Effect of selected cardiovascular factors on mortality in patients with ST-segment elevation myocardial infarction treated with primary coronary intervention.

OBJECTIVE: This work was aimed at analyzing in-hospital, 30-day and 1-year mortality rates, impact of selected cardiovascular factors on mortality of patients with ST-segment elevation myocardial infarction (STEMI) manifested on electrocardiogram (ECG) and treated by the percutaneous coronary intervention (PCI) at our cardiac center, comparing the subgroup of non-shock (survivors and deceased) patients after STEMI and evaluating how these patients differ from each other. METHODS: In total, 270 patients with STEMI manifested on ECG and treated by PCI were enrolled between April 1, 2018, and March 31, 2019, at our cardiologic center. Our study sought to determine the risk of death after acute myocardial infarction with carefully selected factors and parameters such as the presence of cardiogenic shock, ischemic time, left ventricular ejection fraction (LVEF), post­PCI TIMI (thrombolysis in myocardial infarction) flow and serum levels of cardio­specific markers, namely troponin T, creatine kinase and N-terminal pro-brain natriuretic peptide (NT-proBNP). Further evaluation included in-hospital, 30-day and 1-year mortality rates in shock and non-shock patients and determination of factors that influence the survival separately in each subgroup. The follow-up was carried out for 12 months after the myocardial infarction in form of outpatient examinations. After 12 months of follow-up, the collected data were statistically evaluated. RESULTS: Shock and non-shock patients differed in mortality and several other parameters including NT-proBNP values, ischemic time, TIMI flow defect and LVEF. In all outcomes (in-hospital, 30-day and 1-year mortality rates) the shock patients did worse than non-shock patients (p < 0.001). In addition, age, gender, LVEF, NT-proBNP and post­PCI TIMI flow less than 3 were found to be important factors influencing the overall survival. In shock patients, the survival was associated with age, LVEF and TIMI flow, while in non-shock patients, the factors predicting survival were age, LVEF, level of NT-proBNP and troponin levels. CONCLUSION: Shock patients differed in terms of mortality in post-PCI TIMI flow, while non-shock patients varied in troponin and NT-proBNP levels. Despite early intervention, certain risk factors might affect the clinical outcome and prognosis of patients with STEMI treated by PCI (Tab. 5, Fig. 1, Ref. 30). Text in PDF www.elis.sk Keywords: myocardial infarction, primary coronary intervention, shock, mortality, cardio­specific markers.

Comparison of long-term effect of dual-chamber pacing and alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy.

INTRODUCTION: Nonpharmacological treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM) comprises surgical myectomy (SME), alcohol septal ablation (ASA), and dual-chamber (DDD) pacing. The aim of the study was to compare the long-term effect of DDD pacing and ASA in symptomatic HOCM patients. PATIENTS AND METHODS: We evaluated retrospective data from three cardiocenters; there were 24 patients treated with DDD pacing included and 52 treated with ASA followed for 101 ± 49 and 87 ± 23 months, respectively. RESULTS: In the group treated with DDD pacing, the left ventricle outflow tract gradient (LVOTG) decreased from 82 ± 44 mmHg to 21 ± 21 mmHg, and NYHA class improved from 2.7 ± 0.5 to 2.1 ± 0.6 (both P < 0.001). In the ASA-treated group, a decline in LVOTG from 73 ± 38 mmHg to 24 ± 26 mmHg and reduction in NYHA class from 2.8 ± 0.5 to 1.7 ± 0.8 were observed (both P < 0.001). The LVOTG change was similar in both groups (P = 0.264), and symptoms were more affected by ASA (P = 0.001). CONCLUSION: ASA and DDD pacing were similarly effective in reducing LVOTG. The symptoms improvement was more expressed in patients treated with ASA.

Trends in outcomes of women with myocardial infarction undergoing primary angioplasty-Analysis of randomized trials.

Background: Sex- and gender-associated differences determine the disease response to treatment. Aim: The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women. Methods and results: We performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, p = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, p < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03-3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0-2.23]), and also for an optimal procedural result (4.24 [2.12-8.49], p < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17-0.91], p = 0.029). Conclusion: The prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.

