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Background: Rotational atherectomy (RA) has been proven to be efficient for the treatment of calcified and diffuse coronary artery lesions. However, the optimal burr-to-artery ratio (BtAR) remains unidentified as well as an influence of change in blood flow on long-term outcome. Aim of our study was to examine the association between long-term outcome, and both BtAR and change in coronary flow during RA., Methods: We conducted a retrospective study including patients who underwent RA. Two independent observers calculated BtAR, pre- and postprocedural corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC) for artery treated with RA. The long-term outcome was defined as all-cause mortality., Results: Receiver operating characteristic curve analysis of BtAR determined threshold of 0.6106 for all-cause mortality detection with sensitivity 50.0%, specificity 90.8%, and area under the curve 0.730 (p < 0.001). Kaplan-Meier survival analysis showed that the all-cause mortality rate in the group with the BtAR > 0.6106 is significantly higher compared to the patients with lower BtAR (hazard ratio [HR] 3.76, 95% confidence interval [CI] 1.51-9.32; p < 0.001). Kaplan-Meier survival analysis revealed that the all-cause mortality rate in the group with impairment in coronary flow was significantly higher compared to group with cTFC difference ≤ 0 after RA (HR 3.28, 95% CI 1.56-9.31; p = 0.02)., Conclusions: Burr-to-artery ratio > 0.6106 is associated with worse prognosis of patients treated with RA. Patients showing post-RA impairment in blood flow in the target artery have worse prognosis.

Background: Impella is a percutaneous mechanical circulatory support device for treatment of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCIs). IMPELLA-PL is a national retrospective registry of Impella-treated CS and HR-PCI patients in 20 Polish interventional cardiological centers, conducted from January 2014 until December 2021., Aims: We aimed to determine the efficacy and safety of Impella using real-world data from IMPELLA-PL and compare these with other registries., Methods: IMPELLA-PL data were analyzed to determine primary endpoints: in-hospital mortality and rates of mortality and major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months post-discharge., Results: Of 308 patients, 18% had CS and 82% underwent HR-PCI. In-hospital mortality rates were 76.4% and 8.3% in the CS and HR-PCI groups, respectively. The 12-month mortality rates were 80.0% and 18.2%, and post-discharge MACCE rates were 9.1% and 22.5%, respectively. Any access site bleeding occurred in 30.9% of CS patients and 14.6% of HR-PCI patients, limb ischemia in 12.7% and 2.4%, and hemolysis in 10.9% and 1.6%, respectively., Conclusions: Impella is safe and effective during HR-PCIs, in accordance with previous registry analyses. The risk profile and mortality in CS patients were higher than in other registries, and the potential benefits of Impella in CS require investigation.

Background: Renal denervation is a novel therapeutic option in resistant hypertension (RHT). The anatomy of renal arteries and the presence of additional renal arteries are important determinants of the effect of the procedure. The aim of this study was to assess the anatomy of renal arteries using angio- -computed tomography in patients with RHT, who were qualified for renal denervation., Methods: We analyzed angio-computed tomography scans of the renal arteries of 72 patients qualified for renal denervation. We divided the study population into two groups: a resistant hypertension group (RHT) and a pseudo-resistant hypertension group (NRHT). The biochemical and endocrine diagnostic procedures were performed to rule out secondary hypertension. We analyzed the morphology, the diameters, and the number of additional renal arteries., Results: In both groups, we found additional renal arteries (ARN). ARN were more frequent in RHT than in patients with non-resistant hypertension (48.4% vs. 24.3%; p < 0.05). They were present more often on the left side (18 left side vs. 7 right side). The ARNs were longer than main renal artery - left side 41.7 ± 12.1 mm vs. 51.1 ± 11.8 mm, right side 49.2 ± 14.5 mm vs. 60 ± ± 8.6 mm, respectively (p < 0.05). The diameters of ARN were similar in both groups. In the group of patients with RHT the number of ARN was significantly higher (p < 0.04)., Conclusions: The ARNs occur more often in patients with RHT. It seems that there is no connection between the resistance of hypertension and the diameters of renal arteries.

