Background and Aim The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coro... more Background and Aim The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI). Methods This is a systematic review and meta-analysis. Randomized controlled trials and non-randomized studies were included. Outcomes evaluated were combined major adverse cardiovascular events (MACEs), myocardial infarction (MI), target vessel revascularization, death and bleeding complications. Summary estimates of the relative risks with therapy were calculated. Results Twenty-three studies met the selection criteria and included 60,907 patients. Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction (RRR) of MACE (95% confidence interval [CI] = 0.68–0.89...
Introduction. The outcome of patients with ST-elevation myocardial infarction (STEMI) strongly de... more Introduction. The outcome of patients with ST-elevation myocardial infarction (STEMI) strongly depends on a successful reperfusion. In some patients receiving an effective treatment myocardial infarction can be aborted. Aim. The aim of the study was to estimate the incidence, clinical outcome, prognosis and inflammatory response in patients with aborted MI. Material and methods. 119 consecutive patients with STEMI treated with a primary percutaneous coronary intervention (pPCI) were enrolled in the study. Aborted MI was diagnosed when the maximal increase in cardiac enzymes (CK-Mb) was up to twice the upper limit of normal (CK-Mb ≤ 50 U/I) and at least 50% reduction of ST-segment deviation was observed within 90 min of pPCI. Results. Aborted MI was diagnosed in 16 subjects (13.4%). Patients with the aborted MI had lower serum troponin I levels (p < 0.0001). The time to treatment was significantly shorter in the aborted MI group (101 min vs. 220 min, p < 0.00001). Patients with aborted MI had a lower corrected TIMI frame count (p < 0.05) and a lower wall motion score index (p < 0.005), less pronounced inflammatory response (lower serum levels of IL-6, p < 0.01, and MCP-1, p < 0.05), higher ejection fraction six months after MI (72% vs. 64%, p < 0.05). None of the aborted MI patients died during the 3-year follow-up, while there were 13 deaths among patients with non-aborted MI. Conclusions. The abortion of myocardial infarction results in a better outcome and more favorable prognosis. An inflammatory response is less pronounced in the aborted MI.
Introduction: Patent foramen ovale (PFO) is associated with the occurrence of cryptogenic strokes... more Introduction: Patent foramen ovale (PFO) is associated with the occurrence of cryptogenic strokes, transient neurological ischemic attacks (TIA) and migraine. Therefore despite the recent ambiguous results of prospective controlled trials, percutaneous closure of PFO is still performed in many centers. Aim: To evaluate the safety and effectiveness of percutaneous PFO closure in the prevention of recurrence of neurologic events and migraine symptoms in long-term observation. Material and methods: In 70 patients (31 male, age: 38 ±18 years) percutaneous PFO closure was successfully performed with the Amplatzer PFO Occluder. An interview in conjunction with neurological follow-up was performed in all patients to reveal recurrence of embolism such as TIA or stroke and the presence of migraine symptoms before and after the procedure. Results: The mean follow-up period was 857 ±363 days (median: 571 days). No serious complications of the procedure and no death were observed. Neurological events recurred in 5 (7.1%) patients-stroke in 1 patient, TIA in 3 patients, ocular embolism in 1 patient. All of these patients were over 40 years old or had other cardiovascular risk factors. Migraine was observed in 21 (30%) patients before the procedure and in 11 (15.7%) after the procedure (p = 0.04). Conclusions: The complication rate and recurrence of neurological events in young patients after PFO closure are low. However, careful qualification and postprocedural monitoring of the patients are necessary. Patent foramen ovale closure seems to result in attenuation of migraine symptoms.