The effects of Click 500 SC (terbuthylazine) on common carp Cyprinus carpio under (sub)chronic conditions.

OBJECTIVES: Effects of the herbicide formulation Click 500 SC (terbuthylazine 500 g/l) on common carp Cyprinus carpio were assessed through biometric, biochemical, haematological and antioxidant indices, induction of xenobiotic metabolizing enzymes and histological examination of selected tissues. DESIGN: The fish were exposed to the formulation with terbuthylazine concentrations of 380 ng/l (environmental concentration); 60 µg/l and 550 µg/l for up to 91 days. Haematological indices were assessed using unified methods of haematological examination in fish. Biochemical indices in plasma were measured by biochemical analyzer, ferric reducing ability of plasma (FRAP) and ceruloplasmin activity were determined spectrophotometrically. Concentration of total cytochrome P450, glutathione-S-transferase activity and glutathione content were assessed spectrophotometrically in liver. Activity of liver ethoxyresorufin-O-deethylase (EROD) activity was measured spectrofluorimetrically. Histopathological examination of liver, skin, gills, spleen, cranial and caudal kidney was performed by light microscopy. RESULTS: An increase (p<0.05) was observed in hepatosomatic index and condition factor in fish from the environmental concentration. A decrease (p<0.05) in haemoglobin and mean corpuscular haemoglobin concentration (MCHC) was found in fish treated with terbuthylazine of 550 µg/l. There was a decline in mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) (p<0.05) in terbuthylazine of 60 µg/l and 550 µg/l. Triglycerides (TAG) (p<0.01) were elevated in all pesticide-treated groups. Alanine aminotransferase (ALT) (p<0.01) and phosphorus (p<0.05) decreased in fish exposed to terbuthylazine of 60 µg/l and 550 µg/l, while albumin (p<0.01) rised in the same groups. An elevation in natrium (p<0.05) in terbuthylazine of 550 µg/l and a rise in protein (p<0.01) in the concentrations of 380 ng/l and 550 µg/l were observed. Correlations between several indices were significant. Ceruloplasmin activity and FRAP were augmented (p<0.01) in the highest concentration tested. Examined xenobiotic detoxification systems were not significantly affected by the exposure. Non-specific histopathological changes were found in the gills and skin of the test fish. CONCLUSION: The fish treated with terbuthylazine developed a disorder in several haematological and plasma biochemical indices. The levels of markers of oxidative stress increased in response to the exposure. Examined systems involved in detoxification of xenobiotics did not reflect long-term contact with the herbicide. Detected histological lesions were non-specific. The environmental concentration of terbuthylazin affected biometric indices of the test fish.

Effects of subchronic exposure to Spartakus (prochloraz) on common carp Cyprinus carpio.

OBJECTIVES: The aim of the study was to investigate effects of the fungicide formulation Spartakus (prochloraz 450 g.L-1) on common carp Cyprinus carpio through biometric, biochemical, haematological and antioxidant indices, induction of xenobiotic metabolizing enzymes and histological examination of selected tissues. DESIGN: The test was performed on juvenile fish, which was exposed to Spartakus (concentrations of prochloraz: 0.05; 0.15 and 0.38 mg.L-1) for 28 days. Haematological indices were assessed using unified methods of haematological examination in fish. Plasma biochemical indices were determined by biochemical analyzer. Concentration of total cytochrome P450 (CYP), glutathione (GSH) content and glutathione-S-transferase (GST) activity were determined spectrophotometrically in hepatopancreas. Activity of liver ethoxyresorufin-O-deethylase (EROD) activity was measured spectrofluorimetrically. Ferric reducing ability of plasma (FRAP) and ceruloplasmin activity were assessed spectrophotometrically. Histological changes in samples of hepatopancreas, skin, gills, spleen, head kidney and caudal kidney were examined by light microscopy. RESULTS: There was a significant rise in hepatosomatic index (HSI) (p<0.01), CYP and EROD (p<0.05) of fish exposed to prochloraz of 0.15 and 0.38 mg.L-1 whereas GST was induced by all concentrations tested and GSH by 0.38 mg.L-1 (p<0.05). Red blood cell count decreased significantly (p<0.05) in prochloraz of 0.05 and 0.15 mg.L-1. Plasma potassium increased (p<0.01) in all Spartakus treated groups, a decline in total protein (p<0.05), ALT, Na+ and Ca (p<0.01) was found in fish exposed to prochloraz of 0.38 mg.L-1. Ceruloplasmin activity was elevated (p<0.05) in the highest concentration tested, FRAP declined (p<0.05) in the same group. Histopathological changes in gills were demonstrated in all pesticide treated groups, with a decreased activity of skin mucous cells in prochloraz of 0.38 mg.L-1. CONCLUSION: The subchronic exposure to Spartakus influenced HSI, induced xenobitic metabolizing enzymes, initiated a disorder of selected plasma indices and a decline in red blood cell count, caused minor histological impairment, and affected antioxidant activities of the test fish.

