[Prevalence of age, gender and body weight on the frequency of hypertension and diabetes mellitus in patients hospitalized in cardiology department]. / Wplyw wieku, plci oraz masy ciala na czestosc wystépowania nadcisnienia tetniczego oraz cukrzycy, u pacjentów hospitalizowanych na oddziale kardiologicznym.

UNLABELLED: Overweight and obesity are a major medical problems of the twenty-first century. According to the World Health Organization (WHO) in the world are about 1.6 billion people with overweight and at least 400 million adults are obese. The aim of this study was to analyze the effects of age, sex, and selected anthropometric parameters on the incidence of hypertension and diabetes mellitus in patients hospitalized in the cardiology department. The study included 1188 patients aged 18 - 94 years (mean age 66.9 years, SD 13.2), including 610 men (mean age 65.9 years, SD 12.7) and 578 women (mean age 67.9 years, SD 13.7), hospitalized in the Department of Cardiology Specialist Hospital Louis Rydygier in Krakow in 2009. All patients defined age, height and weight. Based on these results calculated body mass index (BMI). All patients were collected history on the prevalence of hypertension and type 2 diabetes mellitus. Then performed a statistical analysis of the incidence of hypertension and diabetes mellitus compared to sex, median age, BMI. RESULTS: In the study population normal blood pressure and hypertension grade 2 occurred significantly more often in men. Grade 3 hypertension occurred significantly more often in women. The median age was 67 years. In the older group occurred more frequently hypertension 2 and Grade 3. Also, diabetes mellitus was more common among older people. In obese people (BMI> 30) and overweight (BMI 25-29.99) occurred significantly more grade 3 hypertension compared to those of normal weight. CONCLUSIONS: 1. Diabetes mellitus and hypertension are more common in postmenopausal women compared to men the same age. 2. Obesity and overweight predisposes to hypertension grade 3 and diabetes mellitus.

[Epidemiology of pulmonary embolism in patients with cardiac department]. / Epidemiologia zatorowosci plucnej u pacjentów oddzialu kardiologicznegom.

UNLABELLED: Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a embolic material. ZP is usually a manifestation of venous thromboembolism (VTE), which in addition to the ZP includes deep vein thrombosis. The aim of this study was to analyze the epidemiology of pulmonary embolism in patients in the cardiology department with regard to gender and age. Material for the study was the medical documentation of patients hospitalized in the Department of Cardiology Hospital Louis Rydygiera in Cracow in the period of 7 years (1 I 2004 - 31 December 2010). During this time 11,435 patients were hospitalized. The study included 67 (1.23%) patients (31 men, 36 women) aged 30 - 93 years (mean 70.3 years, SD 13.3) who were diagnosed with acute pulmonary embolism. Collected information on gender, age, body weight and coexisting disease. An analysis of the documentation in terms of symptoms on admission and the cause of pulmonary embolism. RESULTS: The study included 67 patients, aged 30 - 93 years (mean age 70.3 years, SD 13.3) including 31 males (mean age 71.7 years, SD 13.8) and 36 women (average age 69.1 years, SD 12.9). The incidence of pulmonary embolism was 6 people per 1000 hospital admissions (0.58%). The average age of women was lower compared to men (69.1 +/- 12.9 vs. 71.7 +/- 13.8 years). Among the most common coexisting diseases were coronary heart disease (44.8%), hyperlipidemia (40.3%) and varicose veins of the lower limbs (49.3%). The most common symptoms on admission were dyspnea (88.1%), chest pain (59.7%) and hypotension (44.8%). Among the predisposing factors for pulmonary embolism occurs most frequently in the history of surgery (55.2%), venous thrombosis of lower limbs (50.7%), smoking (34.3%). The median age was 70.3 years. Pulmonary embolism was significantly more common among older people (37.3% vs. 62.7%, p = 0.04) and in men (35.5% vs. 64.5%, p = 0.04) and women (38.9% vs. 61.1%, p = 0.04). Pulmonary embolism was reported most frequently in the age group between 70-79 years of age in the study group (43.3%). CONCLUSIONS: 1. Pulmonary embolism occurs in 6 per 1000 patients hospitalized in the cardiology department. 2. Pulmonary embolism occurs most frequently in the age group 70-79 years. 3. The most common factors that causes pulmonary embolism are state after surgery and a history of deep vein thrombosis.

Impact of early abciximab administration on myocardial reperfusion in patients with ST-segment elevation myocardial infarction pretreated with 600 mg of clopidogrel before percutaneous coronary intervention.

