Postepy W Kardiologii Interwencyjnej最新文献

Introduction: The optimal timing of revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) with multivessel disease (MVD) remains controversial.

Aim: We investigated the impact of different revascularization strategies on clinical outcomes to assess the optimal revascularization strategy for these patients.

Methods: We performed a network meta-analysis of cohort studies comparing revascularization strategies in NSTEMI with MVD. Effect sizes were calculated as odds ratios (ORs) using a random-effects model. The primary efficacy outcome was all-cause mortality and the primary safety outcome was recurrent myocardial infarction.

Results: Eight eligible studies involving 34,151 patients receiving four revascularization strategies were analyzed. Compared to conventional culprit-only revascularization (COR), planned complete multi-vessel percutaneous coronary intervention during a second hospitalization (MV-PCI) reduced the risk of major adverse cardiovascular events (MACEs) (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.38-0.74) and decreased all-cause mortality (MV-PCI vs. COR: OR = 0.53; 95% CI: 0.30-0.93) and the likelihood of repeat revascularization (MV-PCI vs. COR: OR = 0.55; 95% CI: 0.37-0.82). However, compared to COR, immediate complete revascularization (ICR) but not MV-PCI was associated with reduced risk of recurrent MI (COR vs. ICR: OR = 1.39; 95% CI: 1.07-1.81; MV-PCI vs. COR: OR = 0.64; 95% CI: 0.40-1.01). Compared to MV-PCI: COR and staged complete revascularization during index PCI (SCR) increased the risk of cardiovascular mortality (MV-PCI vs. COR: OR = 0.48; 95% CI: 0.34-0.70; MV-PCI vs. SCR: OR = 0.62; 95% CI: 0.40-0.96). COR also had significantly higher cardiovascular mortality compared to ICR (COR vs. ICR: OR = 1.38; 95% CI: 1.02-1.85).

Conclusions: Complete revascularization is more effective compared to culprit-only revascularization for most follow-ups.

Introduction: Coronary artery disease (CAD) remains one of the major problems of contemporary medicine. Hematological disorders seem to play an important role in progression and severity of CAD. The aging of the population results in an increase in the number of patients with both CAD and anemia.

Aim: To assess the impact of anemia on clinical outcomes in patients with multivessel CAD who underwent percutaneous coronary intervention (PCI) in long-term follow-up.

Material and methods: In this retrospective study we examined 6-year outcomes of 679 individuals with multivessel CAD treated with PCI based on the hemoglobin (HGB) value before the interventional procedure. We classified the participants into two groups: anemia and non-anemia. The primary endpoint was overall mortality. Secondary endpoints were major adverse cardiac or cerebrovascular events (MACCE) (i.e. overall mortality, stroke, myocardial infarction (MI), or repeat revascularization (RR)) and separate components of MACCE.

Results: We found that 35.4% (240 out of 679) of the patients were anemic. The occurrence of the primary endpoint significantly differed between anemia and non-anemia-groups (48/240 (20.0%) vs. 51/439 (11.6%), p = 0.003). The co-existence of anemia was associated with increased rates of MACCE, MI and in-hospital mortality (177/240 (73.8%) vs. 211/439 (48.1%); 51/240 (21.3%) vs. 44/439 (10.0%) and 21/240 (8.8%) vs. 4/439 (0.9%) for non-anemia, p < 0.001 for all, respectively).

Conclusions: Our research identified an important risk factor for stratifying PCI patients. Given the high incidence of anemia in CAD patients undergoing PCI, HGB levels should be assessed upon admission and factored into risk stratification.

Introduction: Agatston coronary artery calcium (CAC) scoring is the primary scoring method used to determine the summed value of calcium burden. The Agatston CAC score method is a non-invasive, rapid, easily accessible tool that helps identify the weighted sum of the calcium burden in arteries using multi-detector computed tomography. The Agatston CAC score is a significant prognostic indicator for vascular diseases in the long term.

Aim: To investigate the relationship between the Agatston CAC score and contrast-induced acute kidney injury (C-AKI) in patients with stable coronary artery disease (CAD) following a percutaneous coronary intervention (PCI).

Material and methods: This retrospective study included 360 patients with stable CAD who received PCI between January 2023 and December 2023. The Agatston score was measured non-invasively on computed tomography before the coronary angiography. Receiver operating characteristics (ROC) curve analysis was used to determine the sensitivity and specificity of the Agatston CAC score and the optimal cutoff value for predicting C-AKI.