Intracoronary Imaging for Assessment of Vascular Healing and Stent Follow-up in Bioresorbable Vascular Scaffolds.

Bioresorbable Vascular Scaffolds (BVS) are polymer-based materials implanted in the coronary arteries in order to treat atherosclerotic lesions, based on the concept that once the lesion has been treated, the material of the implanted stent will undergo a process of gradual resorption that will leave, in several years, the vessel wall smooth, free of any foreign material and with its vasomotion restored. However, after the first enthusiastic reports on the efficacy of BVSs, the recently published trials demonstrated disappointing results regarding long-term patency following BVS implantation, which were mainly attributed to technical deficiencies during the stenting procedure. Intracoronary imaging could play a crucial role for helping the operator to correctly implant a BVS into the coronary artery, as well as providing relevant information in the follow-up period. This review aims to summarize the role of intracoronary imaging in the follow-up of coronary stents, with a particular emphasis on the role of intravascular ultrasound and optical coherence tomography for procedural guidance during stent implantation and also for follow-up of bioabsorbable scaffolds.

Intracoronary delivery of bone marrow cells to the acutely infarcted myocardium. Optimization of the delivery technique.

OBJECTIVES: Intracoronary cell transplantation during catheter balloon inflations may be associated with adverse events. We studied the effectiveness of an alternative transplantation technique--intracoronary cell infusion. METHODS: Fourteen pigs, which had survived acute myocardial infarction, were randomized into 2 treatment groups and 2 controls. Three days after infarction, 12 pigs underwent allogeneic intracoronary mononuclear bone marrow cell transplantation using either the standard technique (short-term cell injections during repeat balloon inflations, technique A, n = 6) or continuous intracoronary cell infusion without balloon inflations (technique B, n = 6). Implanted cells were stained with fluorescent dye. After transplantation, the pigs were euthanized and myocardial samples were analyzed by fluorescent microscopy. RESULTS: The mean numbers of fluorescently labeled bone marrow cells in the infarction border zone, in the infarction mid-area and in the center of myocardial infarction were 84, 72 and 55 using technique A, and 29, 57 and 46 using technique B, respectively. The mean cell retention in the infarction border zone of 84 cells for technique A and 29 cells for technique B differed significantly (p = 0.034, two-tailed t test). CONCLUSION: The continuous intracoronary cell infusion technique is a less efficient cell delivery technique as compared with the standard technique using repeat intracoronary balloon inflations.

Effects of subchronic exposure to Successor 600 (pethoxamid 600 g L-1) on common carp Cyprinus carpio.

