Indirect impact of the war in Ukraine on primary percutaneous coronary interventions for ST-elevation myocardial infarction in Poland.

INTRODUCTION: The Russian invasion of Ukraine in February 2022 resulted in the displacement of approximately 12.5 million refugees to adjacent countries including Poland, that may have strained healthcare service delivery. OBJECTIVES: Using the ST-elevation myocardial infarction (STEMI) data, we aimed to evaluate whether the Russian invasion of Ukraine has indirectly impacted the delivery of acute cardiovascular care in Poland. PATIENTS AND METHODS: We analyzed all adult patients undergoing percutaneous coronary interventions (PCI) for STEMI across Poland between 25th February 2017 to 24th May 2022. Centers were allocated to regions of <100km and >100km of the Polish-Ukraine border. Mixed effect generalized linear regression models with random effects per hospital were used to explore the associations between the war in Ukraine starting with several outcomes of interest, and whether these associations differed across regions of 100km from the Polish-Ukraine border. RESULTS: A total of 90,115 procedures were included in the analysis. The average number of procedures per-month was similar to predicted volume for centers in the >100km region, while the average number of PCI was higher than expected (by an estimated 15 (11-19)) for the <100km region. There was no difference in adjusted fatality rate or quality of care outcomes pre- vs. during-war in both <100 and >100 km regions, with no evidence of a difference-in-difference across regions. CONCLUSIONS: Following the Russian invasion of Ukraine, there was only a modest and temporary increase in primary PCI predominantly in centers situated within 100km of the border, although no significant impact on in-hospital fatality rate.

Does PM 2.5 and PM 10-associated heavy metals affect short-term and long-term survival after out-of-hospital cardiac arrest? Four-year study based on regional registry.

BACKGROUND: This study aims to investigate the effect of arsenic (As), cadmium (Cd), nickel (Ni) and lead (Pb) suspended on particulate matters (PM) 2.5 and PM 10 taking into account clinical factors on 30-day and one-year survival after out-of-hospital cardiac arrest (OHCA). METHODS: A retrospective 4-year study that involved patients hospitalized after OHCA. Patients' data were obtained from Emergency Medical Services dispatch cards and the National Health Fund. The concentration of air pollutants was measured by the Environmental Protection Inspectorate in Poland. RESULTS: Among the 948 patients after OHCA, only 225 (23.7%) survived for 30 days, and 153 (16.1%) survived for 1 year. Survivors were more commonly affected by OHCA in urban areas (85 [55.6%] vs. 355 [44.7%]; P=0.013) and had slightly higher one-year mean concentration of As (0.78 vs. 0.77; P=0.01), Cd (0.34 vs. 0.34; P=0.012), and Pb (11.13 vs. 10.20; P=0.015) with no differences in daily mean concentration. Significant differences in mean concentrations of heavy metals and PM 2.5 and PM 10 were observed among different quarters. However, survival analysis revealed no differences in long-term survival between quarters. Heavy metals, PM 2.5, and PM 10 did not affect short-term and long-term survival in multivariable logistic regression. CONCLUSIONS: The group of survivors showed slightly higher mean one-year concentrations of As, Cd and Pb, but they also experienced a higher incidence of OHCA in urban areas. There were no differences in long-term survival between patients who suffer OHCA in different quarters. Heavy metals did not independently affect survival.

Risk factors for cardiovascular diseases: the focus on primary prevention.

Views on the etiopathogenesis of atherosclerosis are subject to evolution. In addition to the classic well-known risk factors, new ones related to mental state, social life and environment are being discovered. Both acute and chronic stress stimulate inflammatory processes. Due to the change in lifestyle and eating habits, the accumulation of risk factors in childhood is an increasing problem. Knowledge of risk factors allows for effective primary prevention of cardiovascular diseases. The effectiveness of prevention increases when the activities cover the largest possible part of the society, and access to a doctor is easy. Therefore, government programs are being implemented offering patients easier access to diagnostics of cardiovascular diseases at the level of primary health care, which enables faster identification of people at the greatest cardiovascular risk. Easier access to primary care and a good doctor-patient relationship improve patient compliance. In this situation, the importance of the family doctor as a key link in the diagnosis, prevention and treatment of cardiovascular diseases is increasing.

