Double protection in patients with a massive thrombus in the infarct-related artery - a single-center retrospective study.

Introduction: ST-segment elevation myocardial infarction (STEMI) is associated with thrombus formation on a ruptured or ulcerated atherosclerotic plaque. The consequences of a massive thrombus (MT) may include lack of reperfusion, extensive myocardial infarction (MI) and its complications. Although there are various treatment options for patients with coronary thrombi, double protection (DP) - manual thrombectomy (MTH) with a distal protection device (DPD) - has not been tested yet. Aim: To present DP outcomes in the treatment of patients with STEMI and MT patients. Material and methods: Fourteen patients with STEMI and MT were included in the study. Those patients underwent primary percutaneous coronary intervention (PPCI) with DP. Results: Inferior MI was found in 12 (85.8%) patients. Stents were implanted in 13 (92.8%) patients. Thrombolysis In Myocardial Infarction (TIMI) Thrombus Grade 5 was present in 11 (78.6%) patients and Grade 4 in 3 (21.4%) patients. The median thrombus length was 39.1 mm. Complete reperfusion (TIMI flow 3) was observed in 11 (78.6%) patients and TIMI flow 2 in 3 (21.4%) patients. Myocardial Blush Grade (MBG) was used in patients with TIMI flow 3 and Grade 3 was found in 5 (35.7%) patients. Resolution in ST-segment elevation > 50% was obtained in 13 (92.8%) patients. No myocardial rupture, stroke, or death occurred during hospitalization. Conclusions: DP in MT patients is a safe and feasible procedure. However, further observations and studies are needed to assess the efficacy of this method.

Assessment of the Level of Anxiety for COVID-19 Vaccinations.

Research published especially in the last decade indicates the influence of anxiety on the human decision-making process. This study analyzes the anxiety among individuals who decided to undergo vaccinations for COVID-19. The study assesses that the level of education, especially medical education, age, and gender, had an influence on the level of anxiety in terms of vaccination situations. The STAI self-assessment questionnaire was used. The study was conducted anonymously using the paper-pencil method during two rounds of vaccination; therefore, the respondent sample included mainly medical personnel and elderly people. A total of 898 questionnaires were issued. Age did not affect the trait and state of anxiety, but highly educated people tested during vaccination had a lower anxiety level. Gender had no influence on the trait but did influence the state of anxiety. Overall, women were the group that exhibited a higher level of anxiety than men. Nurses were particularly vulnerable to the negative effects of situational medication in this group.

Early and long-term outcomes of bioresorbable vascular scaffolds in the treatment of patients with coronary artery disease in real-world clinical practice - insights from the ZABRZE-BVS registry.

INTRODUCTION: Randomized trials have proven the feasibility and safety of the bioresorbable vascular scaffold (BVS) in selected populations of patients. Data concerning the results of BVS in "real-world" registries with an appropriate sample size are limited. AIM: Assessment of early- and long-term outcomes of patients undergoing bioresorbable scaffold implantation in an all-comers population of the ZABRZE-BVS registry. MATERIAL AND METHODS: The ZABRZE-BVS registry is a prospective registry including consecutive patients treated in the period 2013-2016 with the intention to implant a BVS (ABSORB, Abbott Vascular, Santa Clara, California). The primary endpoint was occurrence of the 12- and 24-month device-oriented composite endpoint (DoCE) defined as cardiac death, target-vessel myocardial infarction (TV-MI) or target lesion revascularization (TLR). The secondary endpoint includes occurrence of patient-oriented composite endpoint (PoCE) at 12 and 24 months, device (lesion basis) and procedural success (patient basis). RESULTS: A total of 456 patients during 467 procedures received 588 scaffolds in 563 lesions. Of note, 25.4% of patients presented with diabetes mellitus and 62.3% had an acute coronary syndrome. In QCA analysis, 78.7% of patients had type B2/C lesions, minimal lumen diameter was 0.78 ±0.54 mm, whereas post-procedural acute lumen gain was 1.61 ±0.61 mm. Median follow-up was 781 days. The cumulative rate of DoCE was 6.7% at 12 months and 12.2% at 24 months. Rates of 12- and 24-month PoCE were 12.4% and 20.1%, respectively. The percentage of device success was 98.7%, while the procedural success rate was 96.9%. CONCLUSIONS: The Absorb BVS was successfully and safely implanted in an unselected group of patients. Scaffold thrombosis developed predominantly in patients with acute coronary syndrome (ACS).

