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Januszek R, Siudak Z, Dziewierz A, Rakowski T, Dudek D, Bartuś S. Chronic obstructive pulmonary disease affects the angiographic presentation and outcomes of patients with coronary artery disease treated with percutaneous coronary interventions. Pol Arch Intern Med 2017; 128:24-34. [PMID: 29112944 DOI: 10.20452/pamw.4145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The incidence of chronic obstructive pulmonary disease (COPD) in patients treated with percutaneous coronary intervention (PCI) is underestimated, and the effect of COPD on atherosclerosis and the outcomes of PCI is not fully understood. OBJECTIVES The aim of this study was to assess the impact of COPD on periprocedural outcomes of PCI, as well as its relationship with clinical presentation and the type of coronary artery lesions. PATIENTS AND METHODS Data were prospectively collected using a national electronic registry of PCI procedures performed in Poland between January 2015 and December 2016. Out of the 221 187 PCIs, 5594 patients had been diagnosed with COPD before the intervention. RESULTS Patients with COPD were older than those without COPD (mean [SD] age, 70.3 [9.9] years vs 67 [10.8] years; P <0.001) and more often were males (72.3% vs 67.8%; P <0.001). Non-ST‑segment elevation myocardial infarction (NSTEMI) was a more common clinical presentation of coronary artery disease (CAD) in the COPD group, while ST‑segment elevation myocardial infarction (STEMI) occurred more frequently in the non‑COPD group. Multivessel disease (MVD) with or without left main coronary artery (LMCA) involvement and separate LMCA was diagnosed more often in the COPD group. At baseline, the culprit lesion was more often restenosis and in‑stent thrombosis in the COPD group, whereas de‑novo lesion-in the non‑COPD group. The rates of periprocedural mortality and myocardial infarction did not differ between the groups with and without COPD (0.13% vs 0.12%, P = 0.88 and 0.53% vs 0.45%, P = 0.39, respectively). COPD was found to be an independent predictor of restenosis assessed before PCI in patients with a history of PCI (P = 0.006). CONCLUSIONS Patients with COPD diagnosed before PCI are at an increased risk of MVD with or without LMCA involvement and NSTEMI. Restenosis and in‑stent thrombosis occur more often in patients with COPD before PCI.
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Rakowski T, Dziewierz A, Kleczynski P. TCT-675 Contrast Induced Nephropathy in Patients with Acute Coronary Syndromes Referred to Coronary Angiography. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ruzsa Z, Wojtasik-Bakalarz J, Nyerges A, Rakowski T, Kleczynski P, Bartus S. Long-Term Follow-up After Retrograde Recanalization of Superficial Femoral Artery Chronic Total Occlusion. THE JOURNAL OF INVASIVE CARDIOLOGY 2017; 29:336-339. [PMID: 28974660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to assess the safety of the retrograde procedure with long-term follow-up of 86 patients after retrograde recanalization of the superficial femoral artery (SFA). BACKGROUND Chronic total occlusion (CTO) of SFAs occurs in >50% of the patient population with peripheral artery disease. The retrograde technique is an option for patients with unsuccessful antegrade percutaneous interventions, but data from long-term follow-up after retrograde recanalization are still limited. METHODS The study included 86 patients (67% males), who underwent percutaneous retrograde recanalization. Major adverse cardiovascular or cerebrovascular events and major adverse peripheral events were assessed from long-term (47.5 ± 40 months) follow-up data. RESULTS Mean patient age was 64 ± 9 years. Retrograde puncture was successful in all cases. Procedural success rate was 93%. In-hospital observation showed vascular perforation/bleeding in 4.7%, proximal hematoma in 9.3%, distal hematoma in 4.7%, pseudoaneurysm in 1.2%, thrombosis in 1.2%, puncture-site bleeding in 3.5%, and local inflammation in 1.2%. Mortality rate was 6.98%. Target-vessel reintervention was needed in 20.9% of cases, and percutaneous transluminal angioplasty of another artery was done in 27% of cases. Amputation rate was 4.7%. CONCLUSIONS Long-term follow-up shows that retrograde recanalization is connected with a high rate of technical success and low percentage of reinterventions. Retrograde technique is safe and related to low complication rates; most complications were localized in nature.
