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Unlabelled: The benefit of immediate reperfusion in the treatment of ST-segment elevation myocardial infarction (STEMI) is indisputable. Unfortunately, no reperfusion therapy is applied to nearly 30% of patients without contraindication to such treatment. We aimed to analyze the impact of therapeutic approach on the prognosis after acute phase of STEMI., Material and Methods: The study group consisted of 26035 consecutive STEMI patients (8989 females, 34.4%) hopitalized in 456 sites during one year. Data were available from the Polish Registry of Acute Coronary Syndromes (PL-ACS) launched in Silesian Center for Heart Diseases, Zabrze., Results: Patiens treated with primary percutaneous intervention (pPCI) had the best outcome. All therapeutic strategies resulted in worse prognosis in women when compared to men. Women had greater 12-month mortality in the conservative, fibrinolytic and interventional treatment group: 33.1% vs 23.2%; p < 0.0001; 24.3% vs 16.2%; p < 0.0001 i 11.4% vs 8.2%, p < 0.0001, respectively. Differences in the surgically treated group were insignificant (men: 25%, women: 8%, p = 0.42)., Conclusions: The outcome of conservative, fibrinolytic and interventional treatment was worse in the female group. Primary coronary angioplasty was the most benefical therapeutic strategy.

Blood fractionation and storage improve the availability of blood products, e.g., packed red blood cells (RBCs) for transfusion. But the following question appears: how long-stored RBCs are safe and effective? In many clinical retrospective studies authors indicated risk of transfusion of stored RBCs, especially in critically ill patients eg. with acute myocardial infarction syndrome. They observed higher frequency of mortality, morbidity, infections, renal and lung failure, inflammation and thrombosis when RBC units were long-stored and non-leucoreduced than when they were fresh and leucoreduced. Responsible mechanisms are unknown but some factors are suspected eg.: RBCs do not deliver oxygen, because they have low concentration of ATP and 2.3 DPG and their shape changes. Also cytokines, enzymes and ions (K, Ca) from white blood cells (WBCs) can influence RBCs and transfused patients. Changes involve some membrane molecules associated with adhesion, oxygen transport, complement regulation during the storage of RBCs. It is interesting how the long-period storage and presence of WBCs can influence the membrane surface of RBCs and then their biological functions. Proposed study can improve our knowledge about changes in RBCs during their storage and then may be safety of blood transfusion.

Post mortem examination protocols of the Chair and Department of Forensic Medicine, University of Medical Sciences in Poznan, pertaining to deaths occurring in the Sobering Station in Poznan in the years 1956-2008 were selected. In the analyzed period, 117 such cases were identified, what constituted approximately 2 deaths per annum. The majority of deaths occurred in males; women constituted a small percentage of all the cases. Over 3/4 of deaths were seen in patients between 26 and 50 years of life. Acute alcohol intoxication, acute respiratory and circulatory failure and cerebrocranial injuries constituted the main causes of death. Moreover, in few cases, the detained person committed suicide by hanging. Only in a few situations had the deceased patients been previously examined by a doctor in a hospital, but had been refused admission and had been referred to a sobering station. The results show that over 3/4 of deaths in the Poznan Sobering Station was a consequence of misdiagnosis, most frequently concerning unrecognized acute alcohol intoxication, cerebrocranial injuries or acute myocardial infarction. A change of regulations concerning the functioning of sobering stations involving introduction of breathanalyzers for testing blood alcohol levels and implementation of other tests did not result in a decreased number of deaths in sobering stations due to acute alcohol intoxication.

Background: According to the presenting electrocardiogram, acute myocardial infarction (MI) can by categorised generally as non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI)., Aim: To assess the impact of the different acute MI categories on in-hospital management and mortality in hospitals without on-site invasive facilities., Methods: We identified 380 NSTEMI and 334 STEMI patients treated in the Malopolska Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Data concerning in-hospital management and mortality were assessed., Results: Patients with NSTEMI were older and were more likely to have prior angina, prior MI and prior heart failure symptoms than STEMI patients. The NSTEMI patients were less likely to be transferred for invasive treatment (23.9 vs. 41.9%, p <0.0001) and receive glycoprotein IIb/IIIa inhibitors during index hospital stay. The use of low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II antagonists, nitrates and statins was more frequent in NSTEMI patients. Among patients treated non-invasively, in-hospital mortality was high, but was lower in NSTEMI than STEMI patients (12.1 vs. 22.7%, p <0.0001). Independent predictors of in-hospital death in this group were age, cardiogenic shock, chronic obstructive pulmonary disease, and STEMI., Conclusions: Despite current recommendations, NSTEMI patients are still less likely to be transferred for invasive treatment than STEMI patients. Among patients treated non-invasively during index hospital stay, NSTEMI is associated with more favourable prognosis than STEMI, but the risk of in-hospital death is high. The hospital network should implement more frequently the strategy of early and urgent invasive treatment of NSTEMI patients.

Background: Efficacy and safety of primary percutaneous coronary angioplasty (PCI) in elderly patients with acute ST-elevation myocardial infarction (STEMI) have not yet been definitely established because these patients were usually excluded from large randomised trials., Aim: To evaluate in-hospital and one-year outcome after primary PCI in elderly patients, and to assess clinical characteristics of this group., Methods: The study population included 1061 consecutive STEMI patients, mean age 60.6+/-17 years, treated with primary PCI. Clinical characteristics and results of 127 patients aged > or = 75 years were compared to the younger group., Results: Elderly patients were more frequently female (48.4 vs. 23.6%, p <0.005) and diabetics (22.2 vs. 12.1%, p <0.02) and more frequently had renal and/or left ventricular failure (22.3 vs. 9.1%, and 9.1 vs. 4.5%, p <0.005, respectively). In older patients less frequently stents were implanted and TIMI flow 3 was restored (65.1 vs. 78.8%, p <0.05 and 74.6 vs. 84.7%, p <0.03). In-hospital mortality in older versus younger patients was 11.8 vs. 3.0%, p <0.005. The incidence of in-hospital complications (stroke, major bleeding and reinfarction) was similar in both groups. The one-year mortality and MACE rates were higher in older patients (21.3 vs. 6.0% and 24.9 vs. 11.0%, p <0.0005). In multivariate analysis Killip class II-IV (OR 6.73; 95% CI 1.75-25.97, p=0.006) and heart rate (OR 1.04; 95% CI 1.01-1.07, p=0.03) were independent predictors of one-year mortality in patients aged > or = 75 years., Conclusions: Primary PCI in older STEMI patients is associated with a favourable in-hospital and one-year outcome, although inferior to that seen in younger patients. The in-hospital complication rate is similar in the elderly and in younger patients.