The Impact of Routine Angiographic Follow-Up in a Population of Patients Undergoing Percutaneous Coronary Intervention Within the Left Main Coronary Artery.

Prognostic value of angiographic follow-up in patients undergoing percutaneous coronary interventions (PCIs) of the left main coronary artery (LMCA) still remains uncertain. The aim of the study was to compare clinical characteristics, mortality, and major cardiovascular events in patients with versus without angiographic follow-up after PCI of the LMCA as well as to identify independent risk factors for death after PCI of the LMCA. Study population consisted of 217 patients of 290 consecutive participants who underwent PCI of the LMCA and subsequently were divided into 2 groups: angiographic follow-up group (angio FU group, n = 155) and clinical follow-up group (clinical FU group, n = 62). In angio FU group, significantly lower mortality (19.4% vs 32.3%, P < .05) and higher repeated revascularization rates (PCI: 46.5% vs 8.1%, P < .001 and coronary artery bypass grafting: 12.9% vs 1.6%, P < .05) were observed. Independent risk factors for death were as follows: metal stent implantation (hazard ratio [HR]: 2.753), no angiographic follow-up (HR: 1.959), and an increase in serum creatinine level of 1 µmol/L (HR: 1.006). These preliminary data suggest that the lack of angiographic follow-up after PCI of the LMCA may result in higher long-term mortality.

Stroke and death prediction with CHA2DS2-vasc score after myocardial infarction in patients without atrial fibrillation.

AIMS: The CHA2DS2-VASc score is widely used to stratify the risk of stroke in patients with nonvalvular atrial fibrillation. The aim of the study was to assess whether the CHA2DS2-VASc score might be useful to identify patients at a high risk of ischemic stroke and death among individuals after acute myocardial infarction and with no history of atrial fibrillation. METHODS: We analysed consecutive patients with acute myocardial infarction admitted to our centre between 2003 and 2008. On the basis of the CHA2DS2-VASc score, four groups were distinguished: low-risk (1 point), intermediate-risk (2-3 points), high-risk (4-5 points) and very high-risk (>5 points). Data on long-term follow-up were screened to identify patients who experienced stroke or died during remote observation. RESULTS: Out of 2980 registry participants, 333 were excluded because of atrial fibrillation and/or ongoing therapy with oral anticoagulants. Finally, 2647 individuals were included into the analysis. An ischemic stroke occurred in 71 (2.68%) patients, whereas 439 (16.58%) died during a median follow-up of 41.5 months. The risk of stroke and death increased four-fold in the high-risk group compared with the low-risk group (P < 0.001). Every point in the CHA2DS2-VASc score was independently associated with 41% increase in stroke risk and 23% increase in mortality rate (for both P < 0.001). CONCLUSION: The mortality rate and risk of stroke were strongly associated with the CHA2DS2-VASc scores. Hence, this scoring system could be useful to identify high-risk patients with no history of atrial fibrillation, in whom additional preventive measures might be beneficial to improve the outcome.

Ostial stenosis of the left main coronary artery as the result of the previous percutaneous coronary intervention on the left coronary artery.

A 76-year-old patient was admitted to hospital due to recurrent chest pain. Angiography revealed multivessel coronary artery disease with significant stenosis in medial and distal parts of the left main coronary artery (LMCA). Two drug-eluting stents (DES) were implanted from the medial part of the LMCA to the proximal part of the left anterior descending (LAD) artery. An excellent angiographic result was achieved. After 20 days the patient returned to our clinic because of acute coronary syndrome (ACS). Angiography showed 80% stenosis in the ostial LMCA. The lesion was stented with DES, obtaining a good angiographic result.