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Daniec M, Nawrotek B, Sorysz D, Rakowski T, Dziewierz A, Rzeszutko Ł, Kleczyński P, Trębacz J, Tomala M, Żmudka K, Dudek D. Acute and long-term outcomes of percutaneous balloon aortic valvuloplasty for the treatment of severe aortic stenosis. Catheter Cardiovasc Interv 2017; 90:303-310. [PMID: 27514931 DOI: 10.1002/ccd.26697] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/03/2016] [Accepted: 07/11/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aimed to evaluate the indications, short- and long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe aortic stenosis (AS). METHODS A cohort of 112 patients with AS underwent 114 BAV procedures between October 2012 and July 2015 in two Polish interventional cardiology centers. Clinical and echocardiographic data were prospectively collected within 1, 6, and 12 months follow-up. RESULTS BAV was performed as a bridge to TAVI (51.8%), surgical aortic valve replacement (AVR, 5.4%), before urgent noncardiac surgery (8.0%), for symptom relief (33.0%) and cardiogenic shock (1.8%). Periprocedural, in-hospital, 1-, 6-, 12-month mortality were 2.7%; 8.9%; 8.9%; 16.9%; 22.3%, respectively. Serious periprocedural adverse events occurred in 18.8% of patients. After the procedure, mean aortic valve area (AVA) increased from 0.59 ± 0.18 to 0.82 ± 0.24 cm2 , mean peak aortic valve gradient (pAVG) decreased from 94.0 ± 27.6 to 65.4 ± 20.0 mm Hg, mean aortic gradient decreased from 58.0 ± 17.8 to 40.5 ± 14.6 mm Hg, P < 0.05 for all. Left ventricular ejection fraction (LVEF) increased from median (interquartile range) of 53.5 (30 - 64) to 60 (45 - 65)% after 1 month (P < 0.05). In patients with impaired left ventricle function (LVEF <40%), LVEF significantly improved (median increase of 16%) after 1 and 6 months (P < 0.05). At 12 months patients had higher AVA, pAVG, and LVEF as compared to baseline (P < 0.05). CONCLUSIONS BAV is a useful procedure in high-risk AS patients, where achieved effects can be sufficient in bridging patients for TAVI/AVR. © 2016 Wiley Periodicals, Inc.
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Rakowski T, Dudek D, van 't Hof A, Ten Berg J, Soulat L, Zeymer U, Lapostolle F, Anthopoulos P, Bernstein D, Deliargyris EN, Steg PG. Impact of acute infarct-related artery patency before percutaneous coronary intervention on 30-day outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention in the EUROMAX trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017. [PMID: 28631502 DOI: 10.1177/2048872617690888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS Early infarct-related artery patency has been associated with improved outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. However, it is unknown whether this relationship persists in contemporary practice with pre-hospital initiation of treatment, use of novel P2Y12 inhibitors and frequent use of drug-eluting stents. The purpose of the study was to determine the impact of early infarct-related artery patency on outcomes in the contemporary EUROMAX trial. METHODS AND RESULTS A total of 2218 patients were enrolled. The current analysis was done on 1863 patients who underwent percutaneous coronary intervention and had infarct-related artery patency data. Thirty-day outcomes were compared according to infarct-related artery flow before percutaneous coronary intervention (Thrombolysis in Myocardial Infarction (TIMI) flow 0/1 vs. TIMI flow 2/3), and interaction with antithrombotic strategy was examined. A patent infarct-related artery (TIMI flow 2/3) was present in 707 patients (37.9%) and was associated with a higher rate of final TIMI 3 flow grade (98.9 vs. 92.6%; p<0.001). At 30 days, a patent infarct-related artery was associated with lower rates of cardiac death (1.3% vs. 2.9%; p=0.026) and the composite of death or myocardial infarction (2.7% vs. 4.6%; p=0.039). There were no interactions between antithrombotic treatment and the impact of infarct-related artery patency on cardiac death, myocardial infarction, or the composite of death or myocardial infarction (Breslow-Day interaction p-values of 0.21, 0.33 and 0.46, respectively). CONCLUSION Despite evolution in primary percutaneous coronary intervention strategies, early infarct-related artery patency is still associated with higher procedural success and improved clinical outcomes. The choice of antithrombotic strategy did not interact with the benefits of a patent infarct-related artery at presentation.