Background: In recent years significant progress has been made in invasive treatment of patients with acute myocardial infarction (AMI). Primary coronary stenting is currently a routine strategy which replaced primary balloon angioplasty with bailout stenting preferred in the past. Studies comparing these two strategies of stenting in AMI are scarce., Aim: To compare the immediate and long-term outcomes after primary angioplasty strategy and bailout stenting versus primary stent placement strategy in patients with AMI., Methods: We analysed data from a single-centre registry of consecutive patients with ST segment elevation myocardial infarction admitted between January 1998 and October 2003. In our centre in years 1998-2000 stenting was used only after failed or suboptimal balloon angioplasty. Starting from year 2001 we used routine primary stenting strategy. We compared these two angioplasty strategies applied in different time intervals with regard to in-hospital outcome and long-term mortality. Patients with cardiogenic shock at admission were excluded., Results: Out of a total of 1602 patients treated invasively for AMI (cardiogenic shock excluded) 479 underwent primary balloon angioplasty strategy with bailout stenting - group 1 (years 1998-2000) and 1123 were treated with primary stenting strategy - group 2 (years 2001-2003). In group 1 bailout stenting occurred in 34.4% of patients whereas in group 2 stents were implanted in 83% of patients. Patients in the balloon angioplasty group were younger, had shorter time from the onset of symptom to hospital arrival and more frequently underwent rescue coronary intervention after failed thrombolysis. In-hospital mortality was 2.9 vs. 2.4% in groups 1 and 2, respectively (p=NS). Twenty-four month mortality rate was 9.8% in group 1 and 10.06% in group 2 (p=NS)., Conclusions: 1. Effectiveness of coronary angioplasty is high and comparable in both groups. 2. In-hospital and long-term mortality and procedure-related complication rate are all low and comparable with both stenting strategies. 3. Independent factors increasing long-term mortality include: culprit vessel reocclusion, multivessel coronary disease, older age and hypertension. 4. Patients with complete patency of culprit vessel restored and with higher left ventricular ejection fraction presented lower 2-year mortality rate. 5. Bailout stenting did not increase 2-year mortality.

Background: The ACC/AHA guidelines for management of patients with ST-elevation myocardial infarction (STEMI) have recommended primary PCI (pPCI) as the preferred reperfusion therapy, when it can be performed in a timely fashion, within 90-110 min from the first contact with medical personnel. The impact of treatment delays on outcomes in patients undergoing pPCI has been controversial., Aim: To evaluate the impact of time delays on in-hospital mortality and on the frequency of cardiac events during 30 days after STEMI., Methods: 1723 patients were stratified on the basis of their time delays: from symptom onset until balloon inflation. The patients were divided into 4 groups: group 1 (311 patients) - time from symptom onset <90 min; group 2 (731 patients) - time delays of 90-180 min; group 3 (535 patients) - time delays of 180-360 min, and group 4 (146 patients) - time from symptom onset >360 min., Results: The median time delay was 268.5+/-206 min, the median door to balloon time was 36.12+/-11.2 min. The patients with longer time delays (group 4) were older, more often were women, and had a higher frequency of diabetes, anterior MI and Killip class 4. During hospitalisation, 70 (4.1%) patients died. In-hospital mortality was significantly higher in group 4 (13.6%) than in other groups. Complications of STEMI such as cardiogenic shock considerably influenced mortality (45.6%). During a 30-day follow- -up, the patients with cardiogenic shock and the elderly had an increased risk of cardiac events. Also, time delays >360 min and failed pPTCA were independent adverse risk factors in multivariate regression analysis., Conclusion: Delays in time to pPCI have an impact on outcomes, especially in those treated >6 hours from the onset of symptoms.

Background: Data on the efficacy of coronary angioplasty in patients with ST-segment elevation myocardial infarction (STEMI) treated during off-shift hours are limited, but some publications suggest a worse outcome in this group of patients., Aim: To compare the results of percutaneous coronary interventions (PCI) in STEMI patients admitted to hospital during the daytime and off-shift hours and to identify factors which influence prognosis., Methods: From January 1998 to October 2003, 1992 patients with STEMI were hospitalised and 1778 of them were treated with immediate PCI, including 482 admitted in the daytime (weekdays 8 a.m. - 3 p.m.; group I) and 1296 during off-shift hours (weekdays 3 p.m. - 8 a.m., weekends and holidays; group II). The clinical characteristics of both groups were similar, except for less frequent hypercholesterolaemia in the daytime group (52.1 vs. 59.7%; p=0.0041)., Results: There was no significant difference between the groups regarding time from admission to angiography (30 vs. 25 minutes), rates of reocclusion (5.2 vs. 4.9%), stroke (1.4 vs. 1.6%), haemorrhagic complications (8.1 vs. 6.9%), in-hospital mortality (6.8 vs. 6.2%) and long-term (24 months) mortality (13.7 vs. 13.6%) (p >0.05 for all parameters). The rate of stent implantation was significantly higher in the daytime group (71.2 vs. 66.2%; p=0.047)., Conclusions: The proper organisation of duties of the division of cardiology and the cardiac catheterisation laboratory, with focus on providing onsite staffing of the cardiac catheterisation laboratory around the clock, enables similar results of PCI in patients with ST-segment elevation myocardial infarction treated during off-shift hours as compared with patients treated during the daytime.

Background: Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients aged > or =80 years., Aim: To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patients > or =80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age., Methods: In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83+/-3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied., Results: Severity of coronary atherosclerosis measured by angiographic Gensini score and author's own score was similar in diabetic and non-diabetic patients (23.25+/-9.6 vs. 20.6+/-10.2; NS, and 9.1+/-6.0 vs. 8.1+/-5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosis <20%, was obtained in 92.2% of patients with DM compared to 83.7% of non-diabetics (NS). One-day mortality was 7.1 vs. 6.1% (NS), in-hospital mortality was 7.1 vs. 17.4% (NS). Successful pPCI reduced 30-day mortality threefold (OR=0.31; p <0.05). Contrast-induced nephropathy occurred in 35.7% of diabetic patients compared to 26.5% of those without diabetes (NS) Contrast-induced nephropathy increased risk for in-hospital mortality fivefold (p <0.02). No significant correlation between DM or baseline glucose level and in-hospital mortality was found. During one-year follow-up mortality rate in diabetic patients was 38.5% compared to 7.3% of those without diabetes (p <0.01). One-year mortality predictors were: age (OR=1.27; p=0.0047), metabolic syndrome (OR=4.4; p <0.04), type 2 diabetes (OR=5.25; p <0.02), insulin treatment (OR=5.7; p <0.03), baseline glucose level (OR=1.01; p <0.007), maximum CK-mass level (OR=1.006; p <0.05), noninvasive STEMI management (OR=5.0; p <0.02), and stroke (OR=7.5; p <0.006). Stroke (OR=40.0; p <0.005) and diabetes (OR=6.2; p <0.01) were identified by multivariable analysis as independent risk factors of one-year mortality., Conclusions: In patients with DM aged > or =80 years with ACS-STE, severity of coronary atherosclerosis and in-hospital prognosis after pPCI seems to be similar to subjects in the same age without DM. Diabetes mellitus is an independent risk factor of one-year mortality after successful pPCI.