The article presents the most common, current indications for the use of intravascular invasive imag-ing diagnostic techniques, i.e. intravascular ultrasound and optical coherence tomography in Polish invasive cardiology centers. The application of the above-mentioned techniques in the diagnosis of stenosis of the left main coronary artery, optimization of stent implantation procedures, treatment of calcified lesions, and other clinically important issues are discussed.

Background: There is limited data on the optimal revascularization strategy in patients with recurrent in-stent restenosis (R-ISR)., Aims: To compare the long-term outcomes of patients treated with either a thin-strut drug-eluting stent (thin-DES) or a drug-eluting balloon (DEB) for R-ISR in a drug-eluting stent (DES)., Methods: A multicenter DEB-DRAGON registry was used to retrospectively identify patients with R-ISR who received either a thin-DES or a DEB. Propensity score matching was applied to adjust for baseline differences. The primary outcome was target lesion revascularization (TLR)., Results: Out of 311 patients (mean age, 67 years; 63% male) with R-ISR, 86 (27.7%) were treated with a thin-DES and 225 (72.3%) with a DEB. Median follow-up was 2.6 years. TLR occurred in 18 (20.9%) patients who received thin-DES and 61 (27.1%) patients treated with DEB (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.33-0.98; log-rank P = 0.04). The difference remained significant in a propensity score-matched cohort of 57 patients treated with thin-DES and 57 patients treated with a DEB (17.5 vs. 33.3%, respectively; HR, 0.38; 95% CI, 0.17-0.86; P = 0.01). The risks of device-oriented adverse cardiac events and all-cause mortality were similar after thin-DES or DEB in both unadjusted and propensity score-matched cohorts. In a multivariable Cox proportional hazard model, the treatment with a thin-DES was an independent predictor of a TLR-free survival (HR, 0.33; 95% CI 0.13-0.84; P = 0.02)., Conclusions: In patients with R-ISR implantation of a thin-DES is associated with a lower risk of repeated revascularization compared with angioplasty with a DEB.

Background: Transfemoral access is the preferred approach for transcatheter aortic valve implantation (TAVI), as it is characterized by the lowest complication rate. In the majority of patients ineligible for transfemoral access, the transcarotid approach can be used., Aims: This study aimed to compare short‑term outcomes in 2 groups of patients treated with transcarotid or transfemoral TAVI., Methods: A retrospective comparison included 265 patients in whom the TAVI procedure was performed between 2017 and 2019 (transcarotid TAVI, n = 33; transfemoral TAVI, n = 232). Preoperative characteristics, procedural and postprocedural outcomes, as well as 30‑day mortality were assessed., Results: Compared with the transfemoral TAVI group,patients undergoing transcarotid TAVI presented with a higher New York Heart Association (NYHA) functional class (median [interquartile range (IQR)], 3 [3-3] vs 2 [2-3]; P <0.001), a higher surgical risk (median [IQR] EuroSCORE II, 6 [4.8-10.7] vs 4.8 [2.8-7.9]; P = 0.003), and a higher incidence of peripheral artery disease (36.4% vs 18.1%; P = 0.035). The median (IQR) procedure duration in the transcarotid TAVI group was shorter than in patients undergoing transfemoral TAVI (65 [60-80] min vs 90 [80-110] min; P <0.001, respectively). In both study groups, we noted a high percentage of procedural success (transcarotid vs transfemoral TAVI, 96.9% vs 97.2%; P = 0.66). We found no significant differences between transcarotid TAVI and transfemoral TAVI in terms of periprocedural and 30‑day mortality as well as the number of strokes. Regardless of the access route chosen, echocardiographic parameters and the NYHA class similarly improved compared with preprocedural data., Conclusions: Despite posing a higher baseline risk and presenting a greater anatomic complexity, transcarotid access is safe and associated with 30‑day outcomes similar to those observed for transfemoral access. Importantly, procedural time was short and no periprocedural strokes or vascular complications were reported.

