Postepy W Kardiologii Interwencyjnej最新文献

Introduction: Percutaneous coronary intervention (PCI) of a left main coronary artery (LMCA) bifurcation lesion is a challenging topic among interventional cardiologists. The optimal stenting modality for patients requiring a 2-stent strategy is still debated.

Aim: To compare the clinical outcomes of double kissing (DK) crush and DK culotte techniques in distal LMCA bifurcation lesions.

Material and methods: Patients with unprotected distal LMCA bifurcation lesions undergoing PCI with DK crush or DK culotte technique were enrolled in 9 heart centers. The primary endpoint of the study was target lesion failure (TLF) as a composite endpoint of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), and cardiac death.

Results: A total of 245 patients with unprotected distal LMCA bifurcation lesions treated with DK culotte (121 patients) or DK crush (124 patients) technique were followed up for 3 years. The incidence of 3-year TLF was lower in the DK culotte group than the DK crush group (5.0% vs. 11.3%, HR = 0.557, 95% CI: 0.211-1.471; p = 0.06). There was also no difference in 3-year TLR (5.0% vs. 7.3%, HR = 0.907, 95% CI: 0.310-2.651; p = 0.42), TVMI (2.5% vs. 3.2%, HR = 0.762, 95% CI: 0.160-3.627; p = 0.71), or cardiac death (0.8% vs. 2.4%, HR = 0.733, 95% CI: 0.063-8.550; p = 0.32) between groups.

Conclusions: In the present multicenter study, the DK culotte group had a lower TLF ratio than the DK crush group, without a statistically significant difference in distal true left main bifurcation lesions.

Introduction: Despite its importance, comprehensive contemporary data on pericardiocentesis (PC) outcomes, etiologies, and prognostic indicators remain limited.

Aim: We aimed to evaluate the etiologies, pericardial fluid characteristics, and in-hospital and total mortality rates in patients who underwent PC in our center. Additionally, we sought to identify factors associated with total mortality.

Material and methods: We conducted a single-center retrospective study that included patients who underwent PC performed with the fluoroscopy-guided subxiphoid approach in the catheterization laboratory in our center between November 2019 and November 2024. The patients were classified into two groups: survivors and non-survivors.

Results: A total of 127 patients were included in this study. The median follow-up was 16 months. In-hospital mortality occurred in 27 (21.3%) patients, and total mortality occurred in 56 (44.1%) patients during follow-up. The most common etiology was malignancy, accounting for 34.6%, followed by idiopathic causes (33.9%). Malignant etiology, presentation with pericardial tamponade, and low albumin levels were found to be independent predictors of mortality (p < 0.001, p = 0.007, p = 0.026, respectively). Malignant pericardial effusion (PE) had a worse prognosis according to the Kaplan-Meier survival curve analysis (log-rank p < 0.001).

Conclusions: Understanding etiologies is crucial for the prognosis and management of PE. Malignant PE had a worse prognosis compared with non-malignant PE. Therefore, in addition to cytological analysis of the pericardial fluid, the use of advanced imaging methods plays a pivotal role in the evaluation of malignancy, especially in patients without a known malignancy, as PE may be the first sign of cancer.

Introduction: Coronary anomalies (CAs) are rare congenital abnormalities often found incidentally on conventional coronary angiography (CCA), coronary computed tomographic angiography (CCTA), or autopsy.

Aim: This study aimed to investigate the prevalence of origin and termination coronary artery anomalies via CCTA, and to evaluate outcomes over an 8-year follow-up.

Material and methods: To diagnose CAs, the CCTA data of 3017 consecutive patients who had undergone CCTA between January 2015 and January 2023 were analyzed retrospectively and followed up.

Results: Among the 3017 patients, 60 (2%) had coronary anomalies. Fifty-seven (95%) patients had origin and distribution anomalies, and 3 (5%) patients had a coronary artery fistula. The most common origin anomaly (13, 21.7%) was an anomalous origin of the right coronary artery (RCA), and the second one was (12, 20%) congenital atresia of the left main artery. It was also found that among anomalies, the most common (16, 26.6%) was the anomaly of course. Statistical analysis showed that the presence of CAs did not affect the development of major cardiovascular events (MACE) or mortality (p > 0.05). Kaplan-Meier analysis showed that the presence of CCA did not affect mortality (log-rank p = 0.516) or the development of MACE (log-rank p = 0.206).

Conclusions: In this single-center study, the prevalence of CAs (2%) and the results of MACE and mortality were similar to those reported in the literature.

Introduction: The Coordinated Care Program in Patients after Myocardial Infarction (KOS-MI) has substantially reduced mortality and heart failure-related hospitalizations through its comprehensive approach, including unlimited rehabilitation, cardiologist ambulatory care, complete revascularization, and electrotherapy in various long-term studies.

Aim: This study evaluated the outcomes and adherence to secondary preventive measures in patients who completed the KOS-MI Program 1 year and 3 years after myocardial infarction.

Material and methods: We conducted a retrospective registry involving 331 myocardial infarction patients who participated in the KOS-MI Program. Baseline and follow-up data included laboratory results (low density-lipoprotein (LDL) and glucose levels), echocardiography assessments, and drug compliance records.

Results: At 12 months, 79.2% of patients (n = 262) had completed the program. Among them, 69.1% were men, and 46.2% presented with ST-elevation myocardial infarction. Complete revascularization was achieved in 55.7% of cases. Patients engaged in stationary or ambulatory rehabilitation constituted 56.1% and 43.9%, respectively. Notably, LDL levels significantly decreased from 129 mg/dl to 85.8 mg/dl (p < 0.001), with 19.1% of cases achieving the LDL goal of < 55 mg/dl. An HbA_1c level below 7% was achieved by only 49% of diabetes patients. Left ventricular ejection fraction (LVEF) showed a statistically significant improvement (48.3% vs. 56.1%; p = 0.001). Drug adherence to dual antiplatelet therapy was 100%, while statin adherence was 99.6%.