Background: TIMI scale is commonly used for angiographic assessment of reperfusion effectiveness and early risk stratification in patients treated with primary angioplasty for ST-elevation myocardial infarction (STEMI). Since ST-resolution analysis allows a noninvasive insight into the reperfusion status at the myocardial tissue level, it may be a better predictor of outcome after primary angioplasty., Aim: To compare the prognostic value of the reperfusion effectiveness evaluation based on either the epicardial blood flow assessment according to the TIMI scale, or ST-segment resolution analysis in patients treated with primary coronary angioplasty for STEMI., Methods: 324 consecutive patients treated within 12 hours from the pain onset were studied. Based on the analysis of maximal ST-segment elevation/depression identified in a single ECG lead recorded after the procedure (maxSTE), patients were classified into groups of high versus medium/low risk. Independently, distinguished were groups with restored normal (TIMI 3) and abnormal (TIMI 0-2) final blood flow in infarct related artery., Results: The 30-day and one-year mortality rates were higher in the high-risk maxSTE group (25% of all patients) than in the other patients (14.8% vs. 2.5%, p<0.001 and 18.5% vs. 5.4%, p<0.001 respectively). In subjects (82%) with restored TIMI grade 3 blood flow, mortality at one-month and one-year was lower than in the group with abnormal final blood flow (3.1% vs. 15.6%, p=0.001 and 6.2% vs. 18.8%, p=0.005). Comparison in multivariate analysis revealed that maxSTE stratification but not final TIMI grade assessment remained an independent predictor of both, 30-day and one-year mortality (high vs. medium/low-risk category; OR 5.3, 95% CI 1.6-16.7, p=0.005, and OR 3.3, 95% CI 1.4-7.8, p=0.007, respectively). Furthermore, maxSTE proved to stratify the risk of death even in subgroup of patients with restored normal blood flow (OR 6.2, 95% CI 1.4-27.8, p=0.016, and OR 3.0, 95% CI 1.1-8.7, p=0.039, respectively)., Conclusions: Analysis of extent of maximal ST-segment elevation or depression identified in a single ECG lead after primary coronary angioplasty allows better prognosis of subsequent 30-day and one-year mortality than the assessment of final epicardial blood flow, stratifying risk of death even in a subgroup of patients with restored normal blood flow.

Ischemic heart disease and myocardial infarction in patients with SLE--are usually secondary to early coronary atherosclerosis. Estimation if antiphospholipid syndrome and antiphospholipid antibodies are the risk factor for myocardial infarction and ischemic heart disease in patients with TRU. We examined 129 patients with SLE (114 women and 15 men). All the patients underwent comprehensive physical examination. ECG, ultrasound heart examinations were performed. They were followed by heart scintygraphic examination if indicated. Routine biochemical and hematological laboratory tests were performed including fasting glucose level, concentration of homocysteine, uric acid and lipids. Wide range of immunological essays were performed, testing for antinuclear antibodies (ANA), extractable nuclear antigen antibodies (ENA), antiphospholipid antibodies (anticardiolipin antibodies--aCL, lupus anticoagulant--LA, antiprothrombine antibodies aPT, anti-beta2glicoprotein-I antibodies), anti-dsDNA antibodies, anti-nucleosome antibodies, antihistone antibodies, antineutrophil cytoplasmic antibodies (ANCA) and antiendothelial antibodies (AECA). Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rang Spearman tests. Multivariate regression analysis was also done. Ischemic heart disease was found in 20 (15.5%) SLE patients, myocardial infarctions were diagnosed in 9 (6.97%). Ischemic heart disease and myocardial infarction were significantly related to presence of secondary antiphospholipid syndrome (SAPS), OR: 4.21, p = 0.008 and OR: 12.8; p = 0.02 respectively). They were also related to high activity of SLE, OR: 7.18; p = 0.012 and OR: 27.3; p = 0.006 respectively. Ischemic heart disease was significantly more common in older patients (52.75 years versus 42.15 years; p = 0.0008) and in patients with hypertension (p < 0.05). Impaired glucose tolerance (OR: 8.44; p = 0.03), presence of aCL IgG (OR; 2.93; p = 0.05) and p-ANCA anti-MPO (OR: 6.08; p = 0.036) were found to be risk factors of ischemic heart disease. Myocardial infarction was significantly associated with high uric acid level (OR: 5.01; p = 0.052) and impaired glucose tolerance (OR: 7.42; p = 0.047) and with presence of the following antibodies: aCL IgG and/or aCL IgM (OR: 5.61; p = 0.039), ANCA in the indirect immunofluorescence essay (OR: 5.78; p = 0.035), anti-MPO antibodies (OR: 6.58; p = 0.051) and AECA (OR: 11.10; p = 0.026). Presence of antiphospholipid antibodies and SAPS are significant risk factors of ischemic heart disease and myocardial infarction in SLE patients. The risk factors of ischemic heart disease and myocardial infarction in SLE patients significantly differ from the ones in general population.

Introduction: Prognosis in patients (pts) after myocardial infarction (MI) with chronic heart failure (CHF) and asymptomatic left ventricular dysfunction (ALVD) differs. Acute coronary syndromes (ACS) worsen CHF and prognosis in these pts. A diagnostic tool that identifies the group of high risk pts is needed. Prognostic factors include left ventricle ejection fraction (LVEF) and stage of heart failure. The aim of the study was evaluation if decreased LVEF worsen prognosis in pts with CHF and ALVD and whether LVEF is more powerful predictor of poor prognosis than severity of heart failure., Material and Methods: 112 consecutive pts (95 men and 17 women age range 34-75, mean 52.9) post MI in stage B (ALVD) or stage C (CHF) according to ACC/AHA classification were studied. LVEF was determined in standard echocardiography with Simpson's method. Pts were divided into four groups: I--stage B and LVEF < or = 40% (6 pts); II--stage B and LVEF > 40% (52 pts); III--stage C and LVEF < or = 40% (19 pts); IV--stage C and LVEF > 40% (35 pts). The pts were followed for 30 months for the occurrence of the composite endpoint: major acute coronary events (MACE) i.e: ACS and cardiovascular deaths (CVD). In analysis we used chi2 test., Results: There were 35 MACE during follow-up: 30 in pts in stage C and 5 in stage B. There were more MACE in group I than in group III (p < 0.01) and in group II than in group IV (p < 0.001). Pts in group I had more MACE than in group IV (p < 0.05). There were more MACE in group II than in group III (p < 0.01). Other results were not statistically significant., Conclusions: Stage of heart failure evaluated clinically is more powerful predictor of MACE than decreased LVEF. The more advanced stage of heart failure in post-MI pts, the higher risk of ACS or CVD. LVEF does not influence the risk of MACE in pts in the same stage of heart failure.

Background: Spironolactone--non-selective mineralocroticoid receptor blocker in patients with chronic heart failure reduces the risk of death. Its efficacy was not assessed in patients with postinfarction (post-MI) left ventricular dysfunction. The purpose of this study was to evaluate the effect of spironolactone on mortality in survivors of acute myocardial infarction with depressed ejection fraction < 30% (EF%) during a 24-month, long-term observation., Methods: Study population consisted of 47 patients, 38 men and 9 women aged 41-79 years, mean age 62 +/- 10 years with severe post-MI left ventricular dysfunction (EF% < 30%). Patients were divided into 2 groups according to applied treatment: the group spironolactone (+) - 22 pts who received spironolactone at daily dose 25-50 mg and the group spironolacton (-) - 25 pts not treated with spironolactone. The end point of this observation was mortality from all causes during a 24-month follow-up., Results: During long-term observation - 19 of 47 patients died (40%). Mortality from all causes in the group spironolactone (+) - 11/22 (50%) was non significantly higher as compared to the group spironolactone (-) - 8/25 (32%)., Conclusion: In patients with severe left ventricular dysfunction (EF < 30%) after acute myocardial infarction long-term treatment with spironolactone at daily dose 25-50 mg does not reduce mortality rate in long-term follow-up.