Background: Although the femoral approach is the most common route utilised in transcatheter aortic valve implantation (TAVI), it still carries a substantial risk of severe bleeding and vascular complications., Aim: The aim of our study was to compare the safety and efficacy of the complete percutaneous (CPC) approach with surgical cut-down and closure (SCC) in TAVI patients., Methods: The study population comprised 683 patients with severe aortic stenosis, who underwent transfemoral TAVI. Bleeding and vascular complications were defined according to the Valve Academic Research Consortium (VARC-2) criteria. Propensity-matched cohorts were created to reduce the potential bias of non-random assignment to the type of vascular access technique (SSC, n = 203 vs. CPC, n = 203)., Results: The rate of minor vascular complications was higher in the CPC cohort (18.2% vs. 9.9%, p = 0.02). There were no differences in major vascular complications or in any type of bleedings between the two groups. Age (odds ratio [OR] 1.044; 95% confidence interval [CI] 1.003-1.09, p = 0.046), preprocedural haemoglobin (OR 0.849; 95% CI 0.760-0.944, p = 0.03), and baseline estimated glomerular filtration rate < 30 mL/min (OR 3.216; 95% CI 1.176-8.741, p = 0.021) were independent predictors of life-threatening/disabling and major bleedings. Diabetes remained the only independent predictor of major vascular complications (OR 1.695; 95% CI 1.014-3.156, p = 0.046)., Conclusions: In this retrospective analysis both vascular access and closure techniques were associated with a similar risk of severe bleeding and major vascular events. However, these findings should be further confirmed in a multicentre, randomised study.

The common use of stents, including antiproliferative drug-eluting stents, has been a major breakthrough in invasive cardiology. Nowadays, a change in the clinical presentation of patients treated with percutaneous coronary intervention (PCI) is observed. The typical clinical characteristics now include advanced age, diabetes, chronic kidney disease, heart failure, and multilevel atherosclerosis. Age, diabetes, and chronic kidney disease are the main predictors of coronary artery calcifications. Severe coronary artery calcifications are the main factor limiting the efficacy of PCI. Successful stent implantation is challenging in the presence of calcifications, because it is difficult to achieve full stent expansion and proper stent apposition. Therefore, it is necessary to adequately prepare the lesion before stent implantation. This document presents the technique of rotational atherectomy (rotablation) as well as indications for and contraindications to the procedure, along with its possible complications and their prevention. Training in rotablation for operators as well as reimbursement policy for the procedure in Poland are also discussed.

Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multi-disciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establish-ment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.

Bioresorbable scaffold coated with antimitotic drug is the latest development in the coronary stents technology. The concept of temporary scaffolding and natural vessel healing after angioplasty is a very attractive alternative to conventional metal stents. The results of the first observational studies have confirmed their ultimate biodegradation. Newest results of randomised trials and registries in broader clinical and anatomical indications also revealed the limitations of the first generation of scaffolds. The relatively thick polymeric struts and compliance with specific implantation protocol may influence the results. In this document, the group of experts presents the current state of knowledge, with a particular focus on the advantages and limitations of the new technology; it presents practical guidelines for optimal implantation techniques and clarifies documented indications for patients and lesions selection.