Background: Coronary artery bifurcation stenting using standard stents is associated with increas... more Background: Coronary artery bifurcation stenting using standard stents is associated with increased risk of complications and poor long-term prognosis. Bifurcation-dedicated stents raise a hope of improving the acute and late results of such procedures. Aim: To assess the early and mid-term results of bifurcation stenting with the specially designed bifurcation-dedicated Tryton side-branch stent. Methods and results: We evaluated 40 consecutive procedures of coronary artery bifurcation stenting using a Tryton stent in patients with stable angina or acute coronary syndrome without ST elevation. The stent was successfully implanted in 39 patients. The main vessel was treated with drug-eluting stents in 38 cases, whereas bare metal stents were used in the remaining two. In one case the procedure was complicated by non-Q wave myocardial infarction. During 30-day and 6-month observation no additional major adverse cardiac events were observed. Conclusion: Coronary bifurcation stenting with the Tryton side-branch stent is highly effective, with a low rate of acute and midterm complications.
Left main (LM) percutaneous coronary interventions (PCI) are challenging and highly invasive proc... more Left main (LM) percutaneous coronary interventions (PCI) are challenging and highly invasive procedures. Periprocedural myocardial injury (Troponin (Tn) elevation > 99th percentile) is frequently detected after LM PCI, being identified even in up to 67% of patients. However, the prognostic implications of periprocedural Tn elevation after LM PCI remain controversial. We aim to assess the impact and prognostic significance of the periprocedural troponin elevation on long-term outcomes in patients undergoing LM PCI in a real-world setting. Consecutive 673 patients who underwent LM PCI in our department between January 2015 to February 2021 were included in a prospective registry. The first group consisted of 323 patients with major cardiac Troponin I elevation defined as an elevation of Tn values > 5× the 99th percentile in patients with normal baseline values or post-procedure Tn rise by >20% in patients with elevated pre-procedure Tn in whom the Tn level was stable or falli...
Background: High risk ST segment elevation myocardial infarction patients undergoing reperfusion ... more Background: High risk ST segment elevation myocardial infarction patients undergoing reperfusion therapy continue to exhibit significant morbidity and mortality due in part to myocardial reperfusion injury. Reperfusion, although it relieves or reduces ischemia and necrosis, is followed by morphological and functional changes that ultimately result in tissue damage known as reperfusion injury. Adenosine, which is capable of dilating the coronary resistance vessels and increasing flow is one of the used agents in the treatment of no-reflow. Moreover, adenosine antagonizes many of biochemical and physiological mechanisms implicated in ischemia-reperfusion injury and has been shown to reduce postischemic ventricular dysfunction and myocyte necrosis and apoptosis. The exact mechanisms of cardioprotective effect of adenosine is not fully understood, although neutrophil activation and prevention of endothelial damage seem to play a major role. Objectives: The aim of single-center, randomized placebo-controlled trial in 70 consecutive patients (64±14 years) with acute myocardial infarction was to examine the role of new protocol of adenosine administration during primary angioplasty on immediate electrocardiographic and angiographic results, clinical outcome and one-year follow-up. Methods: Group A (n=35) received two times intracoronary adenosine through the guiding catheter: immediately after crossing the lesion of the infarct related artery with guidewire and then after first balloon inflation. Group B (n=35) received placebo. Results: Resolution of ST segment elevation was more frequently observed in adenosine than in placebo group (p<0.01). PCI resulted in borderline better TIMI 3 flow after procedure in adenosine group than in placebo group. Myocardial blush grade 3 at the end of procedure was significantly improved in adenosine compared to placebo group (p<0.05). The 1-year the composite end-point of death, recurrent myocardial infarction, heart failure and clinically driven target vessel revascularization was present in 8 patients in adenosine group and 16 patients in placebo group (P<0.05). Conclusions: Intracoronary adenosine improved electrocardiographic and angiographic results in patients undergoing primary percutaneous coronary intervention and seemed to be associated with more favorable clinical course.