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Daniec M, Dziewierz A, Sorysz D, Kleczyński P, Rakowski T, Rzeszutko Ł, Trębacz J, Tomala M, Nawrotek B, Żmudka K, Dudek D. Sex-Related Differences in Outcomes After Percutaneous Balloon Aortic Valvuloplasty. THE JOURNAL OF INVASIVE CARDIOLOGY 2017; 29:188-194. [PMID: 28570233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We aimed to evaluate sex-related differences in short-term and long-term outcomes of patients undergoing balloon aortic valvuloplasty (BAV) for severe aortic stenosis (AS). METHODS A total of 112 patients with severe AS underwent 114 BAV procedures as palliative procedure, bridge to definitive treatment, or before urgent non-cardiac surgery. Patients were followed for 24 months. RESULTS Of the 112 patients, 70 (62.5%) were women. Women were older, and had a higher STS score and higher prevalence of chronic kidney disease and arterial hypertension. Indications for BAV did not differ by gender. Women had a higher risk of vascular complications than men (15.7% vs 0.0%; P=.01), but with a similar rate of major periprocedural complications (17.1% vs 9.5%; P=.40). Transcatheter aortic valve implantation (TAVI) was performed in 22.8% of women and 26.2% of men (P=.61) and surgical aortic valve replacement in 10% of women and 11.9% of men (P=.70). Women and men treated finally with TAVI/aortic valve replacement had lower mortality as compared with conservative treatment (P<.01). No difference in in-hospital and 24-month mortality between women and men was observed (11.4% vs 4.9% [P=.26]; 63.3% vs 39.0% [P=.22], respectively). In a multivariable Cox model, STS score above 9.8% (hazard ratio, 2.29; 95% confidence interval, 1.09-4.83; P=.03) was an independent predictor of all-cause death only in women. CONCLUSION Despite the presence of sex-related differences in baseline and procedural characteristics as well as in the risk of vascular complications, no difference in major procedural complications and long-term mortality was confirmed for patients with severe AS undergoing BAV.
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Bobrowska B, Rakowski T, Dziewierz A. A myocardial infarction in a patient with previous myocardial revascularization presenting with tachyarrhythmia. Is it type 1, 2 or 4c myocardial infarction? Minerva Cardioangiol 2016; 64:704-706. [PMID: 27760985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Bobrowska B, Rakowski T, Dziewierz A. A myocardial infarction in a patient with previous myocardial revascularization presenting with tachyarrhythmia. Is it type 1, 2 or 4c myocardial infarction? Minerva Cardioangiol 2016; 64:706-708. [PMID: 27668340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Rakowski T, Siudak Z, Dziewierz A, Sawina A, Dudek D. Prehospital Clopidogrel Administration in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary PCI: Real-Life Experience From the Multicenter NRDES Registry. THE JOURNAL OF INVASIVE CARDIOLOGY 2016; 28:E56-E58. [PMID: 27236013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Dudek D, Mehran R, Dziewierz A, Brener SJ, Rakowski T, Brzezinski M, Brodie BR, Xu K, Fahy M, Lansky AJ, Zmudka K, Stone GW. Impact of bifurcation target lesion on angiographic, electrocardiographic, and clinical outcomes of patients undergoing primary percutaneous coronary intervention (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] trial). EUROINTERVENTION 2016; 9:817-23. [PMID: 24280158 DOI: 10.4244/eijv9i7a135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Using the database from the large-scale, prospective, randomised HORIZONS-AMI trial, the authors sought to assess the impact of bifurcation target lesions (BTL) on angiographic, electrocardiographic, and clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In HORIZONS-AMI, bifurcation lesions in which a provisional approach was planned were eligible for enrolment. By angiographic core laboratory assessment of 3,306 patients with STEMI undergoing primary PCI, 333 patients (10%) had ≥1 BTL, and 2,973 patients had no BTL. There were no significant differences in baseline characteristics between the groups, except for lower left ventricular ejection fraction and more frequent