Isolated right ventricular myocardial infarction (RVMI) is a very rare complication of ischemic heart disease. Generally it accompanies infero-posterior or antero-septal myocardial infarction cases. Right ventricular myocardial infarction is a strong predictor of acute right ventricular failure, bradyarrythmia, ischemic and mechanical complications and is frequently complicated by cardiogenic shock which often leads to death. Acute right ventricular ischemia (RVI) and RVMI are big problem particularly during and early post-operative cardiosurgery procedures. Atherosclerotic changes and heart blood flow disturbances predispose to RVI or RVMI that occur more often in cardiosurgical patients, especially in early postoperative period. On the other hand early intraoperative diagnosis and longer reperfusion period result in the correction of heart function and better prognosis.

Ischemic heart disease (IHD) and acute myocardial infarction (AMI) present several important specificities in their clinical course. The problem how these circumstances influence the life of the persons with diabetes (DM) in longer perspective is not well elaborated. Therefore the assessment of the medical history of persons with DM after first MI was undertaken based on analysis of the following endpoints: the recurrence of MI, hospitalization due to acute heart ischemic incidents, the procedure of coronary revascularization, appearance of stroke, death due to cardiovascular causes., Investigated Group and Methods: During the years 1996-2000 69 subjects with AMI were hospitalized from the area of the local, urban hospital. The medical documentation supplemented by the patient and family home reviews and data from death registry office for the period of 2 years since the hospitalization due to first AMI was analyzed., Results: In the group under study the males aged between 61 and 70 years were preponderant - 20,3%, the largest females subgroup was in the age between 71 and 80 years - 17,4%. The first AMI was the revelatory of the previously not known DM in 30,4% of cases, 21,7% subjects had the diagnosis of DM made in the last 5 years before first AMI. The symptoms of IHD were present before first AMI in 49% of subjects. 82% of them had the Q type AMI in 23% localized in inferior, in 17% in anterior and in 16% in lower-posterior wall of the heart. The frequencies of other then hyperglycaemia risk factors were: arterial hypertension - 67%, obesity and overweight respectively 38% and 26%, smoking - 32%, dyslipidemia - 28%. The risk factors were often multiple in the form of metabolic syndrome. During the 2 years of the follow-up after first AMI, 34,6% of subjects died. In 72,2% of this subgroup the mortality was due to the cardiovascular syndromes - recurrent MI, cardiac failure, stroke and "generalized atherosclerosis". The rate of hospitalization caused by acute ischemic incidents was 25%, recurrent MI - 11,5%, cardiosurgical intervention - 5,8%, stroke - 3,8%., Conclusions: The mortality level of 34,6% during 2 years after first AMI due to new cardiovascular events is the measure of the specific unfavourable prognosis for diabetic persons after first AMI. It underlines the need of the implementation in this subgroup of the intensified cardio-diabetological secondary prevention plan.

Background: Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation., Hypothesis: The aim of the study was analysis of clinical characteristics, in-hospital outcome and factors of in-hospital mortality., Methods: The study group comprised 853 patients who were defined as high-risk, based on resting pain episodes within previous 24 hours, changes of ST-T segment in ECG, and elevated serum cardiac markers. All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 73.1% of patients. 16.7% were assigned to CABG (coronary artery bypass graft), 1.6% of patients underwent PCI and CABG and 8.6% of patients were treated conservatively., Results: Overall in-hospital mortality was 3%; 1.4% in the PCI group, 8.4% in the CABG group and 6.8% in conservatively treated patients. The independent risk factors of in-hospital deaths were: Braunwald's IIIC class angina (OR 7.8; 95%CI 3.6-12.37 p=0.004), recurrent angina after revascularization (OR 13.04; 95%CI 7.62-29.23 p=0.002), congestive heart failure (OR 11.45; 95%CI 8.01-18,38 p=0.00001) and evolving myocardial infarction with ST-segment elevation (OR 12.77; 95%CI 8.35-27.35 p=0.0001). Stent implantation was associated with decreased risk of in-hospital death (OR 0.12; 95%CI 0.07-0.41; p=0.003)., Conclusions: Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.

Unlabelled: The paper aims at presenting selected elements of the epidemiological situation concerning cardiovascular diseases (CVD) in the Lodz region compared to Poland. The analysis contained in our paper draws on the latest version of the WHO mortality database, data provided by the Ministry of Health, the Central Statistical Office and the database of the Lodz Regional Centre of Public Health. Mortality rates due to CVD were subject to direct standardisation in order to remove the bias stemming from different age structures of the compared populations., Results: The population of the Lodz region is characterised by the highest feminisation rate as well as the strongest ageing process nation-wide. The standardised mortality rates due to CVD in 2002 in the Lodz region amounted to 455.76 per 100,000 in the general population, 450.70 among males, and 463.74 among females, whereas the respective indices for Poland were as follows: 442.82, 432.77, and 452.26. Furthermore, we present the data on death causes by ICD-10 groups and categories, with a particular attention paid to the coronary heart disease and the cerebrovascular diseases., Conclusions: Taking into account the epidemiological situation due to cardiovascular diseases (CVD), the Lodz region occupies an unfavourable position on the map depicting the health status of Poland. One of the relevant indicators is the highest mortality rate due to CVD across all Polish regions.

Background: Electrocardiographic exercise tests are widely recommended for patients before discharge after myocardial infarction, what justify the search for new variables which may improve their prognostic value. QT dispersion in 12 lead ECG reflects the heterogeneity of ventricular repolarisation. Increased QT dispersion is a noninvasive marker of ischaemia and electrical instability., Aim: Evaluation of the prognostic value of exercise-induced changes of QT dispersion in patients after an acute myocardial infarction., Methods: Heart rate limited treadmill exercise test according to modified Bruce was performed 14+/-5 days after infarction in 77 patients (age 56+/-11,8 female). QT dispersion was measured at rest and on peak exercise. Patients were followed up for mean 88 months., Results: QT dispersion was higher at peak exercise in those patients who died due to cardiovascular causes (n=8) or suffered from non-fatal myocardial infarction during follow-up (n=15), than in remaining group (71+/-20 vs 58+/-22 msec, p<0.01). At rest QT dispersion was similar in both groups (64+/-17 vs 66+/-20 msec, NS)., Conclusions: The lack of an exercise-induced decrease in QT dispersion identifies a subgroup of patients after myocardial infarction with a poor long-term prognosis.

Background: Tissue perfusion during acute myocardial infarction (AMI) may be assessed by means of the angiographic method -- TIMI myocardial perfusion (TMP). We hypothesised that TMP grade (TMPG) after primary coronary angioplasty (PCI) implicates immediate and long-term clinical outcomes., Methods: We studied 588 consecutive patients (mean age 58.7+/-10.8 years) with ST-segment elevation AMI treated with PCI. Infarct-related TMPG was evaluated before and after PCI. Myocardial injury was expressed as an area under the curve (AUC) of CK-MB release in the first 48 hours of reperfusion. Left ventricular ejection fraction (LVEF) was assessed by 2-dimensional echocardiography one day after PCI. Clinical end-points during a 12-month follow-up included death, recurrent MI and repeated revascularisation or hospitalisation. At the end of the follow-up, NYHA functional class was evaluated in all patients., Results: Before PCI, TMPG -3, -2 and -0/1 values were observed in 52 (8.8%), 77 (13.1%) and 459 (78.1%) patients, respectively. After PCI, TMPG-3, -2 and -0/1 were achieved in 196 (33.3%), 174 (29.6%) and 218 (37.1%) patients, respectively. Patients with TMPG-3, -2, and -0/1 had AUC of 10341+/-1194, 12330+/-1272 and 16718+/-1860 (U/l x h) (p<0.01) and LVEF of 53.6+/-8.6%, 45.5+/-9.5% and 41.7+/-10.4% (p<0.001), respectively. In-hospital mortality rate in patients with TMPG-3, -2 and -0/1 was 0%, 4% and 11.9%, respectively (p<0.001), and after 12-months - 2%, 6.3% and 16.5%, respectively (p<0.001). The event-free survival rate after 1-year was 83.2%, 74.1% and 65.1% respectively (p<0.001). The percentage of patients in NYHA class > or =2 was 10.2%, 16.1% and 20.6% (p=0.003), respectively., Conclusions: The TIMI myocardial perfusion grade after primary coronary angioplasty in acute myocardial infarction effects left ventricular injury and function as well as early and long-term clinical outcome.

