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Zdzierak B, Krawczyk-Ożóg A, Zasada W, Bartuś S, Dziewierz A. Successful treatment of extensive coronary artery dissection with cutting balloon. Kardiol Pol 2024:VM/OJS/J/100135. [PMID: 38638094 DOI: 10.33963/v.phj.100135] [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: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- KCRI, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Krawczyk-Ożóg A, Hołda MK, Batko J, Jaśkiewicz K, Dziewierz A, Zdzierak B, Zasada W, Gil K, Hołda J. Description and prevalence of ventricular mitral annular disjunction: variation of normality or pathological variant? Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00129-4. [PMID: 38641167 DOI: 10.1016/j.rec.2024.04.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to investigate a new variation of the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures: the ventricular mitral annular disjunction (v-MAD). This new variant is characterized by spatial displacement of the mitral leaflet hinge line by more than 2mm toward the left ventricle. METHODS We examined a cohort of autopsied human hearts (n=224, 21.9% females, 47.9±17.6 years) from patients without known cardiovascular disease to identify the presence of v-MAD. RESULTS More than half (57.1%) of the hearts showed no signs of MAD in the mural mitral leaflet or mitral commissures. However, v-MAD was found in 23.6% of cases, located within 20.1% of mural leaflets, 2.2% in superolateral commissures, and 1.3% in inferoseptal commissures. V-MAD was not uniformly distributed along the mitral annulus circumference, with the most frequent site being the P2 scallop (19.6% of hearts). The v-MAD height was significantly greater in mural leaflets than in commissures (4.4 mm±1.2 mm vs 2.1 mm±0.1 mm; P<.001). No specific variations in mitral valve morphology or anthropometrical features of donors were associated with the presence or distribution of v-MADs. Microscopic examinations revealed the overlap of the thin layer of atrial myocardium over ventricular myocardium in areas of v-MAD. CONCLUSIONS Our study is the first to present a detailed definition and morphometric description of v-MAD. Further studies should focus on the clinical significance of v-MAD to elucidate whether it represents a benign anatomical variant or a significant clinical anomaly.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland; Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland.
| | - Mateusz K Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Jakub Batko
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland
| | - Kacper Jaśkiewicz
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland; 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, Krakow University Hospital, Krakow, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Hołda
- Department of Anatomy, Heart Embryology and Anatomy Research Team (HEART), Jagiellonian University Medical College, Krakow, Poland. https://twitter.com/@Jakub_Batko_
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Węglarz P, Węgiel M, Kuszewski P, Konarska-Kuszewska E, Staszel M, Nowok M, Bajor G, Mizia-Stec K, Dziewierz A, Rakowski T. Atrial septum anatomy as a predictor of ischemic neurological episodes in patients with a patent foramen ovale. Kardiol Pol 2024; 82:303-307. [PMID: 38493455 DOI: 10.33963/v.phj.99619] [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] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The correlation between atrial septum anatomy and the risk of ischemic neurological events remains underexplored. AIMS This study aimed to examine both the functional and anatomical attributes of the atrial septum and identify predictors of stroke and/or transient ischemic attack (TIA) in patients diagnosed with patent foramen ovale (PFO). METHODS A total of 155 patients diagnosed with PFO, with a cardiological cause of neurological events, were enrolled. Transesophageal echocardiography was utilized to assess the anatomy of the PFO canal, size of the right-to-left shunt, thickness of the primary and secondary atrial septum, presence of atrial septum aneurysm, and anatomical structures of the right atrium. RESULTS Regression analysis showed that factors such as female sex, hypercholesterolemia, PFO canal width, and a large right-to-left shunt were significantly associated with stroke and/or TIA. Receiver operating characteristic analysis indicated that the width of the PFO canal holds a relatively weak, although significant predictive, value for ischemic neurological episodes (area under the curve = 0.7; P = 0.002). A PFO canal width of 4 mm was associated with 70% sensitivity and 55% specificity for predicting stroke and/or TIA. CONCLUSIONS The atrial septum's anatomy, especially the dimensions of the PFO canal and the magnitude of the right-to-left shunt, combined with specific demographic and clinical factors, are linked to ischemic neurological incidents in PFO patients.
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Affiliation(s)
- Przemysław Węglarz
- Center for Invasive Cardiology, Electrotherapy and Angiology, Oświęcim, Poland
- Department of Cardiology, Tytus Chalubinski Hospital, Zakopane, Poland
| | - Michał Węgiel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Piotr Kuszewski
- Department of Cardiology, Municipal Hospital No. 4, Gliwice, Poland
| | - Ewa Konarska-Kuszewska
- Center for Invasive Cardiology, Electrotherapy and Angiology, Oświęcim, Poland
- Department of Cardiology, Tytus Chalubinski Hospital, Zakopane, Poland
| | - Michał Staszel
- Department of Cardiology, Tytus Chalubinski Hospital, Zakopane, Poland
| | - Michał Nowok
- Department of Cardiology, Municipal Hospital No. 4, Gliwice, Poland
| | - Grzegorz Bajor
- Department of Human Anatomy, Medical University of Silesia, Katowice, Poland
| | | | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Rakowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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Krawczyk-Ożóg A, Batko J, Zdzierak B, Dziewierz A, Tyrak K, Bolechała F, Kopacz P, Strona M, Gil K, Hołda J, Hołda MK. Morphology of the mural and commissural atrioventricular junction of the mitral valve. Heart 2024; 110:517-522. [PMID: 37935571 DOI: 10.1136/heartjnl-2023-322965] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/23/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE This study investigates mitral annular disjunctions (MAD) in the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures. METHODS We examined 224 adult human hearts (21.9% females, 47.9±17.6 years) devoid of cardiovascular diseases (especially mitral valve disease). These hearts were obtained during forensic medical autopsies conducted between January 2018 and June 2021. MAD was defined as a spatial displacement (≥2 mm) of the leaflet hinge line towards the left atrium. We provided a detailed morphometric analysis (disjunction height) and histological examination of MADs. RESULTS MADs were observed in 19.6% of all studied hearts. They appeared in 12.1% of mural leaflets. The P1 scallop was the primary site for disjunctions (8.9%), followed by the P2 scallop (5.4%) and P3 scallop (4.5%). MADs were found in 9.8% of all superolateral and 5.8% of all inferoseptal commissures. The average height for leaflet MADs was 3.0±0.6 mm, whereas that for commissural MADs was 2.1±0.5 mm (p<0.0001). The microscopical arrangement of MADs in both the mural leaflet and commissures revealed a disjunction shifted towards left atrial aspect, filled with connective tissue and covered by elongated valve annulus. The size of the MAD remained remarkably uniform and showed no correlation with other anthropometric factors (all p>0.05). CONCLUSIONS In the cohort of the patients with healthy hearts, MAD is present in about 20% of all studied hearts. The MADs identified tend to be localised, confined to a single scallop. Moreover, MADs in the commissures are notably smaller than those in the mural leaflet.
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Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Jakub Batko
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Kamil Tyrak
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Filip Bolechała
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Kopacz
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Strona
- Department of Forensic Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Hołda
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Hołda
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
- The University of Manchester, Manchester, UK
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Roczniak J, Tarnawski A, Dziewierz A, Glanowski S, Pawlik A, Sabatowski K, Januszek R, Rzeszutko Ł, Surdacki A, Bartuś S, Chyrchel M. Radial artery spasms - angiographic morphology, risk factors and management. Postepy Kardiol Interwencyjnej 2024; 20:53-61. [PMID: 38616935 PMCID: PMC11008508 DOI: 10.5114/aic.2024.136936] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Radial artery is the preferred access for coronary interventions. However, the procedure is sometimes interrupted by a spasm which causes pain, prolongs the procedure, and can force the access crossover. Aim To observe factors contributing to a symptomatic radial artery spasm. Material and methods In this prospective study, we present results of 103 consecutive patients regarding radial artery spasm and angiographic image of the punctured artery. Angiography of the radial artery was performed in 70 (68.0%) patients. Potential risk factors for radial artery spasm were evaluated. Results The overall incidence of the radial artery spasm was high - 25 (24.3%). Signs of spasm were present in 37.1% of radial artery angiographies before the procedure and 60.1% after, however, it did not always indicate a symptomatic spasm. Risk factors related to radial artery spasm included female sex (OR = 2.94, p = 0.02), failure of the first puncture attempt (OR = 3.12, p = 0.014) and use of non-hydrophilic sheath (OR = 9.56, p = 0.036). Radial artery narrowing at the tip of the sheath was also a risk factor for spasm (p = 0.022). No spasms were observed after hydrophilic sheath application (n = 13). The administration of a radial cocktail was not observed to significantly decrease the spasm odds. Conclusions Risk factors for radial artery spasm include female sex and multiple puncture attempts. Hydrophilic sheath coating protects against radial artery spasm. Overall signs of a spasm in the angiography are common and do not imply a symptomatic spasm, which can be predicted by a tight narrowing at the tip of the sheath.
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Affiliation(s)
- Jan Roczniak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | | | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Glanowski
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Pawlik
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Rafał Januszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Krakow, Poland
| | - Łukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Chyrchel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Doolub G, Mamas MA, Dziewierz A, Malinowski KP, Oleś I, Kuleta M, Zdzierak B, Siudak Z. Do two operators improve outcomes in left main percutaneous coronary intervention? Insights from the ORPKI Registry. Minerva Cardiol Angiol 2024; 72:79-86. [PMID: 37870423 DOI: 10.23736/s2724-5683.23.06364-0] [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: 10/24/2023]
Abstract
BACKGROUND Significant left main coronary artery (LMCA) disease is prevalent in 7% of patients undergoing angiography. Limited data exists on the impact of double scrubbing in LMCA PCI. We sought to assess periprocedural outcomes in two-operator LMCA percutaneous coronary intervention (PCI). METHODS Using data from the Polish National Registry of PCI (ORPKI), we collected data on 28,745 patients undergoing LMCA PCI from 154 centers. Patients were divided into two groups based on the number of operators performing PCI (one vs. two operators). RESULTS LMCA PCI was performed by a single operator in 86% of the cases and by two operators in 14% of cases. Patients treated by two operators had a greater comorbidity burden including diabetes mellitus, arterial hypertension, previous myocardial infarction, and previous revascularization. In addition, these were more likely to be treated in high-volume centers, by operators with higher volume of LMCA PCIs. The risk of periprocedural death (2.37% vs. 2.44%; P=0.78), as well as cardiac arrest, coronary artery perforation, no-reflow, and puncture site bleeding was comparable between the two groups. On multivariable analysis, we found that a two-operator strategy was an independent predictor of periprocedural death, with this effect being much more profound in an elective setting (OR=5.13 [1.37-19.26]; P=0.015), compared to an urgent (ACS) setting (OR=1.32 [1.00-1.73]; P=0.047). CONCLUSIONS Our study suggests that a two-operator approach is not necessarily routinely recommended for LMCA interventions, although it can be considered for more complex cases.
