Association between exposure to air pollution and increased ischemic stroke incidence: a retrospective population-based cohort study (EP-PARTICLES study).

AIMS: Short-term effects of Polish smog, particularly benzo(alpha)pyrene (B(a)P), are unclear. We aimed to examine the association between short-term exposure to air pollution and ischemic stroke (IS) incidence. METHODS: We conducted a retrospective population-based cohort study including an EP-PARTICLES cohort of 8 million inhabitants in the years 2011-2020 (80 million person-years of observation). Individual clinical data on emergency hospitalizations due to IS - ICD-10: I63.X was analyzed. We used quasi-Poisson models to examine municipality-specific associations between air pollutants and IS, considering various covariates. RESULTS: We recorded 146,262 cases of IS with a dominance of females (51.8%) and people over 65 years old (77.6%). In the overall population, exposure to PM2.5, NO2, B(a)P and SO2 increased the risk of IS onset on the day of exposure by 2.4%, 1%, 0.8%, and 0.6%, respectively. Age and sex were modifying variables for PM2.5, NO2 and B(a)P exposure with more pronounced effects in non-elderly individuals and women (all pinteraction< 0.001). Residents of regions with high tobacco and alcohol consumption were more sensitive to the effects of PM2.5 and SO2. The slopes of response-effect curves were non-linear and steeper at lower concentrations. CONCLUSIONS: Exposure to air pollution may be associated with higher IS incidence, particularly posing a higher risk to non-elderly women. Harmful lifestyle habits might exacerbate its impact. Exposure to even low levels of air pollutants had negative effects.

The present study aimed to analyze the association between exposure to air pollution and IS incidence: Exposure to even low levels of air pollution, including B(a)P, might be associated with higher IS incidence and characteristics of the patients or their place of residence can modify its effectThe most vulnerable phenotype is non-elderly woman and harmful lifestyle habits, such as smoking and drinking alcohol, can further increase the negative effects of air pollution.

Exploring the Relationship between Acute Coronary Syndrome, Lower Respiratory Tract Infections, and Atmospheric Pollution.

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student's t-test, the Mann-Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 µm (PM2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS.

A Comprehensive Review of Percutaneous and Surgical Left Atrial Appendage Occlusion.

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and is associated with a significant risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative for patients with contraindications or intolerance to anticoagulant therapy. This review summarises the current evidence, indications, and technical advancements in surgical and percutaneous LAAO. Preprocedural planning relies on various imaging techniques, each with unique advantages and limitations. The existing randomised clinical trials and meta-analyses demonstrate favourable results for both percutaneous and surgical LAAO. Postprocedural management emphasises personalised anticoagulation strategies and comprehensive imaging surveillance to ensure device stability and detect complications. Future focus should be put on antithrombotic regimens, investigating predictors of device-related complications, and simplifying procedural aspects to enhance patient outcomes. In summary, LAAO is presented as a valuable therapeutic option for preventing AF-related thromboembolic events, with ongoing research aimed at refining techniques and improving patient care.

Drug-Eluting Balloons and Drug-Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention Due to Restenosis-DM-Dragon Registry.

Background: The rate of in-stent restenosis (ISR) is decreasing; however, it is still a challenge for contemporary invasive cardiologists. Therapeutic methods, including drug-eluting balloons (DEBs), intravascular lithotripsy, excimer laser coronary atherectomy, and imaging-guided percutaneous coronary intervention (PCI) with drug-eluting stents (DES), have been implemented. Patients with diabetes mellitus (DM) are burdened with a higher risk of ISR than the general population. Aims: DM-Dragon is aimed at evaluating the clinical outcomes of ISR treatment with DEBs vs. DES, focusing on patients with co-existing diabetes mellitus. Methods: The DM-Dragon registry is a retrospective study comprising data from nine high-volume PCI centers in Poland. A total of 1117 patients, of whom 473 individuals had DM and were treated with PCI due to ISR, were included. After propensity-score matching (PSM), 198 pairs were created for further analysis. The primary outcome of the study was target lesion revascularization (TLR). Results: In DM patients after PSM, TLR occurred in 21 (10.61%) vs. 20 (10.1%) in non-diabetic patients, p = 0.8690. Rates of target vessel revascularization (TVR), target vessel myocardial infarction, device-oriented composite endpoint (DOCE), and cardiac death did not differ significantly. Among diabetic patients, the risk of all-cause mortality was significantly lower in the DEB group (2.78% vs. 11.11%, HR 3.67 (95% confidence interval, CI) [1.01-13.3), p = 0.0483). Conclusions: PCI with DEBs is almost as effective as DES implantation in DM patients treated for ISR. In DM-Dragon, the rate of all-cause death was significantly lower in patients treated with DEBs. Further large-scale, randomized clinical trials would be needed to support these findings.

