AHF patients brought by an ambulance by 15.9% (P < 0.001). The length of hospital stay was overall similar (7.7 ± 2.8 vs. 8.2 ± 3.7 days; P = not significant). The in-hospital all-cause mortality in AHF patients was 444 (5.2%) in 2019 vs. 406 (6.5%) in 2020 (P < 0.001). A total number of AHF patients with concomitant COVID-19 was 239 (3.2% of AHF patients hospitalized in 2020). The rate of in-hospital deaths in AHF patients with COVID-19 was extremely high accounting 31.4%, reaching up to 44.1% in the peak of the pandemic in November 2020. CONCLUSIONS: Our study indicates that the COVID-19 pandemic led to (i) reduced hospital admissions for AHF; (ii) decreased number of self-referred AHF patients and increased number of AHF patients brought by an ambulance; and (iii) increased in-hospital mortality for AHF with very high mortality rate for concomitant AHF and COVID-19.
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COVID-19 , Insuficiência Cardíaca , Doença Aguda , Carbidopa , Combinação de Medicamentos , Insuficiência Cardíaca/epidemiologia , Humanos , Levodopa/análogos & derivados , Pandemias , Estudos Retrospectivos , SARS-CoV-2RESUMO
BACKGROUND AND AIM: Significant left main coronary artery stenosis (LMS) conveys adverse prognosis and until recently its treatment has been restricted to surgical intervention. We evaluated the long term outcome of patients with LMS treated using different approaches i.e. medical treatment, surgical (CABG, coronary artery bypass graft) and percutaneous (PCI, percutaneous coronary intervention). METHODS: We analysed 450 patients with significant LMS (%DS > 50%). Group 1 (G1) included 105 patients who did not qualify for invasive treatment. Group 2 (G2) included 282 patients who underwent CABG. Group 3 (G3) comprised 67 patients who received stent into LMS. We analysed the incidence of invasive treatment complications in G2 and G3 and the overall incidence of adverse cardiac events that comprised death, repeated myocardial infarction, and the necessity of repeated revascularisation during hospital stay and long term follow-up. RESULTS: During the 5-year follow-up, the highest mortality was noted in the G1 in comparison to G2 and G3 (31.3% vs 24.5% vs 26.8% respectively). There was no difference in mortality between G2 and G3. The incidence of myocardial infarction was the lowest in G3 (22.2%) followed by G1 (40.8%) and G2 (45.1%). No difference was detected in the occurrence of repeated PCI in LMS (G2 - 19.85%, G3 - 13.4%) and CABG (G1 - 12.2%, G2 - 10.2%, G3 - 9.0%). The incidence of target vessel revascularisation was the highest in G1, followed by G2 and G3 (69.49% vs 53.19% vs 31.35% respectively). CONCLUSIONS: Our study showed that CABG and PCI provide similar long-term outcome in patients with LMS.
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Angioplastia Coronária com Balão , Ponte de Artéria Coronária , Estenose Coronária/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Estenose Coronária/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Recidiva , Stents , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: This study explores predictors of side branch (SB) compromise in the main vessel only stenting group and its influence on long-term follow-up of the patients. METHODS: We hypothesised that the geometric factors determining plaque distribution in branching regions influence SB compromise. Angiographic analysis of bifurcation lesions (all Medina types) was performed before, immediately after, and 9-12 months after the procedure. Control angiography was performed when clinically indicated. Specific attention was given to the influence of angle alpha - the angle between main vessel and SB axes. RESULTS: Fifty-five patients (62 lesions) formed the study group. The LAD lesions were dominant (73%). Drug-eluting stents were used in 48% and kissing balloon inflation in 31%. The value of angle alpha was associated with significant SB stenosis. There was significant worsening of ostial SB stenosis (from 48% to 69%) after main vessel stenting, with the only independent predictor angle alpha. For SB ostial MLD independent predictors were angle alpha, SB vessel diameter and MB reference diameter. Predictors of SB occlusion (6.5%) were angle alpha <30 degrees and age >82 years. At follow-up (mean 11 months) SB restenosis rate was 52%, but was associated with symptoms only if the main vessel was affected (8/55, 15%). Angle alpha and main vessel reference diameter, main branch minimal diameter after stenting and stent type were predictors of target vessel revascularisation rate (25%). CONCLUSION: Angle alpha predicts SB compromise after main vessel stenting and is the main predictor of restenosis in the main vessel.