Multiple sclerosis, an unlikely cause of chronic cerebrospinal venous insufficiency: retrospective analysis of catheter venography.

OBJECTIVES: It is unknown if a relationship exists between multiple sclerosis and chronic cerebrospinal venous insufficiency and if this venous pathology is a causal factor for multiple sclerosis or is a product of a neurological disease. Even so, one should expect that if multiple sclerosis were the cause for venous lesions, then patients with an extended history of the disease would present with a more severe venous pathology. DESIGN: Retrospective analysis of catheter venography of the azygous and internal jugular veins, and duration of clinical history of the disease in multiple sclerosis patients. SETTING: Mono-profile specialist hospital. PARTICIPANTS: 353 multiple sclerosis patients, with duration of the disease: 0.5-41 years (median: 10 years). MAIN OUTCOME MEASURES: We performed statistical analysis of the correlations between the duration of multiple sclerosis and the degree and number of venous lesions revealed using catheter venography. RESULTS: We observed weak, statistically insignificant correlations between the severity of chronic cerebrospinal venous insufficiency and the duration of multiple sclerosis. For the cumulated scores of venous lesions, Spearman and Kendall's tau correlation coefficients were 0.03 and 0.02, respectively; for maximal scores of venous lesions, coefficients were 0.06 and 0.05, while for the number of diseased veins they were 0.007 and 0.006, respectively. Consequently, this analysis did not yield any data supporting the idea that MS is the cause of venous lesions. CONCLUSION: The results of our survey indicated that venous malformations are most likely congenital, and multiple sclerosis had no significant impact on the development of venous pathology.

Radial vs femoral approach with StarClose clip placement for primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. RADIAMI II: a prospective, randomised, single centre trial.

BACKGROUND: Compared to the transfemoral approach (TFA), the transradial approach (TRA) for primary percutaneous coronary intervention (PCI) is associated with less risk of access site complications, greater patient comfort and faster mobilisation. Using vascular closure devices during TFA can offer similar advantages. AIM: To compare the results of TRA and TFA using a StarClose device for primary PCI in patients with ST-elevation myocardial infarction (STEMI). METHODS: Patients were randomised to PCI using TRA (n = 49) or PCI using TFA and StarClose (n = 59). RESULTS: Door-to-balloon inflation time was 67.4 ± 17.1 vs 57.5 ± 17.5 min (p = 0.009) in the TRA and TFA groups respectively. Procedural success rate was 100% and 98.3%, respectively (NS). There were no significant differences in the incidence of major adverse cardiac events (MACE) or bleeding complications between the groups: 2.1% and 8.2% in the TRA group vs 1.7% and 10.2% in the TFA group (NS). Time to resume an upright position and time to full mobility was comparable in both groups. CONCLUSIONS: The TRA for PCI in patients with STEMI is related to a significantly longer door to balloon time compared to the TFA. This had no influence on the incidence of MACE. The duration and efficacy of PCI were comparable in both groups. Using StarClose after PCI performed via the TFA resulted in an incidence of access site and bleeding complications comparable to that found when using TRA.

The impact of unsuccessful percutaneous coronary intervention on short- and long-term prognosis in STEMI and NSTEMI.