Noise and light exposure and cardiovascular outcomes: A review of evidence, potential mechanisms and implications.

Cardiovascular diseases (CVD) are the leading cause of global non-communicable disease-related deaths. In recent years there has been increasing discussion about the influence of environmental risk factors, including noise and light, on the occurrence and course of these conditions. Recent studies highlight the impact of road traffic noise on an elevated risk of stroke and increased mortality in the course of coronary artery disease (CAD). In the case of threats arising from light pollution, there are more limited published studies; however, these show an increased hospitalization risk associated with CAD. Existing analyses cannot dismiss these environmental factors, highlighting the need for further research. Future studies should investigate not only road traffic noise but also consider railway and aircraft noise. Additionally, research on light pollution should include younger individuals too. In the future, incorporating individual assessments of noise and light pollution exposure, along with the identification of particularly vulnerable groups, could contribute to refining methods of individual risk stratification and implementing new preventive strategies.

Long-term outcomes following paclitaxel-coated balloons versus thin-strut drug-eluting stents for treatment of in-stent restenosis in chronic coronary syndrome (CCS Dragon-Registry).

BACKGROUND: The long-term outcomes for patients with in-stent restenosis (ISR) presenting with chronic coronary syndrome (CCS) are not well studied. AIMS: We aimed to investigate the outcomes for patients with drug-eluting stents (DES)-ISR and CCS undergoing percutaneous coronary intervention (PCI) with drug-coated balloons (DCB) or thin strut-DES. METHODS: A total of 846 consecutive patients from the Dragon-Registry with CCS and DES-ISR who underwent PCI with thin (strut thickness <100 µm) strut-DES (381 [45%]) or paclitaxel-DCB (465 [55%]) for DES-ISR were enrolled between February 2008 and October 2021. The median follow-up was 1006 (IQR 426-1770) days. The primary outcome was target lesion revascularization (TLR). Secondary outcomes were target vessel revascularization (TVR) and device-oriented composite endpoint (DOCE: cardiac death, TLR, or target vessel myocardial infarction [TV-MI]). RESULTS: Patients who received DES, compared with those who received DCB, had lower crude rates of TLR (hazard ratio [HR], 0.50 [95% CI, 0.34-0.74]; P <0.001), TVR (HR, 0.56 [95% CI, 0.39-0.86]; P <0.001), and DOCE (HR, 0.63 [95% CI, 0.45-0.88]; P = 0.007). The incidence of cardiac death and TV-MI were similar in both groups. After matching, the observed differences persisted in terms of TLR (HR, 0.54 [95% CI, 0.33-0.88]; P = 0.013), TVR (HR, 0.57 [95% CI, 0.41-0.80]; P = 0.009) and DOCE (HR, 0.65 [95% CI, 0.42-0.99]; P = 0.046) between the DES and DCB groups, respectively. CONCLUSIONS: In long-term follow-up of CCS patients undergoing PCI of ISR, the use of DES was associated with reduced rates of TLR, TVR, and DOCE compared with patients treated with DCB.

Effect of air pollution exposure on risk of acute coronary syndromes in Poland: a nationwide population-based study (EP-PARTICLES study).