Early rapid platelet inhibition with abciximab before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is suggested as beneficial. In previous studies on early abciximab administration clopidogrel was administered in cathlab in low loading dose. We investigated the role of early abciximab administration on top of early clopidogrel 600 mg loading dose in patients with STEMI treated with PPCI. A total of 73 non-shock STEMI < 6 h patients admitted to remote hospitals with anticipated delay to PPCI < 90 min were randomly assigned to three study groups--24 pts received abciximab before transfer to cathlab (early = group EA), 27 in cathlab during PPCI (late = group LA) and in 22 abciximab administration was left to operator's discretion during PPCI (selective = SA; given in 22.7% of patients). All patients received clopidogrel (600 mg), aspirin and heparin (70 U/kg) before transfer to cathlab. Angiography revealed more frequent infarct-related artery patency (TIMI 2 + 3: EA vs LA vs SA: 45.8 vs 18.5 vs 13.6%, P = 0.024), better myocardial tissue perfusion (MBG 2 + 3: EA vs LA vs SA: 45.8 vs 14.8 vs 13.6%, P = 0.02) in EA group in baseline angiography. There was no difference in these angiographic parameters and ECG ST-segment resolution after PPCI. In multivariate analysis early abciximab administration was an independent predictor of infarct-related artery patency in baseline angiography (OR 6.5; 95% CI 1.83-23.1; P = 0.004). Early abciximab administration before transfer for PPCI in patients with STEMI pretreated with 600 mg of clopidogrel results in more frequent infarct-related artery patency and better myocardial tissue perfusion before PPCI.

European registry on patients with ST-elevation myocardial infarction transferred for mechanical reperfusion with a special focus on early administration of abciximab -- EUROTRANSFER Registry.

BACKGROUND: Abciximab is established as adjunct to primary percutaneous coronary intervention (PCI). Based on some smaller studies, ST-segment elevation myocardial infarction (STEMI) networks in various European countries have adopted the start of abciximab before transfer to the catheterization laboratory (cathlab) hospital as part of their routine treatment options. Although a recently published study did not reveal improved clinical outcome when starting abciximab before the cathlab, a potential benefit from such early administration, in particular in the setting of transfer networks, remains unclear and has been the subject of debate. METHODS: Data of consecutive patients with STEMI transferred for primary PCI in hospital/ambulance-feeded STEMI networks treated between November 2005 and January 2007 at 15 PCI centers from 7 European countries were collected in the web-based EUROTRANSFER Registry. RESULTS: Data from a total of 1,650 patients were collected. Abciximab was administered to 1086 patients (66%), of whom 727 received early abciximab (EA group: abciximab started before admission to cathlab, at least 30 minutes before balloon). Another 359 patients received late abciximab (LA group: periprocedural administration of abciximab in the cathlab). Preprocedural TIMI 3 flow was observed in 17.7% of patients with EA and in 8.9% in the LA group (P < .0001). Thirty-day mortality was 3.9% in the EA group versus 7.5% with LA (OR 0.49, 95% CI 0.29-0.85, P = .011), and composite 30-day outcome including death, repeated myocardial infarction, and urgent revascularization was present in 5.5% and 10.3%, respectively (OR 0.51, 95% CI 0.32-0.81, P = .004). These differences remain statistically significant in favor of early abciximab after accounting and adjustment for differences between the groups by means of a multivariate regression model and propensity score. CONCLUSIONS: Patients in STEMI networks transferred for primary PCI who have received abciximab before transfer rather than in the cathlab had more patent arteries before PCI and showed lower rates for death and the composite clinical outcome at 30-day follow-up.

Local hospital networks for STEMI treatment for a population of half a million inhabitants increase the use of invasive treatment of acute coronary syndromes to the European recommended level. The Malopolska Registry of Acute Coronary Syndromes 2005-2006.

BACKGROUND: According to the European Society of Cardiology (ESC) consensus, over 75% of patients with ST-elevation myocardial infarction (STEMI) should receive reperfusion therapy. An early invasive strategy is also advocated for high-risk non-ST elevation acute coronary syndromes (NSTE ACS). Until 2005, a single high-volume percutaneous coronary intervention (PCI) centre provided 24-hour service for the population of 3.2 million inhabitants in the Krakow Hospital Network Region. In August 2005 and December 2005 two additional round-the-clock duty PCI centres were launched in remote municipal hospitals (Tarnow and Nowy Sacz). METHODS: 29 non-PCI centres participated in the Registry of ACS in February-March 2005 (Period 1) and in December 2005-January 2006 (Period 2), so while Period 2 was conducted, three PCI centres provided 24-hour service for the Malopolska Region. RESULTS: A total of 1404 patients with ACS were enrolled - 695 during Period 1 and 709 in Period 2. In comparison to Period 1, a non-significant trend towards more frequent mechanical reperfusion of STEMI patients with chest pain onset <12 hours was observed in Period 2 (54 vs. 60%; p=NS). A steep and significant rise was observed particularly among STEMI patients treated in non-PCI centres outside of the Krakow City Network (51 vs. 78%; p=0.001). In the newly established Tarnow and Nowy Sacz (eastern Malopolska) PCI networks the reperfusion rates for STEMI patients with chest pain <12 hours were 78% and 88%, respectively, in comparison to 55% in western Malopolska (p=0.001). The transfer rate for invasive treatment of NSTE ACS has increased from 13.8% in Period 1 to 19% in Period 2 (p=0.031) in the entire region. The in-hospital mortality for patients receiving conservative treatment in community hospitals has decreased among NSTE ACS patients (6.8 vs. 3.9%; p=0.045) and remained unchanged in STEMI (21.3 vs. 19%; p=NS). CONCLUSIONS: Opening of new PCI centres, based on population magnitude and structure, improves local adherence to the guideline-recommended invasive approach in high-risk ACS patients. The Malopolska Programme model showed that one high-volume 24-hour duty PCI centre with a network of cooperating non-PCI centres for a population of 0.5 million might be sufficient to provide invasive treatment according to the ESC guidelines for eligible patients.