Background: Over 1/3 of all patients treated for acute myocardial infarction are elderly (over 70 years of age). Blood flow restoration in the infarct-related artery is a fundamental therapeutic strategy, however reperfusion therapy is rarely used in the elderly as compared with younger groups. Mortality and complication rates are much higher in the elderly than in younger patients irrespective of the type of reperfusion therapy. Elderly patients are modestly represented in studies undertaken to analyze the efficacy of various types of reperfusion therapy. For this reason the choice of an optimal therapy in acute myocardial infarction in the elderly remains an open question., Methods: In the I Department of Cardiology PCI has been the strategy of choice in the treatment of acute myocardial infarction. This is a retrospective analysis of early and late outcomes of primary coronary angioplasty in elderly patients with myocardial infarction. Between June 2001 and December 2003 four hundred and five (405) consecutive patients were admitted to our centre due to acute myocardial infarction. A group of 352 patients treated by primary coronary angioplasty was analyzed. Patients were divided into two subgroups one subgroup--over 70 years of age (84 patients) and the second one--below 70 years of age (268 patients) serving as controls. Early (in-hospital) and late (at 30 days, 6 and 12 months) outcomes were assessed., Results: The most important observation was that elderly patients with myocardial infarction may be safely and effectively treated with primary coronary angioplasty. In-hospital mortality (5.9% vs. 2.2%, p < 0.05) and the number of bleeding complications (9.5% vs. 4.1%, p < 0.05) were higher in the elderly than in younger patients, but still lower than in the studies where fibrinolysis was used as a reperfusion strategy. Another important fact was the relatively frequent use of a platelet glycoprotein IIb/IIIa inhibitor (abciximab) in the elderly group (46.4% patients)., Conclusions: Our results prove that these agents may also be safely administered in elderly patients with myocardial infarction. It is probable that the relatively frequent use of platelet glycoprotein IIb/IIIa inhibitors in our elderly patients was one of the reasons for lower early mortality as compared with the findings of other investigators.

Background: Acute myocardial infarction (AMI) is one of the main causes of death in the elderly, however, the optimal therapy of AMI in this age-group has not yet been established., Aim: To compare the early outcome of patients with AMI aged > or =75 years who underwent primary percutaneous coronary interventions (PCI) or were treated conservatively., Methods: In-hospital outcome of 180 patients aged > or =75 years, hospitalised due to AMI, was retrospectively analysed. Ninety two consecutive patients, admitted with AMI between May 2001 and October 2002, underwent primary PCI whereas 88 patients, treated for AMI between 1993 and 2002, received standard pharmacological therapy without thrombolysis., Conclusions: Primary PCI in the elderly with AMI is significantly more effective than conservative therapy, except with patients with cardiogenic shock in whom mortality is similar regardless of the therapy used.

Background: Prospective, randomized, double-blind study (POLENOX) proved that administration of low molecular weight heparin (LMWH)--enoxaparin for elective percutaneous coronary interventions (PCI) is as safe and as effective like unfractionated heparin (UFH). The aim of the present study was to determine safety and efficacy of the other LMWH--dalteparin for elective PCI., Methods: 100 patients planned for elective PCI were enrolled to the study. PCI were performed after i.v. dalteparin administration; 120 U/kg (up to 10 000 U). Importantly, all patients were pretreated with aspirin (75-325 mg per day) and ticlopidine (250 mg bid) prior to the procedure. During hospitalization rate of ischemic cardiac events and haemorrhagic complications were assessed. Serial CK and CK-MB were obtained 0, 8, 16, 24 hours after PCI. The results were compared with data from POLENOX study. Group 1 was treated with dalteparin, group 2 with UFH and group 3 with enoxaparin., Results: Rate of death, myocardial infarction (CK-MB elevation > x 5 normal level) and repeated revascularization in groups was similar. In group 1 (0%; 2%; 1%) in group 2 (0.5%; 2%; 0%) in group 3 (0%, 2%, 0%) respectively. In group 1 CPK elevation (> 3 x normal) after PCI was more frequent (9%) in comparison with group 2 (3.5%) and group 3 (5%), but without statistical significance (p=0.14). Major bleeding complications were not observed in treated groups. Minor bleeding complications were more frequent in group 1 (9%) and 3 (8.5%) than in group 2 (2%), p< 0.001., Conclusions: The use of dalteparin during PCI in patients with aspirin and ticlopidine pre-treatment is safe. However, more frequent benign local bleeding complications and mild CK-MB elevations may be expected.

Background: Primary percutaneous coronary intervention (PCI) in patients (pts) with ST-segment elevation myocardial infarction is regarded as treatment superior to thrombolysis. Coronary stents and GP IIb/IIIa receptor inhibitors improved safety and clinical outcome of interventional procedures. Safety of primary PCI procedure in catheterisation laboratories which do not have on-site surgical backup is still under evaluation., Methods: In a cohort of 249 consecutive patients we analysed short and long-term clinical outcome of primary PCI performed in catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time < 30 minutes., Results: Coronary stents were implanted in 43% pts. GP IIb/IIIa receptor inhibitors were used in 54.2% pts. Cardiogenic shock on admission was diagnosed in 7.2% pts. Intra-aortic balloon counterpulsation usage was necessary in 6.4% pts. In-hospital mortality was 6% (3.5% in non-shock pts). In two pts (0.8%) during hospitalization repeat PCI was performed--in one case due to reinfarction. No urgent cardiosurgery intervention was necessary. Mortality and myocardial infarction rate after hospital discharge during 6 month follow up was 2.4% and 2.8% respectively. In 4% pts repeated PCI was performed due to restensosis. Cumulative event free survival was 84%., Conclusion: Primary PCI procedure for acute myocardial infarction seems to be feasible and safe in catheterisation laboratories without on-site surgical backup provided usage of stents, GPIIb/IIIa receptor inhibitors and intraaortic balloon counterpulsation and cooperation with a nearby cardiosurgery department with short transfer time.