OBJECTIVES: To compare the impact of the efficacy of percutaneous coronary intervention (PCI) on prognosis in ST and non-ST elevation myocardial infarction (STEMI and NSTEMI) patients with respect to infarct-related artery (IRA). BACKGROUND: The significance of the efficacy of PCI in STEMI and NSTEMI depending on the type of IRA has yet to be clarified. METHODS: Study population consisted of 2,179 STEMI and 554 NSTEMI consecutive patients treated with urgent PCI. The efficacy of PCI (TIMI [thrombolysis in myocardial infarction] 3 vs. TIMI < 3) was assessed with regard to the type of IRA (left anterior descending artery, circumflex artery [Cx] or right coronary artery). The mean follow-up was 37.5 months. RESULTS: The rate of unsuccessful PCI was similar in STEMI and NSTEMI irrespectively of IRA (14.1 vs. 17.7%; P = 0.062). In STEMI, unsuccessful PCI was associated with significantly higher early (23.1 vs. 5.6%; P < 0.001) and late (29.9 vs. 12.8%; P < 0.001) mortality regardless of IRA. In NSTEMI, the inefficacious PCI significantly increased early (19.0% vs. 0.9%; P < 0.001) and late (27.3% vs. 6.3%; P < 0.001) mortality only in patients with Cx-related infarction. Unsuccessful PCI of IRA was an independent risk factor for death in STEMI (HR 1.64; P < 0.05), but not in NSTEMI (P = 0.64). Further analysis showed that whilst unsuccessful PCI of any vessel in STEMI is an independent risk factor for death, in NSTEMI this applies to unsuccessful PCI of Cx only. CONCLUSIONS: The significance of unsuccessful PCI of IRA seems to be different in STEMI and NSTEMI. Unsuccessful PCI is an independent risk factor for death in STEMI regardless of IRA and in NSTEMI with the involvement of Cx.

Prognosis in diabetic patients with acute myocardial infarction treated invasively is related to renal function.

BACKGROUND: The prevalence of diabetes mellitus (DM) and chronic kidney disease (CKD) is rapidly increasing. Both comorbidities are considered significant risk factors for cardiovascular complications. The aim of the study was to evaluate the impact of DM with and without CKD on prognosis in patients with acute myocardial infarction (AMI) treated invasively. MATERIAL/METHODS: This single-center prospective study encompassed 3334 AMI-patients without cardiogenic shock, who were divided into 2 major groups: 999 patients with type 2 DM diagnosed prior to or during index hospitalization, and 2335 non-diabetics. All diabetic patients were divided with respect to their renal status into: diabetics with CKD (DM-CKD; n=264) and without (DM-nCKD; n=735). Short- and long-term outcomes were compared between study groups. Independent predictors of death and composite end-point were selected with multivariate Cox-regression model. RESULTS: Mortality rates were significantly higher in DM group compared to nDM in all observation periods. DM-CKD was associated with excessive total mortality (35.6%) when compared to DM-nCKD (11.6%, P<0.001) and to nDM (9.8%, P<0.001). Mortality and major adverse cardiovascular event rates did not differ significantly between DM-nCKD and nDM groups. Diabetes coexisting with CKD was one of the strongest independent risk factors for death (hazard ratio 1.93; confidence interval 1.79-2.07; P<0.001). CONCLUSIONS: The prognosis in diabetics with AMI is significantly related to renal function. Diabetics without CKD had similar prognosis to non-diabetics. Multivariate analyses showed that unlike diabetes without renal dysfunction, DM-CKD was an independent risk factor for cardiovascular complications and total mortality.

RADIal versus femoral approach for percutaneous coronary interventions in patients with Acute Myocardial Infarction (RADIAMI): A prospective, randomized, single-center clinical trial.

BACKGROUND: The transradial approach for percutaneous coronary intervention (PCI) seems to be superior to transfemoral. The safety and efficacy of transradial approach for PCI in acute myocardial infarction is not well-established. METHODS: Hundred patients with acute myocardial infarction qualified to PCI were randomly assigned to transradial (group I; n = 50) and transfemoral (group II; n = 50) approaches. RESULTS: PCI was successful for almost all patients, except one from group II. There were no significant differences between groups in X-ray exposition, volume of contrast and total procedure duration. Small but significant elongation of door to stent time in group I was caused mostly by a longer time between beginning of procedure and arterial sheath introduction. Major bleeding complications occurred in three patients from group I and seven from group II. There were no significant differences observed between the two groups. Time to ambulation in group I was significantly shorter then in group II (22.6 +/- 10.3 h vs. 34.7 +/- 34.6 h; p = 0.003). CONCLUSIONS: The transradial approach for PCI in acute myocardial infarction has the same efficacy as transfemoral. There are no differences in total procedure duration, X-ray exposition or volume of contrast between the two approaches. A longer time from the patient's admission to the individual stages of the PCI procedure in group I was mostly due to the longer times of the initial stages of the procedure. The use of transradial approach reduces the time to ambulation and allows rehabilitation to begin sooner. In both groups, bleeding complications occurred rarely.