Background: Clinical studies have suggested increased risk of thrombotic events after planned cessation of clopidogrel therapy, due to increased platelet reactivity (platelet rebound); however, in many studies platelet function was not assessed before introducing clopidogrel. Patients who are scheduled to stop clopidogrel therapy, do it abruptly, so a gradual drug cessation might provide a beneficial treatment strategy., Aim: To determine whether a clopidogrel discontinuation results in platelet rebound hyperaggregability with increased activity compared to pre-treatment values and to assess whether abrupt or tapering clopidogrel cessation may affect platelet reactivity., Methods: Patients with stable coronary artery disease (n = 49), on chronic acetylsalicylic acid treatment, who underwent coronary angiography, and were scheduled for elective percutaneous coronary intervention with stent implantation were en-rolled. Patients were randomised to either a tapering clopidogrel discontinuation during a two-week period (tapering group, n = 25) or abrupt drug cessation (abrupt group, n = 24). After 12 months of dual antiplatelet therapy with clopidogrel and acetylsalicylic acid, we performed three follow-up visits with blood sampling. Platelet aggregation was assessed using a mul-tiple electrode aggregometer at inclusion, at cessation day, and seven and 14 days after complete clopidogrel discontinuation. The primary endpoint was the level of adenosine-diphosphate (ADP)-induced platelet aggregation. We also analysed platelet function in the ASPI test and platelet count as secondary endpoints., Results: In 36 patients included in the main analysis, we found significant differences between the two study groups in the levels of ADP-induced platelet aggregation at days seven and 14 after cessation of clopidogrel (p = 0.004 and p = 0.04, respectively). In the abrupt group, platelet aggregation returned to the values similar to baseline at day seven. There were no significant differences between baseline, seven, and 14 days after drug cessation (p = 0.92 and p = 0.37, respectively). However, in the tapering group, ADP values at seven and 14 days after drug cessation were significantly decreased, comparing to baseline (p < 0.0001 and p = 0.009, respectively). For the ASPI test and platelet count we did not find significant differ-ences between the groups. All values returned to levels similar to the baseline. During the follow-up there were no serious cardiovascular events or bleedings., Conclusions: Tapering vs. abrupt discontinuation of clopidogrel treatment results in significantly lower platelet aggregation values after 14 days from complete drug cessation. We found no evidence of a platelet rebound effect.

Background: Coexisting anaemia is associated with an increased risk of major adverse cardiac and cerebrovascular events (MACCE) and bleeding complications after percutaneous coronary intervention (PCI), especially in patients with acute coronary syndrome., Aim: To assess the impact of anaemia in patients with coronary artery disease (CAD) treated with first- and second-generation drug-eluting stents (DES) on one-year MACCE., Methods and Results: The registry included 1916 consecutive patients (UA: n = 1502, 78.3%; NSTEMI: n = 283, 14.7%; STEMI/LBBB: n = 131, 6.8%) treated either with first- (34%) or second-generation (66%) DES. The study population was divided into two groups: patients presenting with anaemia 217 (11%) and without anaemia 1699 (89%) prior to PCI. Anaemia was defined according to World Heart Organisation (haemoglobin [Hb] level < 13 g/dL for men and < 12 g/dL for women). Patients with anaemia were older (69, IQR: 61-75 vs. 62, IQR: 56-70, p < 0.001), had higher prevalence of co-morbidities: diabetes (44.7% vs. 36.4%, p = 0.020), chronic kidney disease (31.3% vs. 19.4%; p < 0.001), peripheral artery disease (10.1% vs. 5.4%, p = 0.005), and lower left ventricular ejection fraction values (50, IQR: 40-57% vs. 55, IQR: 45-60%; p < 0.001). No difference between gender in frequency of anaemia was found. Patients with anaemia more often had prior myocardial infarction (MI) (57.6% vs. 46.4%; p = 0.002) and coronary artery bypass grafting (31.3% vs. 19.4%; p < 0.001) in comparison to patients without anaemia. They also more often had multivessel disease in angiography (36.4% vs. 26.1%; p = 0.001) and more complexity CAD as measured by SYNTAX score (21, IQR: 12-27 points vs. 14, IQR: 8-22 points; p = 0.001). In-hospital risk of acute heart failure (2.7% vs. 0.7%; p = 0.006) and bleeding requiring transfusion (3.2% vs. 0.5%; p < 0.001) was significantly higher in patients with anaemia. One-year follow-up showed that there was higher rate of death in patients with anaemia. However, there were no differences in MI, stroke, target vessel revascularisation (TVR) and MACCE in comparison to patients with normal Hb. There were no differences according to type of DES (first vs. second generation) in the population of patients with anaemia., Conclusions: In patients with anaemia there is a significantly higher risk of death in 12-month follow-up, but anaemia has no impact on the incidence of MI, repeat revascularisation, stroke and MACCE. There is no advantage of II-DES over I-DES generation in terms of MACCE and TVR in patients with anaemia.