Background: Reperfusion therapy reduces mortality rate in patients with acute myocardial infarction with ST-segment elevation (STEMI)., Aim: The aim of the study was to access the early outcome of patiens (pts) with STEMI admitted to Upper Silesian Cardiology Centre in 2002., Methods: 957 pts with AMI were enrolled into the study. The influence of several factors on in-hospital mortality was analised., Results: Out of 957 pts 51 died during hospitalization (5,3%). Coronary angiography was performed in 98,0% of pts. Primary PTCA was performed in 94,5% of pts. Stents were implanted in 85,9% of patients who underwent PTCA. The following factors significantly contributed to increased mortality among pts with acute myocardial infarction: female sex (p<0,02), multivessel disease (p<0,05), age above 65 yrs (p<0,001), time from the onset of chest pain above 6 hours (p<0,01) and 12 hours (p<0,001). The use of GP IIB/IIIA inhibitors significantly reduced the mortality rate (p<0,05). Cardiogenic shock was the only independent factor of the increased risk of mortality in multivariate regression analysis (p<0,0001) with relative risk of death (RR 33,5). The mortality rate in pts with shock was 40,2%: 70,8% in case of conservative treatment, 70% in the group of failed PTCA and only 17,2% in the group of successful PTCA. Among pts who underwent primary PTCA the failure to restore coronary blood flow of the infarct related artery contributed to increased relative risk of death (RR 14,5) (p<0,001). Stents improved the survival rate (p<0,01). In PTCA group cardiogenic shock and failed PTCA were independent risk factors in multivariate regression analysis., Conclusions: The results of our study show low rate of in-hospital mortality in pts without cardiogenic shock (1,2%). PTCA is highly successful method of treatment of pts with shock with mortality rate 17,2% in pts who underwent successful procedure.

Unlabelled: To date, the clinical significance of fused T and U waves, termed as TU complexes, has not been evaluated. The aim of the study was to present the clinical characteristics of the patients with TU complexes and to assess the value of this ECG abnormality in risk stratification after myocardial infarction. In the group of 330 postinfarction patients (mean age 61 +/- 10 years, 279 men and 51 women), 50 (15%) had TU complexes in one or more leads of a standard ECG. In patients with TU complexes, the decreased left ventricular ejection fraction, frequent (> or = 10/hour) ventricular premature beats and non-sustained ventricular tachycardia detected on 24-hours ECG monitoring, increased QT dispersion, ST-segment depression and ST-segment elevation on a routine ECG were more common than in patients without TU complexes. During a follow-up period of 43 +/- 17 months, 88 patients died from all causes. At univariate Cox analysis the presence of TU complexes (hazard ratio 3.30; 95% confidence interval 2.09-5.21) and left ventricular ejection fraction < 40% (hazard ratio 3.82; 95% confidence interval 2.51-5.82) were the best predictors of mortality among the 9 evaluated clinical and electrocardiographic variables. The multivariate, stepwise Cox analysis selected ejection fraction < 40% (hazard ratio 3.09; 95% confidence interval 2.00-4.80), TU complexes (hazard ratio 2.28; 95% confidence interval 1.42-3.69), RR interval < 800 ms (hazard ratio 1.62; 95% confidence interval 1.06-2.47), and age of patients > 65 years (hazard ratio 1.58; 95% confidence interval 1.03-2.42) as an independent predictors of all cause mortality., Conclusion: The presence of TU complexes on a routine ECG is associated with impaired left ventricular function, increased predisposition to ventricular arrhythmias and higher risk of mortality. TU complexes may be considered as a new electrocardiographic marker of poor prognosis in patients after myocardial infarction.

From public health perspective cardiovascular diseases are the major challenge in Poland. Monitoring the risk of death and its spatial variation is important tool in the assessment of environmental determinants of health. Crude and age-standardized cardiovascular mortality in the period of 1999-2001 in TriCity (Gdansk, Sopot, Gdynia) was assessed in this work. The source of information was the official death registry that provides complete records of all deaths in Pomeranian province. These records contain detailed specification of the cause of death and place of residence. A cause of death was coded according to International Statistical Classification of Diseases, Injuries, and Causes of Death (Tenth Revision). Overall cardiovascular mortality (I00-I99) and four disease-specific mortality rates were analysed in this study. The following specific causes of death were included into the study: coronary artery disease (I20-I25), myocardial infarction (I21), sudden cardiac death (I46) and stroke (I60-I69). The highest crude mortality from cardiovascular diseases was observed for Sopot city. However, after standardization the difference has diminished or even reversed. There were spatial differences in cardiovascular mortality in those three cities. Demography and social conditions could be the explanations for observed differentiations. Differences in age distribution that is the biggest proportion of elderly people in Sopot may reflect social patterns of environmental conditions observed.

Unlabelled: Diabetes mellitus (DM) is one of the most potent risk factor of in-hospital and long-term prognosis after myocardial infarction (MI). The study aim was to compare in-hospital management and long-term prognosis in diabetics with acute transmural MI especially in the aspect of thrombolytic therapy. We analyzed 881 patients with acute MI treated in our hospital in 1992-1996. DM was found in 21.5% of all studied patients. Data based on past history, management of in-hospital course and next ambulatory control exams in the period 2-6 years were performed using statistical methods and then compared together. Diabetics had significant more often risk factor of development of coronary artery disease. Thrombolytic therapy had received 18.0% of diabetics and 22.1% nondiabetic patients in the age under 80 years-old. Thrombolytic therapy performed at patients with DM significantly reduced in-hospital mortality., Conclusions: 1. Diabetics had worse in-hospital course of acute MI because of more frequent hemodynamic complications. The overall incidence of arrhythmia and A-V conduction disturbances did not differ from nondiabetics. 2. In-hospital mortality in all patients with DM was twofold higher than in the rest (22.2% vs 11.0% p < 0.001). Mortality among patients with thrombolytic therapy did not significantly differ between the ones (5.9% vs 6.7%). 3. Mortality rate after MI in diabetics is 1.66 times higher to compare to nondiabetic.

The subject of this study was a group of 757 patients hospitalized because of acute myocardial infarction in years 1992-1996, who survived the in-hospital course and were under observation for 2-6 years after the infarction. During the 14-18th day of the hospital stay they were made an echocardiographic test, including the ejection fraction (EF). The aim of this study was to define the influence of the ejection fraction value lowered below 40% on the long-term prognosis in patients after acute myocardial infarction. We compared two groups of patients; group I, consisting of 130 (17.2%) patients with EF lowered below 40% and group II, which included 627 patients with EF over 40%. To estimate the statistic significance we used the chi-square and t-Student test. The morbidity curves were made with the Kaplan-Meier method. The course of the myocardial infarction was much more grave in group I than in group II, what is confirmed by a more often anterior ventricular infarction and the quantity of dangerous complications which occurred during the in-hospital phase. The multi-factor regressive analysis showed that the ejection fraction lowered below 40% raises 2.47 times (95% confidence interval 1.50-4.07) (p < 0.001) the risk of death during the first year after myocardial infarction and nearly two times during the 5 year follow-up, compared to patients with a higher EF value. The influence of the EF value lowered below 40% on the creation of an infarction was not significant. The EF value lowered below 40% in patients after acute myocardial infarction was a significant risk factor in the long-term prognosis. More than 40% of deaths during the long-term prognosis in this group were caused by heart failure.

There are presented in the paper laboratory findings, echocardiographic and radioisotope studies results, as well as heart catheterization including coronarography in the pediatric patients suffering from heart infarction. Mortality and malignant arrhythmias due to heart infarct in pediatric age are shortly discussed, too. At last there are some remarks concerning myocardial infarction treatment in children.