left anterior descending infarct artery in the BTL group. BTLs required longer procedural and fluoroscopy times and higher contrast loads, but rates of TIMI 3 flow post PCI were similar in both groups (with vs. without BTL 99% vs. 87%, p=0.25). ST-segment resolution ≥70% by core laboratory analysis was similar in both groups (48% vs. 50%, p=0.47). Importantly, there was no difference between groups in the rate of death (6.1% vs. 6.7%, p=0.72), definite or probable stent thrombosis (4.2% vs. 5.2%, p=0.42), and ischaemic target vessel revascularisation (14.3% vs. 14.0%, p=0.86) during three-year follow-up. CONCLUSIONS Although the PCI procedure involving BTL was more complex, the acute results and late outcomes in patients with BTLs were comparable to those in patients without BTLs.
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Dziewierz A, Siudak Z, Rakowski T, Zasada W, Legutko J, Żabówka A, Partyka Ł, Dudek D. The impact of multiple stent implantation in the infarct-related artery on one-year clinical outcomes of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Data from the Polish NRDES Registry. Kardiol Pol 2016; 74:717-725. [PMID: 26898971 DOI: 10.5603/kp.a2016.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM We sought to evaluate the impact of multiple stent implantation in the infarct-related artery (IRA) on one-year clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS Data on 1741 consecutive patients with STEMI, who underwent immediate PCI with implantation of ≥ 1 stent, enrolled the National Registry of Drug Eluting Stents (NRDES) were assessed. Patients were stratified based on the number of implanted stents in IRA: 1 vs. ≥ 2 stents. At the discretion of operators, ≥ 2 stents in IRA were implanted in 247 (14.2%) patients. The remaining 1494 patients were treated with a single stent. Patients treated with multiple stents were less likely to achieve Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow after primary PCI. Overall mortality at one year was 8.3% in the single stent group and 10.3% in the ≥ 2 stents group (p = 0.37; adjusted for propensity score p = 0.13). After propensity score matching, patients treated with ≥ 2 stents were at higher risk of definite or probable stent thrombosis and urgent revascularisation at one year. CONCLUSIONS In patients with STEMI undergoing primary PCI, a need for implantation of ≥ 2 stents in IRA carries an increased risk of stent thrombosis and urgent revascularisation at one year.
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Rakowski T, Dziewierz A, Wiśniewski A, Bartuś S, Dudek D. A 24-year-old male with acute coronary syndrome due to the circumflex coronary artery thrombosis. Diagnostic challenge in everyday practice. Int J Cardiol 2015; 198:131-3. [PMID: 26163904 DOI: 10.1016/j.ijcard.2015.06.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/27/2015] [Indexed: 11/24/2022]
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Dudek D, Dziewierz A, Brener SJ, Abizaid A, Merkely B, Costa RA, Bar E, Rakowski T, Kornowski R, Dressler O, Abizaid A, Silber S, Stone GW. Mesh-covered embolic protection stent implantation in ST-segment-elevation myocardial infarction: final 1-year clinical and angiographic results from the MGUARD for acute ST elevation reperfusion trial. Circ Cardiovasc Interv 2015; 8:e001484. [PMID: 25603802 DOI: 10.1161/circinterventions.114.001484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The MGuard, a bare metal stent covered with a polymer mesh, was designed to reduce distal embolization during percutaneous coronary intervention in ST-segment-elevation myocardial infarction. In the MGUARD for Acute ST Elevation Reperfusion trial, the primary end point of complete ST-segment resolution was significantly improved with the MGuard compared with control. We evaluated 1-year clinical and angiographic results. METHODS AND RESULTS Patients with ST-segment-elevation myocardial infarction ≤12 hours undergoing primary percutaneous coronary intervention of a single de novo native lesion were randomized to the MGuard versus any commercially available metallic stent (39.8% drug-eluting). Clinical follow-up was performed through 1 year, and angiography at 13 