Jasińska-Gniadzik K, Łomiak M, Pręgowski J
… +20 more, Chmielak Z, Kasprzyk P, Kasprzyk J, Gałąska R, Chmielecki M, Jaguszewski MJ, Fijałkowski M, Topolska A, Sekuła M, Grabowski M, Kochman J, Rdzanek A, Scislo P, Kapłon-Cieślicka A, Główczyńska R, Budnik M, Piątkowski R, Kołtowski Ł, Pietrasik A, Gąsecka A
BACKGROUND: The COAPT risk score, developed based on the COAPT trial, is a tool to predict the risk of death or hospitalization for heart failure (HFH) within two years after transcatheter edge-to-edge repair (TEER) of m...BACKGROUND: The COAPT risk score, developed based on the COAPT trial, is a tool to predict the risk of death or hospitalization for heart failure (HFH) within two years after transcatheter edge-to-edge repair (TEER) of mitral regurgitation using a MitraClip device. We aimed to validate the Score in a Polish population. METHODS: Patients with severe mitral regurgitation who underwent TEER with MitraClip at three cardiology centers in Poland between November 2015 and February 2023 were included. Patients were divided into two groups based on the COAPT trail criteria: COAPT eligible and COAPT non-eligible. Clinical data were collected from medical records and the COAPT risk score was calculated for each patient. Outcomes were collected during the two-year follow-up period. The primary endpoint was a composite of all-cause mortality and HFH at two-year follow-up and evaluated in the overall cohort and separately for COAPT-eligible and -non-eligible patients. RESULTS: A total of 225 patients were included in the study: 134 COAPT eligible (60%) and 91 COAPT non-eligible (40%). Higher COAPT risk score was associated with increased risk of primary endpoint in the overall population and in COAPT-eligible patients. The score demonstrated moderate discrimination (area under curve [AUC] = 0.581) and poor calibration (Hosmer-Lemeshow [HL] p = 0.085) in the overall population, whereas it showed moderate discrimination (AUC = 0.600) and good calibration (HL p = 0.308) in COAPT-eligible patients. CONCLUSIONS: In Polish patients fulfilling COAPT criteria, the COAPT risk score has moderate predictive value for post-procedural outcomes. In COAPT non-eligible patients, novel tools are required to predict outcomes.
BACKGROUND: Our study compared the effect of P2Y12 receptor inhibitors in combination with abciximab on clinical outcomes in patients with acute coronary syndrome (ACS). METHODS: Our study is retrospective, consisting of...BACKGROUND: Our study compared the effect of P2Y12 receptor inhibitors in combination with abciximab on clinical outcomes in patients with acute coronary syndrome (ACS). METHODS: Our study is retrospective, consisting of 852 consecutive ACS patients who presented to our clinic between 2015 and 2021, underwent primary percutaneous coronary intervention (PCI), and received abciximab in addition to dual antiplatelet therapy. The P2Y12 receptor inhibitors were compared in terms of in-hospital and 1-year major adverse cardiac events (MACE), and clinically significant in-hospital and 1-year bleeding complications. RESULTS: The patients' mean age was 60.4 ± 11 years, and 702 (82.4%) were male. In-hospital MACE, in-hospital mortality, 1-year MACE, and 1-year mortality were significantly higher in the clopidogrel group compared to the ticagrelor group. There was no significant difference in the development of in-hospital and 1-year bleeding between clopidogrel and the more potent P2Y12 receptor inhibitors. According to the BARC score, there was no difference in major bleeding between ticagrelor and clopidogrel (p = 0.641), but minor bleeding was significantly lower in the ticagrelor group (p < 0.001). In logistic regression analysis, the 1-year MACE rate was lower in the potent P2Y12 receptor inhibitors group compared to clopidogrel. At the same time, no association was found with short- and long-term mortality, bleeding, or in-hospital MACE. CONCLUSIONS: In our study, potent P2Y12 receptor inhibitors combined with abciximab decreased 1-year MACE without significantly increasing bleeding in ACS patients undergoing PCI compared to clopidogrel. This study suggests that potent P2Y12 receptor inhibitors can be safely used with abciximab, considering the bleeding risk.
