1
|
Terlecki M, Kocowska-Trytko M, Kurzyca A, Pavlinec C, Zając M, Rusinek J, Lis P, Bednarski A, Wojciechowska W, Stolarz-Skrzypek K, Rajzer M. The sodium-chloride difference: A marker of prognosis in patients with acute myocardial infarction. Eur J Clin Invest 2024; 54:e14157. [PMID: 38226439 DOI: 10.1111/eci.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND The difference between serum sodium and chloride ion concentrations (SCD) may be considered as a surrogate of a strong ion difference and may help to identify patients with a worse prognosis. We aimed to assess SCD as an early prognostic marker among patients with myocardial infarction. METHODS Data of 594 consecutive patients with acute myocardial infarction treated with PCI (44.9% STEMI patients; 70.7% males) was analysed for SCD in relation to their 30-day mortality. A restricted cubic spline regression model was used to study the relationship between mortality and SCD. Cox regression models were used to assess the association between SCD and the mortality risk. RESULTS Patients with Killip class ≥3 had lower SCD values in comparison to patients with Killip class ≤2: (32.0 [30.0-34.0] vs. 33.0 [31.0-36.0], p = .006). The overall 30-day mortality was 7.7% (n = 46). There was a significant difference in SCD values between survivors and non-survivors groups of patients (median (IQR): (33.0 [31.0-36.0] vs. 31.5 [28.0-34.0] (mmol/L), p = .002). The restricted cubic splines model confirmed a non-linear association between SCD and mortality. Patients with SCD <30 mmol/L (in comparison to SCD ≥30 mmol/L) had an increased mortality risk (unadjusted HR 2.92, 95% CI 1.59-5.36, p = .001; and an adjusted HR 2.30, 95% CI 1.02-5.19, p = .04). CONCLUSIONS Low SCD on admission is associated with an increased risk of 30-day mortality in patients with acute myocardial infarction treated with PCI and may serve as a useful prognostic marker for these patients.
Collapse
Affiliation(s)
- Michał Terlecki
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland
| | - Maryla Kocowska-Trytko
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Kurzyca
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
2
|
Terlecki M, Kocowska-Trytko M, Dadański E, Pavlinec C, Zając M, Rusinek J, Wojciechowska W, Rajzer M. Prognostic accuracy of mean arterial pressure and serum lactate level among patients with acute myocardial infarction. Kardiol Pol 2024:VM/OJS/J/100271. [PMID: 38638092 DOI: 10.33963/v.phj.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Michał Terlecki
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland
| | - Maryla Kocowska-Trytko
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | | | - Christopher Pavlinec
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- Student's Scientific Group in the 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland.
| |
Collapse
|
3
|
Terlecki M, Kocowska-Trytko M, Pavlinec C, Ostrowska A, Lis P, Bednarski A, Wojciechowska W, Stolarz-Skrzypek K, Rajzer M. The role of stress hyperglycemia and hyperlactatemia in non-diabetic patients with myocardial infarction treated with percutaneous coronary intervention. Cardiol J 2023:VM/OJS/J/93870. [PMID: 37345365 DOI: 10.5603/cj.a2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Stress hyperglycemia and lactates have been used separately as markers of a severe clinical condition and poor outcomes in patients with myocardial infarction (MI). However, the interplay between glucose and lactate metabolism in patients with MI have not been sufficiently studied. The aim in the present study was to examine the relationship of glycemia on admission (AG) and lactate levels and their impact on the outcome in non-diabetic MI patients treated with percutaneous coronary intervention (PCI). METHODS A total of 405 consecutive, non-diabetic, MI patients were enrolled in this retrospective, observational, single-center study. Clinical characteristic including glucose and lactate levels on admission and at 30-day mortality were assessed. RESULTS Patients with stress hyperglycemia (AG ≥ 7.8 mmol/L, n = 103) had higher GRACE score (median [interquartile range]: 143.4 (115.4-178.9) vs. 129.4 (105.7-154.5), p = 0.002) than normoglycemic patients (AG level < 7.8 mmol/L, n = 302). A positive correlation of AG with lactate level (R = 0.520, p < 0.001) was observed. The coexistence of both hyperglycemia and hyperlactatemia (lactate level ≥ 2.0 mmol/L) was associated with lower survival rate in the Kaplan-Meier estimates (p < 0.001). In multivariable analysis both hyperglycemia and hyperlactatemia were related to a higher risk of death at 30-day follow-up (hazard ratio [HR] 3.21, 95%, confidence interval [CI] 1.04-9.93; p = 0.043 and HR 7.08; 95% CI 1.44-34.93; p = 0.016, respectively) CONCLUSIONS: There is a relationship between hyperglycemia and hyperlactatemia in non-diabetic MI patients treated with PCI. The coexistence of both hyperglycemia and hyperlactatemia is associated with lower survival rate and are independent predictors of 30-day mortality in MI patients and these markers should be evaluated simultaneously.