Conclusions: The KOS-MI Program has significantly reduced LDL cholesterol levels and improved LVEF, especially in patients with the lowest initial LVEF. Future research should focus on optimizing LDL management and exploring long-term outcomes related to left ventricular function.

Introduction: Although coronary angiography adjunctive technologies (AT) provide valuable insights into lesion severity and characteristics, their use increases radiation and contrast exposure.

Aim: To assess the impact of AT on patients' radiation dose, irradiation and procedural times, and contrast usage.

Material and methods: Dose-area product (DAP), patient effective dose, irradiation and procedural times, and contrast usage were compared between two groups, each comprising 258 patients who underwent coronary angiography with AT (AT group) or without (NoAT group). Multivariate analysis was performed on the whole patient group and the AT group to identify significant predictors of elevated DAP and contrast.

Results: Compared to the NoAT group, DAP, patient effective dose, and contrast usage increased by 70-73%, while irradiation and procedural times were 120% and ~135% longer, respectively, in the AT group. Whole patient group analysis revealed that AT use was the strongest predictor of increased DAP and contrast usage (1.7; 95% CI: 1.6-1.8; p < 0.001). Higher contrast usage was observed in patients with a history of CABG (1.4; 95% CI: 1.2-1.7; p < 0.001). In AT group analysis, both DAP and contrast usage were significantly associated with gender, AT process type, number of AT procedures, and procedural time. Male gender and ad-hoc AT processes were the strongest predictors of elevated DAP and reduced contrast usage, respectively (1.2; 95% CI: 1.1-1.3; p < 0.001 and 0.8; 95% CI: 0.7-0.9; p < 0.001). Procedures via right radial artery access were linked to reduced contrast usage (0.9-fold; 95% CI: 0.8-1.0; p < 0.001). Both analyses showed that DAP increased by 1.04-1.05 per unit rise of BMI (95% CI: 1.0-1.1; p < 0.001).

Conclusions: In real-world clinical settings, the use of AT led to significant increases in patients' radiation dose, irradiation and procedural times, and contrast usage.

Introduction: While the impact of altitude on coronary artery disease (CAD) mortality and acute high-altitude exposure in cardiovascular disease has been studied, no prior research has specifically examined the relationship between CAD severity and long-term residence at higher altitudes.

Aim: This study aimed to evaluate the relationship between CAD severity and altitude.

Material and methods: A total of 532 de novo non-ST elevation myocardial infarction (non-STEMI) patients admitted to healthcare centers at different altitudes - a low-altitude center (70 m) and a moderate-altitude center (1690 m) - between January 2023 and December 2023 were retrospectively included. Inverse probability weighted propensity score weighting and doubly robust estimation were used to reduce bias and balance covariate distribution. Patients were analyzed based on their living altitude.

Results: The median age of the patients was 64 years (IQR: 56-70), and 71.6% were male. SYNTAX scores were significantly higher in the moderate-altitude group, while other demographic and clinical variables were similar between the groups. Living at moderate altitude was an independent predictor of higher SYNTAX scores (estimate: 4.21, 95% CI: [2.34-6.08]; p < 0.001). Additional independent predictors of higher SYNTAX scores included elevated low-density lipoproteins (LDL) levels, reduced left ventricular ejection fraction (LVEF), hypertension (HT), and age.

Conclusions: This study demonstrated that living at a higher altitude was associated with higher SYNTAX scores in non-ST elevation myocardial infarction patients, in addition to other well-established risk factors such as hypertension, elevated LDL levels, reduced ejection fraction, and smoking. These findings suggest that altitude-related factors may influence CAD severity and warrant further investigation.

Introduction: The clinical relevance and long-term mortality in hyponatremic patients with takotsubo syndrome (TTS) remain poorly elucidated.

Aim: We sought to investigate whether hyponatremia identified in TTS patients influenced in-hospital and long-term outcomes in this group of patients.

Material and methods: Among 7771 patients hospitalized with acute myocardial infarction, TTS was diagnosed in 100 (1.3%) patients. Hyponatremia on admission was defined as sodium level < 135 mmol/l. In-hospital clinical characteristics and long-term all-cause mortality were assessed in hyponatremic and normonatremic TTS patients.

Results: On admission, hyponatremia was identified in 14 (14%) TTS patients. Hyponatremic patients were older (78.5 vs. 69 years, p = 0.013) and more frequently had a history of stroke (7.1 vs. 0%, p = 0.046) or heart failure (50 vs. 12.8%, p = 0.001) than normonatremic patients. Hyponatremic subjects more often demonstrated ST-segment elevation (78.6 vs. 48.8%, p = 0.033) and apical TTS type (100 vs. 81.4%, p = 0.021). During the index hospitalization, hyponatremic versus normonatremic TTS patients showed attenuated improvement of left ventricular ejection fraction (0 [0-5] vs. 10 [0-20]%, p = 0.039) and its lower values at discharge (40 [35-45] vs. 50 [42-55]%, p = 0.032). Within a median observation period of 53 months, higher all-cause mortality was found in hyponatremic versus normonatremic TTS patients (35.7 vs. 15.1%, p = 0.038). Cox proportional hazard regression showed that sodium plasma level on admission was independently associated with long-term mortality (HR = 0.919, 95% CI: 0.866-0.975, p = 0.005).

Conclusions: Our pilot findings indicate that hyponatremia, observed in every seventh TTS patient, was associated with lower in-hospital left ventricular ejection fraction improvement and higher long-term all-cause mortality.