Background: Data from clinical trials suggested that biodegradable-polymer-based drug-eluting stents (DES) might improve long-term clinical outcomes. PROLIM (Balton, Warsaw, Poland) DES is based on a stainless steel platform with a closed cell design releasing sirolimus from biodegradable copolymer (lactic and glycolic acid) in eight weeks., Aim: In the present study the safety and the efficacy of a PROLIM stent was assessed in patients with de novo coronary lesions in 12-month clinical follow-up., Methods: It was a single-centre, observational, prospective registry to assess the safety and efficacy of a PROLIM stent implantation in all consecutive patients with de novo coronary artery lesions treated with percutaneous coronary intervention (PCI). The primary study endpoint was a composite safety (cardiac death, non-fatal myocardial infarction), and the second study endpoint was the efficacy of PROLIM implantation-clinically driven target vessel revascularisation (TVR) assessed at 12-month follow-up., Results: One hundred patients were enrolled into the study and 118 PROLIM stents were implanted. Thirty-two (32%) patients had diabetes, 46 (46%) patients were prior PCI, and 17 (17%) patients had coronary artery bypass grafting. 67% of stented lesions were complex ones (B2/C) and 17% were bifurcations. During the 12-month follow-up primary study endpoints occurred in five (5%) patients. Two (2%) cardiac deaths were reported and three (3%) TVRs were performed, of which one was related to in-PROLIM stent restenosis., Conclusions: PCI with biodegradable-polymer PROLIM DES seems to be safe and effective in 12-month follow-up. A larger trial is warranted to assess clinical outcomes post PROLIM stent implantation.

Background: According to a recent survey, Poland is one of the leaders of interventional cardiology in Europe in terms of the number of primary percutaneous coronary intervention (PCI) procedures per million inhabitants., Aim: To present temporal trends in epidemiology, demographics, treatment, and periprocedural outcome of patients referred for percutaneous coronary angiography and angioplasty in Poland in 2005-2011, based on the Polish National PCI Registry., Methods: Patients who underwent percutaneous coronary angiography (ANGIO group) and/or angioplasty (PCI group) were included in the Polish National PCI Registry - a prospective observational registry study in Poland., Results: There were 935,429 patients in the ANGIO group and 501,117 in the PCI group in Poland in 2005-2011. The number of catheterisation labs increased from 75 to 137, angiography procedures rose from 99,195 to 180,935, and PCIs from 50,297 to 99,614. The procedural mortality and stroke rates for the ANGIO group have remained stable whereas for the PCI group procedural mortality has increased over the years. The use of drug eluting stents (DESs) rose from 32.8% to 55.3% in stable angina and the use of a radial approach from 26.8% to 39.1%., Conclusions: Use of modern attributes of interventional cardiology like DES stents, radial approach, and treatment of higher risk patients has increased in Poland in 2005-2011. The adoption of the "Stent for Life" initiative has resulted in an increasing number of percutaneous coronary procedures over the years.