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Affiliation(s)
- Gemina Doolub
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
- Unit of Translational Health Sciences, University of Bristol, Bristol, UK
| | - Mamas A Mamas
- Center for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Artur Dziewierz
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital of Krakow, Krakow, Poland
| | - Krzysztof P Malinowski
- Jagiellonian University Medical College, Department of Bioinformatics and Telemedicine, Krakow, Poland
- Jagiellonian University Medical College, Digital Medicine and Robotics Center, Krakow, Poland
| | - Izabela Oleś
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Martyna Kuleta
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Barbara Zdzierak
- Jagiellonian University Medical College, Second Department of Cardiology, Institute of Cardiology, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland -
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Dziewierz A, Rzeszutko Ł, Dudek D, Legutko J, Kleczyński P. Impact of chronic kidney disease on fractional flow reserve accuracy in severe aortic stenosis. Pol Arch Intern Med 2024; 134:16649. [PMID: 38133884 DOI: 10.20452/pamw.16649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Łukasz Rzeszutko
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Dariusz Dudek
- Digital Medicine and Robotics Center, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Clinical Department of Interventional Cardiology, St. John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland; Clinical Department of Interventional Cardiology, St. John Paul II Hospital, Kraków, Poland.
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Węgiel M, Surmiak M, Malinowski KP, Dziewierz A, Surdacki A, Bartuś S, Rakowski T. In-Hospital Levels of Circulating MicroRNAs as Potential Predictors of Left Ventricular Remodeling Post-Myocardial Infarction. Medicina (Kaunas) 2024; 60:149. [PMID: 38256409 PMCID: PMC10819680 DOI: 10.3390/medicina60010149] [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] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Biochemical and molecular regulation of both adaptive and pathological responses of heart tissue to ischemic injury is widely investigated. However, it is still not fully understood. Several biomarkers are tested as predictors of left ventricle (LV) remodeling after myocardial infarction (MI). The aim of this study was to assess the relationship between selected microRNAs (miRNAs) and LV function and morphology in patients after MI. Materials and Methods: Selected miRNAs related to heart failure were assessed in the acute phase of MI: miR-150-3p, miR-21-5p, miR-19b-3p, miR-155-5p, miR-22-5p. Echocardiography with 3D imaging was performed at baseline and after 6 months. Remodeling was defined as >20% increase in LV end-diastolic volume, whereas reverse remodeling was defined as >10% reduction in LV end-systolic volume. Results: Eighty patients entered the registry. Remodeling occurred in 26% and reverse remodeling was reported in 51% of patients. In the presented study, none of the analyzed miRNAs were found to be a significant LV remodeling predictor. The observed correlations between miRNAs and other circulating biomarkers of myocardial remodeling were relatively weak. Conclusions: Our analysis does not demonstrate an association between the analyzed miRNAs and LV remodeling in patients with MI.
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Affiliation(s)
- Michał Węgiel
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
| | - Marcin Surmiak
- Department of Internal Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Krzysztof Piotr Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, 30-688 Krakow, Poland; (M.W.); (A.D.); (S.B.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
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Sorysz D, Dziewierz A, Opalinska M, Sowa-Staszczak A, Grochowska A, Malinowski KP, Maruszak N, Bartuś S, Dudek D. 18F-fluorodeoxyglucose and 18F-sodium fluoride positron emission tomography imaging in assessing early stages of aortic valve degeneration after transcatheter aortic valve implantation. Pol Arch Intern Med 2023; 133:16607. [PMID: 37966038 DOI: 10.20452/pamw.16607] [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: 11/16/2023]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis, primarily in elderly patients. With an increasing number of procedures and younger patients, understanding the valve degeneration and its risk factors becomes crucial. OBJECTIVES We aimed to utilize 18F‑sodium fluoride (18F‑NaF) and 18F‑fluorodeoxyglucose (18F‑FDG) positron emission tomography/computed tomography (PET/CT) to evaluate early TAVI valve degeneration. PATIENTS AND METHODS In this prospective study with a prespecified follow‑up protocol, 71 TAVI patients underwent baseline transthoracic and transesophageal echocardiography, and PET/CT with 18F‑NaF and 18F‑FDG. Of these, 31 patients completed 24‑month control examinations, while the others were lost to mortality and the COVID‑19 pandemic. We measured PET tracer activity and compared 18F‑NaF and 18F‑FDG PET/CT uptake at baseline and 24‑month follow‑up. RESULTS PET/CT and echocardiography data were analyzed for 31 of the 71 enrolled TAVI patients at a median age of 84 years (interquartile range, 80-86). After TAVI, an improvement in the valve function was observed. During follow‑up, the valve function remained stable. PET/CT demonstrated an increase in 18F‑FDG maximal uptake in the inner (tissue‑to‑background ratio, P = 0.009) and outer (P = 0.01) sides of the TAVI valve stent, but no difference in 18F‑NaF maximal activity (inner, P = 0.17; outer, P = 0.57). CONCLUSIONS Twenty‑four months post‑TAVI, an increase in 18F‑FDG uptake, indicative of inflammation, was observed in the valve, while the uptake of the calcification marker (18F‑NaF) remained stable. Theseobservations might suggest early stages of TAVI valve degeneration, although further investigation is required to confirm this interpretation.
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Affiliation(s)
- Danuta Sorysz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marta Opalinska
- Clinical Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Sowa-Staszczak
- Clinical Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
- Department of Endocrinology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Grochowska
- Department of Radiology, University Hospital, Kraków, Poland
| | - Krzysztof P Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kraków, Poland
| | - Natalia Maruszak
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kraków, Poland
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Gołąbek N, Jakubowski W, Król S, Kozioł M, Niewiara Ł, Kleczyński P, Legutko J, Dziewierz A, Surdacki A, Chyrchel M. ECG patterns suggestive of high-risk coronary anatomy in non-ST-segment elevation acute coronary syndrome - an analysis of real-world patients. Postepy Kardiol Interwencyjnej 2023; 19:326-332. [PMID: 38187480 PMCID: PMC10767565 DOI: 10.5114/aic.2023.132161] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Electrocardiographic (ECG) patterns suggestive of high-risk coronary anatomy are indications for an urgent invasive approach in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Aim To estimate the frequency of the observed phenomenon and assess the clinical characteristics of NSTE-ACS subjects associated with Wellens syndrome, the de Winter sign, or ST-segment depressions by ≥ 1 mm in ≥ 6 classic ECG leads with simultaneous ST-segment elevation in aVR and/or V1. Material and methods Out of 207 pre-screened subjects diagnosed with NSTE-ACS, 64 patients (26 women and 38 men) with complete medical records (including admission ECG and coronary angiography during the index hospitalization), and significant culprit stenosis or occlusion of the left main coronary artery (LMCA) or the proximal/middle segment of the left anterior descending artery (LAD) entered the final analysis. Clinical characteristics of patients exhibiting any of the high-risk ECG patterns was compared to their counterparts with significant lesions in LMCA or proximal/middle LAD without any of the high-risk ECG patterns. Results Among 64 patients with significant culprit lesions in LMCA or LAD, 19 (29.69%) exhibited one of the high-risk ECG patterns: Wellens syndrome (n = 10), the de Winter sign (n = 0), or multiple ST-segment depressions (n = 9). Clinical characteristics were comparable in 19 NSTE-ACS patients with the high-risk ECG patterns and their 45 counterparts. Conclusions Because ECG patterns suggestive of high-risk coronary anatomy are relatively frequent in patients with NSTE-ACS and culprit lesions in LMCA or LAD, their early recognition is of clinical importance.
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Affiliation(s)
- Natalia Gołąbek
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Jakubowski
- Students’ Scientific Group at the Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Król
- Students’ Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Mateusz Kozioł
- Students’ Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Łukasz Niewiara
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Chyrchel
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Zdzierak B, Zasada W, Rakowski T, Krawczyk-Ożóg A, Bartuś S, Surdacki A, Dziewierz A. Influence of diabetes mellitus on the invasive assessment of myocardial ischemia in patients with coronary artery disease. Pol Arch Intern Med 2023; 133:16502. [PMID: 37227217 DOI: 10.20452/pamw.16502] [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: 05/26/2023]
Abstract
INTRODUCTION Current guidelines recommend physiological evaluation of borderline coronary artery stenoses using hyperemic (fractional flow reserve [FFR]) and nonhyperemic (instantaneous wave‑free ratio [iFR] and resting full‑cycle ratio [RFR]) methods. However, comorbidities, such as diabetes mellitus (DM), may influence the results of the assessment. OBJECTIVES We sought to investigate the impact of DM and insulin treatment on the discordance between FFR and iFR/RFR. PATIENTS AND METHODS A total of 417 intermediate stenoses in 381 patients underwent FFR and iFR/RFR assessment. FFR lower than or equal to 0.8 and iFR/RFR lower than or equal to 0.89 indicated significant ischemia. The patients were categorized based on DM diagnosis and insulin treatment status. RESULTS Of the 381 patients, 154 (40.4%) had DM. Among these, 58 patients (37.7%) received insulin treatment. Diabetic patients had higher body mass index and glycated hemoglobin levels, and lower ejection fraction. FFR and iFR/RFR analyses were conducted in 417 vessels with available measurements for both tests. A good correlation between FFR and iFR/RFR was confirmed in both diabetic (R = 0.77) and nondiabetic (R = 0.74) patients. Discordance between FFR and iFR/RFR occurred in approximately 20% of cases, and the frequency of discordance was not affected by the diabetic status. However, insulin‑treated DM was independently associated with a higher risk of negative FFR and positive iFR/RFR discordance (odds ratio, 4.61; 95% CI, 1.38-15.4; P = 0.01). Also, the optimal cutoff value for FFR identifying significant ischemia in DM patients treated with insulin was higher (0.84) than the generally recommended value. CONCLUSIONS The rate of FFR and iFR/FFR discordance was similar regardless of the diabetes status, and insulin‑treated DM was associated with an increased risk of negative FFR and positive iFR/RFR discordance.
