Search

Introduction: Optimal medical therapy (OMT) is the cornerstone of treatment for stable coronary disease with the ISCHEMIA trial showing similar outcomes using OMT with or without an initial invasive approach. Objectives: To describe OMT goal attainment in Polish ISCHEMIA participants compared with other countries. Patients and methods: Among 5179 trial participants, 333 were randomized in Poland. The median follow-up was 3.2 years. OMT targets were: not smoking, high-intensity statin therapy, low-density lipoprotein cholesterol (LDL-C) of less than 70 mg/dl, systolic blood pressure of less than 140 mm Hg, aspirin therapy, and ACEI / ARB, and β-blocker therapy if indicated. Results: Compared with 36 other countries, at randomization, patients in Poland were older (67 [62–75] y vs 65 [58–71] y); P⁠0.001), more often female (30% vs 22%; P = 0.002), with a longer history of angina (3 [1–9] y vs 1 [0–3] y; P⁠0.001), and there were more cases of prior myocardial infarction (32% vs 18%; P⁠0.01) and revascularization (PCI, 40% vs 19%; CABG, 11% vs 3%; P⁠0.001 for both). The number of OMT goals attained increased from baseline to follow-up visits (5 [4–5] vs 6 [5–6]; P⁠0.001) in Poland and other countries alike (P = 0.89 vs P = 0.14). In Poland, significant improvements were achieved regarding high-intensity statin therapy (27% vs 50%), LDL-C⁠70 mg/dl (29% vs 65%), and systolic blood pressure of less than 140 mm Hg (63% vs 81%) (P⁠0.001 for all), whereas not-smoking (89% vs 89%), aspirin (90% vs 88%), ACEI / ARB (93% vs 95%), and β-blocker therapy (94% vs 90%) remained high. Conclusions: With regular surveillance and contemporary medical therapy, high OMT goal attainment was achievable among the participants of the ISCHEMIA trial in Poland relative to other countries. There is still room for improvement in LDL-C and blood pressure management.

Background: This retrospective study was proposed to investigate outcomes of patients with severe aortic stenosis (AS) after implementation of various treatment strategies following dedicated Heart Team (HT) decisions. Methods: Primary and secondary endpoints and quality of life during a median follow-up of 866 days of patients with severe AS qualified after HT discussion to: optimal medical treatment (OMT) alone, OMT and transcather aortic valve replacement (TAVR) or OMT and surgical aortic valve replacement (SAVR) were evaluated. As the primary endpoint composite of all-cause mortality, non-fatal disabling strokes and non-fatal rehospitalizations for AS were considered, while other clinical outcomes were determined as secondary endpoints. Results: From 2016 to 2019, 176 HT meetings were held, and a total of 482 participants with severe AS and completely implemented HT decisions (OMT, TAVR and SAVR for 79, 318 and 85, respectively) were included in the final analysis. SAVR and TAVR were found to be superior to OMT for primary and all secondary endpoints (p &lt, 0.05). Comparing interventional strategies only, TAVR was associated with reduced risk of acute kidney injury, new onset of atrial fibrillation and major bleeding, while the superiority of SAVR for major vascular complications and need for permanent pacemaker implantation was observed (p &lt, 0.05). The quality of life assessed at the end of follow-up was significantly better for patients who underwent TAVR or SAVR than in OMT-group (p &lt, 0.05). Conclusions: We demonstrated that after careful implementation of HT decisions interventional strategies compared to OMT only provide superior outcomes and quality of life for patients with AS.

INTRODUCTION Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel remains a cornerstone of pharmacotherapy after percutaneous coronary intervention (PCI). It has been demonstrated that even up to 30% of patients receiving DAPT have inadequate response to clopidogrel, namely, high on‑treatment platelet reactivity (HPR). The platelet to red cell distribution width (P‑RDW) ratio represents an indicator of cardiovascular risk and may be related to HPR. OBJECTIVES The aim of the present study was to establish whether the P‑RDW ratio predicts HPR in clopidogrel‑treated patients undergoing elective PCI. PATIENTS AND METHODS This was a subanalysis of the prospective randomized‑controlled ONSIDE TEST study. A total of 70 patients were included in the analysis, of whom 12 were identified with HPR. The HPR was defined as the values above the threshold of 208 platelet reactivity units (PRU >208) by the VerifyNowP2Y12 assay. RESULTS The P‑RDW ratio was lower in patients with HPR than in those without HPR (mean [SD], 14.37 [4.13] vs 17.734 [4.96]; P = 0.03). A logistic regression analysis showed that the P‑RDW ratio was associated with HPR (P = 0.03). Using a cut‑off level of 15.23, the P‑RDW ratio predicted HPR with a sensitivity of 69% and specificity of 75% (odds ratio, 6.67; 95% CI, 0.561-0.890; P = 0.02; are under the receiver operating characteristic curve, 0.723). CONCLUSIONS The P‑RDW ratio may serve as a supplementary tool for identification of patients at risk of HPR. Further studies are warranted to assess its role in planning DAPT among patients undergoing PCI.

INTRODUCTION: Superior vena cava (SVC) syndrome is a rare clinical disorder associated with obstructing venous outflow through the SVC. Although the most common cause is mediastinal tumors, the growing number of implantable cardiac devices procedures has resulted in more patients with SVC syndrome of non‐malignant etiology. DISCUSSION: It has been shown repeatedly that the use of cardiac implantable electronic devices (CIEDs) improves the quality of life of patients with symptomatic arrhythmias and reduces the mortality of patients at risk of sudden cardiac death, but the risk of complications also exists. CONCLUSION: The most common finding in patients with cardiac devices is asymptomatic venous thrombosis, but serious complications, including SVC obstruction should always be considered. The rapid identification of clinical symptoms and the implementation of appropriate measures are a key to preventing the morbidity and mortality of the patients. JRCD 2018; 4 (1): 5-8.

Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel remains a cornerstone of pharmacotherapy after percutaneous coronary intervention(PCI). It has been demonstrated that even up to 30% of patients receiving DAPT is characterized by inadequate response to clopidogrel, namely high on