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Doença da Artéria Coronariana/terapia , Reestenose Coronária/etiologia , Reestenose Coronária/prevenção & controle , Estenose Coronária/cirurgia , Stents/efeitos adversos , Idoso , Análise de Variância , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Índice de Gravidade de Doença , Fatores de TempoAssuntos
Angioplastia Coronária com Balão , Materiais Revestidos Biocompatíveis/uso terapêutico , Estenose Coronária/terapia , Stents Farmacológicos , Revascularização Miocárdica/métodos , Idoso , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Planejamento de Assistência ao Paciente , UltrassonografiaRESUMO
INTRODUCTION: Among patients with suspected acute coronary syndromes (ACS) referred for urgent coronary angiography there are some with normal angiograms. AIM: To compare, with respect to angiographic findings, one-year clinical outcomes in patients hospitalised for suspected ACS. METHOD: Between January 2001 and December 2003 emergency angiography was performed in 1169 patients. It revealed no significant coronary lesions in 97 (8.3%) cases, of these 40 being women and 57 men with a mean age of 55+/-15 yrs (Group 1). Sixty consecutive patients with ACS (20 women and 40 men with a mean age of 54+/-9 yrs) and significant coronary artery disease (CAD) confirmed by angiography were the study controls (Group 2). Demographic data, CAD risk factors, angiographic findings, ECG and echocardiographic data as well as laboratory test results were analysed. In a long-term follow-up, the prevalence of recurrent angina and all-cause mortality were assessed. RESULTS: There were no significant differences in patients' demographics between the two groups with the exception of arterial hypertension, which was more frequent in group 1. In group 1 the diagnosis of ACS was established in 14.5% cases, X syndrome in 14.4%, Prinzmetal angina in 4.1%, myocarditis in 6.1% and pulmonary thromboembolization in 5.1%. A definite diagnosis was not related to the cardiovascular disease in 36%. No complications were observed in the late follow-up of group 1 patients. CONCLUSIONS: Apparently normal angiograms are relatively common in patients referred for emergency coronary angiography. In patients without significant CAD on their angiograms the clinical outcome is favourable, without major adverse cardiovascular events in the long-term follow-up.
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Angina Pectoris/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Serviço Hospitalar de Emergência/estatística & dados numéricos , Doença Aguda , Adulto , Angina Pectoris/epidemiologia , Dor no Peito/epidemiologia , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Síndrome , Resultado do TratamentoRESUMO
Transcatheter aortic valve replacement (TAVR) is now an accepted standard of care for patients with symptomatic severe aortic stenosis who are not candidates for surgery or have high surgical risk. Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications. We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure. We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab.
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Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão , Doença da Artéria Coronariana/diagnóstico , Fístula Vascular/diagnóstico , Angiografia Coronária , Ecocardiografia Doppler em Cores , Eletrocardiografia , Feminino , Ventrículos do Coração , Humanos , Pessoa de Meia-IdadeAssuntos
Angioplastia Coronária com Balão/métodos , Doença das Coronárias/terapia , Reestenose Coronária/etiologia , Reestenose Coronária/terapia , Anomalias dos Vasos Coronários/complicações , Stents Farmacológicos/efeitos adversos , Doença das Coronárias/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Desmin plays an essential role in maintaining cell cytoarchitecture, positioning and functioning of organelles, and the intercellular signaling pathway. It has been suggested that remodeling of desmin cytoskeleton might contribute to the progression of idiopathic dilated cardiomyopathy and might affect patients' long-term prognosis. We performed endomyocardial biopsy in 200 patients with idiopathic dilated cardiomyopathy. A total of 5 to 6 specimens were collected from the left ventricular (LV) wall. Desmin was detected with immunohistochemical staining and Western blotting. Immunohistochemistry revealed 4 types of desmin expression: I, normal staining at Z-lines and intercalated disks, giving a regular cross-section pattern; IIA, increased desmin staining at Z-lines and intercalated disks; IIB, increased desmin staining with irregular pattern of cross-striation and/or with presence of aggregates; and III, decreased or lack of desmin staining. Patients with type III had a greater New York Heart Association class and N-terminal pro-brain natriuretic peptide level, larger LV end-diastolic diameter, and lower LV ejection fraction than patients with type I (p <0.001). At the end of follow-up (mean duration 59 ± 33 months), 44 patients (22%) had died and 5 (2.5%) had undergone heart transplantation. Patients with type III had an increased risk of death or heart transplantation in univariate Cox proportional hazard regression models (adjusted hazard ratio 7.18, 95% confidence interval 2.96 to 17.40, p <0.001) and multivariate models (New York Heart Association class, LV end-diastolic diameter, LV ejection fraction, N-terminal pro-brain natriuretic peptide, gender, and age; hazard ratio 5.24, 95% confidence interval 1.58 to 17.38, p = 0.007). In conclusion, in patients with idiopathic dilated cardiomyopathy, a decrease or lack of desmin expression seems to be a strong, independent predictor of an unfavorable prognosis. Our outcomes support the relevance of exploring desmin expression as a potential target to treat heart failure progression.