The Effect of Daylight-Saving Time on Percutaneous Coronary Intervention Outcomes in Acute Coronary Syndrome Patients-Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) in the Years 2014-2022.

INTRODUCTION: Many factors related to the switch to summer/winter time interfere with biological rhythms. OBJECTIVES: This study aimed to analyze the impact of time change on clinical outcomes of patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Electronic data of 874,031 patients with ACS who underwent invasive procedures were collected from the Polish National Register of Interventional Cardiology Procedures (ORPKI) between 2014 and 2021. We determined the number of patients undergoing PCI and periprocedural mortality during the day of spring or autumn time change and within the first 3 and 7 days after the time change. RESULTS: We demonstrated the impact of time changes on the periprocedural mortality of ACS patients within 1 day and the period of 3 and 7 days from the time change. We observed that the occurrence of all ACS and NSTEMI on the first day was lower for both time changes and higher in the case of UA and spring time change. The autumn time change significantly reduced the occurrence of all types of ACS. A significant decrease in the number of invasive procedures was found after autumn transition in the period from the first day to 7 days for ACS, NSTEMI, and UA. CONCLUSIONS: The occurrence of ACS and the number of invasive procedures were lower for both changes over time. Autumn time change is associated with increased periprocedural mortality in ACS and a less frequent occurrence of UA and NSTEMI within 7 days.

COVID-19 as an independent predictor of aspiration thrombectomy in STEMI. National data from the ORPKI register in the years 2020-2022.

Introduction: Coronavirus disease 2019 (COVID-19) exacerbates intravascular thrombosis that occurs in the coronary artery in ST-elevation myocardial infarction (STEMI). Aim: To analyze the impact of COVID-19 on the application and effect of thrombectomy in STEMI patients. Material and methods: 29915 STEMI patients were analyzed, of whom 3139 (10.5%) underwent thrombectomy. COVID-19 (+) was reported in 311 (10.8%). The clinical characteristics and management of STEMI in COVID-19 (+) and COVID-19 (-) patients were compared. A multivariable logistic regression analysis was performed in search of factors influencing thrombectomy. Results: COVID-19 (+) patients had higher Killip class (IV class; n = 33 (12.31%) vs. n = 138 (5.84%); p < 0.0001) and cardiac arrest at baseline was more frequent in this group (n = 25 (8.04%) vs. n = 137 (4.84%); p = 0.016). Thrombolysis in myocardial infarction (TIMI) 3 after percutaneous coronary intervention was less frequent (n = 248 (80.52%) vs. n = 2388 (87.19%); p = 0.001) in the COVID-19 (-) group. Periprocedural mortality was similar in both groups (n = 28 (0.99%) vs. n = 4 (1.29%); p = 0.622). In multivariable regression analysis COVID-19 increased the risk of thrombectomy (OR = 1.23; 97.5% CI: 1.05-1.43; p = 0.001). Conclusions: STEMI patients undergoing aspiration thrombectomy who were COVID-19 (+) were more likely to be in a severe clinical condition (higher Killip class, more frequent cardiac arrest before the procedure) than COVID-19 (-) patients. Despite more intensive antiplatelet and anticoagulant treatment, PCI procedures were less likely to result in an optimal TIMI 3 effect. COVID-19 is an independent strong predictor of patient qualification for aspiration thrombectomy in STEMI.

Factors affecting short- and long-term survival of patients with acute coronary syndrome treated invasively using intravascular ultrasound and fractional flow reserve: Analysis of data from the Polish Registry of Acute Coronary Syndromes 2017-2020.

BACKGROUND: Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are invasive procedures increasingly used in treating acute coronary syndrome (ACS). AIMS: This study aimed to evaluate the frequency of IVUS and FFR use in patients with ACS in Poland and to assess the safety of these procedures as well as their impact on short- and long-term survival. METHODS AND RESULTS: This retrospective study included 103849 patients enrolled in the Polish Registry of Acute Coronary Syndromes in 2017-2020. IVUS was performed in 1727 patients, FFR in 1537 patients, and both procedures in 37 patients. The frequency of performing FFR in ACS patients increased over the years from 1.3% to 1.8% (P <0.0001) and IVUS from 1.7% to 2.3% (P <0.0001). In the FFR and/or IVUS group, a similar incidence of stroke, reinfarction, target vessel revascularization, and major bleeding was observed while in-hospital mortality was lower (0% for IVUS + FFR vs. 0.9% for FFR vs. 2.3% for IVUS vs. 3.7 for no procedure; P <0.0001). FFR and IVUS did not affect the 30-day and one-year prognosis. CONCLUSION: In recent years, the number of FFR and IVUS procedures performed in patients with ACS in Poland has increased. There was lower in-hospital mortality in the FFR and/or IVUS group in ACS patients, and no differences in the incidence of stroke, reinfarction, target vessel revascularization, and major bleeding were observed. Performing FFR and IVUS in ACS patients does not significantly affect 30-day or one-year mortality.