Collapse
Affiliation(s)
- Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland.
| | - Maryla Kocowska-Trytko
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| | - Aleksandra Ostrowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
| |
Collapse
|
4
|
Terlecki M, Wojciechowska W, Klocek M, Drożdż T, Kocowska-Trytko M, Lis P, Pavlinec C, Pęksa JW, Kania M, Siudak Z, Januszewicz A, Kreutz R, Małecki M, Grodzicki T, Rajzer M. Prevalence and clinical implications of atrial fibrillation in patients hospitalized due to COVID-19: Data from a registry in Poland. Front Cardiovasc Med 2023; 10:1133373. [PMID: 36993999 PMCID: PMC10041565 DOI: 10.3389/fcvm.2023.1133373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundAtrial fibrillation (AF) is a common arrhythmia with increasing prevalence with respect to age and comorbidities. AF may influence the prognosis in patients hospitalized with Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis.Methods and resultsWe assessed the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis. Data of all COVID-19 patients hospitalized in the University Hospital in Krakow, Poland, between March 2020 and April 2021, were analyzed. The following outcomes: short-term (30-days since hospital admission) and long-term (180-days after hospital discharge) mortality, major cardiovascular events (MACEs), pulmonary embolism, and need for red blood cells (RBCs) transfusion, as a surrogate for major bleeding events during hospital stay were assessed. Out of 4,998 hospitalized patients, 609 had AF (535 pre-existing and 74 de novo). Compared to those without AF, patients with AF were older and had more cardiovascular disorders. In adjusted analysis, AF was independently associated with an increased risk of short-term {p = 0.019, Hazard Ratio [(HR)] 1.236; 95% CI: 1.035–1.476} and long-term mortality (Log-rank p < 0.001) as compared to patients without AF. The use of novel oral anticoagulants (NOAC) in AF patients was associated with reduced short-term mortality (HR 0.14; 95% CI: 0.06–0.33, p < 0.001). Moreover, in AF patients, NOAC use was associated with a lower probability of MACEs (Odds Ratio 0.3; 95% CI: 0.10–0.89, p = 0.030) without increase of RBCs transfusion.ConclusionsAF increases short- and long-term risk of death in patients hospitalized due to COVID-19. However, the use of NOACs in this group may profoundly improve prognosis.
Collapse
Affiliation(s)
- Michał Terlecki
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Klocek
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Drożdż
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maryla Kocowska-Trytko
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jan W. Pęksa
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Reinhold Kreutz
- Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
- Correspondence: Reinhold Kreutz Marek Rajzer
| | - Maciej Małecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- Correspondence: Reinhold Kreutz Marek Rajzer
| | | |
Collapse
|
5
|
Terlecki M, Wojciechowska W, Klocek M, Olszanecka A, Bednarski A, Drożdż T, Pavlinec C, Lis P, Zając M, Rusinek J, Siudak Z, Bartuś S, Rajzer M. Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography. Front Cardiovasc Med 2022; 9:917250. [PMID: 36211554 PMCID: PMC9536466 DOI: 10.3389/fcvm.2022.917250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI). Methods There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained. Results Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14–18) vs. 12 (12–14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79–18.14; p < 0.001). Conclusion Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.