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Affiliation(s)
- Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- KCRI, Kraków, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Department of Anatomy, HEART – Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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Zasada W, Zdzierak B, Rakowski T, Bobrowska B, Krawczyk-Ożóg A, Surowiec S, Bartuś S, Surdacki A, Dziewierz A. The Impact of Age on the Physiological Assessment of Borderline Coronary Stenoses. Medicina (Kaunas) 2023; 59:1863. [PMID: 37893581 PMCID: PMC10608417 DOI: 10.3390/medicina59101863] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Coronary angiography is the gold standard for diagnosing coronary artery disease (CAD). In the case of borderline changes, patients require further diagnosis through ischemia assessment via one of the recommended methods of invasive evaluation. This study aimed to assess whether clinical factors influence the risk of a positive result in invasive myocardial ischemia assessment and if these potential factors change with the patient's age and the consistency of ischemia assessment. Materials and Methods: Data were collected retrospectively on all consecutive patients hospitalized in the University Hospital in Krakow between 2020 and 2021, on whom physiological assessments of coronary circulation were performed. Patients were divided into two groups: patients aged 60 or younger and patients older than 60. Results: Despite the older patients having more risk factors for CAD, their physiological assessment results of borderline lesions were similar to those of the younger patients. Positive fractional flow reserve (FFR) assessments were obtained from almost 50% of vessels. In the younger patients, cigarette use and type 2 diabetes mellitus increased the risk of a positive FFR result by 3.5 and 2.5 times, respectively. In the older patients, male gender and peripheral vascular disease significantly increased the risk of a positive FFR by 2.5 and 2 times, respectively. Conclusions: Clinical characteristics of patients undergoing physiological assessment of borderline coronary stenosis varied significantly by age. Refining the definition of borderline lesions to include age, gender, and other factors may improve the identification of patients who would benefit from physiological assessment and coronary revascularization.
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Affiliation(s)
- Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- KCRI, 30-347 Krakow, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Beata Bobrowska
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- Department of Anatomy, HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Sławomir Surowiec
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland; (W.Z.); (T.R.)
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
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Węglarz P, Węgiel M, Konarska-Kuszewska E, Kuszewski P, Staszel M, Dziewierz A, Rakowski T. Experience in patent foramen ovale closure with the CERA Lifetech occluder in patients with cryptogenic stroke. Postepy Kardiol Interwencyjnej 2023; 19:257-261. [PMID: 37854971 PMCID: PMC10580839 DOI: 10.5114/aic.2023.131479] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Nowadays, percutaneous closure of patent foramen ovale (PFO) in patients after cryptogenic stroke is becoming a dominating strategy. The most commonly used and investigated device is the Amplatzer occluder. However, several other devices have been designed for transcatheter closure of PFO, which are not so well examined. Aim To assess the effectiveness and safety of PFO closure with the Lifetech CERA occluder. Material and methods A prospective, single-arm registry of patients with PFO treated with CERA occluder (Lifetech Scientific, Shenzhen, China) implantation was conducted. We assessed peri-procedural and 12-month follow-up. Patients were screened for the residual shunt in transcranial Doppler/transesophageal echocardiography. Results Ninety-six patients entered the registry. Most patients were women (76%) and the analyzed group was relatively young (mean age of 42.3 ±13.6 years). Before closure, most patients had a large shunt through the PFO. Procedures of PFO closure were performed under TEE guidance. All procedures were made under local anesthesia and all patients had the PFO successfully closed. No device-related complications were reported in the peri-procedural period or during follow-up. No recurrent neurological ischemic events were reported at 12 months. During follow-up we observed a 9% rate of residual shunts, which were mostly small. Conclusions The study confirmed excellent immediate and 12-month results of CERA occluder implantation in patients with PFO.
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Affiliation(s)
- Przemysław Węglarz
- Center for Invasive Cardiology, Electrotherapy and Angiology, Oświęcim, Poland
- Department of Cardiology, Tytus Chałubiński Hospital, Zakopane, Poland
| | - Michał Węgiel
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Ewa Konarska-Kuszewska
- Center for Invasive Cardiology, Electrotherapy and Angiology, Oświęcim, Poland
- Department of Cardiology, Tytus Chałubiński Hospital, Zakopane, Poland
| | - Piotr Kuszewski
- Department of Cardiology, Municipal Hospital No. 4, Gliwice, Poland
| | - Michał Staszel
- Department of Cardiology, Tytus Chałubiński Hospital, Zakopane, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Zdzierak B, Zasada W, Krawczyk-Ożóg A, Rakowski T, Bartuś S, Surdacki A, Dziewierz A. Influence of sex on the functional assessment of myocardial ischemia. Kardiol Pol 2023; 81:895-902. [PMID: 37448217 DOI: 10.33963/kp.a2023.0154] [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] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) and non-hyperemic resting pressure ratios, such as instantaneous wave-free ratio (iFR) and resting full-cycle ratio (RFR), are recommended for evaluating the significance of angiographically intermediate coronary stenoses. Despite their usefulness, approximately 20% of assessed lesions exhibit discordance between FFR and iFR/RFR. AIMS The role of sex in this discrepancy remains uncertain; thus, we aimed to investigate its impact on the discordance between FFR and iFR/RFR. METHODS We reviewed 417 consecutive intermediate stenotic lesions from 381 patients, stratified by sex and assessed with both FFR and iFR/RFR. FFR ≤0.80 and iFR/RFR ≤0.89 were considered positive for ischemia. RESULTS Of the 381 patients, 92 (24.1%) were women. Women were older, had a lower estimated glomerular filtration rate (eGFR), higher ejection fraction, and were more likely to have peripheral artery disease than men. Median FFR and iFR/RFR values were lower in men than in women (FFR 0.86 vs. 0.80; P <0.001; iFR 0.92 vs. 0.90; P = 0.049). However, overall discordance prevalence was similar for both sexes (20.6% vs. 15.1%; P = 0.22). In men, eGFR, insulin-treated diabetes mellitus, and arterial hypertension were predictors of positive FFR | negative iFR/RFR discordance, while eGFR, insulin-treated diabetes mellitus, atrial fibrillation, and chronic obstructive pulmonary disease were predictors of negative FFR | positive iFR/RFR discordance. No factors associated with either discordance were identified in women. CONCLUSIONS FFR and iFR/RFR results indicating significant ischemia were more common in men than women when assessing intermediate coronary stenoses. Nevertheless, sex did not predict discordant results.
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Affiliation(s)
- Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- KCRI, Kraków, Poland
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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Pelliccia F, Dziewierz A, Pannarale G, Gaudio C. Editorial: Novel approaches in cardiac imaging. Front Cardiovasc Med 2023; 10:1221927. [PMID: 37351286 PMCID: PMC10283001 DOI: 10.3389/fcvm.2023.1221927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Carlo Gaudio
- Department of Cardiovascular Sciences, University Sapienza, Rome, Italy
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16
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Dziewierz A, Vogel B, Zdzierak B, Kuleta M, Malinowski KP, Rakowski T, Piotrowska A, Mehran R, Siudak Z. Operator-patient sex discordance and periprocedural outcomes of percutaneous coronary intervention (from the ORPKI Polish National Registry). Postepy Kardiol Interwencyjnej 2023; 19:113-118. [PMID: 37465632 PMCID: PMC10351079 DOI: 10.5114/aic.2023.129208] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/06/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction A recent study suggested that sex discordance between surgeons and patients negatively affects the outcomes of patients undergoing common surgical procedures. Aim We sought to assess whether such an impact exists for periprocedural outcomes of percutaneous coronary intervention (PCI). Material and methods From 2014 to 2020, data on 581,744 patients undergoing single-stage coronary angiography and PCI from 154 centers were collected. Patients were divided into four groups based on the patient and operator sex. Operator-patient sex discordance was defined as the procedure done by a male operator on a female patient or by a female operator on a male patient. Results Of 581,744 patients treated by 34 female and 782 male operators, 194,691 patients were sex discordant with their operator (female operator with male patient 12,479; male operator with female patient 182,212) while 387,053 were sex concordant (female operator with female patient 6,068; male operator with male patient 380,985). Among female patients, no difference in the risk of periprocedural complications, including death (0.65% vs. 0.82%; p = 0.10), between patients discordant versus concordant with operators was observed. Among male patients the risk of death (0.55% vs. 0.43%; p = 0.037) and bleeding at the puncture site (0.13% vs. 0.08%; p = 0.046) was higher in patients discordant with operators. However, the differences were no longer significant after adjustment for covariates. Conclusions No detrimental effect of operator-patient sex discordance on periprocedural outcomes was confirmed in all-comer patients undergoing PCI. Some of the observed differences in outcomes were primarily related to the differences in baseline risk profile.
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Affiliation(s)
- Artur Dziewierz
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Martyna Kuleta
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | | | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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Sorysz D, Dziewierz A, Staszczak A, Trębacz J, Dudek D. Unusual rapid progression of TAVI valve degeneration confirmed on PET-CT scan after the valve-in-valve procedure followed by early valve thrombosis. Pol Arch Intern Med 2023; 133:16454. [PMID: 36880281 DOI: 10.20452/pamw.16454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Danuta Sorysz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Staszczak
- Nuclear Medicine Unit of the Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, Jagiellonian University Medical College, Kraków, Poland
- Nuclear Medicine Unit of the Department of Endocrinology, Oncological Endocrinology and Nuclear Medicine, University Hospital, Kraków, Poland
| | - Jarosław Trębacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- John Paul II Hospital, Kraków, Poland
| | - Dariusz Dudek
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, Kraków, Poland
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Rakowski T, Węgiel M, Malinowski KP, Siudak Z, Zasada W, Zdzierak B, Tokarek T, Rzeszutko Ł, Dudek D, Bartuś S, Surdacki A, Dziewierz A. Thrombus containing lesions strategies during primary percutaneous coronary interventions in ST-segment elevation myocardial infarction: insights from ORPKI National Registry. J Thromb Thrombolysis 2023:10.1007/s11239-023-02811-z. [PMID: 37093352 DOI: 10.1007/s11239-023-02811-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/25/2023]
Abstract
In the era of potent P2Y12 inhibitors, according to current guidelines, treatment with glycoprotein IIb/IIIa inhibitors (GPIs) should be limited to bail-out and/or highly thrombotic situations. Similarly, the recommendation for aspiration thrombectomy (AT) is downgraded to very selective use. We examine the prevalence, and predictors of GPI and AT use in STEMI patients referred to primary percutaneous coronary intervention (PCI). Data on 116,873 consecutive STEMI patients referred to primary PCI in Poland between 2015 and 2020 were analyzed. GPIs were administered in 29.3%, AT was used in 11.6%, and combined treatment with both in 6.1%. There was a mild trend toward a decrease in GPI and AT usage during the analyzed years. On the contrary, there was a rapid growth of the ticagrelor/prasugrel usage rate from 6.5 to 48.1%. Occluded infarct-related artery at baseline and no-reflow during PCI were the strongest predictors of GPI administration (OR 2.3; 95% CI 2.22-2.38 and OR 3.47; 95% CI 3.13-3.84, respectively) and combined usage of GPI and AT (OR 4.4; 95% CI 4.08-4.8 and OR 3.49; 95% CI 3.08-3.95 respectively) in a multivariate logistic regression model. Similarly, the administration of ticagrelor/prasugrel was an independent predictor of both adjunctive treatment strategies. In STEMI patients in Poland, GPIs are selectively used in one in four patients during primary PCI, and the combined usage of GPI and AT is marginal. Despite the rapid growth in potent P2Y12 inhibitors usage in recent years, GPIs are selectively used at a stable rate during PCI in highly thrombotic lesions.