Vascular abnormalities and cardiomyocyte lipofuscin deposits in endomyocardial biopsy specimens of heart transplant recipients: are they related to the development of cardiac allograft vasculopathy?

OBJECTIVE: The aim of this study was to assess the predictive value of microvascular abnormalities and lipofuscin observed in endomyocardial biopsy samples for the development of cardiac allograft vasculopathy. METHODS: The study group consisted of 68 cardiac allograft recipients (63 men and 5 women, 43 +/- 12 years old). We performed a re-evaluation of 1071 endomyocardial biopsy specimens to search for microvascular diseases and lipofuscin in cardiocytes. Endomyocardial biopsy specimens with an International Society for Heart and Lung Transplantation rejection grade of 2 or more and those without arterioles were excluded. Abnormalities found in the remaining 517 specimens were correlated with the grade of rejection. Biopsy specimens obtained 2 weeks, 12 months, and 36 months after transplantation were compared with coronary angiography results, clinical events of cardiac allograft vasculopathies, and survivals. Kaplan-Meier curves were constructed to compare the time to the development of cardiac allograft vasculopathy or death. RESULTS: Enlarged endothelial cells, lymphocytes inside the arteriolar wall, occluded arteriolar lumen, endothelial vacuolization, and hypertrophy of the vascular muscle were significantly correlated with rejection grade. Although none of the vascular abnormalities predicted cardiac allograft vasculopathy, patients with lipofuscin deposits at the 12-month biopsy specimens were characterized by the rapid development of angiography-confirmed cardiac allograft vasculopathy (P < .08) and events related to cardiac allograft vasculopathy (P < .03, log-rank test). CONCLUSION: Microvascular abnormalities correlate with mild cellular rejection, but they do not seem to be predictive for development of cardiac allograft vasculopathy detected by angiography. The presence of lipofuscin in 12-month endomyocardial biopsy specimens may be predictive of development of angiographically confirmed cardiac allograft vasculopathy.

Quilty effect correlates with biopsy-proven acute cellular rejection but does not predict transplanted heart coronary artery vasculopathy.

BACKGROUND: The appropriate therapy after orthotopic heart transplantation (OHT) is determined by the results of endomyocardial biopsies (EMBs). The Quilty effect (QE) is a recognized cause of discrepancies in EMB grading, but its clinical implications remain unclear. In this study we assess the correlation of the QE with biopsy-proven acute cellular rejection (AR) and coronary artery vasculopathy (CAV). METHODS: We reassessed 5,361 EMB samples, obtained from 429 patients, based on QE occurrence and its impact on EMB score. Next, we divided all patients with at least 1 year of follow-up into two groups: a QE(+) group (n = 202, 58.7% of sample, 172 males/30 females, 44.8 +/- 12 years of age) and a QE(-) group (n = 142, 41.3% of sample, 124 males/18 females, 45.4 +/- 12 years of age), and compared AR and CAV occurrences. RESULTS: The QE was observed in 669 EMBs (12.5%), and at least 1 EMB with QE was found among the 231 patients (53.8%). The initial QE occurrence took place during the first 3 months after OHT in 68% of QE(+) patients, and >1 year post-OHT in 13% of patients. The average EMB score was significantly higher in QE(+) biopsies. A comparison of the two groups revealed a significantly higher number of AR episodes and number of patients with at least one episode of AR in QE(+) patients. There was no significant difference in number of CAV occurrences between groups. CONCLUSIONS: The QE seems to be a marker of the same increased immune system activity that can lead to AR. A relationship between QE and CAV was not supported by the present results.

The comparison of contrast echocardiography and tissue Doppler imaging for evaluation of reperfused myocardium in patients with acute anterior myocardial infarction.