BACKGROUND Many operators are discouraged from performing left main (LM) percutaneous coronary in... more BACKGROUND Many operators are discouraged from performing left main (LM) percutaneous coronary interventions (PCI) in the absence of right coronary artery (RCA) support due to the increased procedure risk. AIMS We aimed to assess the absent functional RCA impact on prognostic implications in patients undergoing unprotected LM PCI. METHODS 613 patients underwent LM PCI in our department between 2015 and 2019. Consecutive 385 patients with unprotected LM and at least 1-year follow-up were included in the study. The study group consisted of 272 patients with unprotected left main coronary artery disease (ULMCAD) with dominant RCA without any significant lesions (Group 1) and 113 ULMCAD patients and with lack of RCA support (Group 2). RESULTS In Group 2, 32.7% patients had a significant RCA stenosis, 48.7% chronic total occlusion (CTO) of RCA and 18.6% recessive RCA. Patients in Group 2 were older and had higher prevalence of COPD. SYNTAX Score (median (IQR) 26.0 (20.0-33.0) vs. 19.0 (1...
A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd ... more A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd di in ng g a au ut th ho or r: : dr n. med. Maciej Lesiak, I Klinika Kardiologii, ul. D³uga 1/2, 61-848 Poznañ, tel.
Background : The aim of our study was to examine the value of Holter monitoring and changes of he... more Background : The aim of our study was to examine the value of Holter monitoring and changes of heart rate variability (HRV) parameters in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) and to assess their value for detection of restenosis after the elective PTCA of single-vessel coronary artery disease. Methods : 56 consecutive patients were studied - 41 men and 15 women (mean age: 56.2 ± 8.3 years) with left anterior descending artery stenosis who underwent successful PTCA. All patients underwent 24 hour Holter monitoring with HRV assessment within 1 week after PTCA and then again before repeated follow-up angiography. Results : Repeated coronary angiography revealed restenosis in 15 patients and no signs of significant stenosis in the remaining 41 patients. The sensitivity of standard ST-segment depression criteria for the prediction of restenosis was low (ranging from 7% to 27%), with quite high specificity (80–93%) and very low diagnostic accuracy (17–...
Przedstawiono przypadek 53-letniej kobiety z dekstrokardią i odwrotnym ulozeniem trzewi. U chorej... more Przedstawiono przypadek 53-letniej kobiety z dekstrokardią i odwrotnym ulozeniem trzewi. U chorej wszczepiono drogą przezzylną dwujamowy stymulator serca z powodu calkowitego bloku serca, powstalego prawdopodobnie w wyniku idiopatycznego zwyrodnienia ukladu przewodzącego serca, ktoremu towarzyszyly wielokrotne zaslabniecia. Poniewaz dekstrokardii czesto towarzyszą inne anomalie ukladu naczyniowego, wydaje sie konieczne wykonanie flebogramu przed wszczepieniem ukladu stymulującego.
Journal of the American College of Cardiology, 2017
CD-TLR) at 12 months were analyzed. Kaplan-Meier (KM) time to event analysis was performed. RESUL... more CD-TLR) at 12 months were analyzed. Kaplan-Meier (KM) time to event analysis was performed. RESULTS Data from 2,996 infra-inguinal LE-PAIs from 2,105 patients between May 2005 and June 2017 were included; 12 months data was available for 1,748 patients. CKD was present in 18% (n¼378) of the cohort. CKD group had higher rates of comorbidities and more severe PAD presentation (Table). CKD was associated with a higher mortality (5.5% vs 2.0%; p¼0.0002) and KM analysis showed significant association with mortality in the 12 months post LE-PAI period (log chi square ¼ 32.12; p<0.0001; Figure). Rates of MI (2.7% vs 1.5%; p¼0.05) and major limb amputation (3.8% vs 1.3%; p<0.0001) were also higher in the CKD group; there was no different in the stroke or CD-TLR rates. Patients (n) CKD (n[378) Non CKD (n [1727) P-value Age (meanAESD) 66.8AE10.3 years 65.9AE10.1 years 0.1113 Female (n, %) 81 (21.3%) 380 (22.0%) 0.6894 Hypertension (n, %) 367 (96.6%) 1526 (88.5%) <0.0001 Diabetes mellitus (n, %) 298 (78.4%) 873 (50.6%) <0.0001 Coronary artery disease (n, %) 279 (73.4%) 1038 (60.2%) <0.0001 Heart failure (n, %) 126 (33.2%) 246 (14.3%) <0.0001 Ankle-brachial index (meanAESD) 0.75AE0.21 0.73AE0.25 0.2082 Rutherford (meanAESD) 3.67AE1.30 3.09AE1.24 <0.