BACKGROUND: There has been insufficient research on the assessment of exercise capacity in patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI) who exhibit inspiratory muscle weak...BACKGROUND: There has been insufficient research on the assessment of exercise capacity in patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI) who exhibit inspiratory muscle weakness (IMW). METHODS: A retrospective cohort study involving CHD patients who underwent PCI at Peking University Third Hospital Heart Rehabilitation Center between January 2019 and December 2021 was conducted. Patients who had undergone inspiratory muscle testing and cardiopulmonary exercise testing (CPET) were included, and their clinical data were collected and analyzed. RESULTS: A total of 571 post-PCI CHD patients were included in the study. The average age was 60.8 ± 4.3 years, and 479 male patients (83.9%) were included. The average maximal inspiratory pressure (MIP) of the enrolled patients was 90.7 ± 26.1 cm H2O, with 56 patients (9.8%) presenting with IMW. The IMW group had lower peak oxygen uptake (VO2peak) (17.4 ± 4.2 vs. 19.3 ± 5.1 mL/ /min/kg, p < 0.001) and oxygen uptake efficiency slopes (OUES) (1464.7 ± 368.5 vs. 1619.2 ± 400.4, p = 0.004). MIP correlated with VO2peak (r = 0.719, p < 0.001) and OUES (r = 0.622, p < 0.001). Multivariate regression analysis revealed that VO2peak (OR = 0.917, 95% CI = 0.858 ~ 0.980) and history of chronic obstructive pulmonary disease (COPD) (OR = 1.705, 95% CI = 0.934~ 3.112) were independent risk factors for IMW. CONCLUSIONS: After PCI, CHD patients exhibiting IMW, especially those with comorbid COPD, demonstrated reduced exercise tolerance and oxygen uptake efficiency.
Percutaneous coronary intervention (PCI) has become a routine revascularization strategy. Percutaneous coronary intervention outcome is affected by patient- and procedure-related factors. Stent design has evolved to over...Percutaneous coronary intervention (PCI) has become a routine revascularization strategy. Percutaneous coronary intervention outcome is affected by patient- and procedure-related factors. Stent design has evolved to overcome the risk of thrombosis and restenosis associated with stent implantation. Bare metal stents were followed by two generations of drug-eluting stents with different strut sizes, polymer types, and antiproliferative drug classes. Modern technologies comprising polymer-free stents, bioresorbable vascular scaffolds, and titanium-nitride-oxide-coated stents are intensively studied. The choice of the appropriate stent is crucial for PCI success, especially in high-risk settings. Hence, to establish a strategy for patient-tailored stent choice, we aimed to discuss the efficacy and safety of coronary stents in specific procedural and clinical scenarios. We concluded that the current evidence may encourage the use of (i) sirolimus-eluting stents (SES) in small vessel disease, (ii) biodegradable-polymer SES in multivessel PCI, (iii) everolimus-eluting stents (EES) and zotarolimus-eluting stents in bifurcation lesions, (iv) EES in chronic total occlusions, (v) SES, EES, and polymer-free stents in diabetic patients, (vi) ultrathin biodegradable-polymer DES and titanium-nitride-oxide-coated stents in acute coronary syndrome, and (vii) polymer-free biolimus-eluting stents in high bleeding-risk patients. Further randomized trials are required to established firm recommendations.
