Kardiologia polska最新文献

Background: Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) was endorsed by trials.

Aims: Aim was to assess prognosis and temporal trends in real-world registry.

Methods: 998 patients undergoing LMCA PCI were hospitalized from 12.27.2007 to 02.21.2022. Analysis included mortality predictors, annual and periodic trends (2007-2015 compared to 2015-2022).

Results: Median age was 71 years (IQR 16), 736 (73.8%) were male and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (HR 1.61, 95% CI 1.17-2.20, P=0.003), myocardial infarction (HR 1.47, 95% 1.06-2.04, P=0.02), previous myocardial infarction (HR 1.43, 95% CI 1.07-1.91, P=0.02), diabetes (HR 1.38, 95% CI 1.03-1.84, P=0.03), atrial fibrillation (HR 1.74, 95% CI 1.26-2.39, P=0.001), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.27-3.20, P=0.003) and previous stroke (HR 1.78, 95% CI 1.17-2.70, P=0.007). Higher ejection fraction (HR 0.98, 95% CI 0.96-0.99, P<0.001 for 1% increase) and intravascular imaging (HR 0.70, 95% CI 0.49-1.00, P=0.047) yielded better outcomes. Rate of LMCA PCI emerged from 2.2% in 2008 to 6.9% in 2021 (P<0.001). There were increases in annual and periodic rates of multimorbidity (P<0.001), intravascular imaging (P<0.001) and decreases in 30-, 90-day (log-rank P<0.001) and 1-year mortality (log-rank P=0.007). Six-year landmark mortality analysis at 30-days showed trend toward worse prognosis in patients hospitalized in late period (log-rank P=0.051).

Conclusions: PCI and multimorbidity rates increased. Short-term mortality decreased, while prognosis beyond 30-days worsened. Advancements in PCI technology may improve early outcomes; however, efforts should be made to reduce burden of multimorbidity.

Background: Despite its importance, prehabilitation, has only been implemented in very few cardiac surgery centers.

Aims: The Pre Surgery Check Team study was designed to evaluate the impact of comprehensive interdisciplinary assessment and implementation of the prehabilitation program on the incidence of postoperative pulmonary complications after elective cardiac surgery.

Methods: 725 adult patients (338 in the study group, 387 in the control group) were included in this single-center, prospective, observational study. Multimodal prehabilitation consisted of four elements: interdisciplinary medical assessment by cardiologist, anesthesiologist and cardiac surgeon, pulmonary assessment for patients at high risk of postoperative pulmonary complications, psychological assessment, and physiotherapeutic assessment and training. The primary endpoint was the occurrence of the postoperative pulmonary complications, and the secondary outcomes were: surgical site infection, rethoracotomy, ICU length of stay and hospital length of stay.

Results: Prehabilitation reduced the number of postoperative complications by 23%. Postoperative pneumonia was almost 3 times less common (5.33% vs 14.21%), and the surgical site infection - 1.4 times less common in the PreScheck group (8.28 vs 11.37%). In the logistic regression model, prehabilitation reduced the odds of postoperative pneumonia (by 0.346) and the odds of respiratory failure (by 0.479). Prehabilitation had no direct effect on ICU length of stay.

Conclusions: Prehabilitation according to the Pre Surgery Check Team standard reduces the incidence of postoperative pulmonary complications and the total number of postoperative complications in patients undergoing elective cardiac surgery. The main benefit of attending the PreScheck Team visit is the opportunity to perform supportive preoperative interventions.