OBJECTIVES: We investigated the effects of the herbicide preparation Successor 600 on biochemical and haematological indices and the histolopathological parameters of common carp after 28 day exposure. Furthermore, the hepatosomatic index and induction of xenobiotic metabolizing enzymes and biomarkers were assessed. DESIGN: Juvenile fish were exposed to sublethal concentrations of Successor(R) 600 (0.06 mg L-1, 0.22 mg L-1 or 0.60 mg L-1) for 28 days. Haematological indices were assessed using unified methods of haematological examination in fish. Plasma biochemical indices were measured by biochemical analyzer, the vitellogenin concentration in male fish plasma was estimated by direct sandwich ELISA. In hepatopancreas, ethoxyresorufin-O-deethylase (EROD) activity was measured spectrofluorimetrically, concentration of total cytochrome P450 (CYP), glutathion (GSH) content and glutathion-S-transferase (GST) activity were determined spectrophotometrically. Histological changes in samples of hepatopancreas, skin, gills, spleen, head kidney and trunk kidney were examined by light microscopy. RESULTS: Haemoglobin, MCH and MCHC were significantly (p<0.05) reduced in fish treated with Successor(R) 600 of 0.22 and 0.60 mg L-1. LDH was enhanced (p<0.05), in the highest concentration of the preparation. Vitellogenin was detected in all male fish, with no difference between groups. HSI, GSH and GST were elevated (p<0.05), owing to the exposure, whereas CYP and EROD were not affected. Slight histopathological changes were demonstrated in skin, gills and hepatopancreas, with steroid tissue in head kidney samples of 0.60 mg L-1 treated fish. CONCLUSION: Successor 600 affected the haematological profile of the treated fish, while the effects on biochemical indices were less expressed. Male plasma vitellogenin concentrations were not indicative of estrogen disruptive effects after 28 days. The importance of GSH and GST for the metabolisation were demonstrated. In contrast, CYP and EROD were not influenced by any concentration tested. HSI was found to reflex pollution with Successor 600. Histopathological indices caused by the treatment were observed in various tissue samples of the treated fish.

Decrease in acute coronary syndrome mortality in Pleven district: implementation of scientific evidence into everyday practice.

Cardiovascular mortality in Bulgaria has increased for the last 25 years, contrary to the rest of the EU countries. One of the reasons is high in-hospital mortality due to acute myocardial infarction. The Bulgarian Cardiac Institute has established a modern cardiac hospital with a catheterization laboratory (cathlab) in the Medical University in Pleven, which helps it decrease acute coronary syndrome (ACS) mortality, taking all the necessary steps according to the guidelines of the European Society of Cardiology (ESC).

Cell therapy in patients with left ventricular dysfunction due to myocardial infarction.

OBJECTIVES: The purpose of this study was to determine the impact of autologous transplantation of mononuclear bone marrow cells on myocardial function in patients with left ventricular (LV) dysfunction due to an acute myocardial infarction. METHODS: The randomized study included 82 patients with a first acute myocardial infarction treated with a stent implantation. This presentation is a subanalysis of 47 patients with left ventricular dysfunction-EF (ejection fraction)

Increased age-adjusted hazard of death associated with a common single nucleotide polymorphism of the human RAD52 gene in a cardiovascular cohort.

Aging may be characterized as the progressive increase of the risk of death caused by a decrease of almost all bodily functions. While a great number of model organism studies have established the role of DNA double strand breaks (DSBs) as one of the main causes of aging, few studies have examined whether common polymorphisms in human DSB repair genes influence aging and mortality. More importantly, to the best of our knowledge, no longitudinal study has thus far examined the link between polymorphisms in DSB repair and the risk of death. This longitudinal study thus analyses whether four common polymorphisms (rs2155209, rs7963551, rs17105278, rs2735383) in four selected DSB repair genes (MRE11A, RAD52, RAD51B, NBS1) influence the hazard of age-adjusted death in a cohort of patients with typical symptoms of ischemic heart disease. The results have shown that rs7963551 G/T heterozygotes exhibit a significantly increased hazard of death when compared with the combined GG and TT homozygotes (HR=1.42, 95% CI: 1.06-1.91, p=0.018). This study indicates that the SNP affecting efficiency of DSB repair may influence aging in humans.

Autologous transplantation of mononuclear bone marrow cells in patients with acute myocardial infarction: the effect of the dose of transplanted cells on myocardial function.