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Affiliation(s)
- Tomasz Rakowski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Węgiel
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Krzysztof P Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, Nowy Sacz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Andrzej Surdacki
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688, Kraków, Poland.
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
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Dziewierz A, Mikołowicz-Mosiądz A, Czemeryński P, Wiśniowski Ł, Witkowski A, Pelliccia F. Coexistence of transient global amnesia, takotsubo syndrome, and spontaneous coronary artery dissection. Kardiol Pol 2023:VM/OJS/J/94731. [PMID: 36999728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
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20
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Zdzierak B, Zasada W, Krawczyk-Ożóg A, Rakowski T, Bartuś S, Surdacki A, Dziewierz A. Comparison of Fractional Flow Reserve with Resting Non-Hyperemic Indices in Patients with Coronary Artery Disease. J Cardiovasc Dev Dis 2023; 10:jcdd10020034. [PMID: 36826530 PMCID: PMC9959762 DOI: 10.3390/jcdd10020034] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Guidelines recommend using hyperemic (FFR) and non-hyperemic (iFR/RFR) methods of evaluating coronary artery stenoses in patients with coronary artery disease. However, in some cases, achieved results indicating significant ischemia may differ between those methods. Thus, we sought to identify predictors of such a discrepancy. Data were collected on all consecutive patients with chronic coronary syndrome hospitalized between 2020 and 2021. For 279 patients (417 vessels), results for both FFR and iFR/RFR were available. Values of ≤0.80 for FFR and ≤0.89 for iFR/RFR were considered positive for ischemia. Discordant measurements of FFR and iFR/RFR were observed in 80 (19.2%) patients. Atrial fibrillation was the only predictor of the overall FFR and iFR/RFR discordance - OR (95%CI) 1.90 (1.02-3.51); p = 0.040. The chance of positive FFR and negative iFR/RFR decreased independently with age - OR (95%CI) 0.96 (0.93-0.99); p = 0.024. On the contrary, insulin-treated diabetes mellitus was the predictor of negative FFR and positive iFR/RFR discrepancy - OR (95%CI) 4.61 (1.38-15.40); p = 0.013. In everyday clinical practice, iFR/FFR correlates well with FFR. However, discordance between these methods is quite common. Physicians should be aware of the risk of such discordance in patients with atrial fibrillation, advanced age, and insulin-treated diabetes mellitus.
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Affiliation(s)
- Barbara Zdzierak
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
| | - Wojciech Zasada
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- KCRI, 30-347 Krakow, Poland
| | - Agata Krawczyk-Ożóg
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- Department of Anatomy, HEART-Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, 33-332 Krakow, Poland
| | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Andrzej Surdacki
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-2250
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21
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Sorysz D, Dziewierz A, Rzeszutko Ł, Wiktorowicz A, Wojakowski W, Parma R, Skoczyńska A, Kleczyński P, Stąpór M, Dudek D, Legutko J, Bartuś S. Safety and efficacy of repeated balloon aortic valvuloplasty in patients with symptomatic severe aortic stenosis. Kardiol Pol 2023; 81:366-372. [PMID: 36648223 DOI: 10.33963/kp.a2023.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe symptomatic aortic stenosis (AS) are poor, and this procedure needs to be repeated in selected cases. AIMS We aimed to investigate the safety and efficacy of repeated BAV (reBAV). METHODS We included consecutive patients who underwent reBAV in three Polish centers between 2010 and 2019. Baseline clinical, echocardiographic, procedural, and outcome data were analyzed. RESULTS Thirty-five patients (median age 81.5 years, 57.1% women) who underwent reBAV were enrolled. In 42.9% of the patients, index BAV was considered a palliative treatment, and in 54.3% a bridge to definitive treatment. Index BAV decreased peak aortic valve gradient (pAVG) from a median of 78.0 mm Hg to 46.0 mm Hg (P <0.001). After a mean of 255.8 days, reBAV was performed. In most cases (71.4%), the reason for reBAV was the worsening of heart failure symptoms and in 54.3% of patients, reBAV was still considered a palliative option. A decrease in pAVG max from a median of 73.0 mm Hg to 45.0 mm Hg (P <0.001), comparable to index BAV, was observed. The frequency of complications were numerically higher for repeated procedures. During the median (IQR) follow-up of 403.0 (152.0-787.0) days from the index procedure, 80.0% of the patients died. CONCLUSIONS Acute hemodynamic results of reBAV are comparable to those achieved during index BAV. However, reBAV may carry an increased risk of complications. Moreover, mortality is high due to unfavorable risk profiles or delays in receiving definitive therapy.
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Affiliation(s)
- Danuta Sorysz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Rzeszutko
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Wiktorowicz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radosław Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Skoczyńska
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Paweł Kleczyński
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Stąpór
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Legutko
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Affiliation(s)
- Artur Dziewierz
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
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23
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Tokarek T, Dziewierz A, Zeliaś A, Malinowski KP, Rakowski T, Dudek D, Siudak Z. Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest. Int J Environ Res Public Health 2022; 20:337. [PMID: 36612658 PMCID: PMC9819125 DOI: 10.3390/ijerph20010337] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Patients with ST-segment-elevation myocardial infarction (STEMI) treated during the COVID-19 pandemic might experience prolonged time to reperfusion. The delayed reperfusion may potentially aggravate the risk of out-of-hospital cardiac arrest (OHCA) in those patients. Limited access to healthcare, more reluctant health-seeking behaviors, and bystander readiness to render life-saving interventions might additionally contribute to the suggested change in the risk of OHCA in STEMI. Thus, we sought to explore the effects of the COVID-19 outbreak on treatment delay and clinical outcomes of patients with STEMI with OHCA. Overall, 5,501 consecutive patients with STEMI complicated by OHCA and treated with primary percutaneous coronary intervention with stent implantation were enrolled. A propensity score matching was used to obviate the possible impact of non-randomized design. A total of 740 matched pairs of patients with STEMI and OHCA treated before and during the COVID-19 pandemic were compared. A similar mortality and prevalence of periprocedural complications were observed in both groups. However, patients treated during the COVID-19 outbreak experienced longer delays from first medical contact to angiography (88.8 (±61.5) vs. 101.4 (±109.8) [minutes]; p = 0.006). There was also a trend toward prolonged time from pain onset to angiography in patients admitted to the hospital in the pandemic era (207.3 (±192.8) vs. 227.9 (±231.4) [minutes]; p = 0.06). In conclusion, the periprocedural outcomes in STEMI complicated by OHCA were comparable before and during the COVID-19 era. However, treatment in the COVID-19 outbreak was associated with a longer time from first medical contact to reperfusion.
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Affiliation(s)
- Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Aleksander Zeliaś
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
| | | | - Tomasz Rakowski
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Dariusz Dudek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-317 Kielce, Poland
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Dziewierz A, Zabojszcz M, Natorska J, Ślusarczyk-Dolecka M, Kuleta M, Siudak Z. Dapagliflozin reduces plasma concentration of plasminogen activator inhibitor-1 in patients with heart failure with preserved ejection fraction and type 2 diabetes. Pol Arch Intern Med 2022; 132. [PMID: 36520466 DOI: 10.20452/pamw.16383] [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] [Indexed: 12/16/2022]
Affiliation(s)
- Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland,Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Michał Zabojszcz
- Department of Internal Medicine and Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Joanna Natorska
- Department of Thromboembolic Diseases, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland,Center for Research and Innovative Technology, John Paul II Hospital, Kraków, Poland
| | | | - Martyna Kuleta
- Department of Internal Medicine and Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Zbigniew Siudak
- Department of Internal Medicine and Cardiology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
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25
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Pęksa JW, Pawlik A, Dziewierz A, Zawiślak B. In-stent balloon rupture and entrapment during post-dilatation in an infarct-related artery followed by successful retrieval. Kardiol Pol 2022; 80:1152-1153. [PMID: 36148912 DOI: 10.33963/kp.a2022.0224] [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: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Jan W Pęksa
- Clinical Department of Cardiology, Interventional Electrocardiology and Hypertension, University Hospital, Kraków, Poland.
| | - Artur Pawlik
- Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Artur Dziewierz
- Clinical Department of Cardiology, Interventional Electrocardiology and Hypertension, University Hospital, Kraków, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Zawiślak
- Intensive Cardiac Care Unit, University Hospital, Kraków, Poland
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Dziewierz A, Zdzierak B, Malinowski KP, Siudak Z, Zasada W, Tokarek T, Zabojszcz M, Dolecka-Ślusarczyk M, Dudek D, Bartuś S, Surdacki A, Rakowski T. Diabetes Mellitus Is Still a Strong Predictor of Periprocedural Outcomes of Primary Percutaneous Coronary Interventions in Patients Presenting with ST-Segment Elevation Myocardial Infarction (from the ORPKI Polish National Registry). J Clin Med 2022; 11:jcm11216284. [PMID: 36362512 PMCID: PMC9657628 DOI: 10.3390/jcm11216284] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
The impact of diabetes mellitus (DM) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was confirmed by several studies. However, it is unclear whether this effect is still present in large groups of unselected patients undergoing up-to-date treatment. Thus, we sought to assess the impact of DM on periprocedural outcomes of primary PCI in STEMI using data from the Polish National Registry of PCI. Data on 150,782 STEMI patients undergoing primary PCI were collected. Of them, 26,360 (17.5%) patients had DM. Patients with DM were higher-risk individuals who experienced longer reperfusion delays and were less likely to have closed infarct-related artery at baseline (TIMI 0 + 1 flow: 73.2% vs. 72.0%; p < 0.0001) and achieve optimal reperfusion after PCI (TIMI 3 flow: 91.8% vs. 88.5%; p < 0.0001). The periprocedural mortality (1.1% vs. 1.9%; p < 0.0001) was higher in patients with DM and DM was identified as an independent predictor of periprocedural death. In conclusion, despite continuous progress in STEMI treatment, DM remains a strong predictor of periprocedural mortality. However, this detrimental effect of DM may be partially explained by the overall higher risk profile of diabetic patients.
