Impact of the presence of chronically occluded coronary artery on long-term prognosis of patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: Multivessel disease (MVD) is a significant risk factor in patients with acute ST-segment elevation myocardial infarction (STEMI). Whether the presence of chronic total occlusion (CTO) poses an additional hazard is still unknown. The objective of this study was to evaluate the impact of CTO on survival in STEMI patients. METHODS: The study group consisted of 836 STEMI patients treated with primary percutaneous coro-nary intervention (PCI). MVD was diagnosed in 52.3%, and CTO in 17.5% of patients. RESULTS: In MVD patients, 30-day mortality was 4.8% (6.8% in the CTO and 3.8% in the non-CTO group, p = 0.167). After 6 years, of the 437 patients with MVD, 56 (38.6%) died in the CTO group, and 74 (25.4%) in the non-CTO group (p = 0.0055). CTO was an independent predictor of long-term mortality (OR 2.07, 95% CI 1.30-3.28, p = 0.002), whereas triple vessel disease was not (OR 1.27, 95% CI 0.78-1.97, p = 0.358). The other independent predictors of mortality were: age, anterior myocardial infarction, and PCI failure. CONCLUSIONS: The presence of CTO is an independent predictor of the long-term mortality in STEMI patients treated with primary PCI. (Cardiol J 2017; 24, 2: 117-124).

The Swietokrzyskie system for the optimal management of acute myocardial infarction.

We present activities undertaken in Poland's Swietokrzyskie province to shorten the time to recanalization of infarct-related arteries in patients with acute myocardial infarction. All emergency medical institutions have been obliged by the Governor of Swietokrzyskie to implement the System for Optimal Management of Acute Myocardial Infarction. The effects of this action are discussed, and similar systems in Europe are reviewed.

[Acute aortic dissection type A in a 28-year-old woman 10 days after delivery]. / Tetniak rozwarstwiajacy aorty zstepujacej u 28-letniej kobiety w dziesiatej dobie pologu.

A case of a 28-year-old women, with acute aortic dissection type B, ten days after childbirth is described. The pregnancy was ended by cesarean section. The patient underwent successful stent grafting. A subsequent one-month follow-up period was uneventful. Diagnosis and treatment of acute aortic dissection are discussed.

[The influence of HRT on exercise performance in women with coronary artery disease]. / Wplyw hormonalnej terapii zastepczej na parametry wysilkowe u kobiet po menopauzie z choroba niedokrwienna serca.

OBJECTIVES: The aim of this study was to evaluate the effect of hormone replacement therapy (HRT) on exercise tolerance and ischemia during treadmill exercise test. DESIGN: Prospective, cohort study. MATERIALS AND METHODS: Fifty-six postmenopausal women with proven coronary artery disease (CAD) were enrolled into the study (31 were assigned to HRT and 25 were matched as a control group). Clinically both groups were comparable. All patients underwent treadmill exercise test at the beginning and after 12 months of follow up. RESULTS: After 12-months of follow-up exercise tolerance increased significantly and similarly in both groups: duration time (sec): HRT 347 +/- 142 to 401 +/- 113; control 328 +/- 112 to 368 +/- 120; workload (MET): 6.6 +/- 2.1 to 6.8 +/- 2.0 and 6.1 +/- 1.9 to 6.8 +/- 1.7; time to onset of ischemia (sec): 256 +/- 116 to 293 +/- 120 and 238 +/- 87 to 299 +/- 133. Number of leads with ST changes and total sum (mm) of ST depression in all leads did not change significantly. All above parameters were comparable at baseline and after 12 months follow-up between both groups. CONCLUSIONS: Short term, combined, transdermal HRT does not improve exercise tolerance nor coronary ischemia during exercise test in women with CAD.