Kardiologia polska最新文献

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.

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.