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Affiliation(s)
- Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Barbara Zdzierak
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Krzysztof P. Malinowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Wojciech Zasada
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Tomasz Tokarek
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Michał Zabojszcz
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland
| | | | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Andrzej Surdacki
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-22-50
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Rakowski T, Wegiel M, Malinowski K, Siudak Z, Zasada W, Tokarek T, Rzeszutko L, Dudek D, Bartus S, Surdacki A, Dziewierz A. Contemporary approach to thrombus containing lesions during primary percutaneous coronary interventions in ST-segment elevation myocardial infarction (from the ORPKI National Registry in Poland). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1418] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the era of potent P2Y12 inhibitors, according to current guidelines on ST-segment elevation myocardial infarction (STEMI), treatment with glycoprotein IIb/IIIa inhibitors (GPI) should be limited to selected bail-out or highly thrombotic situations. Similarly, aspiration thrombectomy (AT) is downgraded in current guidelines for very selective but not routine usage. Both recommendations make the treatment of thrombus containing lesions somewhat defensive, underlining the need for an individualized approach to STEMI patients. However, data concerning current clinical practice of such approach are limited.
Purpose
We examined the prevalence, procedural characteristics, and predictors of GPI administration and AT usage in all-comers contemporary STEMI patients referred to primary PCI in Poland.
Methods
We focused on 116,873 consecutive STEMI patients undergoing primary PCI in Poland between 2015 and 2020.
Results
GPIs were administered in 29.3% of patients and AT was used in 11.6%, with combined treatment with GPI and AT in 6.1% of patients. There was a slight trend towards a decrease in GPI and AT usage during the analyzed years. On the opposite, there was a rapid growth of the ticagrelor/prasugrel usage rate from 6.5% in 2015 to 48.1% in 2020 (Figure 1). Patients with periprocedural GPI administration and combined strategy with GPI and AT were younger, more often men, with history of smoking and presented with cardiogenic shock on admission. They were less likely to have diabetes, chronic kidney disease and previous stroke. Occluded infarct-related artery in baseline angiography and no-reflow during PCI were the strongest independent predictors of GPI administration and combined usage of GPI and AT in a multivariate logistic regression model. Similarly, administration of ticagrelor/prasugrel was an independent predictor of both adjunctive treatment strategies (see table for details).
Conclusions
Despite the rapid growth of potent P2Y12 inhibitors usage in Poland in recent years, GPI and AT are selectively used at a stable level during primary PCI in highly thrombotic STEMI lesions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Rakowski
- Jagiellonian University Medical College , Krakow , Poland
| | - M Wegiel
- Jagiellonian University Medical College , Krakow , Poland
| | - K Malinowski
- Jagiellonian University Medical College , Krakow , Poland
| | - Z Siudak
- Jan Kochanowski University , Kielce , Poland
| | - W Zasada
- Jagiellonian University Medical College , Krakow , Poland
| | - T Tokarek
- Jagiellonian University Medical College , Krakow , Poland
| | - L Rzeszutko
- Jagiellonian University Medical College , Krakow , Poland
| | - D Dudek
- Jagiellonian University Medical College , Krakow , Poland
| | - S Bartus
- Jagiellonian University Medical College , Krakow , Poland
| | - A Surdacki
- Jagiellonian University Medical College , Krakow , Poland
| | - A Dziewierz
- Jagiellonian University Medical College , Krakow , Poland
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Quantitative flow ratio for evaluation of borderline coronary lesions in patients with severe aortic stenosis. Rev Esp Cardiol (Engl Ed) 2022; 75:472-478. [PMID: 34024746 DOI: 10.1016/j.rec.2021.04.008] [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] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Quantitative flow ratio (QFR) is a novel noninvasive method for evaluating coronary physiology. However, data on the QFR in patients with aortic stenosis (AS) and coronary artery disease are scarce. Thus, we compared the diagnostic performance of the QFR with that of the resting distal to aortic coronary pressure (Pd/Pa) ratio, fractional flow reserve (FFR), and instantaneous wave-free ratio (iFR), as well as angiographic indices. METHODS A total of 221 AS patients with 416 vessels undergoing FFR/iFR measurements were enrolled in the study. RESULTS The mean percent diameter stenosis (%DS) was 58.6%±13.4% and the mean Pd/Pa ratio, FFR, iFR, and QFR were 0.95±0.03, 0.85±0.07, 0.90±0.04, and 0.84±0.07, respectively. A FFR ≤ 0.80 was noted in 26.0% of interrogated vessels, as well as an iFR ≤ 0.89 in 33.2% and QFR ≤ 0.80 in 31.7%. The QFR had better agreement with FFR (intraclass correlation coefficient [ICC], 0.96; 95% confidence interval [95%CI], 0.95-0.96) than with the iFR (ICC, 0.79; 95%CI, 0.75-0.82) and Pd/Pa ratio (ICC, 0.52; 95%CI, 0.44-0.58). In addition, the QFR showed better diagnostic accuracy (98.6% vs 94.2%; P <.001) and discriminant function (area under the curve=0.996 vs 0.988; P <.001) when the iFR was used as the reference instead of FFR. CONCLUSIONS In patients with AS, the QFR has good agreement with both FFR and iFR. However, the agreement appears to be even better when the iFR is used as the reference, presumably due to the complex nature of the coronary physiology in the assessment of coronary artery disease in patients with severe AS.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
| | - Artur Dziewierz
- 2(nd) Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Lukasz Rzeszutko
- 2(nd) Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2(nd) Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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Rakowski T, Dziewierz A, Węgiel M, Siudak Z, Zasada W, Jąkała J, Dykla D, Matysek J, Surdacki A, Bartuś S, Dudek D, Wojdyła R. Risk factors of contrast-induced nephropathy in patients with acute coronary syndrome. Kardiol Pol 2022; 80:760-764. [PMID: 35521717 DOI: 10.33963/kp.a2022.0123] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization, higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed. AIMS We aimed to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment. METHODS A total of 2638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 μmol/l) increase in the absolute value. RESULTS Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referred for other treatment strategies (P < 0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was an independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P < 0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN. CONCLUSIONS Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation, and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.
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Affiliation(s)
- Tomasz Rakowski
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Artur Dziewierz
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Węgiel
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Zasada
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Jacek Jąkała
- Krakow Center of Invasive Cardiology, Electrotherapy and Angiology, Kraków, Poland
| | - Dominika Dykla
- Center of Invasive Cardiology, Electrotherapy and Angiology in Nowy Sącz, Nowy Sącz, Poland
| | - Jerzy Matysek
- Krakow Center of Invasive Cardiology, Electrotherapy and Angiology, Kraków, Poland
| | - Andrzej Surdacki
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Roman Wojdyła
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
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Węgiel M, Kleczyński P, Dziewierz A, Rzeszutko Ł, Surdacki A, Bartuś S, Rakowski T. Frailty as a Predictor of In-Hospital Outcome in Patients with Myocardial Infarction. J Cardiovasc Dev Dis 2022; 9:jcdd9050145. [PMID: 35621856 PMCID: PMC9145424 DOI: 10.3390/jcdd9050145] [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: 03/08/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay.
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Affiliation(s)
- Michał Węgiel
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Krakow, Poland;
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland;
| | - Artur Dziewierz
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Łukasz Rzeszutko
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Andrzej Surdacki
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Stanisław Bartuś
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
| | - Tomasz Rakowski
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; (A.D.); (Ł.R.); (A.S.); (S.B.)
- Correspondence: ; Tel.: +48-12-4002200
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Dziewierz A, Rzeszutko Ł, Dudek D, Legutko J, Kleczyński P. Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis. Kardiol Pol 2022; 80:1217-1223. [PMID: 35979641 DOI: 10.33963/kp.a2022.0194] [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: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The validity of functional assessment of coronary artery disease with fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR) in patients with severe aortic stenosis (AS) might be affected by AS per se and other factors, including diabetes mellitus. AIMS We aimed to evaluate the impact of diabetic status on FFR performance in severe AS. METHODS The functional significance of 416 stenoses of intermediate angiographic severity in 221 patients with severe AS was assessed with iFR and FFR. Patients treated with insulin or oral hypoglycemic agents were classified as diabetic patients. RESULTS Of 221 enrolled patients, 68 (32.1%) patients were diabetic. A total of 128 (30.8%) lesions in patients with and 288 in patients without diabetes mellitus were assessed. The mean (SD) FFR was 0.85 (0.07), and iFR was 0.90 (0.04) with no difference between nondiabetic and diabetic patients. Good agreement between iFR and FFR was confirmed for non-diabetic (ICC, 0.83 [95% confidence interval, CI, 0.79-0.86]) and diabetic (ICC, 0.82 [95% CI, 0.76-0.87]) patients. Among patients without diabetes mellitus, the optimal cutoff value for FFR to detect iFR ≤0.89 was 0.81 with sensitivity and specificity of 96.6% and 100.0%. The optimal cutoff value for FFR to detect iFR ≤0.89 for diabetic patients was 0.83 with sensitivity and specificity of 98.0% and 100.0%. CONCLUSIONS In patients with severe AS, FFR correlates well with iFR. However, the optimal threshold for FFR to identify significant ischemia (iFR ≤0.89) in those patients may differ from the standard threshold of FFR ≤0.80 and might be affected by the diabetic status.
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Affiliation(s)
- Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.,Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Łukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland.,Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland
| | - Dariusz Dudek
- Digital Medicine & Robotics Center, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland.,Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland. .,Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland.
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Węgiel M, Wojtasik-Bakalarz J, Malinowski K, Surmiak M, Dziewierz A, Sorysz D, Tokarek T, Dudek D, Bartuś S, Surdacki A, Rakowski T. Mid-regional pro-adrenomedullin and lactate dehydrogenase as predictors of left ventricular remodeling in patients with myocardial infarction treated with percutaneous coronary intervention. Pol Arch Intern Med 2021; 132. [PMID: 34846110 DOI: 10.20452/pamw.16150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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
BACKGROUND The main impact of myocardial infarction (MI) is shifting from acute mortality to adverse remodeling, chronic left ventricle (LV) dysfunction and heart failure. OBJECTIVES The aim of this study was to assess relationships between levels of circulating biomarkers and function of LV after MI. PATIENTS AND METHODS Prospective study of 80 patients with MI treated with percutaneous coronary interventions (PCI). Novel biomarkers including mid-regional pro-adrenomedullin (MR-proADM), Notch-1, syndecan-4, myeloperoxidase, S-100 protein, soluble ST-2, as well as markers of inflammatory response and tissue injury: galectin-3, C-reactive protein (CRP), lactate dihydrogenase (LDH) and interleukin-6 (IL-6) were assessed in the acute phase of MI. Echocardiography was performed at baseline and 6 months. RESULTS Adverse remodeling, defined as >20% increase in LV end-diastolic volume occurred in 26% of patients. Reverse remodeling (>10% reduction in LV end-systolic volume) was observed in 52% of patients. In a univariable analysis higher levels of MR-proADM and LDH were predictors of adverse remodeling and higher levels of MR-proADM, LDH, CRP and Il-6 were negative predictors of reverse remodeling. In a multivariable model LDH remained an independent predictor of adverse remodeling (OR: 3.13; 95%CI: 1.42-8.18; P=0.003) and negative predictor of reverse remodeling (OR: 0.37; 95%CI: 0.17-0.8; P=0.005). CONCLUSIONS LDH and MR-proADM seem to be promising biomarkers of adverse remodeling. On the other hand, higher levels of these biomarkers were associated with reduced chance of occurrence of favorable reverse remodeling in MI patients. However, further studies on larger groups of patients are necessary to confirm this data.