In patients treated with transcatheter aortic valve implantation (TAVI), age is recognized as one... more In patients treated with transcatheter aortic valve implantation (TAVI), age is recognized as one of the most important risk factors. The aim of our study was to evaluate whether early and mid-term results of TAVI were worse in patients over 85 year old compared with the younger population. From September 2010 to November 2015, 162 consecutive patients (mean age 78.4 ±7.1 years, 47.5 % females) underwent TAVI in our Institution. Patients were divided into two groups: 1) elderly (≥ 85 year old) and 2) younger patients (< 85 year old). Primary clinical study endpoints were the following: death, myocardial infarction, stroke, major and minor access site, and bleeding complications. The secondary endpoints included: pacemaker implantation rate, paravalvular leakage, acute kidney injury, and duration of hospitalization. Twenty-six patients were 85 or older (mean 87.5 ± 2.1). In the remaining 136 (84%), the average age was 76.7 ± 6.4. Baseline clinical profiles were similar in both gro...
The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and va... more The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) in patients with chronic coronary artery disease treated who underwent percutaneous coronary intervention with stent implantation, for assessing the risk of restenosis and the occurrence of de novo lesions.
1.52±0.18, p < 0.001). PAL was higher in patients with simple compared with complex congenital he... more 1.52±0.18, p < 0.001). PAL was higher in patients with simple compared with complex congenital heart disease (1.50±0.21 vs. 1.39±0.14, p = 0.019). Among men, active smoking (p=0.015) and lower age (p=0.04) were independently associated with higher PAL, whereas no such associations were observed among women. Conclusion: The majority of the observed patients had low PAL and women had lower PAL compared to men. PAL was related to complexity of heart lesion. Efforts to increase habitual physical activity may be indicated in this population, especially in women and patients with complex congenital heart disease.
Background and Aim The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coro... more Background and Aim The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI). Methods This is a systematic review and meta-analysis. Randomized controlled trials and non-randomized studies were included. Outcomes evaluated were combined major adverse cardiovascular events (MACEs), myocardial infarction (MI), target vessel revascularization, death and bleeding complications. Summary estimates of the relative risks with therapy were calculated. Results Twenty-three studies met the selection criteria and included 60,907 patients. Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction (RRR) of MACE (95% confidence interval [CI] = 0.68–0.89...
Introduction. The outcome of patients with ST-elevation myocardial infarction (STEMI) strongly de... more Introduction. The outcome of patients with ST-elevation myocardial infarction (STEMI) strongly depends on a successful reperfusion. In some patients receiving an effective treatment myocardial infarction can be aborted. Aim. The aim of the study was to estimate the incidence, clinical outcome, prognosis and inflammatory response in patients with aborted MI. Material and methods. 119 consecutive patients with STEMI treated with a primary percutaneous coronary intervention (pPCI) were enrolled in the study. Aborted MI was diagnosed when the maximal increase in cardiac enzymes (CK-Mb) was up to twice the upper limit of normal (CK-Mb ≤ 50 U/I) and at least 50% reduction of ST-segment deviation was observed within 90 min of pPCI. Results. Aborted MI was diagnosed in 16 subjects (13.4%). Patients with the aborted MI had lower serum troponin I levels (p < 0.0001). The time to treatment was significantly shorter in the aborted MI group (101 min vs. 220 min, p < 0.00001). Patients with aborted MI had a lower corrected TIMI frame count (p < 0.05) and a lower wall motion score index (p < 0.005), less pronounced inflammatory response (lower serum levels of IL-6, p < 0.01, and MCP-1, p < 0.05), higher ejection fraction six months after MI (72% vs. 64%, p < 0.05). None of the aborted MI patients died during the 3-year follow-up, while there were 13 deaths among patients with non-aborted MI. Conclusions. The abortion of myocardial infarction results in a better outcome and more favorable prognosis. An inflammatory response is less pronounced in the aborted MI.