Impact of Air Pollution and COVID-19 Infection on Periprocedural Death in Patients with Acute Coronary Syndrome.

Air pollution and COVID-19 infection affect the pathogenesis of cardiovascular disease. The impact of these factors on the course of ACS treatment is not well defined. The purpose of this study was to evaluate the effects of air pollution, COVID-19 infection, and selected clinical factors on the occurrence of perioperative death in patients with acute coronary syndrome (ACS) by developing a neural network model. This retrospective study included 53,076 patients with ACS from the ORPKI registry (National Registry of Invasive Cardiology Procedures) including 2395 COVID-19 (+) patients and 34,547 COVID-19 (-) patients. The neural network model developed included 57 variables, had high performance in predicting perioperative patient death, and had an error risk of 0.03%. Based on the analysis of the effect of permutation on the variable, the variables with the greatest impact on the prediction of perioperative death were identified to be vascular access, critical stenosis of the left main coronary artery (LMCA) or left anterior descending coronary artery (LAD). Air pollutants and COVID-19 had weaker effects on end-point prediction. The neural network model developed has high performance in predicting the occurrence of perioperative death. Although COVID-19 and air pollutants affect the prediction of perioperative death, the key predictors remain vascular access and critical LMCA or LAD stenosis.

Role of Fibrinolysis in the Management of Patients with COVID-19 and Thromboembolic Complications: A Review.

An impaired fibrinolytic process has been demonstrated in patients infected with SARS-CoV-2, including those in severe or critical condition. Disruption of fibrinolysis leads to fibrin deposition, which exacerbates inflammation and fibrosis and damages the pulmonary surfactant. Numerous authors point out the different course of coagulopathy in patients with COVID-19. It is reported that they may have a state of secondary hyperfibrinolysis, which may explain, at least in part, the increased incidence of venous thromboembolism, even among those patients already receiving appropriate anticoagulant treatment. This raises the question of whether current guidelines for the prevention and treatment of embolic-thrombotic complications, among patients with severe COVID-19, are sufficient. Some studies show evidence of clinical improvement in patients who have received fibrinolytic therapy, beyond the current indications for its implementation. However, when considering the inclusion of systemic fibrinolytic therapy, the benefits of such treatment should always be weighed over the risk of adverse effects. Thromboelastography and rotational thromboelastometry can be helpful in making such decisions. The purpose of this study was to review the current knowledge regarding fibrinolysis and its role in the treatment of patients with severe COVID-19, including those with thromboembolic complications.

The Effect of COVID-19 on the Perioperative Course of Acute Coronary Syndrome in Poland: The Estimation of Perioperative Prognosis and Neural Network Analysis in 243,515 Cases from 2020 to 2021.

COVID-19 causes thromboembolic complications that affect the patient's prognosis. COVID-19 vaccines significantly improve the prognosis for the course of the infection. The aim of this study was to evaluate the impacts of patient characteristics, including COVID-19 vaccinations, on perioperative mortality in acute coronary syndrome in Poland during the pandemic. We analyzed the data of 243,515 patients from the National Registry of Invasive Cardiology Procedures (Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej [ORPKI]). In this group, 7407 patients (21.74%) had COVID-19. The statistical analysis was based on a neural network that was verified by the random forest method. In 2020, the most significant impact on prognosis came from a diagnosis of unstable angina, a short period (<2 h) from pain occurrence to first medical contact, and a history of stroke. In 2021, the most significant factors were pre-hospital cardiac arrest, female sex, and a short period (<2 h) from first medical contact to coronary angiography. After adjusting for a six-week lag, a diagnosis of unstable angina and psoriasis were found to be relevant in the data from 2020, while in 2021, it was the time from the pain occurrence to the first medical contact (2−12 h) in non-ST segment elevation myocardial infarction and the time from first contact to balloon inflation (2−12 h) in ST-segment elevation myocardial infarction. The number of vaccinations was one of the least significant factors. COVID-19 vaccination does not directly affect perioperative prognosis in patients with acute coronary syndrome.