months was planned in 50 MGuard patients. There was no difference in major adverse cardiac events (1.8% versus 2.3%; P=0.75) at 30 days between the groups. Major adverse cardiac events at 1 year were higher with the MGuard, driven by greater ischemia-driven target lesion revascularization (8.6% versus 0.9%; P=0.0003). Conversely, mortality tended to be lower with the MGuard at 30 days (0% versus 1.9%; P=0.04) and at 1 year (1.0% versus 3.3%; P=0.09). Late lumen loss at 13 months in the MGuard was 0.99±0.80 mm, and binary restenosis was 31.6%. CONCLUSIONS In patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, a trend toward reduced 1-year mortality was present in patients treated with the MGuard stent. Target lesion revascularization and major adverse cardiac events rates during follow-up were higher in the MGuard group than in the control stent group, and angiographic late loss of the MGuard was consistent with that expected from bare metal stents. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01368471.
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Arif S, Bartuś S, Dziewierz A, Chyrchel M, Brzeziński M, Rakowski T, Bartuś K, Dudek D, Dubiel J. Impact of coronary artery disease presence on the long-term follow-up of carotid artery stenting. Kardiol Pol 2015; 73:274-9. [DOI: 10.5603/kp.a2014.0217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/08/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022]
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De Luca G, van't Hof AW, Gibson CM, Cutlip D, Zeymer U, Noc M, Maioli M, Zorman S, Gabriel HM, Emre A, Rakowski T, Gyongyosi M, Huber K, Bellandi F, Dudek D. Impact of time from symptom onset to drug administration on outcome in patients undergoing glycoprotein IIb-IIIa facilitated primary angioplasty (from the EGYPT cooperation). Am J Cardiol 2015; 115:711-5. [PMID: 25655867 DOI: 10.1016/j.amjcard.2014.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
Contrasting data have been so far reported on facilitation with glycoprotein IIb-IIIa inhibitors (GpIIbIIIa) in patients who underwent primary percutaneous coronary intervention. However, it has been demonstrated a time-dependent composition of coronary thrombus in ST-segment elevation myocardial infarction, with more platelets in the first hours. Subsequently, the benefits of early administration of GpIIbIIIa may be affected by the time from symptoms onset to GpIIbIIIa, that therefore is the aim of this study. Our population is represented by 814 patients who underwent GpIIbIIIa facilitated primary angioplasty included in the Early glycoprotein IIb-IIIa inhibitors in primary angioplasty database. Patients were divided according to quartiles of time from symptom onset to GpIIbIIIa administration (≤65 minutes; 65 to 100 minutes; 101 to 178 minutes; and >178 minutes). Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Time from symptoms onset to GpIIbIIIa was linearly associated with hypertension, diabetes, hypercholesterolemia, and previous myocardial infarction but inversely associated with smoking. Abciximab was more often administrated later from symptoms onset. Time from symptoms onset to GpIIbIIIa was significantly associated with the rate of preprocedural recanalization (thrombolysis in myocardial infarction [TIMI] 2 to 3; p <0.001), postprocedural TIMI 3 flow (p <0.001), the rate of complete ST-segment resolution (p <0.001), and the rate of myocardial blush grade 2 to 3 (p <0.001) and inversely associated with the occurrence of distal embolization (p <0.001). Follow-up data were collected at a median (twenty-fifth to seventy-fifth) of 360 (30 to 1,095) days. A total of 52 patients had died. Time to GpIIbIIIa had a significant impact on mortality (hazard ratio [95% confidence interval] 1.46 [1.11 to 1.92], p = 0.007) that was confirmed after correction for baseline confounding factors (adjusted hazard ratio [95% confidence interval] 1.41 [1.02 to 2.21], p = 0.042). In conclusion, this study showed that in patients who underwent primary angioplasty with upstream GpIIbIIIa, time from symptoms onset to GpIIbIIIa strongly impacts on preprocedural recanalization, distal embolization, myocardial perfusion, and long-term survival.