Introduction: Patent foramen ovale (PFO) is associated with the occurrence of cryptogenic strokes... more Introduction: Patent foramen ovale (PFO) is associated with the occurrence of cryptogenic strokes, transient neurological ischemic attacks (TIA) and migraine. Therefore despite the recent ambiguous results of prospective controlled trials, percutaneous closure of PFO is still performed in many centers. Aim: To evaluate the safety and effectiveness of percutaneous PFO closure in the prevention of recurrence of neurologic events and migraine symptoms in long-term observation. Material and methods: In 70 patients (31 male, age: 38 ±18 years) percutaneous PFO closure was successfully performed with the Amplatzer PFO Occluder. An interview in conjunction with neurological follow-up was performed in all patients to reveal recurrence of embolism such as TIA or stroke and the presence of migraine symptoms before and after the procedure. Results: The mean follow-up period was 857 ±363 days (median: 571 days). No serious complications of the procedure and no death were observed. Neurological events recurred in 5 (7.1%) patients-stroke in 1 patient, TIA in 3 patients, ocular embolism in 1 patient. All of these patients were over 40 years old or had other cardiovascular risk factors. Migraine was observed in 21 (30%) patients before the procedure and in 11 (15.7%) after the procedure (p = 0.04). Conclusions: The complication rate and recurrence of neurological events in young patients after PFO closure are low. However, careful qualification and postprocedural monitoring of the patients are necessary. Patent foramen ovale closure seems to result in attenuation of migraine symptoms.
Background: Coronary artery bifurcation stenting using standard stents is associated with increas... more Background: Coronary artery bifurcation stenting using standard stents is associated with increased risk of complications and poor long-term prognosis. Bifurcation-dedicated stents raise a hope of improving the acute and late results of such procedures. Aim: To assess the early and mid-term results of bifurcation stenting with the specially designed bifurcation-dedicated Tryton side-branch stent. Methods and results: We evaluated 40 consecutive procedures of coronary artery bifurcation stenting using a Tryton stent in patients with stable angina or acute coronary syndrome without ST elevation. The stent was successfully implanted in 39 patients. The main vessel was treated with drug-eluting stents in 38 cases, whereas bare metal stents were used in the remaining two. In one case the procedure was complicated by non-Q wave myocardial infarction. During 30-day and 6-month observation no additional major adverse cardiac events were observed. Conclusion: Coronary bifurcation stenting with the Tryton side-branch stent is highly effective, with a low rate of acute and midterm complications.
Left main (LM) percutaneous coronary interventions (PCI) are challenging and highly invasive proc... more Left main (LM) percutaneous coronary interventions (PCI) are challenging and highly invasive procedures. Periprocedural myocardial injury (Troponin (Tn) elevation > 99th percentile) is frequently detected after LM PCI, being identified even in up to 67% of patients. However, the prognostic implications of periprocedural Tn elevation after LM PCI remain controversial. We aim to assess the impact and prognostic significance of the periprocedural troponin elevation on long-term outcomes in patients undergoing LM PCI in a real-world setting. Consecutive 673 patients who underwent LM PCI in our department between January 2015 to February 2021 were included in a prospective registry. The first group consisted of 323 patients with major cardiac Troponin I elevation defined as an elevation of Tn values > 5× the 99th percentile in patients with normal baseline values or post-procedure Tn rise by >20% in patients with elevated pre-procedure Tn in whom the Tn level was stable or falli...