The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019.

BACKGROUND: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. METHODS: The observational cohort study group consisted of 118,601 participants recruited from the National Registry of Invasive Cardiology Procedures (ORPKI). RESULTS: Procedure-related death occurred in 802 (1.0%) men and in 663 (1.7%) women. The odds of procedure-related death among women were significantly higher than among men (OR, 1.76; 95% CI, 1.59-1.95; p < 0.001). The probability of procedure-related mortality was highest in both men and women with cardiac arrest in the cath lab, critical stenosis of the left main coronary artery, and direct transfer to the cath lab. The factors that reduced the probability of procedure-related mortality in both men and women were thrombolysis in myocardial infarction (TIMI) flow grade and the use of P2Y12 inhibitors in the peri-infarct period. Psoriasis was associated with increased odds of procedure-related death among men, whereas cigarette smoking reduced the odds among women. CONCLUSIONS: Procedure-related deaths occurred more frequently in women than men with STEMI. Additional scrutiny needs to be undertaken to identify factors influencing survival regarding gender differences.

Occurrence of Arrhythmias in Women with Thyroid Cancer Receiving Suppressive Doses of Levothyroxine.

Aim of the study: To assess the occurrence of cardiac arrhythmias caused by high doses of levothyroxine in patients with thyroid cancer with subclinical hyperthyroidism. Materials and Methods: This prospective study included 98 women divided into three groups according to plasma thyroid stimulating hormone (TSH) concentration: <0.1 µU/mL, 0.1-0.39 µU/mL, or 0.4-4.0 µU/mL (control group). All participants underwent laboratory tests and an electrocardiography (ECG) Holter test to assess their heart rate and the occurrence of arrhythmias. Statistical analysis assessed differences between groups in all clinical parameters and factors influencing the occurrence of arrhythmias. Results: There were no differences between groups in the maximum, average, or minimum heart rate or in the incidence of the studied cardiac arrhythmias. Heart rate in women with a TSH concentration of <0.1 µU/mL depended on age and the presence of arterial hypertension, and heart rate in women with a TSH concentration of 0.4-4.0 µU/mL depended on free triiodothyronine concentration and the presence of arterial hypertension; no relationship was identified for women with a TSH concentration of 0.1-0.39 µU/mL. One-way logistic regression analysis did not identify any factors influencing the occurrence of arrhythmias. Conclusions: While maintaining normal free triiodothyronine levels, the use of suppressive doses of levothyroxine after thyroidectomy for differentiated thyroid cancer does not induce clinically significant arrhythmias or affect average heart rate. None of the studied clinical parameters influenced the risk of arrhythmia.

The Most Relevant Factors Affecting the Perioperative Death Rate in Patients with Acute Coronary Syndrome and COVID-19, Based on Annual Follow-Up in the ORPKI Registry.

BACKGROUND: The COVID-19 pandemic is significantly affecting the functioning of the entire healthcare system. The disease itself may be associated with thromboembolic complications. The purpose of this study is to compare patients with acute coronary syndrome (ACS) and patients with ACS who were diagnosed with COVID-19 in terms of their clinical profile, management, treatment complications, and prognosis. METHODS: We analyzed 47,940 cases of patients treated for ACS in 2020, including 44,952 patients (93.8%) who were not diagnosed with COVID-19 and 2988 patients (6.2%) who tested positive for COVID-19. RESULTS: Patients with COVID-19 were significantly more likely to experience out-of-hospital sudden cardiac arrest (7.9 vs. 1.1%; p < 0.0001) and be transported directly to a catheterization laboratory (21.3% vs. 8.1%; p < 0.0001). Mortality was significantly higher in this group (0.9% vs. 0.4%; p < 0.0001). The risk of perioperative death was increased by age over 65 years, use of glycoprotein IIb/IIIa inhibitors (GPI IIb/IIIa), femoral access, critical left main stem coronary artery (LMCA) vascular lesions, ST elevation myocardial infarction (STEMI), and no-reflow phenomenon. CONCLUSIONS: Despite the pandemic, patients with COVID-19 were treated equally to healthy patients. Efficient organization of the healthcare system allowed the prompt transportation of patients to catheterization laboratories. The study group was characterized by a worse prognosis that was affected by multiple factors.