Wybraniec MT, Hoffmann A, Bochenek T
… +10 more, Lelek M, Wita M, Szydło K, Lasek-Bal A, Gąsior M, Kalarus Z, Ptaszyński P, Kaźmierczak J, Mizia-Stec K, Wita K
BACKGROUND: Prompt treatment of pulmonary embolism (PE) prevents morbidity and mortality. The aim of the present study was to evaluate and compare the effectiveness of two FDA-approved catheter-based therapies (CBT) for...BACKGROUND: Prompt treatment of pulmonary embolism (PE) prevents morbidity and mortality. The aim of the present study was to evaluate and compare the effectiveness of two FDA-approved catheter-based therapies (CBT) for acute PE: ultrasound-assisted catheter-directed thrombolysis EKOS (EKOS Corporation, Bothell, WA) and Penumbra Indigo aspiration thrombectomy (Penumbra Inc., Alameda, CA, USA). METHODS: Patients with submassive and massive PE who underwent CBT between 09/2014 and 08/2022 at our institution were identified. Primary efficacy outcome was change in the echocardiographic RV/LV diameter ratio within 48 to 72h of the procedure. RESULTS: A total of 189 patients underwent EKOS (n=119) or Penumbra (n = 70) for submassive (n = 175) and massive (n = 14) PE. The RV/LV ratio showed improvement post intervention, with 21.2% decrease in the EKOS group (EG) and 35.6% in the Penumbra group (PG). PG group had a greater reduction in RV/LV (median change 0.396 (IQR, 0.347) vs. 0.207 (IQR, 0.306), p < 0.001). The rate of complications and in-hospital mortality were similar (15.1% in EG and 10% in PG and 2.5% in EG, 4.3% in PG, p = 0.672; respectively). Subgroup analysis comparing responders, defined as patients with a post-intervention echocardiographic RV/LV ratio < 0.9, and non-responders showed a lower rate of chronic lung disease, (4.3% vs. 19.0%, p = 0.015). CONCLUSIONS: Both CBT options are promising for treating acute submassive or massive PE, with efficacy outcomes favoring aspiration thrombectomy. Presence of chronic lung disease was associated with lower response to CBT in terms of reversal of RV dysfunction. Longer follow-up and randomized controlled trials are needed for definitive conclusions.
Souvaliotis N, Vontetsianos A, Gounaridi MI
… +11 more, Chynkiamis N, Katsarou O, Anastasiou A, Lampsas S, Gialamas I, Theofilis P, Lysandrou A, Marinos G, Oikonomou E, Vavuranakis M, Siasos G
BACKGROUND: Sten graft implantation faces challenges such as deliverability issues, fracture risk, and subsequent restenosis. Recent advancements have introduced thinner coatings for increased flexibility and improved bi...BACKGROUND: Sten graft implantation faces challenges such as deliverability issues, fracture risk, and subsequent restenosis. Recent advancements have introduced thinner coatings for increased flexibility and improved biocompatibility. The aim herein was to assess the safety and performance of a highly flexible cobalt-chromium stent covered with polytetrafluoroethylene (PTFE) in a preclinical model. METHODS: In total 6 PTEF-covered stent grafts 6mm x 38mm cobalt-chromium, (Solaris BXTM, Scitech Produtos Medicos) were implanted compared to 5 controls ( BeGraftTM, Bentley InnoMed GmbH) in the iliac arteries of 11 swine. Stents were evaluated with angiography, high-definition IVUS, and histology for 28 days. RESULTS: All animals underwent successful implantation with 100% survival at follow-up. At 28 days, there was no statistically significant difference in MLD compared to baseline in both groups (test, 5.2 ± 0.7 mm vs 5.3 ± 0.6 mm, p = 0.8; control, 4.9 ± 0.7 mm vs 5.1 ± 0.5 mm, p = 0.8), indicating no LLL (test, -0.2 ± 0.16 vs control, -0.18 ± 0.16 mm; p = 0.8). IVUS revealed a tendency for the less neointimal area in the test group (3.75 ± 0.9mm² vs 5.69 ± 2.2 mm²; p = 0.08), resulting in a tendency toward higher % AS in the control arm (14.07 ± 3.42% vs 20 ± 7%; p = 0.1). Microscopic evaluation revealed minimal vascular injury (test 0.1 ± 0.3 vs control 0.1 ± 0.1) and complete endothelialization coverage (test, 3.2 ± 0.8 vs control 3.8 ± 0.3) in both groups, with minimal inflammation(test vs. control: per strut 0.02 ± 0.06 vs. 0.14 ± 0.22; neointimal 1.2 ± 0.6 vs 1.1 ± 0.4; medial 0.3 ± 0.4 vs 0.3 ± 0.4). CONCLUSION: Solaris BXTM demonstrated highly flexible and biocompatible, with minimal vascular injury, and reduced neointimal hyperplasia compared to the control.