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Cardiomiopatia Dilatada/metabolismo , Desmina/biossíntese , Miócitos Cardíacos/metabolismo , Remodelação Ventricular/fisiologia , Biópsia , Western Blotting , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/fisiopatologia , Desmina/deficiência , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Miócitos Cardíacos/patologia , Prognóstico , Estudos Retrospectivos , Volume SistólicoRESUMO
Fractional flow reserve (FFR) is the gold standard in the assessment of severity of the coronary stenosis. The aim of the study was to compare optical coherence tomography (OCT) obtained intermediate coronary lesions lumen areas measurements with FFR assessments, with the goal to develop an OCT threshold to identify significant coronary stenosis. 48 patients (mean age 65 ± 10 years) was enrolled for the study. Within this population, 71 intermediate coronary lesions were investigated using both FFR and OCT. High dose bolus of Adenosine (120 µg) was used to obtain coronary hyperemia. OCT imaging was performed using non-occlusive technique to assess minimal lumen area (MLA) and diameter. The OCT cut-off value that showed the best correlation with the FFR cut-off of 0.80 was the MLA less than 2.05 mm2 (accuracy 87%, sensitivity 75%, specificity 90%, p < 0.001). The study did not disclose any relationship between FFR value and the lesion length. Vessel size influenced the OCT cut-off values, with greater values being found in presence of arteries with a reference diameter greater than 3.0 mm. OCT derived minimal lumen area might be complementary to FFR measurement in identifying ischemia related lesions. Further studies are warranted to assess threshold values in relation to vessel size and location.
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Cateterismo Cardíaco , Estenose Coronária/diagnóstico , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Tomografia de Coerência Óptica , Adenosina , Idoso , Estenose Coronária/patologia , Estenose Coronária/fisiopatologia , Feminino , Humanos , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Índice de Gravidade de Doença , VasodilatadoresRESUMO
A presented case of a 64-year-old male who underwent unsuccessful rotational atherectomy.
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Aterectomia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Angiografia Coronária , Ponte de Artéria Coronária , Humanos , Masculino , Pessoa de Meia-Idade , Falha de TratamentoRESUMO
A case of a 59-year-old man in whom primary coronary angioplasty was performed using peripheral stent system is presented.
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Infarto do Miocárdio/terapia , Angioplastia Coronária com Balão , Vasos Coronários/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Stents , UltrassonografiaRESUMO
We present a case of 44 year-old female who was admitted to the hospital due to performed radio frequency ablation because of VF during WPW syndrome, which was complicated by dissection of left main. The dissection was treated with success by primary percutaneous coronary intervention with two metal stents.
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Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão/métodos , Ablação por Cateter/efeitos adversos , Angiografia Coronária/métodos , Fibrilação Ventricular/etiologia , Síndrome de Wolff-Parkinson-White/terapia , Síndrome Coronariana Aguda/etiologia , Adulto , Feminino , Humanos , Stents , Resultado do Tratamento , Fibrilação Ventricular/terapiaAssuntos
Anticorpos Monoclonais/administração & dosagem , Dissecção Aórtica/complicações , Aneurisma Coronário/complicações , Trombose Coronária/etiologia , Trombose Coronária/terapia , Fragmentos Fab das Imunoglobulinas/administração & dosagem , Inibidores da Agregação Plaquetária/administração & dosagem , Stents , Abciximab , Dissecção Aórtica/terapia , Angioplastia Coronária com Balão , Aneurisma Coronário/terapia , Angiografia Coronária , Trombose Coronária/diagnóstico , Feminino , Oclusão de Enxerto Vascular/complicações , Oclusão de Enxerto Vascular/terapia , Humanos , Pessoa de Meia-Idade , Stents/efeitos adversos , Resultado do TratamentoAssuntos
Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Vasos Coronários/diagnóstico por imagem , Stents/efeitos adversos , Doença Aguda , Angioplastia Coronária com Balão , Trombose Coronária/terapia , Vasos Coronários/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Terapia Trombolítica , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: transient left ventricular ballooning syndrome (TLVBS) has been recently recognised as an acute disease mimicking myocardial infarction. AIM: we used greyscale and virtual histology (VH) intravascular ultrasound (IVUS) to study the presence and characteristics of atherosclerotic plaque in the left anterior descending (LAD) artery in patients with TLVBS. METHODS: the study population consisted of 14 consecutive patients with a TLVBS diagnosis based on typical symptoms and balloon-like left ventricle abnormalities. The IVUS imaging and analysis included at least the mid and proximal segments of each LAD. Virtual histology (VH)-IVUS analysis colour-coded plaque as calcific, fibrotic, fibrofatty, and necrotic core; VH-IVUS-derived thin-cap fibroatheroma (TCFA) and high-risk plaques were identified. RESULTS: the total length of the IVUS-analysed LAD averaged 55 ± 14 mm. Greyscale analysis revealed a mean plaque burden of 28.9 ± 11%. There were 7 ruptured plaques; these were present in mid-segments of the LAD in 3 patients, and in the proximal segment in 4 patients. The VH-TCFAs were found in 8 patients, while the remaining 6 patients had a necrotic core > 25%. The average number of VH-TCFAs was 4.8 ± 2.9 per patient. Combining greyscale and VH-IVUS data, 8 patients had either a ruptured plaque or a VH-TCFA, while the other 6 patients had a necrotic core > 25%. The distance from the coronary ostium to the cross-sections with a VH-TFCA was 20 ± 2.8 mm. CONCLUSIONS: vulnerable plaques are observed in patients with TLVBS. Our findings support the hypothesis that TLVBS may be related to the natural course of atherosclerotic plaque development. Further study into the relations between vulnerable plaque surface, platelet activity and subsequent thrombus formation is needed in this population.