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Right ventricular infarction (RVI) is most commonly associated with inferior wall infarction (20-50% of cases). Clinical presentation of RVI may vary.Assessment of outcome and clinical course of myocardial infarction in patients with inferior wall myocardial infarction with or without RVI. Additionally, risk stratification was attempted in the above-mentioned groups of patients.The analysis involved 181 consecutive patients (pts) with inferior wall myocardial infarction hospitalised between 1 July 2000 and 1 July 2002.Nineteen in-hospital deaths were noted in the study group (mortality 10.5%), reinfarction occurred in 6 (3.3%) pts, ischaemic stroke in 1 (0.6%) patient, and 2 (1.1%) pts had transient ischaemic attack. Cardiogenic shock occurred in 20 (11.0%) pts , ventricular fibrillation in 15 (8.3%) pts, and pulmonary oedema in 9 (4.9%) pts. In the subgroup of 161 pts without cardiogenic shock 8 (4.9%) pts died. Thrombolytic therapy was administered in 96 (53%) subjects. Isolated inferior wall myocardial infarction was diagnosed in 94 (51.9%) of 181 pts and RVI in 65 (35.9%) pts. Mortality rate in the RVI group was significantly higher than in inferior wall myocardial infarction without RVI and was 18.5% vs 2.12% (p=0.0003), respectively (excluding patients with cardiogenic shock: 11.1% vs 1.2%, respectively; p=0.016). In patients with RVI aged above 70 years, the mortality rate was significantly higher than in younger patients (32% vs 10%, p=0.002). In a subgroup with RVI treated with thrombolysis mortality was considerably higher in subjects aged70 years compared to patients below 70 years (38.5% vs 7.7%, p=0.017).RVI is associated with worse prognosis and increased number of in-hospital complications. Older patients aged70 years have definitely poorer prognosis. Thrombolytic therapy in a subgroup of older patients with RVI remains ineffective.

Time-to-treatment is an important determinant of mortality in primary angioplasty for ST-segment elevation myocardial infarction (STEMI). Thus, the benefits in outcome observed with transferring for primary angioplasty in comparison with on-site thrombolysis may be reduced or even lost when long-distance transportation is required. Even though pharmacological reperfusion might overcome this limitation, no data have been reported so far on the prognostic role of early pharmacological recanalization in STEMI patients undergoing long-distance transportation for primary angioplasty.We enrolled 225 consecutive STEMI patients without shock, eligible for thrombolysis, with at least 90-minute transport time to our primary PCI center. During transport, patients received i.v. heparin 40 U/kg, alteplase 15 mg+35 mg infusion and abciximab 0.25 mg/kg+0.125 microg/kg/min infusion for 12 h.Patients were divided into two groups according baseline angiography, which showed early pharmacological reperfusion (preprocedural TIMI flow 2+3) in 193 patients (85.8%) and no reperfusion (preprocedural TIMI flow 0+1) in 32 patients (14.2%). Despite no difference in postprocedural TIMI flow, early reperfusion was associated with better postprocedural myocardial perfusion (TMPG 3: 54.9% vs. 18.7%, p0.0001), better improvement in left ventricular ejection fraction (LVEF) (from 55.6+/-8.6% to 58.8+/-10.4% p0.001 with early reperfusion vs. 52.9+/-13.4% to 50.4+/-15.8% with no early reperfusion, p=NS) and 1-year outcome (p=0.002 log rank). In multivariate analysis, preprocedural TIMI flow 0+1 independently predicted death and reinfarction at 1 year, and lack of LVEF improvement at 6 months.Early pharmacological reperfusion in STEMI patients undergoing long-distance transportation for primary angioplasty is associated with better postprocedural myocardial perfusion, better LVEF recovery at 6 months and improved 1-year clinical outcome.