Background: Air pollution (AP) is linked up to 20% of cardiovascular deaths. The aim of this nationwide study was to investigate subpopulations vulnerable to AP for non-ST- (NSTEMI) and ST-elevation myocardial infarction (STEMI) incidence. Methods: We analysed short- (lags up to seven days) and mid-term (0-30 days moving average) influence of particulate matter (PM2.5), sulphur dioxide (SO2), nitrogen dioxide (NO2) and benzo(a)pyrene (BaP) on hospitalizations due NSTEMI and STEMI in 2011-2020. Data on AP concentrations were derived using GEM-AQ model. Study included residents of five voivodeships in eastern Poland, inhabited by over 8,000,000 individuals. Findings: Higher NO2 and PM2.5 concentrations increased mid-term risk of NSTEMI in patients aged < 65 years by 1.3-5.7%. Increased SO2 and PM2.5 concentration triggered STEMI in the short- (SO2, PM2.5) and mid-term (PM2.5) amongst those aged ≥ 65 years. In the short- and mid-term, women were more susceptible to PM2.5 and BaP influence resulting in increased STEMI incidence. In rural regions, STEMI risk was triggered by SO2, PM2.5 and BaP. Income-based stratification showed disproportions regarding influence of BaP concentrations on NSTEMI incidence based on gross domestic product (up to 1.4%). Interpretation: There are significant disparities in the influence of air pollution depending on the demographic and socio-economic factors. AP exposure is associated with the threat of a higher risks of NSTEMI and STEMI, especially to younger people, women, residents of rural areas and those with lower income. Funding: National Science Center and Medical University of Bialystok, Poland.

Impact of chronic total occlusion on prognosis in cardiogenic shock due to unprotected left main coronary artery culprit lesion. Insights from the Polish Registry of Acute Coronary Syndromes.

BACKGROUND: Notwithstanding readily available revascularization, significant advancements in mechanical circulatory support, and pharmacological progress, cardiogenic shock (CS) secondary to unprotected left main culprit lesion-related acute myocardial infarction (ULMCL-related AMI) is associated with very high mortality. In this population, chronic total occlusion (CTO) is relatively frequent. AIMS: This study sought to assess the association between the presence of CTO and 12-month mortality in patients with CS due to ULMCL-related AMI. RESULTS: The study included consecutive patients admitted for AMI-related CS with ULMCL who underwent percutaneous coronary intervention (PCI) and were enrolled in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) between January 2017 and December 2021. The patients were stratified into two groups based on the presence of at least one CTO. The primary endpoint was all-cause death at 12 months. Of the 250 included patients, 60 (24%) patients had one or more CTOs of a major coronary artery (+CTO), and in 190 (76%) patients, the presence of CTO was not observed (-CTO). The 12-month mortality rates for the +CTO and -CTO patients were 85% and 69.8%, respectively (P log-rank = 0.03). After multivariable adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (hazard ratio, 1.423; 95% CI, 1.027-1.973; P = 0.034). CONCLUSIONS: Our analysis showed that in patients with CS due to ULMCL-related AMI treated with PCI, the presence of CTO is associated with worse 12-month prognosis.

Cangrelor - Expanding therapeutic options in patients with acute coronary syndrome.

Cangrelor is the only intravenous P2Y12 receptor antagonist. It is an adenosine triphosphate analog that selectively, directly, and reversibly binds to the platelet P2Y12 receptors exerting its antiaggregatory effect. Cangrelor is characterized by linear, dose-dependent pharmacokinetics and rapid onset of action providing potent platelet inhibition exceeding 90%. Cangrelor is rapidly metabolized by endothelial endonucleotidase; thus, its half-life is 2.9 to 5.5 min, and its antiplatelet effect subsides within 60 to 90 min. Data originating from three pivotal cangrelor trials (CHAMPION PLATFORM, CHAMPION PCI, and CHAMPION PHOENIX) indicate that cangrelor reduces the risk of periprocedural thrombotic complications during percutaneous coronary intervention at the expense of mild bleedings. Its unique pharmacological properties allow it to overcome the limitations of oral P2Y12 receptor inhibitors, mainly related to the delayed and decreased bioavailability and antiplatelet effect of these agents, which are often observed in the setting of acute coronary syndrome. Subgroups of patients who could theoretically benefit the most from cangrelor include those in whom pharmacokinetics and pharmacodynamics of oral P2Y12 receptor antagonists are most disturbed, namely patients with ST-segment elevation myocardial infarction, those treated with opioids, with mild therapeutic hypothermia, or in cardiogenic shock. Cangrelor could also be useful if bridging is required in patients undergoing surgery. According to the current guidelines cangrelor may be considered in P2Y12 receptor inhibitor-naïve patients undergoing percutaneous coronary intervention in both acute and stable settings.

Sex-Related Differences in the Prevalence of Classical, Non-Classical Risk Factors and Management of the Chronic Coronary Syndrome.