Mielczarek MJ, Michalski T, Wańha W
… +17 more, Ciećwierz D, Smolka G, Marcinkowska M, Chmielecki M, Tomasiewicz B, Kubler P, Kasprzak M, Chamera M, Gorol J, Bartuś S, Kubica J, Reczuch K, Hawranek M, Ochała A, Wojakowski W, Gruchała M, Jaguszewski M
BACKGROUND: Stentys drug-eluting stent (Stentys DES) was proposed to possess potential benefits over balloon-expandable platforms in large bifurcations, mainly distal left main stem (LMS). Several registries demonstrated...BACKGROUND: Stentys drug-eluting stent (Stentys DES) was proposed to possess potential benefits over balloon-expandable platforms in large bifurcations, mainly distal left main stem (LMS). Several registries demonstrated favourable one-year clinical results of percutaneous coronary intervention (PCI) using Stentys DES for LMS disease. However, long-term follow- up data have been lacking hitherto. METHODS: The study enrolled 175 consecutive patients who underwent PCI with Stentys DES for unprotected LMS and categorized them into acute- and chronic coronary syndrome (ACS/CCS). The primary endpoint was major adverse cardiac and cerebral events (MACCE) composed of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stroke assessed at five years. The secondary endpoints were stent thrombosis (ST), restenosis and target vessel revascularization (TVR). RESULTS: Clinical follow-up at five years was completed for 124 out of 175 patients (70.9%), encompassing 85 with ACS and 39 with CCS. At five years, MACCE occurred in 55 out of 124 patients (44.4%). Although, there was a higher rate of MACCE (53% vs 28.2%, p = 0.018), MI (27.1% vs 2.6%, p = 0.016) and TLR (20% vs 2.6%, p = 0.036) in ACS vs. CCS patients, the rates of cardiac deaths were similar (27.1% vs. 25.6%, p = 0.77, respectively). CONCLUSIONS: Herein, favourable long-term outcome of LMS PCI with Stentys DES in the CCS setting are shown. In the ACS setting, worse one-year outcome persisted at five years and was partially related to high rate of acute/subacute ST that might be optimized by immediate loading with potent antiplatelet drugs.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition, classified as group 4 pulmonary hypertension (PH), caused by stenosis or occlusion of the pulmonary arteries due to unres...Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition, classified as group 4 pulmonary hypertension (PH), caused by stenosis or occlusion of the pulmonary arteries due to unresolved thromboembolic material. The prognosis for untreated CTEPH patients is poor because it leads to elevated pulmonary artery pressure and right heart failure. Early and accurate diagnosis of CTEPH is crucial because it remains the only form of PH that is potentially curable. However, diagnosing CTEPH is often challenging and frequently delayed or misdiagnosed. This review discusses the current role of multimodal imaging in diagnosing CTEPH, guiding clinical decision-making, and monitoring post-treatment outcomes. The characteristic findings, strengths, and limitations of various imaging modalities, such as computed tomography, ventilation-perfusion lung scintigraphy, digital subtraction pulmonary angiography, and magnetic resonance imaging, are evaluated. Additionally, the role of artificial intelligence in improving the diagnosis and treatment outcomes of CTEPH is explored. Optimal patient assessment and therapeutic decision-making should ideally be conducted in specialized centers by a multidisciplinary team, utilizing data from imaging, pulmonary hemodynamics, and patient comorbidities.