BACKGROUND: Prediction of functional myocardial recovery post acute myocardial infarction should be based not only on flow patency of the infarct related artery (IRA) but also on the quality of microcirculation in at-risk segments. Myocardial blush grade (MBG) is a method of perfusion assessment which has an established value in prediction of both ventricular remodelling and prognosis. However, its invasive character encourages the search for other methods able to reflect myocardial recovery following successful reperfusion. Echocardiography is an imaging modality which has the potential to assess, noninvasively, myocardial perfusion and, quantitatively, the loss of contractile function. The aim of this study was to compare the values of myocardial contrast echocardiography (MCE), MBG and tissue Doppler imaging (TDI) in the assessment of microcirculation in patients with first acute myocardial infarction of the anterior wall. METHODS: The study group consisted of 39 patients (15 female and 24 male, mean age 58.8 +/- 12.2 years) with first anterior infarction within 6 hours of chest pain onset. All patients underwent angioplasty of the anterior descending artery (LAD). Myocardial blush grade was assessed directly after angioplasty, whereas MCE using SonoView contrast accompanied by TDI study was performed 4 days thereafter. RESULTS: Neither of the quantitative MCE parameters showed significant correlation with perfusion assessed by MBG. Significant negative correlation of MBG was found with maximal systolic strain ( e) (R = -0.51, p = 0.003) and post systolic shortening (R = -0.49, p = 0.007) in infarcted segments, but this was not the case with the unaffected segments. CONCLUSIONS: Use of MCE in the assessment of myocardial perfusion in myocardial infarction is limited, as shown by poor correlation with MBG. The presence of impaired contractile function by TDI corresponds better with myocardial perfusion than MCE does.

[Femoral artery pseudoaneurysms: treatment with ultrasound guided thrombin injection in 28 patients]. / Tetniaki rzekome tetnic udowych: wyniki leczenia 28 chorych za pomoca iniekcji trombiny pod kontrola ultrasonograficzna.

INTRODUCTION: Femoral artery pseudoaneurysms (PSA) develop in 0.2-8% patients undergoing procedures that require femoral artery cannulation. Ultrasound guided thrombin injection has been described as successful and safe alternative to ultrasound guided compression and surgical treatment. AIM OF THE STUDY: Assessment of efficacy and safety of PSA treatment with USGTI. METHODS: 28 patients (pts) (18 female, mean age 64.6 +/- 11.4) with femoral pseudoaneurysms developed due to coronary angiogram or percutaneous coronary angioplasty were treated with ultrasound guided thrombin injection. 24 PSAs arose from right common femoral artery, 3 from right superficial femoral artery, and 1 from left common femoral artery. 24 patients were receiving antiplatelet and 4 anticoagulation therapy at the time of the procedure. With ultrasound guidance, a 21Gx11/2 needle was placed into pseudoaneurysm lumen followed by thrombin injection (1074 +/- 473 U). No complications of the procedure were observed. In 24-hour observation USGTI was successful in 28 (100%) patients. However, in 7-day follow-up resolution of 1 PSA was found, which reduced efficacy rate to 96.3%. CONCLUSIONS: Ultrasound guided thrombin injection is a successful, safe and well tolerated method of pseudoaneurysms treatment. Neither antiplatelet nor anticoagulation therapy affects success rate of the method.

[Adaptation of different neuroprotection devices during carotid stenting procedures]. / Zastosowanie róznych systemów neuroprotekcji podczas zabiegów stentowania tetnicy szyjnej wewnetrznej na podstawie opisu wybranych przypadków.

Carotid artery stenting (CAS) is, apart from surgical endarterectomy, a common method of treatment of atherosclerosis in carotid arteries. Percutaneous angioplasty of carotid artery narrowings has been developing in recent years due to introduction of neuroprotection systems, which significantly reduced number of complications. Nowadays three neuroprotection systems are in common use: filters, temporary occlusion and aspiration systems and flow reversal systems. We present three cases of successful CAS with application of three different neuroprotection systems. We discuss indications, contraindications and limitations of every device.