Combined therapy with fibrinolytic agent and platelet GPIIb/IIIa inhibitor not followed by an interventional procedure does not improve prognosis in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) when compared to fibrinolysis alone. On the other hand, in the past percutaneous coronary interventions (PCI) performed after fibrinolysis were associated with low angiographic efficacy, a high risk of bleeding and a high rate of early cardiovascular events.Evaluation of angiographic and clinical outcomes in patients with STEMI treated with PCI following combined fibrinolytic therapy.Complete angiographic and clinical data of 187 patients who underwent PCI immediately after combined fibrinolytic therapy were obtained from a survey of 669 consecutive patients with STEMI12 hours, at age75 years, without cardiogenic shock, who were transferred from regional hospitals to the catheterisation laboratory within 90 minutes and after the initiation of combined fibrinolytic therapy (alteplase 15 mg iv as a bolus followed by an infusion of 35 mg over 60 minutes; abciximab iv bolus of 0.25 mg/kg followed by a 12 h infusion of 0.125 microg/kg per minute; unfractionated heparin). At baseline angiographic examination revealed no flow (TIMI 0+1) in the infarct-related artery in 17.1% of patients, impaired flow (TIMI 2) in 17.1% and normal (TIMI 3) in 65.8% of cases. After immediate PCI, a significant improvement in epicardial perfusion (TIMI 2+3, 99.5%) and in microcirculation was achieved. This favourable effect was seen only in the group of patients with baseline TIMI 0+1 flow, whereas PCI in the group with baseline TIMI 3 flow did not cause any further improvement in microcirculatory perfusion. The rate of cardiovascular events within the first 30 days and 12 months after the procedures were similar in the studied subgroup of patients.PCI performed after combined fibrinolytic therapy in STEMI patients is associated with high efficacy and improvement in indices of epicardial perfusion and microcirculation. These benefits are confined mainly to patients with primarily impaired flow in the infarction-related artery (TIMI 0+1). However, the clinical results of this strategy, particularly in patients undergoing PCI following successful combined fibrinolytic therapy, must still be proved in further randomised trials.

Although in patients with interventricular septum rupture complicating acute myocardial infarction urgent cardiac surgery is suggested as a method of choice by current ESC and ACC/AHA guidelines, mortality is high. In some patients, intra-aortic counterpulsation and optimisation of medical therapy may stabilise patients condition and increased the safety of elective cardiac surgery which can be performed a few weeks later. In this report we describe two patients with this condition who were successfully treated using a conservative approach and subsequent elective surgery.

Carotid angioplasty and stenting (CAS) has been introduced as an alternative to carotid endarterectomy for the treatment of carotid atherosclerosis. Due to the risk of embolisation during CAS, the usage of cerebral protection devices is obligatory.To assess the safety and efficacy of the novel cerebral protection device -- the MO.MA system.Twenty one patients selected for carotid stenting were included into the study. We estimated the deliverability of the device to the target site, procedural success rate and the incidence of adverse events.All performed procedures were successful without major cerebro-vascular complications during both 30-day and 6-month follow-up periods.The MO.MA system is safe and effective in preventing stroke during CAS.

Carotid angioplasty with stent implantation (CAS) has become an alternative for carotid endarterectomy in treatment of carotid arteries atherosclerosis due to low procedural injury and comparable procedural risk. Wide application of cerebral protection devices decreased the procedural risk. The aim of the study was to estimate the procedural safety of CAS procedures with application of different cerebral protection systems. CAS procedures were performed in 48 patients. One procedure was unsuccessful, in this patient stroke occurred. Distal occlusion balloon system was used in 5 patients, proximal occlusion balloons for common carotid artery was used in 21 pts and filter systems in 22 pts. During 6-months follow-up, we observed no death nor stroke (40 pts). In one patient we revealed TIA. Moreover we found restenosis in one patient 6 months after CAS (total occlusion). In our experience CAS procedures were safe and incidence of major cerebro-vascular complications comparable to other centers.

Clopidogrel, especially when combined with aspirin, reduces the rate of ischaemic events in patients with coronary artery disease (CAD). There are scare data in literature on the inter-individual variability in response to clopidogrel.To assess the incidence of clopidogrel resistance using rapid whole blood platelet function assessment, and to examine the possibility of early identification of non-responders.In 31 consecutive patients with stable angina treated with aspirin, the degree of platelet aggregation inhibition (DPAI) in the whole blood was assessed at baseline and 3, 6, 12 as well as 24 hours after administration of loading dose of clopidogrel (300 mg). Response to clopidogrel was measured by calculating the absolute difference between the baseline DPAI and DPAI obtained at the investigated time-points (DPAI).After 24 hours from clopidogrel administration, seven (22.6%) patients were identified as non-responders (DPAIor =10%). Demographic and clinical variables as well as baseline DPAI were similar in responders and non-responders (DPAI: 5.8+/-3.7% vs 7.1+/-5.3%, p=NS). Out of the patients who were found to be resistant to clopidogrel at the six-hour time-point, 87.5% remained resistant to this agent 24 hours after drug administration. DPAI calculated at the 24-hour time-point highly correlated with the six-hour DPAI (r=0.74). No differences in the rate of ischaemic or bleeding complications between responders and non-responders were noted.The assessment of the degree of platelet aggregation inhibition allows early (six hours from the initiation of treatment) identification of patients who are resistant to clopidogrel. The method of the rapid whole blood platelet function assessment is feasible in every-day clinical practice.