BACKGROUND: Klotho is a transmembrane and secretory protein and acts as a co-receptor for fibroblast growth factor 23 (FGF23). This study aimed to analyse the concentration of Klotho and FGF23 proteins in patients with m...BACKGROUND: Klotho is a transmembrane and secretory protein and acts as a co-receptor for fibroblast growth factor 23 (FGF23). This study aimed to analyse the concentration of Klotho and FGF23 proteins in patients with myocardial infarction (MI). METHODS: The study group comprised 129 patients diagnosed with acute coronary syndrome (ACS), who were referred for further invasive diagnostics (MI group). Blood samples were collected at 4 time points: at admission, and 6h, 24h, and between 24-48h post-admission. The criteria for the control subjects (n = 30) were no declaration of MI and ACS (non-MI group). Klotho and FGF23 concentrations in plasma were tested by ELISA at each time point. RESULTS: The concentration of soluble Klotho in the MI group was increased at admission, 6h and 24 h post-admission, and then normalized at 24-48h. Klotho concentration was also significantly increased in patients with ST-segment elevation MI (STEMI) only at admission, in comparison to non-ST-segment elevation MI (NSTEMI). The concentration of FGF23 in the MI group was higher at admission, 6h and 24h post-admission, and continued to increase after 24-48 h. There was an increase in FGF23 concentration in the STEMI group at 24-48h post-admission, in comparison to NSTEMI. CONCLUSIONS: The concentrations of Klotho and FGF23 in plasma were higher in patients with MI and changed over time. Thus, Klotho and FGF23 may be recognized as new factors in the diagnosis and/or monitoring of ACS, as well as novel therapeutic targets.
BACKGROUND: Transcatheter closure has become the method of choice for treating patent ductus arteriosus (PDA) in a majority of patients. The only approved device for treating infants weighing less than 6 kilograms is the...BACKGROUND: Transcatheter closure has become the method of choice for treating patent ductus arteriosus (PDA) in a majority of patients. The only approved device for treating infants weighing less than 6 kilograms is the Amplatzer Piccolo Occluder (APO). The aim of this study is to summarize the experience of two centers in performing transcatheter PDA closure in infants weighing less than 6 kilograms. METHODS: Retrospective, descriptive, and nonrandomized analysis included all 45 infants weighing less than 6 kg who underwent transcatheter PDA closure between 2013 and 2023 at two tertiary centers, following the introduction of APO. Medical records, procedural outcomes, and one-month follow-up were analyzed. Applied devices were: APO in 37 (of whom 3 were off-label due to PDA size), Amplatzer Duct Occluder I (ADO) in 3, and Amplatzer Vascular Plug II (AVP) in 5 cases. RESULTS: The overall success rate was 97.8%. There were 2 major complications (4.4%), including one device protrusion. A residual shunt was noted in one patient 24 hours after the procedure, but none were observed after one month. Off-label devices were implanted in insignificantly larger and longer PDAs. There were no significant differences between the labeled and off-label groups in terms of procedural success, major complications, or residual shunts. CONCLUSIONS: APO is a safe and effective device to treat PDA in infants weighing less than 6 kilograms, however, off-label devices are needed in a considerable number of patients. Proper use of off-label devices yields comparable to APO results.
Kubica J, Adamski P, Buszko K
… +38 more, Buszman P, Elmasri N, Fabiszak T, Foryś J, Gajda R, Gąsior M, Gil R, Grzelakowski P, Hajdukiewicz T, Jaguszewski M, Kern A, Kochmann W, Konarski J, Kubica A, Kudla T, Kuliczkowski W, Kusińska-Czyczyło A, Laskowska E, Magielski P, Michalski P, Milewski K, Mrzywka N, Niezgoda P, Ostrowska M, Piasecki M, Podhajski P, Prokopczuk J, Ratajczak J, Rzepka-Cholasińska A, Skonieczny G, Specchia G, Szarpak Ł, Szymański P, Topolska M, Umińska JM, Ziółkowski M, Żurakowski A, Navarese EP
According to the 2024ESC Guidelines for the management of chronic coronary syndromes dual antithrombotic treatment comprising aspirin and a second antithrombotic drug for extended long-term prevention should be considere...According to the 2024ESC Guidelines for the management of chronic coronary syndromes dual antithrombotic treatment comprising aspirin and a second antithrombotic drug for extended long-term prevention should be considered in patients at increased ischemic risk without high bleeding risk. However, no clear indications regarding the choice of a second antithrombotic agent are provided. It was therefore decided to discuss the available evidence regarding this issue. The guidelines provided the number needed to treat (NNT) and the number needed to harm (NNH) for each proposed medication. However, the presented data are misleading and may result in unjustified therapeutic decisions. Due to the great impact of this document on clinical practice all data provided in this document should be carefully verified and commented regarding limitations.