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Dziewierz A, Siudak Z, Rakowski T, Kleczyński P, Zasada W, Dubiel JS, Dudek D. Impact of direct stenting on outcome of patients with ST-elevation myocardial infarction transferred for primary percutaneous coronary intervention (from the EUROTRANSFER registry). Catheter Cardiovasc Interv 2014; 84:925-31. [DOI: 10.1002/ccd.25266] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 10/17/2013] [Indexed: 11/06/2022]
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Dziewierz A, Rakowski T, Dudek D. Abciximab in the management of acute myocardial infarction with ST-segment elevation: evidence-based treatment, current clinical use, and future perspectives. Ther Clin Risk Manag 2014; 10:567-76. [PMID: 25071373 PMCID: PMC4111647 DOI: 10.2147/tcrm.s50002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction of antiplatelet agents has contributed substantially to improve the outcome of patients with acute coronary syndromes. Meta-analysis of the studies on abciximab administration during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI) has clearly confirmed the mortality benefit associated with intravenous bolus and infusion of abciximab compared to placebo. Recently, introduction of new oral P2Y12 inhibitors (prasugrel, ticagrelor), with a faster and more pronounced antiplatelet effect, have decreased the use of abciximab even in patients with STEMI. However, recent studies have shown a delayed onset of antiplatelet effect of new oral antiplatelet drugs in the setting of STEMI, especially in patients with hemodynamic compromise. Thus, the use of abciximab as an intravenous agent should be strongly considered when oral P2Y12 inhibitors might fail or cannot be given before primary PCI for STEMI. An additional benefit of abciximab administration was reported when abciximab was given early, before primary PCI, compared to typical periprocedural use. To the contrary, no clear clinical benefit was confirmed for intracoronary administration of abciximab compared with intravenous administration. Future studies should focus on the role of abciximab given on top of new oral P2Y12 inhibitor (prasugrel, ticagrelor) or used as an alternative to an intravenous P2Y12 inhibitor (cangrelor). Undoubtedly, the results of these studies will change everyday practice of STEMI treatment.
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Siudak Z, Mielecki W, Dziewierz A, Rakowski T, Legutko J, Bartuś S, Bryniarski KL, Partyka Ł, Dudek D. No long-term clinical benefit from manual aspiration thrombectomy in ST-elevation myocardial infarction patients. Data from NRDES registry. Catheter Cardiovasc Interv 2014; 85:E16-22. [PMID: 24909662 DOI: 10.1002/ccd.25572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/30/2014] [Accepted: 05/25/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Current STEMI guidelines recommend thrombectomy should be considered during primary PCI. Multiple data from randomized clinical trials, registries, and metanalysis have confirmed the efficacy of thrombectomy in terms of surrogate endpoints like better myocardial perfusion, less pronounced distal embolization, and conflicting results on lower all-cause mortality. Our aim was to analyze long-term outcome of STEMI patients treated with manual thrombectomy during primary PCI in a contemporary national registry. METHODS There were 13 catheterization laboratories in Poland that enrolled patients in NRDES Registry. Patients were divided into two groups: those that were treated with manual thrombectomy for their primary PCI vs. those who were not. RESULTS There were altogether 2,686 patients enrolled in the NRDES Registry of whom 1,763 were diagnosed with STEMI (66%). Aspiration thrombectomy was used in 673 of these cases (38%) and 1,090 (62%) patients were treated without thrombectomy during the index primary PCI. Overall mortality at 1 year was 11.03% in thrombectomy and 7.46% in no thrombectomy group respectively (P = 0.0292 which became insignificant after propensity score matching adjustment P = 0.613). Specific subgroup analyses revealed that there was no benefit from aspiration thrombectomy in neither subgroup. CONCLUSIONS Manual aspiration thrombectomy in patients undergoing primary PCI for STEMI was not associated with improved long-term 1-year clinical outcome. Subgroup analysis did not reveal any specific setting in which thrombectomy would be clinically superior. © 2014 Wiley Periodicals, Inc.