Right heart catheterisation (RHC) is the 'gold standard' for haemodynamic assessment of the pulmonary circulation. For the diagnosis of pulmonary hypertension (PH), the guidelines of the European Society of Cardiology require a mean pulmonary arterial pressure ≥ 25 mm Hg to be confirmed by direct haemodynamic measurement. Additionally, RHC provides a lot of valuable information about the differential diagnosis and severity of PH, and also helps determine the patient's prognosis. Acute vasoreactivity testing performed in patients with pulmonary arterial hypertension is intended to identify the group of patients who should be treated with calcium channel blockers. Patients referred for heart transplantation require advanced pulmonary vascular disease to be ruled out either on resting examination or during vasoreactivity testing. RHC is a component of such interventional procedures as balloon atrial septostomy, closure of intracardiac shunts in congenital heart and great vessel defects, valvuloplasty for pulmonary valve stenosis, and pulmonary angioplasty. Pulmonary angiography is an examination recommended when selecting patients for pulmonary endarterectomy or balloon pulmonary angioplasty in thromboembolic PH. Due to the dynamic growth in the number of patients diagnosed with and treated for PH in Poland, the Boards of the Polish Cardiac Society's Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions have undertaken a joint project to develop recommendations to standardise guidelines for RHC procedure, acute vasoreactivity testing and pulmonary angiography at cardiac wards and haemodynamic laboratories in Poland. This document has been prepared by experts delegated by the Working Group on Pulmonary Circulation and the Association of Cardiovascular Interventions, and subsequently approved by the Boards of both organs of the Polish Cardiac Society.

Background: Current revascularisation guidelines recommend coronary stenting with either a bare metal stent or a drug eluting stent. The results of bioresorbable vascular scaffold (BVS) implantation in the setting of both stable angina and acute coronary syndrome (ACS) have proven to be both safe and efficacious., Aim: To describe current use and real life experience among Polish percutaneous coronary intervention (PCI) operators in using BVS since they were made commercially available on our market., Methods: We performed a one-arm retrospective observational registry study which enrolled patients in 30 invasive cardiology centres in Poland who had their PCI procedure performed between October 2012 and November 2013. All patients who received at least one BVS stent during index PCI were included in the registry. There were no additional inclusion or exclusion criteria., Results: There were 591 patients enrolled in the registry in 30 centres in Poland. Of these, 48% were with stable angina (CCS I-III) and 52% with ACS (23% unstable angina, 18% NSTEMI and 11% STEMI). Radial access for PCI was used in 70% of cases. Left anterior descending was the target lesion in 48% of patients and predilatation used in 90%. PCI complications occurred very rarely with dissection in 2.9% of patients, slow-flow in 0.5%, no-reflow in 0.17%, and side branch occlusion in 0.33%. Technical success, defined as successful BVS delivery to the lesion, was achieved in all cases (100%). There were no periprocedural deaths., Conclusions: The early in-hospital results of this large scale national registry of 'real world' utilisation of BVS in Poland present excellent device performance in a properly selected group of patients with appropriate lesion preparation.

We present a case of a 73 year-old man with, long-segment thigh stenosis in the right common and internal carotid artery with occlusion left common carotid artery. Complex angioplasty with modification proximal and distal system protection was successful performed. There were no procedure-related complications. We concluded that in very complex, multilevel lesions in carotid artery, there is a place for safe double system protection. This maneuver can increase safe of the carotid artery stenting and minimise potential complications.

We present a case of a 72 year-old male who underwent successful closure of two mitral paravalvular leaks with the Amplatzer vascular Plug II using a transapical approach.

Despite a dramatic reduction in restenosis and target vessel revascularisation rates by drug eluting stents (DES), conflicting concerns have been raised over the risk for late DES thrombosis when compared to bare metal stents. Certainly, the heterogeneity of DES results from the introduction of a great variety of new DES types with diverse efficacy and safety parameters. Furthermore, we observe a steady increase in DES availability without parallel and robust data from randomised clinical trials. Thus, the postulated class effect of DES should be regarded as non-obligatory. This article is based on 110 randomised DES trials performed on 72 305 patients. Current status of DES and guidelines for DES implantation in various clinical scenarios were discussed.