Results: The 360 patients included in the study were divided into two groups. 71 patients were classified as C-AKI+ while 289 patients were classified as C-AKI-. There was no significant difference in terms of gender, but the C-AKI+ group was significantly older. The C-AKI+ group was observed to have significantly higher levels of uric acid, Agatston score and Mehran score. Regression analyses showed that age, uric acid, Agatston score and Mehran score were independent risk factors for C-AKI.

Conclusions: The Agatston CAC score was found to be an independent risk factor for C-AKI in patients with stable CAD with PCI.

Introduction: Wide-awake local anesthesia (WALA) with epinephrine has been demonstrated to be effective in orthopedics and hand surgery, as it offers adequate local anesthesia and obviates the requirement for patient sedation and even the use of a tourniquet to block the blood supply to the proximal extremity.

Aim: To evaluate the effect of wide-awake local anesthesia on pain and bleeding levels in patients who received cardiac implantable electronic device implantation.

Material and methods: The patients were randomly assigned to two groups: Group 1, consisting of 21 patients, referred to as the WALA group; and Group 2, consisting of 21 patients, which served as the control group and received local anesthesia. After surgery, the primary operator assigned a bleeding score ranging from 1 to 10 to each patient. The Visual Analog Scale was employed to assess pain.

Results: The control group had a significantly higher median bleeding score compared to the WALA group (5 vs. 2, p < 0.001). The median intra-procedural and post-procedural pain scores were significantly lower in the WALA group compared to the control group (2 vs. 4, p < 0.001, and 1 vs. 3, p < 0.001, respectively). No surgical revision was necessary for any pocket hematoma.

Conclusions: WALA anesthesia significantly reduces intra- and post-procedural bleeding and pain. The potential benefits of the technique, such as preventing the formation of pocket hematoma, shortening the duration of the procedure, and accelerating the recovery period, must be demonstrated in randomized trials conducted on a larger number of patients.

Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality after kidney transplantation. Physical inactivity is an important factor for the development of cardiovascular disease (CVD) risk.

Aim: To evaluate CVD risk and its association with accelerometer-based physical activity (PA) parameters in kidney transplant recipients (KTRs).

Material and methods: This cross-sectional study included 43 KTRs. Number of steps, total energy expenditure, average sleep and lying times, average metabolic equivalent (MET), and PA duration were assessed with SenseWear Armband. CVD risk was predicted using a web-based interactive tool (HeartScore program).

Results: CVD risk was negatively correlated with number of steps, average MET and PA duration. Average MET and PA duration were significantly higher in KTRs with low CVD risk compared to KTRs with moderate CVD risk (p = 0.004 and p = 0.007, respectively). Average MET, PA duration and number of steps were significantly higher in KTRs with low CVD risk compared to KTRs with high CVD risk (p < 0.001, p < 0.001 and p = 0.009, respectively). Number of steps was higher in KTRs with moderate CVD risk compared to KTRs with high CVD risk (p = 0.010). The linear regression analysis revealed that average MET was a predictor of CVD risk, accounting for 15.9% of the variance.

Conclusions: CVD risk is associated with accelerometer-based PA parameters and average MET is a significant predictor of CVD risk after kidney transplantation in KTRs. Wearable technologies can be used to objectively measure PA parameters in order to determine CVD risk and to monitor the efficiency of PA interventions after kidney transplantation.

Introduction: Aortic stenosis (AS) leads to left ventricular outflow tract obstruction and can result in the development of heart failure. Patients with severe AS exhibit similar symptoms to those with iron deficiency (ID), raising the question of whether ID, if diagnosed, could be linked to the lack of physical performance improvement after transcatheter aortic valve implantation (TAVI).

Aim: The aim was to assess the prevalence of ID in patients scheduled for TAVI and to evaluate its impact on 6-minute walk test (6MWT) results.

Material and methods: Patients with severe AS, qualified for TAVI, were tested for ID, and underwent 6MWT with the assessment of heart rate recovery (HRR) parameters before TAVI and after 3 months.

Results: ID was diagnosed in 59% of screened patients. There was no significant difference in baseline (277.6 ±121.9 m vs. 287.3 ±116.6 m; p = 0.74) and follow-up 6MWT distance (313.1 ±119.6 m vs. 319.4 ±111 m; p = 0.93) between the two study arms. In both groups the 6MWT distance improved significantly after TAVI (32.1 ±62.9 m in ID group, p < 0.003; (39.4 ±68.7 m in non-ID group, p < 0.005). There were no statistical differences in HRR parameters between the two groups before and after TAVI.

Conclusions: The results of the study indicate that ID has no significant effect on 6MWT results before and after the TAVI procedure. ID likely has no impact on physical capacity in patients with severe AS.