Risk of perioperative death and sudden cardiac arrest: A study of 113 456 cases from the National Registry of Invasive Cardiology Procedures (ORPKI) for estimation of the perioperative prognosis.

BACKGROUND: Despite optimizing treatment of ST-segment elevation myocardial infarction (STEMI), a number of patients die during the invasive procedure or experience sudden cardiac arrest (SCA) that complicates further hospitalization. AIMS: This study aimed to identify the most important risk factors leading to SCA and death in the cath lab among STEMI patients. METHODS: We used data from the National Registry of Invasive Cardiology Procedures (ORPKI) collected between 2014 and 2019. The study population consisted of 113 465 patients. Descriptive statistics, univariate and multiple logistic regression analysis of factors affecting perioperative mortality (PM) and SCA in the cath lab were performed. RESULTS: Death and SCA occurred in 1549 (1.4%) and 945 (0.8%) patients, respectively. Diabetes (odds ratio [OR], 1.76; P <0.0001), previous brain stroke (OR, 2.26; P <0.0001), prior myocardial infarction (OR, 1.81; P <0.0001), psoriasis (OR, 1.79; P = 0.04), and chronic renal failure (OR, 2.79; P <0.0001) were the strongest predictors of PM. The occurrence of SCA was dependent mainly on diabetes (OR, 1.37; P = 0.0001), previous brain stroke (OR, 2.23; P <0.0001), prior myocardial infarction (OR, 1.73; P <0.0001), psoriasis (OR, 2.03; P = 0.04), and chronic renal failure (OR, 2.79; P <0.0001). Of the pre-hospital factors, the Killip-Kimball class showed the strongest relationship with the two endpoints (OR 3.53; P <0.0001 and OR 2.65; P <0.0001, respectively). CONCLUSIONS: Diabetes, previous brain stroke, myocardial infarction, psoriasis, chronic renal failure, and the Killip-Kimball class were the strongest predictors of PM and SCA in the cath lab among STEMI patients.

Analysis of the Correlation of Galectin-3 Concentration with the Measurements of Echocardiographic Parameters Assessing Left Atrial Remodeling and Function in Patients with Persistent Atrial Fibrillation.

Galectin-3 (gal-3) is a fibrosis marker and may play a role in fibrosis of the left atrium (LA). Left atrial wall fibrosis may influence the transition from paroxysmal to non-paroxysmal atrial fibrillation (AF). In this study, we assessed the correlation of gal-3 concentration with the main echocardio-graphic parameters evaluating dimensions, volume, compliance, and left atrial contractility during AF and after successful electrical cardioversion (DCCV). The study included 63 patients with left atrial enlargement who qualified for DCCV due to persistent AF. The procedure recovered sinus rhythm in 43 (68.3%) patients. The concentration of gal-3 was negatively correlated with the echocardiographic parameters of LA including dimensions (LA length pre, rho = -0.38; p = 0.003), volume (LAV pre, rho = -0.39; p = 0.003), compliance (LASr mean post, rho = -0.33) and contractility (pLASRct mean post, rho = -0.33; p = 0.038). Negative correlations of gal-3 concentration were also observed in relation to the volume and contractility of the left ventricle. The concentration of gal-3 significantly negatively correlates with the size, systolic function, and compliance of the LA wall in patients with persistent AF. Determining gal-3 concentration in patients with persistent AF may help in the assessment of remodeling of the LA wall.

The influence of air pollution by PM2.5, PM10 and associated heavy metals on the parameters of out-of-hospital cardiac arrest.