Background: Myocardial reperfusion following primary percutaneous coronary intervention (pPCI) is limited due to, among other things, microembolic events. Abciximab and a mechanical system of distal protection both reduce their incidence during PCI., Aim: Prospective, randomised study to compare effectiveness of abciximab and protection devices in reduction of microembolic complications during pPCI., Methods: One hundred and twenty consecutive patients with ST elevation acute myocardial infarction referred for pPCI after coronary angiography were randomly assigned to the following groups: Group A (n=63), treated with abciximab; and Group B (n=57), treated using the distal protection system. Primary endpoint was blood flow through the infarct-related artery (IRA) using TIMI grading after pPCI; secondary endpoints included myocardial perfusion assessment using myocardial blush grade (MBG), ST resolution and improvement of echocardiographic left ventricular ejection fraction (LVEF) after pPCI., Results: TIMI grade 3 flow after pPCI was obtained in 89% of patients in both groups, TIMI grade 2 flow in 5% (NS). Myocardial perfusion after pPCI assessed with MBG scored 3 in 66% of patients in group A and 62% of patients in group B (NS). ST resolution was present in 62% (26-84) in group A and 68% (41 - 86) in group B (NS). Logistic regression analysis showed no significant influence of selected variables on the primary endpoint. Analysis performed in the distal protection group revealed significant effects on the following factors on the final TIMI flow in IRA: presence of thrombus prior to pPCI (p=0.026), presence of residual thrombus after aspiration (p <0.001), and IRA diameter of > or =3.5 mm (p=0.01). Median LVEF in group A at sixth month of follow-up was 46% (44-50%), similar to group B - 46% (45-49%) (NS)., Conclusions: Use of the PercuSurge distal protection device during pPCI allows angiographic and electrocardiographic measures of reperfusion to be improved. It has a similar effect on left ventricular systolic function as administration of abciximab. The device seems to be useful in patients with culprit artery diameter of > or =3.0 mm, and optimally > or =3.5 mm and thrombus visible on angiography. Successful initial thrombectomy prior to deployment of stent seems particularly important when using the PercuSurge system.

We describe a case of a 55-year-old male with anterior myocardial infarction, treated in the acute phase with thrombolysis. Transthoracic echocardiography showed hypokinetic apical segments, ejection fraction of 55% and reduced coronary flow reserve in the left anterior descending (LAD) coronary artery. Elective coronary angiography revealed a borderline (40-50%) lesion in LAD. The patient underwent successful angioplasty of LAD with stent implantation. Non-invasive coronary flow reserve measurements were repeated 3 days, 6 weeks and 6 months after angioplasty showing continuous improvement in this parameter. The role of non-invasive echocardiographic assessment of coronary flow reserve in the selection for angioplasty and monitoring of the effects of treatment is discussed.

Background: Cytomegalovirus (CMV) infection has been suggested to play an important role in the pathogenesis of atherosclerosis. Whether CMV may be involved in the development of acute myocardial infarction (MI) has not yet been established., Aim: To asses the prevalence of active or latent CMV infection in patients with angina or acute MI., Methods: The study group consisted of 158 subjects divided into three groups: group I - 70 patients (49 males, mean age 57.1+/-10.4 years) with acute MI, group II - 40 patients (21 males, mean age 59.1+/-7.9 years) with stable angina, and group III - 48 healthy controls (18 males, mean age 54.9+/-12.1 years). Anti-CMV IgM and IgG antibody titre in blood serum was measured in all subjects. In those in whom anti-CMV antibodies were present, quantitative polimerase chain reaction (Q-PCR) was performed in order to detect DNA of CMV in peripheral blood mono-nuclear cells (PBMC) and in serum., Results: Anti-CMV IgM antibodies were not detected in any of the subjects. A positive result of anti-CMV IgG test was present in 60 (85.7%) patients from group I, 34 (85%) patients from group II, and 15 (31.5%) control subjects. The mean IgG antibody concentration was 72.2+/-13.6 aU/ml, 74.23+/-12.8 aU/ml and 19.57+/-3.56 aU/ml, respectively (p<0.001). In patients from group I, a significantly higher prevalence of serum DNA CMV was noted than in the remaining groups., Conclusions: Patients with symptomatic coronary artery disease have a significantly higher anti-CMV antibody titre than healthy subjects. The active form of infection is significantly more prevalent in patients with acute MI than in patients with stable angina.

A case of 65 year old male with acute myocardial infarction is described. The patient underwent successful primary coronary angioplasty with the use of a distal embolic protection device.

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.