Out of 3673 patients with myocardial infarction treated between 1989 and 1998, 128 (54 males and 74 females) deceased due to left ventricle wall rupture (death rate: 18.5%). Thrombolytic therapy started to be used in 1992. It was administered in 36.0% patients with myocardial infarction in the years 1992-1998. Out of the patients deceased due to left ventricle wall rupture thrombolytic was carried out in 24.2%, predominantly in males (31.5%) as compared to females (18.8%). Left ventricle wall rupture during acute myocardial infarction occurred mainly in females (57.7%), in patients with first infarction (89.8%), in the case of anterior wall infarction (66.4%), hypertension (80.5%), in patients aged 61-80 and more (86.7%). Majority of the patients (83.6%) deceased because of this condition between 1 and 7 hospitalisation day, mainly during the first 48 hours (48.4%).

The aim of our study was to assess frequency of death from myocardial infarction in patients (pts) treated for small cell lung cancer (SCLC). 33 out of 845 patients treated for SCLC died from myocardial infarction. All patients were smokers. In 6 patients coexisted hypertension, in 2--diabetes and in 5--obesity. Eight patients have had cardiac disease in anamnesis. All patients were treated with one or more number of cardiotoxic drugs as DDP, VCR or VBL, E, MTX and ADR which are able to cause ischemic heart disease or myocardial infarction. Sixteen out of 33 patients have had radiotherapy of lung tumour. Death from myocardial infarction occurred from 0.5 up till 98.5 months from the beginning of start treatment. Eighteen men died from myocardial infarction in the first year of treatment. Risk of death from myocardial infarction was 15 times greater in men with SCLC than in men of the polish population at the same age and at the same time.

In 2514 patients with myocardial infarction (1961 male and 823 female) hospitalized between 1991 and 1997 right ventricle myocardial infarction was diagnosed based on of V3R-V5R electrocardiographic leads tracing in 147 patients aged 35-86 (105 male and 42 female), which means 5.4% of treated patients. Only one case of isolated right ventricle infarction was observed. In other cases it coexisted with left ventricle infarction--most often with inferior myocardial infarction (118 cases, which means 10.7% cases with this localization). Streptokinase was administered to 64 patients with right ventricle infarction, which means 43.5% treated. 10 patients, including 5 female, deceased during the hospitalization, hospital mortality was 6.8%. Cardiogenic shock was the reason of death in all cases. The frequency of concomitant chronic diseases (hypertension, congestive heart failure, diabetes mellitus) and hyperlipidaemia (hypercholesterolaemia and/or hypertriglyceridaemia), as well as arrhythmia and conduction disturbances, in patients with right ventricle myocardial infarction did not differ from the ones estimated in people with left ventricle infarction. According to the analysis of our own material (the most numerous group of patients as juxtaposed to ones observed by other authors) inferior myocardial infarction is most commonly accompanied by right ventricle infarction. Low hospital mortality in these patients is connected with fibrinolytic therapy. The performance of V3R-V5R electrocardiographic leads tracing is indispensable in patients with acute myocardial infarction. The diagnosis of right ventricle infarction is highly important because of the specific treatment of these patients.

This study describes comparison of the management in 997 patients treated in 1977-85 with acute transmural myocardial infarction (MI), their in-hospital and long-term mortality, with 881 patients treated in 1992-96. The study included geographically the same population treated by the same medical staff but in another decade period and the same MI criteria in both cohorts. Main changes were associated with the management of MI. Both groups were adjusted to age (59.3 +/- 11 vs. 59.9 +/- 11.7), history prior to myocardial infarction, diabetes mellitus, habit of smoking and hospital complications except rarer presence of block A-V II degrees and III degrees in the period 1992-96. The increase in percentage of female patients was noticed in the analysis (from 21% to 28.5%). The crude in-hospital mortality was statistically lower in 1992-96 than in 1977-85 (19.8% vs. 13.4% p < 0.11) and the follow up mortality in the next 2-6 years decreased from 6.97% to 4.95%. Mortality in the first year after MI in both periods was high and raised to 9.6% and 8.9%, respectively (NS). Significant diminish of mortality in next years after myocardial infarction was observed in all age adjusted groups of patients treated in 1992-96.

The contention that female gender is an independent factor that affects survival after acute myocardial infarction (AMI) is still controversial. The aim of this retrospective study was to assess whether or not early and late mortality after AMI is greater in women than in men. Data of 464 consecutive patients (130 women and 334 men) who had a documented acute myocardial infarction in our Department of Cardiology between 1990 and 1993 were eligible for the study. We excluded 48 patients from the study for the following reasons: the location of infarct could not be determined in 18 patients: 16 patients refused to take part in the study and we were not able to contact 14 patients. The remaining 416 patients were analyzed in the study. The mean follow-up period was 36 months (from 1 to 72 months). Women were significantly older than men (62.1 +/- 11.2 vs 58.1 +/- 11.6; p < 0.001), especially those who died in hospital (70.7 +/- 9.3 vs 64.4 +/- 8.7; p < 0.01). In hospital died 26 women (20%) and 39 men (11.7%)--p < 0.05. However, age-adjusted in-hospital mortality did not differ between women and men (p = 0.256). We did not find any significant difference in 3-year survival after AMI between women and men (22% vs 20.7%; NS). Total mortality was also similar (38% vs 30.2%; NS). QMI was diagnosed in 85 women and 234 men (73% vs 78%; NS), NQMI in 31 women and 66 men (27% vs 22%; NS). The rate complications of acute phase of AMI (acute heart failure and/or rhythm disturbances) was similar in women and men. Fibrinolytic treatment was introduced in 27.2% of women and in 26.4% of men. Hypercholesterolemia and hypertension were more often associated with female gender. In multivariate analysis we found that age, acute heart failure, previous MI, hypercholesterolemia and diabetes mellitus were significant factors which affects survival after AMI. Of these only age and diabetes mellitus appeared to be significant in women.

Extracerebral complications which were observed in great number of ischemic stroke patients increased the risk of death and disability. Pneumonia, myocardial infarction, pulmonary embolisms and urinary tract infections are most often. We considered the influences of extracerebral complications on anterior circulation territory disturbances. A cohort of 1697 patients with first-ever ischemic stroke within anterior circulation region was evaluated. Patients were divided into three groups: A, B, C according to the heaviness of stroke. We understood the heaviness of stroke as a degree of cerebral disfunction occurring within the first 24 hours of the onset and assessed it using Clinical Groups of the Whole Body Activity (CG WBM). CG WBM is an original classification, a three-degree one, prepared by Department of Neurology University School of Medicine Sciences in Bydgoszcz. The rate of complications was statistically significantly lower in group A with the mild course of ischemic stroke than in group B with moderate or in group C with the severe course of ischemic stroke. Pneumonia, myocardial infarction and pulmonary embolism were recognized more often in patients with fatal outcome. The amount of extracerebral complications raised with the severity of the ischemic stroke.

Calcium antagonists are widely used in therapy of hypertension and angina pectoris. Their advantage is good efficacy, relatively few and not dangerous side effects and first of all lack of bad metabolic effects (hypokalemia, hyperuricemia, hyperinsulinemia and hyperlipoproteinemia). In contrast to beta-blockers and diuretics, which decline mortality from myocardial infarctions and strokes there are not similar information concerning calcium antagonists. Two meta-analysis from 1995 unexpectedly suggest, that some preparations of calcium antagonists increase mortality from myocardial infarctions and strokes. In our paper we discuss possible pathogenetic (harmful) mechanisms, pay attention to each class of calcium antagonists and time of action of the particular drugs. Short acting nifedipine formulation should be withdrawn from chronic hypertension and angina pectoris therapy. Ongoing multicenter trials in several European countries and in USA will decide the usefulness of other calcium antagonists preparations.