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Affiliation(s)
- Michał Węgiel
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof Malinowski
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Surmiak
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Sorysz
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, Kraków, Poland
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, Kraków, Poland
- Center for Intensive Care and Perioperative Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow, Kraków, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Rakowski
- Second Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland.
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Tokarek T, Dziewierz A, Malinowski K, Rakowski T, Bartus S, Dudek D, Siudak Z. Treatment delay and clinical outcomes in patients with ST-elevation myocardial infarction during the COVID-19 pandemic. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1470] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic negatively affected access to health-care system and timeline of treatment. The fear of contamination might potentially forbear from accessing the emergency system.mFurthermore, pandemic-specific protocols require additional time to prepare medical stuff and catheterization laboratory before procedure. Thus, patients with ST-segment elevation myocardial infarction (STEMI) might be exposed to a longer delay for revascularization and higher risk of mortality.
Purpose
The aim of this study was to evaluate treatment delay and clinical outcomes in COVID-19 positive and negative patients with STEMI treated with percutaneous coronary intervention (PCI) during on- and off hours.
Methods
All consecutive patients with STEMI treated with PCI and stent implantation between 1st March 2020 and 31st December 2020 were enrolled into analysis. To overcome potential bias related to the non-randomized design a propensity score match (PSM) was used to compare COVID-19 positive and negative patients for both working frames hours. The study group consisted of 877 matched pairs treated during regular hours (everyday 7:00AM-16:59PM) and 418 matched pairs with PCI performed during off-hours (everyday 17:00PM and 06:59AM) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry).
Results
After PSM there were no differences between COVID-19 positive and negative patients in baseline characteristics during both on- and off-hours. However, patients diagnosed with COVID-19 were admitted with cardiac arrest more frequently as compared to COVID-19 negative patients during regular working hours (180 (20.5%) vs. 64 (7.30%); p=0.001). There were no differences in radiation doses and total amount of contrast between both groups. Similarly, no differences in rate of periprocedural complications were observed despite of time of intervention, including stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. Furthermore, there were no differences in periprocedural mortality between both groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%),p=0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%),p=0.5). However, COVID-19 positive patients were exposed to longer time from first medical contact to angiography during both on-hours (133.76 (±137.10) vs. 117.14 (±135.83) [min]; p=0.001) and off-hours (148.08 (±201.56) vs. 112.19 (±138.72) [min]; p=0.003). Time from pain to first medical contact remained similar during both working frame hours (On-hours and off-hours, respectively: p=0.7 and p=0.9).
Conclusions
Patients diagnosed with COVID-19 might experience a longer time from first medical contact to revascularization. There was no impact of COVID-19 diagnosis on rate of periprocedural mortality or periprocedural complication, irrespective of time of intervention. System-level changes might be crucial to improve health-care during COVID-19 pandemic.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Tokarek
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - A Dziewierz
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - K Malinowski
- Jagiellonian University Medical College, Cracow, Poland
| | - T Rakowski
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - S Bartus
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - D Dudek
- Jagiellonian University Medical College, Cracow, Poland
| | - Z Siudak
- The Jan Kochanowski University in Kielce, Kielce, Poland
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Kleczynski P, Kulbat A, Brzychczy P, Dziewierz A, Trebacz J, Stapor M, Sorysz D, Rzeszutko L, Bartus S, Dudek D, Legutko J. Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy. J Clin Med 2021; 10:jcm10204657. [PMID: 34682783 PMCID: PMC8538854 DOI: 10.3390/jcm10204657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/13/2022] Open
Abstract
The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55-2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62-3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
- Correspondence:
| | - Aleksandra Kulbat
- Students’ Scientific Group at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (A.K.); (P.B.)
| | - Piotr Brzychczy
- Students’ Scientific Group at the Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (A.K.); (P.B.)
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Jaroslaw Trebacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
| | - Maciej Stapor
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
| | - Danuta Sorysz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Stanislaw Bartus
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (D.S.); (L.R.); (S.B.); (D.D.)
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland; (J.T.); (M.S.); (J.L.)
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Zasada W, Bobrowska B, Plens K, Dziewierz A, Siudak Z, Surdacki A, Dudek D, Bartuś S. Acute myocardial infarction in young patients. Kardiol Pol 2021; 79:1093-1098. [PMID: 34472075 DOI: 10.33963/kp.a2021.0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is an incredibly destructive disease when it occurs in a young patient. Thus, the investigation of the disease presentation and treatment options seem to be particularly important in young patients with AMI. AIMS The study objective was to investigate the differences between young and older patients diag-nosed with AMI in terms of clinical characteristics and treatment strategies. METHODS The patient data comes from the National Registry of Procedures of Invasive Cardiology (ORPKI). Between 2014 and 2017, data of more than 230 000 patients with a diagnosis of AMI were collected in that registry. Young patients were defined as under 40 years old. RESULTS Young patients with AMI (n = 3208, 1.3%) compared with older patients with AMI were more often men (86.3% vs. 65.8%; P <0.001) with higher body weight (mean 85.9 vs. 79.7 kg; P <0.001). Typical risk factors of coronary heart disease were less frequent in younger patients than in older patients. However, in the under-40 group, there was a significantly higher number of current smokers (37.5% vs. 23.0%; P <0.001). Young patients with AMI were more often diagnosed with ST-segment elevation myocardial infarction (STEMI; 62.0% vs. 50.0%; P <0.001). Moreover, they had more frequently non-significant ste-nosis in coronary arteries diagnosed (14.4% vs. 6.8%; P <0.001). The left anterior descending artery was more frequently an infarct-related artery in young patients (51.3% vs. 36.3%; P <0.001). Bioresorbable vascular scaffolds were more commonly implanted in young patients with AMI than in the older ones (5.6% vs. 0.9%; P <0.001). The relative number of AMI in the young patients increased from 1.20% in 2014 to 1.43% in 2017. CONCLUSIONS Smoking is the most common risk factor in young adults. The relative number of AMI in young patients is growing.
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Affiliation(s)
- Wojciech Zasada
- KCRI, Kraków, Poland. .,Department of Cardiology, University Hospital, Kraków, Poland.
| | - Beata Bobrowska
- Department of Cardiology, University Hospital, Kraków, Poland
| | | | - Artur Dziewierz
- KCRI, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Andrzej Surdacki
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Department of Cardiology, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology, University Hospital, Kraków, Poland.,Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Hyperemic versus non-hyperemic indexes for coronary physiology assessment in patients with severe aortic stenosis. Adv Med Sci 2021; 66:366-371. [PMID: 34315011 DOI: 10.1016/j.advms.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Recent data suggests that fractional flow reserve (FFR) may underestimate intermediate coronary stenosis in the presence of severe aortic stenosis (AS), whereas instantaneous wave-free ratio (iFR) values may remain similar after treatment of AS, yet the evidence still lacks to use iFR as the reference. We aimed to compare FFR/iFR values in the AS setting. MATERIALS AND METHODS The functional significance of 416 coronary lesions in 221 patients with severe AS was investigated with iFR and FFR. RESULTS The diagnostic agreement between iFR and FFR has been tested, using the cut-off value of 0.89 for iFR and 0.80 for FFR. The mean diameter stenosis was 58.6 ± 13.4% with FFR of 0.85 ± 0.07 and iFR of 0.90 ± 0.04. FFR ≤0.80 was identified in 26.0% and iFR≤0.89 in 33.2% of interrogated vessels. Good agreement between iFR and FFR was confirmed (Intraclass Correlation Coefficient 0.83 [95%CI 0.79-0.85]). The overall diagnostic accuracy (AUC in ROC analysis) of FFR in detecting iFR≤0.89 was 0.997 (95%CI 0.986 to 1.000; p<0.001) and of iFR in detecting FFR≤0.80 was 0.995 (95%CI 0.983 to 0.999; p<0.001). The optimal cut-off value for FFR to detect iFR≤0.89 was 0.82 with sensitivity, specificity, and accuracy of 97.1%, 98.9%, and 97.7%, respectively, and for IFR to detect FFR≤0.80 was 0.88 with sensitivity, specificity, and accuracy of 99.1%, 95.8%, and 97.4%, respectively. CONCLUSION In the presence of AS, FFR has good agreement with iFR. However, the optimal FFR/iFR threshold to identify iFR≤0.89/FFR≤0.80 may be different from the standard thresholds of ischemia.
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Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
| | - Artur Dziewierz
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Lukasz Rzeszutko
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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Tokarek T, Dziewierz A, Malinowski KP, Rakowski T, Bartuś S, Dudek D, Siudak Z. Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic. J Clin Med 2021; 10:jcm10173920. [PMID: 34501369 PMCID: PMC8432080 DOI: 10.3390/jcm10173920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 02/02/2023] Open
Abstract
Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%); p = 0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%); p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min); p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min); p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention.
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Affiliation(s)
- Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-22-62
| | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Krzysztof Piotr Malinowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Tomasz Rakowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-369 Kielce, Poland;
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. El cociente de flujo cuantitativo en pacientes con estenosis aórtica grave y lesiones coronarias intermedias. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Tokarek T, Dziewierz A, Plens K, Rakowski T, Dudek D, Siudak Z. Radial approach reduces mortality in patients with ST-segment elevation myocardial infarction and cardiogenic shock. Pol Arch Intern Med 2021; 131:421-428. [PMID: 33739779 DOI: 10.20452/pamw.15886] [Citation(s) in RCA: 3] [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
INTRODUCTION The beneficial outcome of the radial (RA) over femoral approach (FA) in ST-segment elevation myocardial infarction (STEMI) has been widely demonstrated. However, most of the studies excluded patients with STEMI and cardiogenic shock (CS). OBJECTIVES We sought to evaluate periprocedural outcomes of percutaneous coronary intervention (PCI) with RA and FA in patients with STEMI complicated by CS using data from the Polish National PCI Registry (ORPKI). PATIENTS AND METHODS A total of 3,565 consecutive patients with STEMI and CS treated with emergent PCI and stent implantation were included. Data was collected prospectively between 2014 and 2018 from 151 tertiary primary-PCI centers in Poland. To avoid possible selection bias, a propensity score matching (PSM) was used to create 945 matched pairs treated via RA or FA. RESULTS No differences were reported in baseline characteristics, clinical presentation and delays in treatment between RA and FA after the PSM. Similar radiation doses and the total amount of contrast were used in both groups. A similar rate of periprocedural complications was observed in both RA and FA. However, RA was associated with reduced periprocedural mortality (9.4% (89) vs. 18.6% (176); P=0.001) and lower incidence of cardiac arrest (9.7% (92) vs. 16.1% (152); P=0.001). In multivariable analysis, FA was the strongest independent predictor for increased periprocedural mortality (OR 2.087, 95% CI 1.629-2.674; P=0.001). CONCLUSIONS The radial approach was associated with lower periprocedural mortality compared with FA in patients with STEMI complicated by CS. RA seems to be a valuable option in technically feasible situations.