Background: High risk ST segment elevation myocardial infarction patients undergoing reperfusion ... more Background: High risk ST segment elevation myocardial infarction patients undergoing reperfusion therapy continue to exhibit significant morbidity and mortality due in part to myocardial reperfusion injury. Reperfusion, although it relieves or reduces ischemia and necrosis, is followed by morphological and functional changes that ultimately result in tissue damage known as reperfusion injury. Adenosine, which is capable of dilating the coronary resistance vessels and increasing flow is one of the used agents in the treatment of no-reflow. Moreover, adenosine antagonizes many of biochemical and physiological mechanisms implicated in ischemia-reperfusion injury and has been shown to reduce postischemic ventricular dysfunction and myocyte necrosis and apoptosis. The exact mechanisms of cardioprotective effect of adenosine is not fully understood, although neutrophil activation and prevention of endothelial damage seem to play a major role. Objectives: The aim of single-center, randomized placebo-controlled trial in 70 consecutive patients (64±14 years) with acute myocardial infarction was to examine the role of new protocol of adenosine administration during primary angioplasty on immediate electrocardiographic and angiographic results, clinical outcome and one-year follow-up. Methods: Group A (n=35) received two times intracoronary adenosine through the guiding catheter: immediately after crossing the lesion of the infarct related artery with guidewire and then after first balloon inflation. Group B (n=35) received placebo. Results: Resolution of ST segment elevation was more frequently observed in adenosine than in placebo group (p<0.01). PCI resulted in borderline better TIMI 3 flow after procedure in adenosine group than in placebo group. Myocardial blush grade 3 at the end of procedure was significantly improved in adenosine compared to placebo group (p<0.05). The 1-year the composite end-point of death, recurrent myocardial infarction, heart failure and clinically driven target vessel revascularization was present in 8 patients in adenosine group and 16 patients in placebo group (P<0.05). Conclusions: Intracoronary adenosine improved electrocardiographic and angiographic results in patients undergoing primary percutaneous coronary intervention and seemed to be associated with more favorable clinical course.
BACKGROUND Many operators are discouraged from performing left main (LM) percutaneous coronary in... more BACKGROUND Many operators are discouraged from performing left main (LM) percutaneous coronary interventions (PCI) in the absence of right coronary artery (RCA) support due to the increased procedure risk. AIMS We aimed to assess the absent functional RCA impact on prognostic implications in patients undergoing unprotected LM PCI. METHODS 613 patients underwent LM PCI in our department between 2015 and 2019. Consecutive 385 patients with unprotected LM and at least 1-year follow-up were included in the study. The study group consisted of 272 patients with unprotected left main coronary artery disease (ULMCAD) with dominant RCA without any significant lesions (Group 1) and 113 ULMCAD patients and with lack of RCA support (Group 2). RESULTS In Group 2, 32.7% patients had a significant RCA stenosis, 48.7% chronic total occlusion (CTO) of RCA and 18.6% recessive RCA. Patients in Group 2 were older and had higher prevalence of COPD. SYNTAX Score (median (IQR) 26.0 (20.0-33.0) vs. 19.0 (1...
A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd ... more A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd di in ng g a au ut th ho or r: : dr n. med. Maciej Lesiak, I Klinika Kardiologii, ul. D³uga 1/2, 61-848 Poznañ, tel.
Background : The aim of our study was to examine the value of Holter monitoring and changes of he... more Background : The aim of our study was to examine the value of Holter monitoring and changes of heart rate variability (HRV) parameters in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) and to assess their value for detection of restenosis after the elective PTCA of single-vessel coronary artery disease. Methods : 56 consecutive patients were studied - 41 men and 15 women (mean age: 56.2 ± 8.3 years) with left anterior descending artery stenosis who underwent successful PTCA. All patients underwent 24 hour Holter monitoring with HRV assessment within 1 week after PTCA and then again before repeated follow-up angiography. Results : Repeated coronary angiography revealed restenosis in 15 patients and no signs of significant stenosis in the remaining 41 patients. The sensitivity of standard ST-segment depression criteria for the prediction of restenosis was low (ranging from 7% to 27%), with quite high specificity (80–93%) and very low diagnostic accuracy (17–...
