Prognostic implications of mean platelet volume on short- and long-term outcomes among patients with non-ST-segment elevation myocardial infarction treated with percutaneous coronary intervention: A single-center large observational study.

BACKGROUND: Mean platelet volume (MPV) is a simple and reliable indicator of platelet size that correlates with platelet activation and their ability to aggregate. We studied the predictive value of MPV in patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated with percutaneous coronary intervention (PCI). METHODS: We analyzed the consecutive records of 1001 patients who were hospitalized due to NSTEMI at our center. The primary end point was a composite end point that included the rates of all-cause death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) driven revascularization at 12 months. The enrolled patients were stratified according to the quartile of the MPV level at admission. RESULTS: Along with the increasing quartile of MPV, the 12-month composite end point increased significantly (p = 0.010), and this association remained significant after the risk-adjusted analyses (per 1 fL higher MPV; adjusted hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.02-1.27; p = 0.026). In the multivariate analysis, the MPV was also an independent factor of all-cause mortality (per 1 fL increase; adjusted HR 1.34; 95% CI 1.12-1.61; p = 0.0014) and death or non-fatal myocardial infarction (per 1 fL increase; adjusted HR 1.16; 95% CI 1.03-1.31; p = 0.017). CONCLUSION: In patients with NSTEMI treated with PCI, a high MPV value was associated with a significantly increased incidence of long-term adverse events, particularly for all-cause mortality.

Prediction of early death after myocardial infarction in patients with reduced left ventricular ejection fraction. The search for new indications for cardioverter-defibrillator implantation (ICD).

BACKGROUND: The highest rate of death is in the first few weeks after myocardial infarction (MI). However, the assessment of indications for primary prevention implantable cardioverter-defibrillator (ICD) implantation should be postponed until at least 40 days after MI. AIMS: Our aim was to identify the subgroup of high-risk patients with reduced left ventricular ejection fraction (LVEF) who would benefit from primary prevention ICD implantation within 40 days of MI. METHODS: Out of 205 606 patients with MI, in this study, we included 18 736 patients treated invasively, with LVEF <40%, who survived until hospital discharge. Patients were divided into two groups according to the survival status at 40 days - patients who died within this period (n = 1331) and patients who survived (n = 17405). RESULTS: Among all patients who died within 12-months after MI, 37.7% did die during the first 40 days. Patients with cardiac arrest before hospital admission or within the first 48 hours of hospitalization (hazard ratio [HR], 3.35; 95% confidence interval [CI], 2.82-3.98; P <0.0001], cardiogenic shock before admission or during hospitalization (HR, 3.06; 95% CI, 2.62-3.59; P <0.0001), unsuccessful percutaneous coronary interventions (PCI; HR, 2.42; 95% CI, 2.11-2.84; P <0.0001), LVEF <20% (ref. LVEF ≥30%; HR, 2.75; 95% CI, 2.25-3.36; P <0.0001) had approximately threefold and patients with chronic kidney disease almost 1.5-times (HR, 1.25; 95% CI, 1.47-3.59; P = 0.0053) higher 40-day mortality compared to patients without these risk factors. The most striking differences in mortality between these subgroups were observed shortly after discharge. CONCLUSIONS: The highest risk of death in patients with reduced LVEF who survived until hospital discharge occurred within the first 40 days after MI. There is a possibility to select patients with the worst prognosis and treat them more aggressively.

Clinical characteristics, and in-hospital and long-term outcomes of stable angina treatment in patients below and over 40 years of age (from the PRESAGE registry).

BACKGROUND: There is a paucity of data concerning young patients with stable angina (SA). AIM: The study aimed to compare the characteristics, as well as in-hospital one-, two-, and five-year outcomes of patients aged ≤ 40 and > 40 years with SA. METHODS: The analysis involved 80 patients aged ≤ 40 years and 9299 patients aged > 40 years with SA treated in the 3rd Department of Cardiology in Zabrze between 2006 and 2014, and enrolled in the ongoing PRESAGE Registry. Propensity scores matching was used to adjust for differences in patients' baseline characteristics. The composite endpoint involved death, non-fatal myocardial infarction, and acute coronary syndrome (ACS) or ACS-driven unplanned revascularisation within one-, two-, and five-year follow-up periods. RESULTS: In comparison to older patients, the younger ones had a higher incidence of smoking (58.3% vs. 35.2%, p < 0.0001) and previous percutaneous angioplasty (45% vs. 33.7%, p = 0.033). There was no significant difference in in-hospital outcomes. The composite endpoint incidence did not differ significantly between the young and old group within one year (1.3% vs. 8.1%, p = 0.068), two years (5.8% vs. 12.9%, p = 0.08), and five years (23.1% vs. 25.7%, p = 0.71) after discharge. Young patients had a borderline lower mortality rate (0% vs. 4.5%, p = 0.053) after a one-year follow-up and a significantly lower mortality rate within two and five years after index hospitalisation (0% vs. 7.8%, p = 0.02 and 5.1% vs. 17.1%, p = 0.04, respectively). After propensity score matching analysis, a significantly lower two-year mortality was observed in the ≤ 40 age group (0% vs. 8.1%; p = 0.016), without significant difference during five-year follow-up (5.1% vs. 13.5%; p = 0.21). CONCLUSIONS: The younger and older groups of patients with SA differed in clinical characteristics, with no significant difference in the in-hospital outcomes and composite endpoint incidence in the follow-up period. However, younger patients had a borderline lower mortality rate one year after discharge and a significantly lower mortality rate two and five years after the index hospitalisation.