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Affiliation(s)
- Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland; Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland,2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Tomasz Rakowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland,2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
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Kleczyński P, Dziewierz A, Rzeszutko Ł, Dudek D, Legutko J. Borderline coronary lesion assessment with quantitative flow ratio and its relation to the instantaneous wave-free ratio. Adv Med Sci 2021; 66:1-5. [PMID: 33190031 DOI: 10.1016/j.advms.2020.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/15/2020] [Accepted: 10/31/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Quantitative flow ratio (QFR) is a recently developed image-based index for the assessment of borderline coronary artery disease. We sought to investigate a correlation between QFR and instantaneous wave-free ratio (iFR) for the assessment of intermediate coronary stenoses. MATERIALS AND METHODS Patients with borderline coronary lesions (40-90% by visual assessment) undergoing iFR assessment were enrolled. QFR was derived from a modeled hyperemic flow velocity derived from angiography without adenosine-induced hyperemia. Pressure wire-derived iFR served as the reference. RESULTS Values of QFR and iFR from 110 vessels with a mean percent diameter stenosis of 44.6 ± 12.0% were compared. Mean iFR was 0.90 ± 0.07 and 38 (34.5%) had iFR ≤0.89. Mean QFR was 0.81 ± 0.10 and 44 (40%) had QFR ≤0.80. A good agreement between QFR and iFR measurements was confirmed with a mean difference of 0.09 (95%CI -0.027 to 0.207) and intraclass correlation coefficient of 0.87 (95%CI 0.81-0.91). The overall diagnostic accuracy (AUC in ROC analysis) of QFR in detecting iFR ≤0.89 was 0.87 (95%CI 0.79-0.93; p < 0.001). Regarding iFR ≤0.89, the optimal cutoff value of QFR was 0.79 with sensitivity, specificity, and accuracy of 76.3%, 83.3%, and 80.0%, respectively. A 100% sensitivity was observed for a QFR cutoff value of 0.88 and a 100% specificity for a QFR cutoff value of 0.69. CONCLUSIONS Our study confirmed good QFR diagnostic performance and correlation with iFR for detecting the functional ischemia caused by intermediate lesions in coronary arteries. However, the pressure wire assessment with iFR might be warranted in 2/3 of patients after QFR assessment.
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Tokarek T, Dziewierz A, Plens K, Rakowski T, Jaroszyńska A, Bartuś S, Siudak Z. Percutaneous coronary intervention during on- and off-hours in patients with ST-segment elevation myocardial infarction. Hellenic J Cardiol 2021; 62:212-218. [PMID: 33540055 DOI: 10.1016/j.hjc.2021.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE There are conflicting data on the clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on the time of admission to the catheterization laboratory. Thus, we aimed to assess clinical outcomes in an unselected cohort of consecutive patients with STEMI treated with PCI during on-and-off hours of work. METHODS A total of 99,783 patients were included in the analysis. Patients were divided using the most frequently used definition: On-hours (Monday-Friday 07:00 AM-04:59 PM); off-hours (Monday-Friday 05:00 PM-06:59 AM, Saturday, Sunday, and nonworking holidays) (37,469 matched pairs). To avoid potential preselection bias, a propensity score was calculated to compare on-and-off hour groups. RESULTS Higher radiation doses were observed for PCIs performed during off-hours (1055.2(±1006.5) vs. 1081.6(±1003.25)[mGy] and p = 0.001). A similar prevalence of periprocedural complications was observed during on- and off-hours. However, there was a higher mortality rate during off-hours than during regular working hours (1.17% (439) vs. 1.49% (559) and p = 0.001). CONCLUSIONS Primary PCIs in STEMI performed during off-hours might be associated with a higher rate of periprocedural mortality and higher radiation doses than procedures conducted during regular working hours.
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Affiliation(s)
- Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland.
| | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | | | - Tomasz Rakowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Anna Jaroszyńska
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-317, Kielce, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-317, Kielce, Poland
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Wiktorowicz A, Wit A, Malinowski KP, Dziewierz A, Rzeszutko L, Dudek D, Kleczynski P. Paravalvular leak prediction after transcatheter aortic valve replacement with self-expandable prosthesis based on quantitative aortic calcification analysis. Quant Imaging Med Surg 2021; 11:652-664. [PMID: 33532265 DOI: 10.21037/qims-20-669] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Paravalvular leak (PVL) is one of the most common complications of transcatheter aortic valve replacement (TAVR) and affects short- and long-term outcomes. The aim of this study was to identify the computed tomography (CT) imaging biomarkers that allow PVL after TAVR to be predicted. Methods Patients were included who had severe aortic valve stenosis, had undergone TAVR with a self-expanding valve, and had undergone a pre-procedural CT scan. Data on baseline characteristics, procedural and long-term outcomes were collected retrospectively. We used MATLAB software with a self-developed algorithm for CT scan analysis and found parameters that quantified aortic valve calcifications (AVC) in detail. Results Fifty patients were included. The identified CT-derived parameters included AVC size, volume, thickness and density, as well as calcium radial distribution. The volume of the largest calcium block, calcium perimeter and calcium size (assessed by Feret's diameter) showed a strong association with PVL occurrence after TAVR (P=0.012, P=0.001 and P=0.045, respectively). The prognostic model showed that a 10 mm2 increase in the local AVC amount in each valve section was associated with a 9.8% (95% CI: 2-18%; P=0.019) increase in the risk of PVL occurrence in the corresponding area after TAVR. ROC analysis revealed that the cut-off point of the AVC area was 96.5 mm2 in the polar coordinate system presentation. Kaplan-Meier curves showed worse PVL-free survival in patients with more than 96.5 mm2 of calcium area (P=0.013; log-rank). Conclusions Quantitative AVC assessment for PVL prediction may play an important role in screening before TAVR. In future, the use of quantitative AVC assessment as an imaging biomarker in TAVR candidates and the creation and extension of an online database containing quantitative AVC parameters may help to identify high PVL risk patients.
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Affiliation(s)
- Agata Wiktorowicz
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Adrian Wit
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, 30-059 Krakow, Poland
| | - Krzysztof Piotr Malinowski
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Artur Dziewierz
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Lukasz Rzeszutko
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Dariusz Dudek
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Pawel Kleczynski
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland
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Januszek R, Siudak Z, Dziewierz A, Rakowski T, Dudek D, Bartuś S. Long-term outcomes of percutaneous coronary interventions within coronary artery bypass grafts. Arch Med Sci 2021; 17:628-637. [PMID: 34025832 PMCID: PMC8130480 DOI: 10.5114/aoms.2018.75608] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/22/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses. MATERIAL AND METHODS We enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG) and death. The mean follow-up was 964 ±799.1 days and was completed among 156 patients. Multivariate analysis was used to assess determinants of study endpoints during follow-up. Moreover, we compared survival curves according to the type of PCI and presence of anti-embolic protection. RESULTS The primary endpoint of the study occurred in 59.7% of patients after the mean time of 669.6 ±598.7 days. The TVR occurred in 37.9% of individuals, TLR in 24.2%, MI in 26.3%, stroke in 4.2%, CABG in 2.1% and death in 30.5% of patients. In Cox multivariate analysis, PCI of two or more bypasses (p < 0.01), post-dilatation (p < 0.05) and no-reflow (p < 0.05) were the independent determinants of the primary study endpoint. No significant impact of anti-embolic protection devices on long-term outcomes was observed. CONCLUSIONS Percutaneous coronary interventions of two or more bypasses, post-dilatation and no-reflow are predictors of worse outcome in patients undergoing PCI within coronary artery bypass grafts.
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Affiliation(s)
- Rafał Januszek
- Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Artur Dziewierz
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Januszek R, Dziewierz A, Siudak Z, Rakowski T, Kameczura T, Tokarek T, Dudek D, Bartuś S. Concomitant multi-vessel disease is associated with a lower procedural death rate in patients treated with percutaneous coronary interventions within the left main coronary artery (from the ORPKI registry). Arch Med Sci 2021; 17:881-890. [PMID: 34336016 PMCID: PMC8314404 DOI: 10.5114/aoms.2019.82666] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In this study, we aimed to distinguish differences in the procedural complication rate in a group of patients undergoing percutaneous coronary interventions (PCI) of the left main coronary artery (LMCA) between patients with isolated LMCA disease and multi-vessel disease (MVD) with LMCA involvement and to identify their predictors. MATERIAL AND METHODS We assessed 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) regarding all PCI procedures performed in Poland in 2015 and 2016. We extracted data of 1,819 patients with isolated LMCA disease and 3,718 patients with MVD and LMCA involvement. We compared those two groups in terms of procedural complications and their predictors. RESULTS The overall rate of procedural complications was significantly higher in patients treated with LMCA PCI both in the group of patients with isolated LMCA (6.5%) and the group with MVD with LMCA involvement (7.3%) compared to the non-LMCA PCI group (1.9%, p = 0.002). Multivariate analysis confirmed that MVD with LMCA involvement is an independent predictor of decreased risk of procedural death in the overall group of patients undergoing PCI of the LMCA (odds ratio: 0.583; 95% confidence interval: 0.4-0.848; p = 0.005). CONCLUSIONS The MVD involvement in patients treated with PCI of the LMCA may play a protective role. Patients with isolated LMCA involvement undergoing PCI should be subjected to special care and protected by various methods, such as devices to support left ventricle function.