BACKGROUND: Despite the reports on successful treatment of acute myocardial infarction using autologous mononuclear bone marrow cell transplantation, many unresolved questions still remain. We studied the impact of the dose of transplanted cells on myocardial function and perfusion. METHODS: Sixty-six patients with a first acute myocardial infarction were randomized into 3 groups. Two groups were intracoronarily given mononuclear bone marrow cells in either higher (10(8) cells, higher cell dose [HD] group, n = 22) or lower (10(7) cells, lower cell dose [LD] group, n = 22) doses. Twenty-two patients without cell transplantation served as a control (C) group. RESULTS: At 3 months of follow-up, the baseline peak systolic velocities of longitudinal contraction of the infarcted wall of 5.2, 4.5, and 4.3 cm/s in C, LD, and HD groups increased by 0.0, 0.5 (P < .05 vs C group), and 0.9 cm/s (P < .05 vs LD group, P < .01 vs C group), respectively, as demonstrated by Doppler tissue imaging. Baseline left ventricular ejection fractions of 42%, 42%, and 41% in C, LD, and HD groups increased by 2%, 3%, and by 5% (P < .05 vs group C), respectively, as assessed by the gated technetium Tc 99m sestamibi single photon emission computed tomography. CONCLUSIONS: Mononuclear bone marrow cell transplantation improves regional myocardial function of the infarcted wall in a dose-dependent manner.

The role of quantitative Tc-99m-MIBI gated SPECT/F-18-FDG PET imaging in the monitoring of intracoronary bone marrow cell transplantation.

BACKGROUND: A lot of unresolved questions still exist concerning the exact mechanism of the beneficial effects of bone marrow cell (BMC) transplantation for myocardial regeneration. The aim of this communication is to report the cases of patients with and without post-transplantation left ventricular function improvement. MATERIAL AND METHODS: To this study we included consecutive patients with irreversible damage after a first acute ST-elevation myocardial infarction treated by coronary angioplasty with stent implantation. The irreversible damage was identified by dobutamine echocardiography and confirmed by rest gated Tc-99m-MIBI gated SPECT and in the majority of patients by F-18-FDG PET imaging as well. Using 4D-MSPECT software, we quantified MIBI/FDG uptake and gated SPECT left ventricular ejection fraction, end-diastolic/end-systolic volumes (LVEF, EDV/ESV) before BMC therapy and 3 months later. RESULTS: The results obtained in the initial group of patients in this study (27 patients in the BMC treated group, 16 patients in the control group) have been published previously [Eur J Nucl Med 2005; 32 (Suppl 1 ): S46]. Among the BMC group, we identified 13 responders to therapy with average LVEF improvement from 43.3% +/- 11% to 51.4% +/- 10.4% and EDV/ESV improvement from 145 ml/84 ml to 133 ml/67 ml. The remaining 14 patients were non-responders to therapy with no significant change in LVEF (39.1% +/- 8.1% versus 39.8% +/- 7.4%), the EDV/ESV increased from 166 ml/105 ml to 188 ml/116 ml. Responders to the cell therapy had prevailing MIBI uptake in the range of 31-50% of maximum in the infarction territory. On the other hand, non-responders to BMC therapy had prevailing MIBI uptake in the range of 0-30% of maximum. Two cases are presented in this report. CONCLUSIONS: Further studies with a larger cohort of patients would be helpful to evaluate our findings. We observed strong interindividual differences in the effectiveness of the cell therapy. Prevailing residual MIBI uptake in the range of 31-50% of maximum was in the subgroup of responders to the cell therapy.

Ventricular Septal Rupture - A Critical Condition as a Complication of Acute Myocardial Infarction.

Ventricular septal rupture is a potentially fatal complication of acute myocardial infarction. The key to management of this critical condition is an aggressive approach to haemodynamic stabilization and surgical closure of the rupture. Where there is a small rupture and the patient is in a haemodynamically stable condition, surgery can be delayed with the prospect of achieving better perioperative results. However, in unstable critically ill patients either immediate surgery or extracorporeal membranous oxygenation support and delayed surgery is indicated. In some patients, trans-catheter closure may be considered as an alternative to surgery.

A haplotype constituted of four MMP-2 promoter polymorphisms (-1575G/A, -1306C/T, -790T/G and -735C/T) is associated with coronary triple-vessel disease.