Gap in gender parity: gender disparities in incidence and clinical impact of chronic total occlusion in non-infarct artery in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease.

A chronic total occlusion in a non-infarct-related artery is an independent predictor of mortality in non-ST elevation myocardial infarction. There are no mortality data about the impact of a chronic total occlusion in patients with non-ST elevation myocardial infarction according to gender. The purpose of this study was to evaluate the prevalence of the chronic total occlusion in in men and women and examine its impact on clinical outcomes. Data from consecutive patients with multivessel coronary artery disease treated in a high-volume center between 2006 and 2012 were included in a prospective registry and divided according to gender and the presence of chronic total occlusion. All of the analyzed patients were followed up for at least 24 months, with all-cause mortality defined as the primary endpoint. Among the 515 patients who fulfilled the inclusion criteria, 32.8% were female. In the female arm, the 24-month mortality for the groups with and without chronic total occlusion was similar (18.9% and 14.7%, respectively; p = 0.47). In contrast, in the male arm, the occurrence of chronic total occlusion was associated with higher 24-month mortality (24.3% vs. 13.4%; p = 0.009). Multivariate analysis of the male arm revealed a trend toward a positive association between the occurrence of chronic total occlusion and 24-month mortality (HR 1.62; 95% CI 0.93-2.83; p = 0.087). The presence of chronic total occlusion in men is associated with an adverse long-term prognosis, whereas in women this effect was not observed.

Medium platelet volume as a noninvasive predictor of chronic total occlusion in non-infarct artery in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease.

BACKGROUND: Chronic total occlusion (CTO) in a noninfarct-related artery (non-IRA) is an independent predictor of mortality in non-ST elevation myocardial infarction (NSTEMI). Mean platelet volume (MPV) is associated with cardiovascular events in NSTEMI. Little is known about the predictors of non-IRA-CTO in patients with NSTEMI. The purpose of this study was to evaluate the relationship between the presence of non-IRA-CTO with MPV level in patients with NSTEMI and multivessel coronary artery disease (MVCAD). METHODS: Data of consecutive patients with NSTEMI and MVCAD treated in high-volume PCI center between 2006 and 2012 and included in the prospective registry were divided according to the presence of CTO and analyzed. RESULTS: In the group of 685 patients fulfilling the inclusion criteria, 308 (45%) patients had CTO (CTO+), and in 377 (55%) patients CTO was not observed (CTO-). The MPV level on admission was significantly higher in the CTO+ group than in the CTO- group (P<0.0001). In the multivariate analysis of the entire study population, independent predictors of occurrence of CTO were medium platelet volume (MPV; per 1fL more; odds ratio [OR] 1.34; 95% confidence interval [CI] 1.15-1.57; P=0.0002) together with left ventricular ejection fraction and prior MI. CONCLUSIONS: MPV at admission is independently associated with more frequent occurrence of non-IRA CTO in patients with NSTEMI and MVCAD.

Complications in recipients of cardioverter-defibrillator or cardiac resynchronization therapy: Insights from Silesian Center Defibrillator registry.

BACKGROUND: Current real-life information from all-comers registries from middle and east Europe about the incidence and type of complications during long-term follow-up of patients with cardioverters-defibrillators (ICD) and cardiac resynchronization devices-defibrillators (CRT-D) is still insufficient. The aim of the study was to assess the incidence and determinants of short- and long-term complications related to implantable ICD and CRT-D. METHODS: We studied 1,105 recipients hospitalized in our center in 2009-2013, followed for a mean of 2.4 years (total of 2,652 patient-years). The independent association between ICD and CRT-D recipients' and implantation-procedures' characteristics with the incidence of complications was analyzed using multivariable Cox regression analysis. RESULTS: In 2-month post-procedural period, 124 (11.2%) patients developed complications. Independent predictors of short-term complications (within 2 months) were: atrial fibrillation, dual chamber ICD implantation, and use of antiplatelet therapy or coumarin. Twenty-seven (2.44%) patients experienced complications, mostly lead-related (n = 21). Independent predictors of long-term complications (2-12 months after implantation) were atrial fibrillation and dual chamber ICD implantation. CONCLUSIONS: Despite significant technological progress and operators' experience, the occurrence of complications in ICD and CRT-D recipients is still substantial. Majority of complications are recorded in the early post-implantation phase. Analysis of independent predictors of complications seem to be essential in helping to reduce adverse events in the future and strongly supports the need for routine follow-up.