(1) Background: Coronary artery disease (CAD) remains the leading cause of death in both sexes. The male sex is considered a classical atherosclerosis risk factor, whereas females should be protected by hormonal effects until menopause. Although there are known differences in the development, type, and prognosis of chronic coronary syndrome (CCS) between both sexes, there are no differences in approach in the guidelines. (2) Methods: The sex-related differences in CAD risk factors, treatment, echocardiographic, and angiographic results were assessed among 3291 patients with CCS. (3) Results: Women were older and had a higher prevalence of hypertension, dyslipidaemia, and diabetes mellitus than men. Women were more often treated conservatively than men. There was no difference in the use of beta-blockers and statins among the sexes. The LDL cholesterol goal was less frequently reached by women. Women were treated less often with aspirin than men, but they were treated more often with angiotensin receptor blockers than men. The left ventricle ejection fraction was higher among females. The number of obstructed vessels was higher in men. (4) Conclusions: Women may be more exposed to the risk factors of CAD than men. Men are diagnosed with CAD earlier, and their prevention and therapy are more efficient.

Hyperuricemia as a Risk Factor in Hypertension among Patients with Very High Cardiovascular Risk.

Hypertension remains a global threat to public health, affecting the worldwide population. It is one of the most common risk factors for cardiovascular disease. Today's treatments focus on creating a hypotensive effect. However, there is a constant search for additional factors to reduce the potential of developing hypertension complications. These factors may act as a parallel treatment target with a beneficial effect in specific populations. Some studies suggest that uric acid may be considered such a factor. This study investigated the potential effect of uric acid concentrations over 5 mg/dL on the incidence of hypertension complications among patients with very high cardiovascular risk. A total of 705 patients with hypertension and very high cardiovascular risk were selected and included in the analysis. The patients were divided and compared according to serum uric acid levels. The study showed a higher occurrence of heart failure (OR = 1.7898; CI: 1.2738-2.5147; p = 0.0008), atrial fibrillation (OR = 3.4452; CI: 1.5414-7.7002; p = 0.0026) and chronic kidney disease (OR = 2.4470; CI: 1.3746-4.3558; p = 0.0024) among individuals with serum uric acid levels over 5 mg/dL, males and those with a BMI > 25 kg/m2. These findings suggest that even serum uric acid concentrations over 5 mg/dL may affect the prevalence of hypertension-related complications among patients with very high cardiovascular risk.

Factors determining the frequency of optical coherence tomography and intravascular ultrasound use in patients treated with percutaneous coronary interventions in recent years: Analysis based on a large national registry.

BACKGROUND: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have demonstrated improvement in the clinical outcome of patients undergoing percutaneous coronary intervention (PCI). AIMS: We aimed to examine the frequency of implementing OCT and IVUS during coronary angiography (CA) and PCI in everyday practice in Poland. Factors related to the more common choice of these imaging techniques were determined. METHODS: Data from the Polish National Registry of Percutaneous Coronary Interventions (ORPKI) were procured for analysis. Between January 2014 and December 2021, we extracted data on 1 452 135 CAs, 11 710 using IVUS (0.8%) and 1471 with OCT (0.1%) and 838 297 PCIs, 15 436 with IVUS (1.8%) and 1680 with OCT (0.2%). We assessed the determining factors for applying IVUS and OCT via multiple regression logistics models. RESULTS: The frequency of applying IVUS during CAs and PCIs increased significantly between the years 2014 and 2021. In 2021, it reached 1.54% for CAs and 4.42% for PCIs, while for OCT, there was a rise regarding the CA group, namely 0.13% in 2021, and, in the PCI group, 0.43%. Age was one of the factors significantly associated with the frequency of using IVUS/OCT during CA/PCI, which was confirmed by multivariate analysis (Odds ratio: 0.981 for IVUS and 0.973 for OCT use with PCI). CONCLUSION: The frequency at which IVUS and OCT were used has undergone a significant increase in previous years. This increase can be largely attributed to the current reimbursement policies. Further improvement is required for this frequency to be at a satisfactory level.

Percutaneous Coronary Intervention for Chronic Total Occlusion-Contemporary Approach and Future Directions.

In the aging society, the issue of coronary chronic total occlusion (CTO) has become a challenge for invasive cardiologists. Despite the lack of clear indications in European and American guidelines, the rates of percutaneous coronary interventions (PCI) for CTO increased over the last years. Well-conducted randomized clinical trials (RCT) and large observational studies brought significant and substantial progress in many CTO blind spots. However, the results regarding the rationale behind revascularization and the long-term benefit of CTO are inconclusive. Knowing the uncertainties regarding PCI CTO, our work sought to sum up and provide a comprehensive review of the latest evidence on percutaneous recanalization of coronary artery chronic total occlusion.