Collapse
Affiliation(s)
- Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Klocek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Bednarski
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Drożdż
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Lis
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Zając
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rusinek
- Student's Scientific Group in the First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
- *Correspondence: Marek Rajzer
| |
Collapse
|
6
|
Klocek M, Wojciechowska W, Terlecki M, Pavlinec C, Grodzicki T, Małecki M, Bociąga-Jasik M, Rajzer M. Cardiac biomarkers on admission and in-hospital mortality in COVID-19 patients with or without concomitant heart failure. Pol Arch Intern Med 2022; 132. [PMID: 35522239 DOI: 10.20452/pamw.16256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION High-sensitive cardiac troponin (hs-cTnT) and N terminal pro B type natriuretic peptide (NT-proBNP) are known markers of cardiac injury. However, the role of these markers in predicting severity of coronavirus disease (COVID-19) remains to be investigated. Objectives: To analyze an association between hs-cTnT and NT-proBNP with in-hospital mortality in COVID-19 patients, with emphasis on those with concomitant chronic heart failure (CHF). PATIENTS AND METHODS 1,729 consecutive patients with COVID-19 were enrolled. Demographic data, laboratory parameters and clinical outcomes (discharged or death) were analyzed. ROC curves and logistic regression analyses for hs-cTnT and NT-proBNP values and the risk of death were performed. RESULTS Hs-cTnT was determined in 1,041 patients, while NT-proBNP was assessed in 715. CHF was present in 179 cases (10.4% of the cohort). The median of hs-cTnT, NT-proBNP values and in-hospital mortality were higher in CHF patients in comparison to those without CHF. In patients without CHF, the mortality was highest in those with the 4 th quartile of hs-cTnT or NT-proBNP values. In the ROC analysis, hs-cTnT ≥ 142 ng/ml, and NT-proBNP ≥ 969 pg/ml predicted in-hospital death. In cases without CHF, each 10 ng/L increase in hs-cTnT or 100 pg/mL increase in NT-proBNP was associated with risk of death: OR 1.01 and OR 1.02 (P<0.01), respectively. CONCLUSION Hs-cTnT or NT-proBNP predicts in-hospital mortality in COVID-19 patients. Both Hs-cTnT and NT-proBNP should be routinely measured at admission in all patients hospitalized due to COVID-19 for early detection of subjects with an increased risk of in-hospital death, even if they do not have concomitant heart failure.
Collapse
Affiliation(s)
- Marek Klocek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland.
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Małecki
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland
| | - Monika Bociąga-Jasik
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
7
|
Terlecki M, Kocowska-Trytko M, Plens K, Drożdż T, Pavlinec C, Gruszka K, Klima Ł, Wojciechowska W, Wordliczek J, Stolarz-Skrzypek K, Rajzer M. Prognostic value of acid-base balance parameters obtained from peripheral venous blood sample on admission in patients with myocardial infarction treated with percutaneous coronary intervention. Pol Arch Intern Med 2022; 132. [PMID: 35289158 DOI: 10.20452/pamw.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Peripheral venous blood sample may be used to obtain acid-base balance parameters (PVA-BP) measured in rapid point-of-care test analyzers (POCT) on admission to emergency department (ED). Thus, lactates, anion gap (AG) and base excess (BE) may be early prognostic markers in patients with myocardial infarction (MI). OBJECTIVES We aimed to confirm the relationship between PVA-BP on admission and the outcome in patients with MI treated by percutaneous coronary intervention (PCI). PATIENTS AND METHODS A retrospective, observational analysis of MI patients admitted primarily to ED and secondly transferred to PCI department. RESULTS 336 patients (41.1% STEMI, 58.9% NSTEMI) were divided according to lactates level: G1:≤2.0 mmol/l (n = 207), G2:>2.0 mmol/l (n = 129). G2 patients had higher values of AG (mean (SD), 9.6 (4.3) vs 6.8 (3.2) mEq/l; P <0.001) and lower BE (median [interquartile range (IQR)], -0.7 [-3.9;0.8] vs 1.0 [-0.2;2.4] mEq/l; P <0.001). In-hospital non-survivors had higher values of lactates (4.0 [2.0;8.7] vs 1.7 [1.3;2.4] mmol/l; P <0.001), AG (10.5 (4.6) vs 7.7 (3.8) mEq/l; P <0.001) and lower BE (-4.8 [-10.6;-1.8] vs 1.5 [-0.8;2.3] mEq/l; P <0.001) compared to survivors. Lactates, AG and BE correlated with GRACE score (r = 0.361; P <0.001, r = 0.158; P = 0.004, r = -0.383; P <0.001, respectively). Only BE independently predicted both 30- and 365-days mortality in whole group (HR 0.79, 95%CI 0.65-0.95; P = 0.01, HR 0.89, 95%CI 0.76-0.99; P = 0.04, respectively) as well as in-hospital mortality among patients without infarct-related out-of-hospital cardiac arrest (OR 0.74, 95%CI 0.57-0.97; P = 0.03). CONCLUSIONS In patients admitted to ED with MI treated with PCI the evaluation of PVA-BP assessed in POCT analyzers may be a reliable tool for early risk stratification.