Renal function on admission affects both treatment strategy and long-term outcomes of patients with myocardial infarction (from the Polish Registry of Acute Coronary Syndromes).

BACKGROUND: Impairment of renal function (IRF) is an independent risk factor of myocardial infarction (MI). AIM: The aim of study was to determine if the presence of IRF affects the choice of treatment strategy in patients with MI, and if long-term mortality rates are influenced by the use of an invasive strategy in patients with MI according to the grade of IRF. METHODS: Data from the PL-ACS Registry of 22,431 patients hospitalised for MI during 2007-2008 with an available estimated glomerular filtration rate (eGFR) with 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula were included. Patients were stratified based on eGFR: ≥ 90 (normal); 60-89 (mild IRF); 30-59 (moderate IRF); 15-29 (severe IRF); and < 15 mL/min/1.73 m² (end-stage IRF). RESULTS: After adjustment, each increase in IRF grade reduced the likelihood of percutaneous coronary intervention by 19% (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.78-0.85; p < 0.001). A higher IRF grade was independently associated with mortality (OR 2.01; 95% CI 1.86-2.18; p < 0.001) and major bleeding (OR 1.42; 95% CI 1.22-1.66; p < 0.001) during hospitalisation, and mortality at 12 (hazard ratio [HR] 1.55; 95% CI 1.49-1.62; p < 0.001) and 36 months (HR 1.50; 95% CI 1.45-1.55; p < 0.001). Invasive treatment was independently associated with improved 12-month prognosis in non-ST-segment elevation MI (NSTEMI) patients with mild-to-severe IRF and in ST-elevation MI (STEMI) patients at all IRF grades. CONCLUSIONS: Invasive procedures were less frequent with worsening renal dysfunction. Invasive treatment was associ-ated with improved 12-month prognosis in STEMI patients regardless of renal function and in NSTEMI patients with eGFR ≥ 15 mL/min/1.73 m².

Safety and efficacy of a second-generation coronary sirolimus-eluting stent with biodegradable polymers in daily clinical practice: a 12-month follow-up of the ALEX registry.

BACKGROUND: Second-generation drug-eluting stents (DESs) have shown higher safety and efficacy compared with first-generation DESs. This effect was achieved by improving biocompatibility using an interalia cobalt-chromium construction, thinner stent struts and biodegradable polymers. OBJECTIVES: To assess clinical and angiographic outcomes of patients receiving a novel second-generation cobalt-chromium sirolimus-eluting stent. MATERIALS AND METHODS: A total of 424 consecutive patients who received an Alex stent were enrolled in the registry from January to December 2012. The primary outcome measure was the occurrence of 12-month major cardiac adverse events, defined as cases of death, nonfatal myocardial infarction and target lesion revascularization. Quantitative coronary angiography for 240 randomly selected patients was performed by an independent Corelab. RESULTS: The primary endpoint occurred in 31 of 424 patients (7.3%). The rates of death, nonfatal myocardial infarction and target lesion revascularization were 3.3, 2.6 and 3.5%, respectively. According to the definition established by the Academic Research Foundation, definitive and probable stent thrombosis (ST) occurred in 1.6% (7/424) of patients, including six cases of early ST and one case of late ST. The acute device success rate was 98.5%. CONCLUSION: The ALEX Registry provides evidence for the safety and effectiveness of the study device in a relevant population. Quantitative analysis showed a satisfactory performance of the study device for complex coronary lesions. The 12-month rates of major cardiac adverse event and ST were similar to those of other second-generation DES registries.

Double stent loss during multivessel percutaneous coronary intervention in non-ST-segment elevation acute coronary syndrome.

The following description presents a case of a 75-year-old female patient with non-ST-segment elevation acute coronary syndrome in whom there occurred an infrequent complication of percutaneous coronary angioplasty: uncontrolled intracoronary stent displacement from a balloon catheter. During the attempt to retrieve the device using the "small-balloon" technique, further slippage of the stent from the balloon catheter to the right deep femoral artery was observed. Therefore, it was decided to provide a commercial intravascular microloop, whereby the stent was successfully retrieved outside the vascular system.