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Dudek D, Dziewierz A, Kleczyński P, Giszterowicz D, Rakowski T, Sorys D, Rzeszutko Ł, Legutko J, Bartuś S, Dragan J, Klecha A, Siudak Z, Żmudka K. Authors’ response. Kardiol Pol 2014; 72:476-7. [DOI: 10.5603/kp.2014.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/16/2014] [Indexed: 11/25/2022]
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Dziewierz A, Siudak Z, Rakowski T, Kleczyński P, Dubiel JS, Dudek D. Early administration of abciximab reduces mortality in female patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the EUROTRANSFER Registry). J Thromb Thrombolysis 2014; 36:240-6. [PMID: 23065325 PMCID: PMC3779007 DOI: 10.1007/s11239-012-0826-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present study assessed the impact of early administration of abciximab in female and male patients with ST-segment elevation myocardial infarction (STEMI) transferred for primary angioplasty (PPCI). Data were gathered for 1,650 consecutive patients with STEMI transferred for PPCI from hospital networks in seven countries in Europe from November 2005 to January 2007 (the EUROTRANSFER Registry population). Among 1,086 patients who received abciximab, there were 186 women and 541 men who received abciximab early (>30 min before PPCI), and 86 women and 273 men treated with late abciximab. Female patients were high-risk individuals, with advanced age and increased rate of ischemic events. Early abciximab administration was associated with enhanced patency of the infarct-related artery before PPCI, and improved epicardial flow after PPCI in both women and men. Early abciximab in women led to the decrease in ischemic events, including 30 day (adjusted OR 0.26, 95 % CI 0.10–0.69, p = 0.007) and 1 year (adjusted OR 0.37, 95 % CI 0.16–0.84, p = 0.017) mortality reduction. In contrast, the reduction in 30 day (adjusted OR 0.69, 95 % CI 0.35–1.39, p = 0.27) and 1 year (adjusted OR 0.68, 95 % CI 0.38–1.22, p = 0.19) mortality was not significant in men. The frequency of bleeding events was similar in the early abciximab group compared to the late abciximab group in both women and men. Early administration of abciximab improved patency of the infarct-related artery before and after PPCI, and led to improved survival in female patients with STEMI.
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Rakowski T, Dziewierz A, Siudak Z, Kleczyński P, Dubiel JS, Dudek D. Introduction of new oral antiplatelet drugs in myocardial infarction hospital network: initial experience. J Thromb Thrombolysis 2014; 37:243-5. [PMID: 23624705 PMCID: PMC3971439 DOI: 10.1007/s11239-013-0930-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rakowski T, Dziewierz A, Legutko J, Kleczynski P, Brzozowska-Czarnek A, Siudak Z, Urbanik A, Dubiel JS, Dudek D. Creatine kinase-MB assessed in patients with acute myocardial infarction correlates with cardiac magnetic resonance infarct size at 6-month follow up. Hellenic J Cardiol 2014; 55:4-8. [PMID: 24491929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION There are still only limited data concerning the use of creatine kinase-MB (CKMB) values for predicting infarct size in long-term follow up in patients with ST-segment elevation myocardial infarction (STEMI) who have undergone primary percutaneous coronary intervention (PCI). The aim of this study was to analyze the correlation between CKMB and both infarct size and left ventricular function during a 6-month follow up. METHODS In a cohort of 68 patients with STEMI treated with PCI, serial CKMB assessment was performed at baseline and at 6, 12, 18, 24 and 48 hours after PCI. The area under the curve (AUC) of CKMB was calculated. Cardiac magnetic resonance (CMR) parameters were assessed at 6 months. RESULTS All CKMB single time-point values, AUC CKMB, and CKMB maximal value after primary PCI were correlated with CMR infarct size and left ventricular function, but a high correlation (r>0.7) was found only for CKMB at 6 hours, CKMB at 12 hours, CKMB AUC, CKMB maximal value, and CMR infarct size (r=0.71, r=0.73, r=0.72, r=0.75, respectively, p<0.001 for all). CONCLUSIONS CKMB assessment is a good predictor of infarct size at 6 months in patients with STEMI treated with PCI. The CKMB value at a single time point 12 hours after PCI is a good predictor of infarct size at 6 months, comparable to serial assessment parameters such as AUC CKMB and CKMB maximal value.