Out-of-hospital cardiac arrest (OHCA), defined as abrupt cessation of mechanical activity of the heart, is one of the most common causes of death in high-income countries. Cardiac arrest is most often a result of severe cardiovascular disease. New evidence shows that air pollutants such as heavy metals and atmospheric particulate matter have an impact on the pathophysiology of many cardiovascular diseases as well on incidences of OHCA. This retrospective analysis includes all OHCA cases that occurred in central Poland covering the area of 11.711 km2 with the population density of 108 people per square kilometer. Among 2878 EMS-treated OHCA cases between 2013 and 2016, cardiopulmonary resuscitation (CPR) was attempted in 2076 (72%) patients. Concentrations of air pollutants were compared with temperature, humidity and clinical factors affecting the CPR. The study shows seasonal variation of PM 2.5 (p < 0.001), PM 10 (p < 0.001), As (p < 0.001) and Cd (p < 0.001) over the years. Air pollution has a significant effect on the parameters of pre-hospital evaluation in OHCA patients, especially with respect to the content of PM2.5/PM10 and heavy metals. Nickel exposure affects the incidence of initial shockable rhythm (IRR 0.92; p = 0.01) and effectiveness of CPR (IRR 0.94; p = 0.003). Arsenic has an impact on overall mortality (IRR 1.07; p = 0.01) and death upon the arrival of EMS team (IRR 1.15; p < 0.001). Overall mortality was also related to ambient levels of PM10 (IRR 1.004; p < 0.047).

Left atrial emptying fraction determined during atrial fibrillation predicts maintenance of sinus rhythm after direct current cardioversion in patients with persistent atrial fibrillation.

Echocardiography is the basic imaging technique used to determine the odds of maintaining sinus rhythm (SR) following direct current cardioversion (DCCV) for persistent atrial fibrillation (AF). However, most studies are focused on the echocardiographic parameters obtained during SR resulting from successful DCCV. The aim of this study was to assess the value of the echocardiographic parameters measured before DCCV for the prognosis of SR maintenance after DCCV. The study included 146 patients with persistent AF who underwent DCCV. Clinical and echocardiographic data were collected directly before DCCV and, for patients with SR, one month, six months, and 12 months after DCCV. We found that left atrial emptying fraction (LAEF) assessed during atrial fibrillation was significantly larger in the group with SR maintenance after 12 months than in the group with AF recurrence (30.8±8.3 vs. 24.6±10.4%; p<0.001). In multivariable logistic regression analysis with a model containing echocardiographic parameters, LAEF (OR 1.053; 95% CI 1.011-1.096; p = 0.013) and the E/e'mean ratio (OR 0.883; 95% CI 0.788-0.990; p = 0.033) were independent predictors of SR maintenance. Analyzing a model including clinical and echocardiographic variables, only LAEF (OR 1.046; 95% CI 1-1.095; p = 0.049) and beta-blockers used before DCCV (OR 14.694; 95% CI 1.622-133.139; p = 0.017) were independent predictors of SR maintenance after 12 months. Our results indicate that LAEF measured during AF is a significant predictor of SR maintenance in the 12 months following DCCV due to persistent AF. Our findings confirm the recently raised hypothesis about the superiority of echocardiographic parameters assessing mechanical remodeling over parameters assessing structural remodeling of left atrium in predicting sinus rhythm maintenance after electrical cardioversion.

Out-of-hospital cardiac arrest: data from the National Registry of Invasive Cardiology Procedures (ORPKI) in a long-term survival analysis of patients with acute coronary syndromes in a Polish region.

BACKGROUND: Out­of­hospital cardiac arrest (OHCA) is one of the leading causes of death in high­income countries. AIMS: This study aimed to analyze long ­term survival in patients with OHCA in the SwietokrzyskieProvince, who were included in the National Registry of Invasive Cardiology Procedures (ORPKI), estimate survival probability, and evaluate associated risk factors. METHODS: Based on the ORPKI registry, we identified subjects with OHCA prior to hospitalization. Data were collected from January 1, 2014 to December 31, 2016. RESULTS: Out­of ­hospital cardiac arrest occurred in 90 of 9855 patients diagnosed with myocardial infarction. We identified 2 significant risk factors: renal failure (HR, 6.53; 95% CI, 1.17-36.40; P = 0.03) and time (hours) from symptom onset to first medical contact (HR, 1.04; 95% CI, 1.01-1.08; P = 0.02). The probability of survival in patients below 66 years of age was almost 2­fold higher (HR, 1.99; 95% CI, 1.1-3.59; P = 0.02) than in those over the age of 66 years. In those without diabetes mellitus, it was more than 2­fold higher (HR, 2.36; 95% CI, 1.12-4.98; P = 0.03) than in diabetic patients, and in individuals with single­vessel coronary artery disease, it was almost 3­fold higher (HR, 2.76; 95% CI, 1.51-5.06; P = 0.001) than in those with multivessel coronary artery disease. CONCLUSIONS: Well­documented predictors of all ­cause mortality include: age, history of diabetesmellitus and renal failure, multivessel coronary artery disease on angiography, and time from pain onset to first medical contact. The total amount of contrast agent administered during invasive procedures and patient radiation exposure during procedures are less commonly reported risk factors for unfavorable outcomes.