Przedstawiono przypadek 53-letniej kobiety z dekstrokardią i odwrotnym ulozeniem trzewi. U chorej... more Przedstawiono przypadek 53-letniej kobiety z dekstrokardią i odwrotnym ulozeniem trzewi. U chorej wszczepiono drogą przezzylną dwujamowy stymulator serca z powodu calkowitego bloku serca, powstalego prawdopodobnie w wyniku idiopatycznego zwyrodnienia ukladu przewodzącego serca, ktoremu towarzyszyly wielokrotne zaslabniecia. Poniewaz dekstrokardii czesto towarzyszą inne anomalie ukladu naczyniowego, wydaje sie konieczne wykonanie flebogramu przed wszczepieniem ukladu stymulującego.
Journal of the American College of Cardiology, 2017
CD-TLR) at 12 months were analyzed. Kaplan-Meier (KM) time to event analysis was performed. RESUL... more CD-TLR) at 12 months were analyzed. Kaplan-Meier (KM) time to event analysis was performed. RESULTS Data from 2,996 infra-inguinal LE-PAIs from 2,105 patients between May 2005 and June 2017 were included; 12 months data was available for 1,748 patients. CKD was present in 18% (n¼378) of the cohort. CKD group had higher rates of comorbidities and more severe PAD presentation (Table). CKD was associated with a higher mortality (5.5% vs 2.0%; p¼0.0002) and KM analysis showed significant association with mortality in the 12 months post LE-PAI period (log chi square ¼ 32.12; p<0.0001; Figure). Rates of MI (2.7% vs 1.5%; p¼0.05) and major limb amputation (3.8% vs 1.3%; p<0.0001) were also higher in the CKD group; there was no different in the stroke or CD-TLR rates. Patients (n) CKD (n[378) Non CKD (n [1727) P-value Age (meanAESD) 66.8AE10.3 years 65.9AE10.1 years 0.1113 Female (n, %) 81 (21.3%) 380 (22.0%) 0.6894 Hypertension (n, %) 367 (96.6%) 1526 (88.5%) <0.0001 Diabetes mellitus (n, %) 298 (78.4%) 873 (50.6%) <0.0001 Coronary artery disease (n, %) 279 (73.4%) 1038 (60.2%) <0.0001 Heart failure (n, %) 126 (33.2%) 246 (14.3%) <0.0001 Ankle-brachial index (meanAESD) 0.75AE0.21 0.73AE0.25 0.2082 Rutherford (meanAESD) 3.67AE1.30 3.09AE1.24 <0.
In patients treated with transcatheter aortic valve implantation (TAVI), age is recognized as one... more In patients treated with transcatheter aortic valve implantation (TAVI), age is recognized as one of the most important risk factors. The aim of our study was to evaluate whether early and mid-term results of TAVI were worse in patients over 85 year old compared with the younger population. From September 2010 to November 2015, 162 consecutive patients (mean age 78.4 ±7.1 years, 47.5 % females) underwent TAVI in our Institution. Patients were divided into two groups: 1) elderly (≥ 85 year old) and 2) younger patients (< 85 year old). Primary clinical study endpoints were the following: death, myocardial infarction, stroke, major and minor access site, and bleeding complications. The secondary endpoints included: pacemaker implantation rate, paravalvular leakage, acute kidney injury, and duration of hospitalization. Twenty-six patients were 85 or older (mean 87.5 ± 2.1). In the remaining 136 (84%), the average age was 76.7 ± 6.4. Baseline clinical profiles were similar in both gro...
The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and va... more The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) in patients with chronic coronary artery disease treated who underwent percutaneous coronary intervention with stent implantation, for assessing the risk of restenosis and the occurrence of de novo lesions.
1.52±0.18, p < 0.001). PAL was higher in patients with simple compared with complex congenital he... more 1.52±0.18, p < 0.001). PAL was higher in patients with simple compared with complex congenital heart disease (1.50±0.21 vs. 1.39±0.14, p = 0.019). Among men, active smoking (p=0.015) and lower age (p=0.04) were independently associated with higher PAL, whereas no such associations were observed among women. Conclusion: The majority of the observed patients had low PAL and women had lower PAL compared to men. PAL was related to complexity of heart lesion. Efforts to increase habitual physical activity may be indicated in this population, especially in women and patients with complex congenital heart disease.
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Papers by Stefan Grajek