Effect of introducing a regional 24/7 primary percutaneous coronary intervention service network on treatment outcomes in patients with ST segment elevation myocardial infarction.

BACKGROUND: In patients with acute ST segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) is the preferred reperfusion method over fibrinolysis, if it is performed in a timely fashion by an experienced team in a centre with on-site primary PCI service. Treatment delay due to patient transfer to the cardiac catheterisation laboratory is an important limitation of mechanical reperfusion in STEMI patients. AIM: To analyse treatment outcomes in STEMI patients hospitalised in a regional hospital in Tarnow before and after introduction of a 24/7 primary PCI service. METHODS: Enrollment into the registry continued for 12 months before introduction of a 24/7 primary PCI service (Period I: 19.04.2004-19.04.2005) and 15 months after introduction of a 24/7 primary PCI service (Period II: 8.08.2005-19.10.2006). Overall, 226 STEMI patients were analysed, including 115 patients in Period I and 111 patients in Period II. STEMI patients in Period I received conservative treatment (n = 59), pharmacoinvasive treatment (a half dose of alteplase, a full dose of abciximab, and transfer to a 24/7 primary PCI reference centre: n = 32) or fibrinolysis with streptokinase (n = 24), while all patients in Period II underwent primary PCI on the first day of hospitalisation. Occurrence of cardiovascular deaths, non-fatal recurrent infarctions, and revascularisation with PCI or coronary artery bypass grafting was evaluated in the two groups during 1-year follow-up. RESULTS: Reperfusion therapy was used in 48.7% of STEMI patients in Period I (pharmacoinvasive treatment in 27.8% and fibrinolysis in 20.9%), and all patients in Period II underwent primary PCI. In-hospital mortality among STEMI patients in Period I was significantly higher than in Period II (23.5% vs. 5.4%, p < 0.001), and it was 23.7% in patients managed conservatively. The hazard ratio for Period II compared to Period I was 0.14 (95% CI 0.03-0.62, p = 0.009). A benefit of invasive treatment was seen during 1 year of follow-up (mortality 26.1% in Period I vs. 9.0% in Period II, p = 0.001). Invasive treatment was also associated with a shorter hospital stay. CONCLUSIONS: Introduction of a 24/7 primary PCI regional service (STEMI network) led to improved accessibility of invasive diagnosis and treatment and increased reperfusion treatment rates, resulting in reduced in-hospital and 1-year mortality among STEMI patients.

Complete infarct-related artery revascularization in acute myocardial infarction patients. CORAMI Registry.

INTRODUCTION: There are still limited data on the occurrence of multiple stenotic lesions within the infarct-related artery (IRA) in acute myocardial infarction (MI), and there is no consensus on the optimal treatment of this patient subgroup, which varies between centers and operators. AIM: To analyse the clinical efficacy of percutaneous coronary intervention (PCI) strategy of culprit lesion only in patients with myocardial infarction. MATERIAL AND METHODS: Patients with acute MI with the presence of at least two significant lesions in the IRA - (1) the target culprit lesion which required immediate stenting (> 50-100% stenosis) and (2) a second distal critical lesion (70-90%) - were included in the registry. Both lesions in the IRA were considered to be independent lesions requiring two separate stent platforms to be covered (no overlap). The decision on the treatment strategy of either complete (CR) or culprit-lesion-only (CLO) revascularization was at the discretion of the operator. RESULTS: There were altogether 95 patients enrolled in the registry, 63 (66%) in the group with CR of the IRA and 32 (34%) with CLO revascularization, which did not differ in terms of baseline demographics. In-hospital and long-term outcomes were similar between the groups. Stent thrombosis at 1 year occurred in 1.6% in CR and in 6.2% in CLO groups respectively (statistically not significant). There were no patients from the CLO group who had a planned percutaneous coronary intervention (PCI) of the 2(nd) lesion in the IRA during 1-year observation. CONCLUSIONS: At 1 year the clinical outcome was similar between those with complete and CLO PCI. Complete coverage of significant lesions did not increase the risk of stent thrombosis or need for repeated revascularization in long-term observation.

Chronic total occlusion in ostium of right coronary artery - retrograde approach as the first-choice method of revascularization?

Recanalization of chronic total occlusion (CTO) located in the ostium may require the operator's ability to use the retrograde approach. We present a case of opening a chronically occluded right coronary artery (RCA) by the retrograde approach after an unsuccessful attempt of recanalization by classic antegrade technique.