Left atrial mechanical remodelling assessed as the velocity of left atrium appendage wall motion during atrial fibrillation is associated with maintenance of sinus rhythm after electrical cardioversion in patients with persistent atrial fibrillation.

The velocity of left atrium appendage (LAA) wall motion during atrial fibrillation (AF) is a potential marker of mechanical remodelling. In this study, we investigated whether the velocity of LAA wall motion during AF predicted the success of electrical cardioversion and long-term sinus rhythm maintenance. Standard echocardiographic data were obtained by transthoracic echocardiography, and LAA wall motion velocities were measured by transoesophageal echocardiography. With logistic regression and receiver operating characteristic curve analyses, we related echocardiographic and clinical data to cardioversion outcomes and sinus rhythm maintenance at 12 months. Of 121 patients prospectively included in the study, electrical cardioversion restored sinus rhythm in 97 (81.2%), and 51 (42%) patients maintained sinus rhythm at 12 months. Patients in whom cardioversion restored sinus rhythm had higher LAA wall motion velocities than did the patients with failed cardioversions (p <0.001). Compared to patients with AF at 12 months, patients who maintained sinus rhythm had lower maximum and end-diastolic left atrial volumes (p ≤ 0.01), lower E/e' ratios (p = 0.005), higher s' values (p = 0.013), and higher LAA motion velocities (p < 0.001). On multivariate logistic regression, only LAA wall motion velocity and E/e' ratios remained significant predictors of sinus rhythm maintenance at 12 months (p ≤ 0.04). LAA wall motion velocity was also a significant predictor of sinus rhythm maintenance when corrected for clinical variables (p = 0.039). Conclusion: LAA wall motion velocity, as a marker of mechanical remodelling, can predict short-term and long-term sinus rhythm maintenance after electrical cardioversion in AF.

Echocardiographic assessment of left atrial morphology and function to predict maintenance of sinus rhythm after electrical cardioversion in patients with non-valvular persistent atrial fibrillation and normal function or mild dysfunction of left ventricle.

BACKGROUND: The aim of this study was to assess whether echocardiographic measurements of left atrial (LA) morphology and function could predict sinus rhythm maintenance after electrical cardioversion among patients with atrial fibrillation (AF) and normal function or mild dysfunction of the left ventricle (LV). METHODS: One hundred seventeen patients with persistent AF who underwent successful electrical cardioversion were prospectively enrolled. Echocardiography was performed one day subsequent to successful cardioversion. Patients were followed up clinically and electrocardiographically at 1, 6, and 12 months. At 12 months, 61 (52%) patients had maintained sinus rhythm (SR). RESULTS: Compared to patients who maintained SR, those with AF recurrence had larger LAs, worse LA systolic function, and increased LV filling pressure. On multivariate stepwise logistic regression, E/A ratios (odds ratio [OR] 0.550, 95% confidence interval [CI] 0.341-0.886; p = 0.014) and E/e' ratios (OR 0.871, 95% CI 0.771-0.985; p = 0.027) were significant predictors of AF recurrence. On receiver operator characteristic curve analysis of AF recurrence at 12 months, the area under curve for both E/A and E/e' ratios were 0.726. With an E/A cutoff of 2.2, the sensitivity for predicting AF recur-rence at 12 months was 72%, and specificity was 73%. With an E/e' cutoff of 9.17, the sensitivity for predicting AF recurrence at 12 months was 72%, and specificity was 74%. CONCLUSIONS: Left ventricular filling pressure assessed with E/A and E/e' ratios predict AF recurrence after electrical cardioversions among patients with AF and normal function of LV.