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Kleczynski P, Rakowski T, Dziewierz A, Jakala J, Dudek D. Ultrasound-guided thrombin injection in the treatment of iatrogenic arterial pseudoaneurysms: single-center experience. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:24-26. [PMID: 24151057 DOI: 10.1002/jcu.22106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 04/04/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to assess the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of postcatheterization arterial pseudoaneurysms. We evaluated retrospectively 82 consecutive subjects treated with percutaneous ultrasound-guided thrombin injection of postcatheterization femoral (n = 79), brachial (n = 2), and radial (n = 1) pseudoaneurysms from January 2006 to April 2012. Pseudoaneurysm size, thrombin dose, and therapy outcome were documented. All pseudoaneurysm sacs were thrombosed with a single injection. The overall primary success rate (complete sac thrombosis) was 92.7%. A 30-day Doppler ultrasound follow-up showed a 100% procedural success. There were no complications.
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Surdacki A, Kruszelnicka O, Rakowski T, Jaźwińska-Kozuba A, Dubiel JS. Asymmetric dimethylarginine predicts decline of glucose tolerance in men with stable coronary artery disease: a 4.5-year follow-up study. Cardiovasc Diabetol 2013; 12:64. [PMID: 23578341 PMCID: PMC3642017 DOI: 10.1186/1475-2840-12-64] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/11/2013] [Indexed: 12/18/2022] Open
Abstract
Background Endothelial dysfunction, largely dependent on impaired nitric oxide bioavailability, has been reportedly associated with incident type 2 diabetes. Our aim was to test the hypothesis that asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide formation, might be linked to future deterioration in glucose tolerance in stable coronary artery disease (CAD). Methods We studied 80 non-diabetic men (mean age 55 ± 11 years) with stable angina who underwent successful elective complex coronary angioplasty and were receiving a standard medication according to practice guidelines. Plasma ADMA and its structural isomer symmetric dimethylarginine (SDMA) were measured prior to coronary angiography. An estimate of insulin resistance by homeostasis model assessment (HOMA-IR index) was calculated from fasting insulin and glucose. Deterioration in glucose tolerance was defined as development of type 2 diabetes or progression from a normal glucose tolerance to impaired fasting glucose. Results Over a median follow-up of 55 months 11 subjects developed type 2 diabetes and 13 progressed to impaired fasting glucose. Incident deterioration of glucose tolerance was associated with ADMA (hazard ratio [HR] per 1-SD increment 1.64 [95% CI: 1.14–2.35]; P = 0.007), log (HOMA-IR index) (HR = 1.60 [1.16–2.20]; P = 0.004) and body-mass index (HR = 1.44 [0.95–2.17]; P = 0.08) by univariate Cox regression. ADMA (HR = 1.65 [1.14–2.38]; p = 0.008) and log (HOMA-IR index) (HR = 1.55 [1.10–2.17]; P = 0.01) were multivariate predictors of a decline in glucose tolerance. ADMA and SDMA were unrelated to body-mass index, HOMA-IR index, insulin or glucose. Conclusions ADMA predicts future deterioration of glucose tolerance independently of baseline insulin resistance in men with stable CAD. Whether this association reflects a contribution of endothelial dysfunction to accelerated decline of insulin sensitivity, or represents only an epiphenomenon accompanying pre-diabetes, remains to be elucidated. The observed relationship might contribute to the well-recognized ability of ADMA to predict cardiovascular outcome.
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