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Affiliation(s)
- Rafał Januszek
- Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland
| | - Artur Dziewierz
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Rakowski
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Kameczura
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Tomasz Tokarek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Dariusz Dudek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- 2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Chyrchel M, Gębska M, Dziewierz A, Rzeszutko Ł, Surdacki A. Recurrent stent thrombosis in a patient with neurofibromatosis type 1. Kardiol Pol 2020; 79:91-92. [PMID: 33394578 DOI: 10.33963/kp.15722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tokarek T, Dziewierz A, Plens K, Rakowski T, Januszek R, Zabojszcz M, Janion-Sadowska A, Dudek D, Siudak Z. Comparison of safety and effectiveness between the right and left radial artery approach in percutaneous coronary intervention. ACTA ACUST UNITED AC 2020; 75:119-128. [PMID: 33221180 DOI: 10.1016/j.rec.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES There is a paucity of data comparing the left radial approach (LRA) and right radial approach (RRA) for percutaneous coronary intervention (PCI) in all-comers populations and performed by operators with different experience levels. Thus, we sought to compare the safety and clinical outcomes of the RRA and LRA during PCI in "real-world" patients with either stable angina or acute coronary syndrome (ACS). METHODS To overcome the possible impact of the nonrandomized design, a propensity score was calculated to compare the 2 radial approaches. The study group comprised 18 716 matched pairs with stable angina and 46 241 with ACS treated with PCI and stent implantation between 2014 and 2017 in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry). RESULTS The rates of death and periprocedural complications were similar for the RRA and LRA in stable angina patients. A higher radiation dose was observed with PCI via the LRA in both clinical presentations (stable angina: 1067.0±947.1 mGy vs 1007.4±983.5 mGy, P=.001; ACS: 1212.7±1005.5 mGy vs 1053.5±1029.7 mGy, P=.001). More contrast was used in LRA procedures but only in ACS patients (174.2±75.4mL vs 167.2±72.1mL, P=.001). Furthermore, periprocedural complications such as coronary artery dissection (0.16% vs 0.09%, P=.008), no-reflow phenomenon (0.65% vs 0.49%, P=.005), and puncture site bleeding (0.09% vs 0.05%, P=.04) were more frequently observed with the LRA in ACS patients. There was no difference in mortality between the 2 groups (P=.90). CONCLUSIONS Our finding of poorer outcomes with the LRA may be related to lower operator experience with this approach. While both the LRA and RRA are safe in the setting of stable angina, the LRA was associated with a higher rate of periprocedural complications during PCI in ACS patients.
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Affiliation(s)
- Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Artur Dziewierz
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Plens
- Krakow Cardiovascular Research Institute LTD, Krakow, Poland
| | - Tomasz Rakowski
- 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Januszek
- Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland
| | - Michał Zabojszcz
- Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland
| | | | - Dariusz Dudek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland; 2(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland.
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Comparison of iFR and FFR for coronary physiology evaluation in patients with severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2479] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Reliable coronary physiology assessment with pressure derived indexes in patients with aortic stenosis (AS) rises problems due to its complex nature. Recent data suggest that fractional flow reserve (FFR) may underestimate intermediate coronary stenosis in a presence of AS whereas instantaneous wave-free ratio (iFR) values may remain similar after treatment of AS. Furthermore, both indices has not been validated yet in AS.
Aim
We aimed to find a thresholds for coronary ischemia in the setting of aortic
Material and methods
The functional significance of 416 coronary lesions was investigated with iFR and FFR measurements in 221 AS patients. The iFR-FFR diagnostic agreement has been tested using the cut-off value for iFR of 0.89.
Results
Mean value of %DS was 58.6±13.4%, FFR was 0.85±0.07 and iFR – 0.90±0.04. FFR ≤0.80 was measured in 26.0% of interrogated vessels, iFR ≤0.89 – in 33.2%. The correlation between iFR and FFR was good (r=0.83, p<0.001) and with good agreement between iFR and FFR (mean difference −0.0059, 95% CI −0.056–0.062). The AUC at ROC curve analysis for iFR ≤0.89 was 0,997 (0,986 to 1,000, p<0.001) for FFR. According to ROC analysis, the best FFR cut-off in predicting iFR ≤0.89 was ≤0.82 (J=0.96). The diagnostic accuracy for identifying iFR ≤0.89 was 97.7% for FFR.
Conclusion
In the presence of AS, FFR had good agreement with iFR values. However, FFR threshold for predicting iFR below 0.89 may be different from a standard threshold and that should be taken into account while assessing coronary physiology in the setting of AS.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Center
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Affiliation(s)
- P Kleczynski
- Jagiellonian University Medical College, Cracow, Poland
| | - A Dziewierz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - L Rzeszutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - D Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - J Legutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Kleczynski P, Dziewierz A, Rzeszutko L, Dudek D, Legutko J. Comparison of FFR with iFR and QFR in assessment of intermediate coronary artery disease in patients with severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2475] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The functional assessment of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) has been barely examined so far, and the best strategy to physiologically investigate the relevance of coronary stenosis in this specific setting of patients remains undetermined. The aim of the study is to compare the diagnostic performance of instantaneous wave-free ratio (iFR), quantitative flow ratio (QFR) and fractional flow reserve (FFR) in patients with severe AS.
Methods
The functional significance of 416 coronary lesions was investigated with iFR, FFR and QFR measurements in 221 AS patients. The iFR-FFR and QFR-FFR diagnostic agreement has been tested using the conventional 0.80 FFR cut-off.
Results
Mean value of FFR was 0.85±0.07; iFR – 0.90±0.04; QFR – 0.84±0.07. The correlation between iFR and FFR was good (r=0.83, p<0.001) and QFR and FFR was goot too (r=0.77, p<0.001), as well as the area under the curve at ROC curve analysis 0,995 (0,983 to 0,999, p<0.001) for iFR and 0,988 (0,972 to 0,996, p<0.001) for QFR. However, using the standard iFR 0.89 and QFR 0.8 threshold, the diagnostic accuracy of iFR was 100% sensitivity and 90.26% specificity and for QFR – 100% and 92.21%, respectively. According to ROC analysis, the best iFR cut-off in predicting FFR ≤0.8 was 0.88 (J=0.94), the best QFR cut-off value was 0.80 (J=0.92).
Conclusions
In the presence of severe AS, iFR and QFR had good agreement with FFR values for assessment of borderline coronary lesions. However, iFR threshold for predicting FFR below 0.8 may be different from a standard value of 0.89.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre
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Affiliation(s)
- P Kleczynski
- Jagiellonian University Medical College, Cracow, Poland
| | - A Dziewierz
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - L Rzeszutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - D Dudek
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - J Legutko
- Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Tokarek T, Dziewierz A, Plens K, Rakowski T, Zabojszcz M, Dudek D, Siudak Z. Percutaneous coronary intervention during on- and off-hours in patients with ST-segment elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1779] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
There are conflicting data on the clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on time of intervention. Concerns have been postulated regarding equally effective in-hospital outcomes for STEMI patients treated with PCI during normal working hours as compared to group treated off-hours.
Purpose
The aim of this study was to assess clinical outcomes in “real-world” patients with STEMI treated with PCI during off-hours and regular hours of work.
Methods
To avoid possible bias related to the non-randomized design, a propensity score was calculated to compare off- and on-hours groups. The study group consisted of 37, 469 matched pairs in STEMI treated with PCI and stent implantation between 2014 and 2018 during regular hours (weekdays 7:00 AM to 16:59 PM) and off-hours (weekdays between 17:00 PM and 06:59AM, weekends, and holidays) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry).
Results
No differences were reported between both groups in baseline characteristics after the propensity score match (PSM). There were no differences in time from pain to first contact (p=0.2) and door to balloon time between both groups (p=0.7). After PSM higher radiation dose was observed in off-hours group (1055.18 (±1006.52) vs. 1081.59 (±1003.25)[mGy]; p=0.001). However, there was no difference in total amount of contrast (on-hours vs. off-hours: 175.69 (±74.71) vs. 176.48 (±74.41)[ml]; p=0.1, respectively). Similar rate of periprocedural complications was observed between both groups of patients, includind stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. However, procedures performed during off-hours were associated with higher incidence of periprocedural death (1.17% (439) vs. 1.49% (559); p=0.001) and periprocedural cardiac arrest (1.76% (658) vs.1.97% (740); p=0.001) as compared to PCI conducted within normal working hours.
Conclusions
Percutaneous coronary intervention in STEMI performed durgin off-hours might be associated with higher rate of periprocedural mortality and higher radiation dose as compared to procedures conducted during regular working hours.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Tokarek
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - A Dziewierz
- Jagiellonian University, 2nd Department of Cardiology, Institute of Cardiology, Krakow, Poland
| | | | - T Rakowski
- Jagiellonian University, 2nd Department of Cardiology, Institute of Cardiology, Krakow, Poland
| | - M Zabojszcz
- The Jan Kochanowski University, Kielce, Poland
| | - D Dudek
- University Hospital, Department of Cardiology and Cardiovascular Interventions, Krakow, Poland
| | - Z Siudak
- The Jan Kochanowski University, Kielce, Poland
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Sorysz D, Dziewierz A, Bagieński M, Parma R, Grygier M, Dębiński M, Kübler P, Stąpór M, Jagielak D, Kleczyński P, Bartuś S, Dudek D. Early results of the ongoing Polish Registry of Valve Thrombosis after Transcatheter Aortic Valve Implantation (ZAK‑POLTAVI). Kardiol Pol 2020; 78:681-687. [PMID: 32543799 DOI: 10.33963/kp.15426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 Conflicting data exist regarding the risk factors for transcatheter heart valve thrombosis (THVT). In addition, no optimal pharmacological strategy to treat THVT has been established so far Aims: The aim of this study was to assess the incidence, risk factors, diagnostic workup, and treatment of THVT in Poland. METHODS Data were collected retrospectively in themulticenter registry of patients with THVT (ZAK‑POLTAVI) between November 2008 and November 2018. Transcatheter heart valve thrombosis was defined as an increased mean transvalvular gradient accompanied by a decreased effective orifice area or severe aortic regurgitation, reversible after treatment. Baseline characteristics and procedural data were compared between patients with THVT and those without THVT (matched by age, sex, and diabetic status). RESULTS In a group of 2307 patients undergoing transcatheter aortic valve implantation (TAVI), 26 patients with THVT were identified (incidence, 1.14%). In half of the patients, THVT was diagnosed within 6 months after TAVI. As compared with the control group, patients with THVT more frequently had chronic obstructive pulmonary disease (P = 0.035), a smaller aortic valve area (P = 0.007), a higher mean postprocedural transvalvular gradient (P = 0.037), and a lower platelet count (P = 0.029) at the time of the diagnosis. A total of 24 patients (84.6%) received anticoagulation therapy for THVT, and complete resolution of THVT was noted in 12 individuals (46.1%). We observed thromboembolic complications in 2 patients (7.7%). CONCLUSIONS Transcatheter heart valve thrombosis is a rare complication of TAVI. However, a higher risk of THVT may be expected in patients with chronic obstructive pulmonary disease, a smaller aortic valve area, a higher mean postprocedural transvalvular gradient, and a lower platelet count. Anticoagulation alone or combined with antiplatelet therapy seems to be the optimal pharmacological treatment in this population.
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Affiliation(s)
- Danuta Sorysz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jagiellonian University Medical College, Kraków, Poland.
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Bagieński
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Radosław Parma
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Dębiński
- 1st Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Piotr Kübler
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Maciej Stąpór
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Paweł Kleczyński
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Dariusz Dudek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jagiellonian University Medical College, Kraków, Poland; 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
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