Urbańska J, Prus A, Królak T
… +12 more, Konopa K, Kamińska J, Naczk E, Nowak R, Szewczyk P, Lewicka E, Liżewska-Springer A, Daniłowicz-Szymanowicz L, Bieńkowski M, Jassem J, Dziadziuszko R, Tomasik B
BACKGROUND: Sacubitril/valsartan (S/V) improve left ventricular ejection fraction (LVEF) in heart failure patients, but the magnitude of improvement may depend on baseline values. METHODS: We analyzed whether baseline LV...BACKGROUND: Sacubitril/valsartan (S/V) improve left ventricular ejection fraction (LVEF) in heart failure patients, but the magnitude of improvement may depend on baseline values. METHODS: We analyzed whether baseline LVEF can predict its improvement in patients with LVEF ≤ 45% receiving S/V. Patients were divided into 4 groups (G) according to baseline LVEF (G1: ≤ 20%; G2: 21-30%; G3: 31-40%; G4: 41-45%). RESULTS: We included 256 patients (age 73 ± 12 years; 73% male; 174 ischemic cardiomyopathy [CM], 82 nonischemic CM) and assessed LVEF at S/V initiation and at 6 and 12 months of therapy. Baseline LVEF (%) values (overall 30.9 ± 8.6) were: G1: 17.3 ± 3.3; G2: 27.5 ± 2.4; G3: 35.5 ± 2; G4: 44.4 ± 1. LVEF increased in 62% of patients, reaching 34.3 ± 10.4% and 35.5 ± 11.2% at 6 and 12 months, respectively (p < 0.001). A significantly higher absolute LVEF increase was found in Groups 3 (7.2 ± 4.3) and 4 (4.2 ± 3.05) than in Groups 1 (0.6 ± 1.5) and 2 (3.5 ± 1.5), in women (5.9 ± 4.4 vs. 4.1 ± 4.5; p < 0.001), with high S/V doses (7.4 ± 4.7 vs. 4.3 ± 4.4; p < 0.001), and in nonischemic CM (6.3 ± 4.9 vs. 3.8 ± 4.2; p < 0.001). On multivariate analysis, female sex (OR 2.18; 95% CI [1.06-4.48]; p = 0.034), high dose (OR 3.38; 95% CI [1.10-10.34]; p = 0.033), and baseline LVEF > 30% (OR 8.62; 95% CI [4.69-15.82]; p = 0.001) were significant predictors of LVEF improvement. CONCLUSIONS: LVEF improvement with S/V depends on baseline values, sex, and dose.
BACKGROUND: The association between coronary microcirculatory function and long-term outcomes in late-presenting patients with ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS: A total of 340 STEMI...BACKGROUND: The association between coronary microcirculatory function and long-term outcomes in late-presenting patients with ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS: A total of 340 STEMI patients with late presentation (> 12 hours from the onset of symptoms) who underwent delayed percutaneous coronary intervention (PCI) were consecutively recruited from 2016 to 2021. The coronary microvasculature was assessed by angiography-derived index of microcirculatory resistance (caIMR) using commercial software. The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all-cause death and myocardial infarction. RESULTS: The median symptom-to-angiography time was 149 hours (interquartile range [IQR], 101-192). The culprit vessels were completely occluded in 120 (35.3%) patients. During the follow-up with a median period of 51 months, MACE occurred in 27 patients (7.9%). After adjusting for risk factors, caIMR > 25 U after PCI was independently associated with an increased incidence of MACE (adjusted hazard ratio, 4.31; 95% confidence interval, 1.92-9.67; p < 0.001). The area under the curve (AUC) for caIMR in predicting MACE was 0.675 (p = 0.020). CONCLUSIONS: Our study indicated that caIMR was an important prognostic predictor in late-presenting STEMI patients who underwent delayed PCI. Preservation of coronary microcirculatory function during PCI could provide long-term prognostic benefits.