Collapse
Affiliation(s)
- Michał Terlecki
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Maryla Kocowska-Trytko
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | | | - Tomasz Drożdż
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Christopher Pavlinec
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Krystian Gruszka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Łukasz Klima
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Jerzy Wordliczek
- Department of Interdisciplinary Intensive Care, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland.
| |
Collapse
|
8
|
Jastrzębski M, Stec J, Fijorek K, Pavlinec C, Czarnecka D. CHADS2 and CHA2DS2-VASc scores as tools for long-term mortality prognosis in patients with typical atrial flutter after catheter ablation. Kardiol Pol 2020; 78:59-64. [PMID: 31827060 DOI: 10.33963/kp.15102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The CHADS2 and CHA2DS2-VASc scores were shown to predict mortality in patients with atrial fibrillation. However, pathophysiology and treatment outcomes of atrial fibrillation and typical atrial flutter (AFL) differ. Consequently, the prognosis of patients with AFL can also be different. AIMS The aim of the study was to assess CHADS2 and CHA2DS2‑VASc scores as mortality predictors in patients with typical AFL. METHODS Large cohort of consecutive patients with typical AFL who underwent catheter ablation was retrospectively analyzed. The CHADS2 and CHA2DS2‑VASc were calculated using hospital record data. All-cause mortality data was obtained from the registry of national personal identification numbers. The Kaplan-Meier method and multivariable Cox proportional hazard models were applied for survival and hazard ratio analyses, respectively. RESULTS A total of 469 patients hospitalized for typical AFL ablation were enrolled (mean [SD] age, 63.7 [12.2] years; male sex, 69.1%). Patients were followed from 2 to 12 years resulting in 2974 patient‑years of follow‑up. The Kaplan-Meier survival analysis revealed a negative impact of each component of the CHADS2 and CHA2DS2‑VASc scores on survival with the exception of stroke (not significant) and female sex (related to abetter survival). Consequently, higher scores were predictive of higher all‑cause mortality rates (2.7%-54% at 10 years); the CHA2DS2‑VASc score was equally predictive as the CHADS2 score. CONCLUSIONS In patients referred for typical AFL ablation, the CHADS2 score can be applied for prognostic assessment. A successful AFL ablation procedure should not divert the attention from recognizing and addressing other medical issues that have an impact on long‑term mortality, which remains very high in this population of patients.
Collapse
Affiliation(s)
- Marek Jastrzębski
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland. mcjastrz@cyf‑kr.edu.pl
| | - Jakub Stec
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Kamil Fijorek
- Department of Statistics, Cracow University of Economics, Kraków, Poland
| | - Christopher Pavlinec
- International PhD Program of Medical Science, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Czarnecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
9
|
Kisiel R, Fijorek K, Moskal P, Kukla P, Pavlinec C, Stec J, Czarnecka D, Jastrzębski M. True left bundle branch block and long-term mortality in cardiac resynchronisation therapy patients. Kardiol Pol 2019; 77:371-379. [DOI: 10.5603/kp.a2019.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/26/2019] [Accepted: 02/20/2019] [Indexed: 11/25/2022]
|