Multi-City Analysis of the Acute Effect of Polish Smog on Cause-Specific Mortality (EP-PARTICLES Study).

Polish smog is a specific type of air pollution present in Eastern Poland, which may cause particularly adverse cardiovascular effects. It is characterized primarily by high concentrations of particulate matter (PM) and different favorable conditions of formation. Our study aimed to assess whether PM and nitrogen dioxide (NO2) have a short-term impact on mortality due to acute coronary syndrome (ACS) and ischemic stroke (IS). The study covered the years 2016-2020, a total of 6 million person-years from five main cities in Eastern Poland. To evaluate the association between air pollution and cause-specific mortality, a case-crossover study design with conditional logistic regression was used at days with LAG from 0 to 2. We recorded 87,990 all-cause deaths, including 9688 and 3776 deaths due to ACS and IS, respectively. A 10 µg/m3 increase in air pollutants was associated with an increase in mortality due to ACS (PM2.5 OR = 1.029, 95%CI 1.011-1.047, p = 0.002; PM10 OR = 1.015, 95%CI 1-1.029, p = 0.049) on LAG 0. On LAG 1 we recorded an increase in both IS (PM2.5 OR = 1.03, 95%CI 1.001-1.058, p = 0.04) and ACS (PM2.5 OR = 1.028, 95%CI 1.01-1.047, p = 0.003; PM10 OR = 1.026, 95%CI 1.011-1.041, p = 0.001; NO2 OR = 1.036, 95%CI 1.003-1.07, p = 0.04). There was a strong association between air pollution and cause-specific mortality in women (ACS: PM2.5 OR = 1.032, 95%CI 1.006-1.058, p = 0.01; PM10 OR = 1.028, 95%CI 1.008-1.05, p = 0.01) and elderly (ACS: PM2.5 OR = 1.03, 95%CI 1.01-1.05, p = 0.003; PM10 OR = 1.027, 95% CI 1.011-1.043, p < 0.001 and IS: PM2.5 OR = 1.037, 95%CI 1.007-1.069, p = 0.01; PM10 OR = 1.025, 95%CI 1.001-1.05, p = 0.04). The negative influence of PMs was observed on mortality due to ACS and IS. NO2 was associated with only ACS-related mortality. The most vulnerable subgroups were women and the elderly.

Environmental and socioeconomic determinants of heart failure.

BACKGROUND: Over 1.5 million people in Poland suffer from heart failure (HF). The risk of hospitalization is related to environmental and socioeconomic factors and the organization of the healthcare system. AIMS: The study aimed to assess the influence of environmental and socioeconomic factors on the prevalence of hospitalization for HF. METHODS: The impact of environmental and socioeconomic factors on HF hospitalizations in Poland in 2012-2019 based on data from the National Institute of Public Health and Central Statistical Office in Poland was estimated by panel data regression techniques. RESULTS: There were 1 618 734 HF-related hospitalizations (51.3% male; 82.6% aged >65 years). An increase in the number of physicians by 10/10 000 population and healthcare expenditure of 100 PLN per capita resulted in 3.5% (-0.035; 95% confidence interval [CI], -0.06 to -0.01; P = 0.002) and 3% (-0.029; 95% CI, -0.04 to -0.013; P <0.001) decrease in hospitalizations, respectively. For each new outpatient healthcare facility per 10 000 population, there was a 3% (-0.031; 95% CI, -0.048 to -0.014; P <0.001) decrease in hospitalizations. One percentage point increase in the proportion of green areas resulted in a 2.7% (-0.027; 95% CI, -0.042 to -0.01; P = 0.049) decrease in hospitalizations. However, an increase in cars by 1000 inhabitants and a 1 percentage point increase in the unemployment rate were associated with a 6% increase in HF hospitalizations (0.064; 95% CI, 0.008-0.121; P = 0.026). CONCLUSIONS: The number of HF-related hospitalizations has been increasing in the last decade. This trend is most noticeable in regions with low socioeconomic development and poor medical facilities. Our study indicates that health policy measures including environmental and socioeconomic instruments may result in positive health outcomes. Additional analyses are needed to compare the impact of socioeconomic and environmental factors against the impact of healthcare alone.