Vascular lesion development is associated with an accumulation of extracellular matrix proteins within the vessel wall. The proteins are degraded by matrix metalloproteinases (MMPs). There is also evidence indicating a participation of the MMPs in the weakening of atherosclerotic plaque that predisposes to lesion disruption. The aim of the study was to test an association among haplotypes of four single nucleotide MMP-2 promoter polymorphisms and the angiographically confirmed coronary triple-vessel disease (TVD). Incidence of haplotypes of four MMP-2 promoter polymorphisms (-1575G/A, -1306C/T, -790T/G and -735C/T) determined by PCR reactions with restriction analyses in 187 patients with coronary TVD (153 men, 34 women, age median 65 years) was compared to 196 control subjects without clinical signs of coronary heart disease (131 men and 65 women, age median 60 years). The incidence of two similar haplotypes was found to be different between patients and healthy subjects. The haplotype GCTC was more frequent in the TVD patients (P=0.01) though the haplotype GCGC was identified only in healthy subjects (P=0.001). Interestingly, the GCTC is the most frequent polymorphic haplotype composed of four promoter SNPs localized in the MMP-2 gene (53% in healthy subjects vs. 66% in patients with TVD) and the haplotype GCGC is the least frequent polymorphic one (4.4% in healthy subjects vs. 0% in patients with TVD). Two different MMP-2 promoter haplotypes differing only in -790T/G allele are significantly more or less frequent in coronary TVD compared to non-ischemic persons. Thus, the -790T/G MMP-2 genotype might be used as a genetic marker representing MMP-2 promoter variability for the TVD with odds ratio for TT and TG genotypes 2.59, 95% confidential interval 1.21-5.55, P=0.009. The analysis of promoter MMP-2 gene variability could help us to understand individual susceptibility to MMP inhibitor treatment of the coronary artery disease.

Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability.

BACKGROUND AND AIM: The choice of optimal treatment strategy in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction is often difficult. The aim of this study was to compare long-term results of patients with chronic CAD, severe heart failure and a defined scope of myocardial viability treated with coronary revascularization, heart transplantation, or kept on medical therapy. METHODS: From 1993 to 2000, viability evaluation using low-dose dobutamine echocardiography was performed in 124 patients with CAD and LV ejection fraction

Prognostic importance of the quantification of myocardial viability in revascularized patients with coronary artery disease and moderate-to-severe left ventricular dysfunction.

The aim of this study was to assess the prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction. To quantify the amount of dysfunctional but viable myocardium, low-dose dobutamine echocardiography was performed. The wall motion was scored using a 16-segment model. The dysfunctional segments were defined as viable if they exhibited functional improvement of at least 1 grade with any dose of dobutamine, or only worsening with dobutamine infusion. Two hundred and twenty patients were revascularized and followed-up for a mean period of 33+/-23 months (range, 0-86) for cardiac-related death and hospitalization for heart failure. Standard follow-up echocardiography was performed 3-6 months after revascularization. Receiver operating characteristic curve analysis identified six dysfunctional but viable segments as the optimal cutoff value for discriminating patients with and without risk of cardiac events. Thirty-eight patients exhibited a large amount of dysfunctional but viable myocardium (>or=6 segments, group A), 103 patients had a small amount of dysfunctional but viable myocardium (2-5 segments, group B), and 79 patients were found to have dysfunctional myocardium irreversibly damaged (group C). Similar baseline left ventricular ejection fractions of 36+/-4, 34+/-5, 35+/-5% in groups A, B, and C increased to 46+/-6% (P<0.01 versus baseline and versus groups B and C), to 39+/-5% (P<0.01 versus baseline and group C), and to 36+/-7% (P<0.01 versus baseline), respectively, after revascularization. The greatest functional improvement after revascularization in group A patients was accompanied by a lower frequency of cardiac events during follow-up (1 vs. 27 in group B, P<0.01, and versus 18 in group C, P<0.01) and by a better cardiac event-free survival according to Kaplan-Meier survival analysis (P<0.01 versus groups B and C, respectively). In conclusion, in revascularized patients with coronary artery disease and moderate-to-severe left ventricular dysfunction, the presence of >or=6 dysfunctional but viable segments identifies patients with the best prognosis.

Interhospital transport for primary angioplasty improves the long-term outcome of acute myocardial infarction compared with immediate thrombolysis in the nearest hospital (one-year follow-up of the PRAGUE-1 study).

