Postepy W Kardiologii Interwencyjnej最新文献

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.

Veterinary interventional cardiology exemplifies the power of reverse translation in cardiovascular medicine. This review examines how procedures initially tested in animal models, refined in human medicine, and subsequently reintroduced to veterinary practice have completed the translational cycle. We analyze several key interventions - pacemaker implantation, patent ductus arteriosus occlusion, balloon valvuloplasty, radiofrequency ablation, septal defect closure, and mitral valve repair by V-Clamp (a veterinary version of the human MitraClip device) - demonstrating how each has evolved through bidirectional knowledge exchange between human and veterinary medicine. We show how spontaneous disease models in companion animals offer superior translational value compared to induced laboratory models. The development costs for cardiovascular devices ($30-94 million) and high failure rates (> 30%) in human trials create compelling economic incentives for integrating veterinary clinical trials as strategic de-risking investments. We provide comparative pathophysiology for key spontaneous disease models, including canine dilated cardiomyopathy and subaortic stenosis, demonstrating their direct relevance to human cardiovascular research through shared genetic, electrophysiological, and hemodynamic features. Current regulatory frameworks lack clear guidance for incorporating veterinary clinical data into human device submissions, creating uncertainty that impedes innovation. As interventional cardiology advances toward miniaturized, intelligent, and personalized therapies, the One Health approach offers a powerful framework for accelerating innovation while improving outcomes across species.

Introduction: Balloon aortic valvuloplasty (BAV) is typically performed in hybrid theaters or hospitals with cardiosurgery wards. Due to limited access to these facilities, BAV may also be conducted in standalone catheterization laboratories (ASC).

Aim: This study compared the safety and efficiency of BAV in ASC versus cardiac surgery-backed units (CSBU).

Material and methods: This multicenter (7 sites) retrospective registry included 514 symptomatic patients with severe aortic stenosis who underwent BAV. Of these, 376 procedures were performed in CSBU and 138 in ASC.

Results: Baseline characteristics were similar, except for a higher prevalence of CAD (ASC 63% vs. CSBU 45%, p = 0.001) and anemia (ASC 47.1% vs. CSBU 11.7%, p = 0.001) in the ASC group. No differences were observed between groups: in-hospital death (ASC 0.72% (n = 1) vs. CSBU 2.93% (n = 11) p = 0.14), tamponades (ASC 0.72% (n = 1) vs. CSBU 1.33% (n = 5) p = 0.57), significant bleeding which required transfusion (ASC 4.34% (n = 6) vs. CSBU 1.86% (n = 7) p = 0.57), pseudoaneurysm (ASC 1.44% (n = 2) vs. CSBU 0.52% (n = 2) p = 0.29) and implanting pacemakers (ASC 4.34% (n = 6) vs. CSBU 1.86% (n = 7) p = 0.57). Balloon dilatation with 18-24 mm diameter balloon catheters reduced the transvalvular gradient in both groups significantly (ASC: 49.6 ±8.2 mm Hg to 34.4 ±5.2 mm Hg, p = 0.01, and CSBU: 50.2 ±7.3 mm Hg to 36.5 ±4.3 mm Hg). There were no significant differences in transvalvular gradient after the procedure.

Conclusions: The safety and efficiency of BAV performed in standalone catheterization laboratories are comparable to those performed in cardiology wards with cardiac surgery backup.

Introduction: Radial or brachial access for endovascular treatment of peripheral arterial disease may reduce access site complications and avoid the need for post-procedure immobilization.

Aim: This study evaluated in-hospital, 30-day, and 12-month outcomes for iliac artery lesion treatment with these access types.

Material and methods: The study retrospectively included 109 patients, 67% males, aged 38-88 years, with chronic lower limb ischemia and atherosclerotic lesions in the iliac arteries. Endovascular treatment was performed via radial or brachial access in 22% and 78% of cases. Iliac artery occlusions, subocclusions, and significant stenoses were present in 11%, 24%, and 65% of patients. We collected data on demographics, comorbidities, procedural details, adverse events, and outcomes.

Results: During the hospital stay and 30-day follow-up, there were no deaths, amputations, or reinterventions. Technical success was achieved in 100% of cases, with no conversions to femoral access required. The overall complication rate related to the access site was 4.6%, with 3.6% of complications necessitating local surgical intervention. Notably, there was one minor ischemic stroke and one distal embolization during using right brachial access. All reported access site complications were associated with brachial access. The average time to discharge after the procedure was 1.2 days. At 12 months, the target lesion revascularization rate was 3.7%.

Conclusions: Radial or brachial access was a safe alternative to femoral access for endovascular procedures in the iliac arteries. Using left-side radial or brachial access enabled 100% technical success.