Ischaemic preconditioning is still a laboratory-based phenomenon, not conclusively documented in patients. In this study it was of interest whether there is any beneficial influence of ischemic preconditioning on 30-day in-hospital mortality in patients undergoing acute Q-wave myocardial infarction. All men and women admitted to our ward between December 1994 and July 1996 with their first acute Q-wave myocardial infarction were divided into two groups. I group--29 patients with prodromal angina, defined as chest pain episodes in the 24-hour period before myocardial infarction. II group--25 patients who showed no chest pain before infarction onset. Both groups did not differ statistically in view of age, sex, smoking habits and adjunctive therapy. The use of streptokinase in the I and II group was also similar--in 58.6% and 56% of patients respectively in the first and second group. In the I group there was no fatal outcome, all 5 death cases occurred in the II group. The results are statistically significant and suggest lower in-hospital mortality in Q-wave myocardial infarction patients with previous ischaemic preconditioning.

Pre and post-operative rehabilitation protocol used in 76 patients with femoral neck fracture treated with Austin-Moore hip plasty is presented. The age of patients ranged from 68 to 91 years (mean 79 years). They were operated on average 5 days after admission (range 1-16 days). The authors emphasize role of rehabilitation leading to regaining of ambulating skills by the operated patient. It also decreases the number of pulmonary and psychoorganic complications, shortens hospital stay. Cardiac infarct and pulmonary vein embolism were causes of two fatalities in postoperative period. Mean hospital stay was 22 days.

The aim of this study was to present early and late results of carotid endarterectomy (CEA). We evaluated prospectively 270 CEA performed from 1990 to 1996. More of our patients were men (62%), their age ranged from 28 to 82 years (mean 62.4). Preoperative high grade stenosis (> 70%) of internal carotid artery stenosis was recognized in over 91% of patients according to duplex examination. All operations were performed by the same surgical team with the use of standard CEA without patching. General anaesthesia was used to the middle of 1993. Then all the patients were operated on under regional anaesthesia. Our follow-up consisted of clinical and duplex-scan examination performed regularly from 3 to 72 months after CEA. In the immediate postoperative period (30 days) four patients died (mortality rate 1.5%), mostly due to MI. The long term (72 months) follow-up revealed 12 deaths mostly due to heart attacks or cancer. We observed 11 high grade (> 70%) late recurrent stenoses. There were no deaths due to stroke from the operated artery. Duplex-scan of carotid arteries is a very effective and safe method of preoperative and postoperative evaluation. Regional anaesthesia allows direct estimation of neurological statement during operation. CEA is the only one method of stroke prevention in patients with symptomatic high-grade stenoses.

Among patients with myocardial infarction, patients up to 40 years of age accounted for 5.1% (5.4% men and 4.1% women). Early mortality due to myocardial infarction was in the all material 42.6% and depended mainly on deaths of men in the prehospitalization period. Prehospitalization mortality varied between men and women. It was 45.3% for men and 11.2% for women. Hospital mortality was low, accounting for 7.8% of the treated subjects.

In 53 patients with recent (< 6 hrs) acute myocardial infarction a study was undertaken to evaluate the safety of conjunctive therapy with streptokinase (1.5 mln U), aspirin (150 mg) and low molecular weight heparin (Fraxiparine). Patients were treated with Fraxiparine 250 U anti-Xa IC/kg/24 hrs iv for 2 days (with bolus 12.5 U anti-Xa IC/kg), and 125 U anti-Xa IC/kg twice a day sc for 5 subsequent days. Clinical course in one-year observation was compared regarding the time the therapy was initiated. In the group undergoing therapy 3-6 hrs after the infarct had occurred 4 (7.5%) patients died (2 during hospitalization, 2 after discharge). In 31 patients treated within 3 hrs of the myocardial infarction there were fewer cases of recurrent myocardial infarction, unstable angina or congestive heart failure necessitating rehospitalization their (9.1%) than in 22 patients included in the treatment regimen between 3 rd and 6th h of the infarction (27.3%). Earlier thrombolysis was also connected with higher left ventricular ejection fraction (55 +/- 8% vs 49 +/- 10%) and more frequent peak CK-MB values 12 hrs after thrombolysis (81% and 68% of patients respectively). Neither symptomatic deep vein thrombosis nor pulmonary embolism was detected. The left ventricular thrombosis was diagnosed by echocardiography in 4 of 20 patients (20%) with the first anterior myocardial infarction. There was neither bleeding requiring blood transfusion nor cerebrovascular stroke. The treatment with Fraxiparine did not induce the prolongation of APTT values. Conjunctive thrombolytic therapy with low molecular weight heparin was safe and followed by a favorable outcome of the acute myocardial infarction, especially if instituted within the first 3 hrs after the onset of infarction.

The WHO MONICA Project is a multicentre collaborative study coordinated by The World Health Organization. The aim is to measure trends in cardiovascular disease mortality and morbidity and to assess the extent, to which these trends are related to changes in risk factor levels and in medical care measured at the same time in defined communities in different countries. There are 38 participating research centres from 21 countries from 4 continents, including two Polish centres: POL-MONICA Warszawa and POL-MONICA Kraków. Population studied in POL-MONICA Warszawa Project consisted of residents of two districts of Warsaw capital. The interest of the research of the POL-MONICA Kraków focuses on problems of the myocardial infarction in semi-rural population and the population observed consisted of men and women at age 25-64 years residents of one Polish province-Tarnobrzeg Voivodship.

The objective of paper was to assess to which extent hypertension, hypercholesterolemia, obesity and smoking are related to the risk of dying due to ischaemic heart disease (IHD) and to which extent changes in IHD risk factors could explain changes in IHD mortality in Polish men. The study was done in population of men at age 35-64 years, inhabitants of one Polish province (Tarnobrzeg Voivodship), which was subjected to POL-MONICA Kraków Project. The risk of IHD death and predicted changes in IHD mortality were assessed by logistic regression model using the risk factors measurements obtained at 3 screening surveys of independent random samples of studied population. Surveys were carried out in 1983-84, 1987-88 i 1992-93 and 2502 men were examined in total. 97% were followed for 12 years and 69 died of IHD. Higher risk of IHD death was found in men who had hypercholesterolemia, hypertension and who were smokers. Odds ratio adjusted to age and other risk factors was 1.87 for hypercholesterolemia, 2.38 for hypertension and 1.73 for smoking. There was no significant relation between obesity and risk of IHD death. In the studied population there was an increase in the prevalence of hypercholesterolemia and decrease in the prevalence of hypertension. There was no significant changes in the prevalance of obesity and smoking. Compared to 1983-84, predicted increase in IHD mortality calculated from changes in risk factors was 7.7% in 1987-88 and 0.2% in 1992-93. Predicted changes were smaller than observed, which were 40.1% and 39.3% increase respectively. In conclusion, despite of confirmed strong relationship between risk factors studied and risk of IHD death, combined effect of spontaneous changes in the risk factors was to small to explain observed changes in IHD mortality in the studied population.