OBJECTIVE: Comparison of the long-term outcomes of three reperfusion strategies in patients with acute ST elevation myocardial infarction presenting to community hospitals. METHODS: One-year clinical outcomes were compared for 300 patients randomized in the PRimary Angioplasty in patients transferred from General community hospitals to specialized percutaneous coronary intervention Units with or without Emergency thrombolysis (PRAGUE-1) study to one of three treatment strategies: thrombolysis in a community hospital (group A, n=99); thrombolysis during immediate transportation for coronary angioplasty (group B, n=100); and immediate transportation for coronary angioplasty without thrombolysis (group C, n=101). RESULTS: Total mortality rates in group A, B and C patients were 18%, 12% and 13%, respectively (not significant). Nonfatal reinfarction occurred in 12%, 6% and 3% of patients, respectively (P<0.05). The combined endpoint (total mortality and nonfatal reinfarction rate) was reported in 30%, 18% and 16% of patients, respectively (P<0.05). In patients randomized within 2 h of the onset of symptoms, mortality rates were 18%, 3% and 8%, respectively (P<0.05). Additional revascularization procedures (percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery) were performed in 35%, 14% and 15% of patients, respectively (P<0.001). CONCLUSIONS: Primary angioplasty (even if delayed due to patient transportation to an interventional centre) is associated with better short- and long-term clinical outcomes than thrombolysis. The combination of the two strategies did not prove superior to coronary angioplasty alone. However, it may be superior in a subset of patients with early admission. The coronary angioplasty strategy decreases the need for revascularization procedures during the subsequent one-year follow-up.

Serial echocardiographic assessment of the left ventricular function after direct PCI.

BACKGROUND: Acute myocardial infarction (AMI) causes remodelling of the left ventricle (LV). Restoration of patency of an infarct-related artery by percutaneous coronary interventions (PCI) may prevent or inhibit cardiac remodelling. AIM: To assess LV contractility and function by serial echocardiographic examinations. METHODS: The study group consisted of 61 patients (47 males, mean age 60+/-10 years) with acute MI treated with direct PCI. Echocardiography was performed 6-8 days after PCI, and 1, 6 and 12 months thereafter. RESULTS: LV ejection fraction increased significantly at the end of the first month in comparison with the baseline examination whereas EF values obtained after 6 months and after 1 year were not significantly different. Wall motion score index showed a significant improvement after one month, whereas it did not show any further improvement when measured after 6 or 12 months after AMI. The baseline LV end-diastolic diameter was 49+/-6 mm and did not change after one or 6 months, whereas it increased significantly 12 months after AMI. The baseline LV end-systolic diameter was 37+/-5 mm. At the one-month and six-month examinations it was similar to the baseline values but increased significantly to 38+/-6 mm after one year. CONCLUSIONS: These results confirm the beneficial effects of PCI-induced infarct-related artery patency on LV remodelling after AMI.

Patients with chronic three-vessel disease in a 15-year follow-up study: genetic and non-genetic predictors of survival.

Genetic and non-genetic predictors of 15-year survival in patients with chronic three-vessel disease (3VD) were investigated. Coronary angiography was performed on 810 subjects with symptoms of stable ischemic heart disease in 1998. The patients with 3VD were genotyped for 23 candidate polymorphisms covering the PPAR-RXR pathway, matrix metalloproteinase-2, renin-angiotensin-aldosterone system, endothelin-1, cytokine genes, MTHFR and APO E variants. Fifteen-year survival data were obtained from the national insurance registry. All data were available in the case of 150 patients with 3VD. Statistical analysis used stepwise Cox regression with dominant, recessive, or additive mode of genetic expression. Involved variables included age, sex, BMI, blood pressure, diabetes, ejection fraction, left main stenosis, previously diagnosed coronary stenosis, myocardial infarction in personal history, and coronary bypass along with polymorphisms pre-selected by log-rank tests. Out of the 23 polymorphisms, four were included in the model construction. SNP in the IL-6 gene rs1800795 (-174 G/C) has been found to be a significant predictor of survival. This SNP was in a linkage disequilibrium with rs1800797 (-597 G/A) in the same gene (D'=1.0), which was also found to constitute a significant predictor of survival when rs1800795 was not included in the model construction. Age, increased BMI, diabetes, low EF, and left main stenosis were also significant predictors in all models. Age, increased BMI, diabetes, low ejection fraction, left main stenosis, and genetic variation in the IL-6 promoter were established as significant independent risk factors for the survival of patients with three-vessel disease.