Kardiologia polska最新文献

Background: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) had beneficial effects on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) in the pre-reperfusion or thrombolytic era. It is unknown if the benefits persist in the contemporary reperfusion era.

Objectives: We sought to determine if ACEI/ARB improves clinical outcomes of patients with STEMI in the contemporary reperfusion era according to the reperfusion strategy.

Methods: 12596 patients were analyzed from the prospective, nationwide, multicenter China Acute Myocardial Infarction (CAMI) Registry. These patients were classified into the no reperfusion group (n=6004) and the primary percutaneous coronary intervention (PCI) group (n=6592). Two-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) were compared.

Results: In the no reperfusion group, ACEI/ARB therapy at discharge may reduce the incidences of 30-day MACCE (4.7% vs 7.4%; adjusted hazard ratio [HR]: 0.67; 95% confidence interval [CI]: 0.53-0.85; P<0.001), stroke (0.5% vs 1.1%; adjusted HR: 0.41; 95% CI: 0.21-0.83; P=0.01), and revascularization (2.1% vs 3.1%; adjusted HR: 0.66; 95% CI: 0.46-0.94; P=0.02) compared to patients not treated with ACEI/ARB. Patients treated with ACEI/ARB also showed a lower rate of two-year MACCE (17.0% versus 19.1%; adjusted HR: 0.87; 95% CI: 0.76-0.99; P=0.04). No differences were observed in the remaining outcomes. In the primary PCI group, no differences were observed for all examined outcomes before and after multivariate adjustments.

Conclusions: Treatment with ACEI/ARB at discharge may reduce cardiovascular events in STEMI patients not receiving reperfusion, while no significant benefits were observed in those receiving primary PCI.

Background: Globally, diseases of the cardiovascular system stand as the principal contributors to mortality and are anticipated to show an upward trajectory. The occurrence of Acute Coronary Syndrome (ACS) has been linked to underlying inflammatory processes. The monocyte-to-high-density lipoprotein-cholesterol (MHR) ratio has garnered significant attention as a prognostic biomarker, encapsulating the synergistic roles of inflammation and lipid metabolism in the pathophysiology of cardiovascular diseases, including ACS.

Aims: This meta-analysis examines the prognostic MHR ratio in ACS patients.

Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library databases to identify the relevant meta-analyses up to February 26, 2024. The findings were aggregated into risk ratios with 95% confidence intervals.

Results: Eleven studies, with 7421 patients, were included. Low MHR levels compared to high MHR levels were associated with statistically significantly lower in-hospital mortality (0.9% vs. 5.5%; respectively; p<0.001), 3-month mortality (4.4% vs. 11.2%; p = 0.02), 6-month follow-up mortality (4.0% vs. 10.2%; p = 0.03), 1-year mortality (4.2%, vs. 10.2%; p<0.001), as well as long-term follow-up mortality (7.5% vs. 13.7%; p<0.001).

Conclusions: MHR has both good predictive properties for mortality and MACE (short- and long-term). Data indicate that MHR may improve in-hospital and long-term cardiovascular risk prediction. It may, therefore, be an effective tool for risk re-estimation and the selection of patients for whom intensive lipid-lowering treatment may be particularly useful.

Background: The direct impact of atherosclerotic lesions in coronary vessels on the occurrence of atrial fibrillation (AF) in patients without a history of acute myocardial ischemia, previous myocardial infarction, or revascularization procedures remains largely unknown.

Aims: To assess the risk and predictors of new-onset AF in patients with coronary atherosclerosis confirmed by coronary computed tomography angiography (CCTA).

Methods: We included consecutive patients referred for CCTA who had been observed and diagnosed with new-onset AF over 10 years.

Results: Of the 549 patients enrolled in the study, 208 (37.9%) were diagnosed with atherosclerotic lesions in the coronary vessels and 63 (11.5%) developed AF during the 10 years of observation. Patients with AF were older (61.8 [10.4] years vs. 58.3 [9.2] years; P = 0.005), had an enlarged left atrium in the anteroposterior dimension (38.2 [7.2] mm vs. 34.4 [5.4] mm; P < 0.001), and had a widened interventricular septum (12.3 [2.0] mm vs. 11.0 [2.1] mm; P < 0.001). We also found a significant correlation between the occurrence of AF in patients with coronary atherosclerotic lesions and with increased thickness of the interventricular septum relative to the posterior wall of the left ventricle (P = 0.017).

Conclusions: Our data indicate an association between coronary atherosclerosis and the greater risk of AF in patients with increased thickness of the interventricular septum relative to the posterior wall of the left ventricle. This finding suggests that by using CCTA we can predict which patients are at higher risk of developing AF.