Subjects with diabetes constitute 13-25% of patients with ST segment elevation acute myocardial infarction (STEMI). In spite of the introduction of thrombolytic therapy, patients with STEMI and diabetes continue to have worse prognosis than those without diabetes. Primary percutaneous coronary intervention (PCI) has been shown in recent years to be the most effective therapy in patients with STEMI.To compare the outcome of STEMI patients with or without diabetes who underwent primary PCI.The study group consisted of 500 consecutive patients with STEMI. The occurrence of major adverse cardiac events (MACE) which included death, reinfarction or repeated PCI of the target vessel, was analysed peri-operatively and during a six-month follow-up period.Results. Diabetes was diagnosed in 68 (13.6%) patients. The mean time duration from the onset of STEMI symptoms to treatment was similar in patients with or without diabetes (230+/-97 min vs 231+/-139 min, NS). Patients with diabetes were older (61.9+/-8.9 vs 57.9+/-10.8 years, p=0.004), had higher body mass index (29+/-4 vs 27+/-5, p=0.002), more frequent history of coronary artery disease (57.4% vs 37.9%, p=0.002), higher prevalence of arterial hypertension (71.6% vs 56.8%, p=0.02) and more frequently the left anterior descending artery as the infarct-related artery (58.8% vs 42.1%, p=0.01). Immediately after PCI, epicardial and myocardial reperfusion rates were lower in patients with rather than without diabetes (TIMI 3: 84.9% vs 91.3%, p=NS, cTFC: 32+/-26 vs 22+/-16, p0.0001, and MPG3: 25% vs 41.9% p=0.008). Diabetes increased the risk of MACE during in-hospital period by 2.7 times. The rate of MACE during a six-month follow-up period was almost two times higher in patients with rather than without diabetes (death: 8.8% vs 5.1%, reinfarction: 1.5% vs 1.2%, repeated PCI: 11.8% vs 6.9%).Primary PCI-achieved epicardial and myocardial reperfusion rate is lower in STEMI patients with rather than without diabetes. The presence of diabetes almost doubles the risk of MACE during a six-month follow-up.

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.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 time30 minutes.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%.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.

Percutaneous coronary intervention (PCI) in patients with non ST segment elevation acute coronary syndrome (NSTEACS) is regarded as a procedure which carries a high risk of immediate and long-term adverse cardiac events. This may potentially limit the use of PCI in catheterisation laboratories which do not have on-site surgical back up. However, stents and GP IIb/IIIa receptor inhibitors improved safety of interventional procedures.To analyse the immediate and long-term outcome of patients with NSTEACS in whom PCI was performed in a catheterisation laboratory without on-site surgical back-up in.In a cohort of 479 consecutive patients (160 with NSTEACS - group A, 319 with stable angina - group B) we analysed short and long-term clinical outcome of PCI performed in our catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time30 minutes.Stent implantation rate and the usage of GP IIb/IIIa blockers were higher in group A than in group B (61.3% vs 50.2%, p=0.04, and 17.5% vs 6.3%; p0.001, respectively). The in- hospital outcome was similar in both groups (death: 0.6 vs 0.6%; myocardial infarction (MI): 2.5 vs 1.6%; and urgent reintervention (rePCI): 1.9 vs 1.3%, all differences NS). Acute PCI complications requiring urgent surgical operation occurred in 1 (0.6%) patient from group A and in 1 (0.3%) patient from group B (NS). Both patients were successfully transferred for cardiac surgery. During a long-term follow-up the incidence of death (2.0 vs 2.0%), MI (0.7 vs 0.7%), rePCI (21.8 vs 25.2%), CABG (1.4 vs 1.4%) or coronary rehospitalisation (5.4 vs 7.7%) was similar in both groups. The Kaplan-Meier survival and event-free curves were parallel.In the era of coronary stents and platelet GP IIb/IIIa receptor inhibitors the short and long-term outcome after PCI in patients with NESTACS and stable angina is similar. The early aggressive approach to patients with NESTACS is feasible and safe in a catheterisation laboratory without on-site cardiac surgery. Surgical back-up is still necessary for only few PCI complications.

Pseudoxanthoma elasticum is caused by mutations of the ABCC6 gene. We hereby report a case of pseudoxanthoma elasticum with clinical features dominated by early coronary involvement in addition to typical skin and ocular abnormalities. A 16-year-old survivor of acute myocardial infarction with 3-vessel coronary artery disease exhibited compound heterozygosity for the well-known nonsense mutation (c.3421C>T; R1141X) in exon 24 and a novel missense mutation (c.3662G>A; R1221H) in exon 26 of the ABCC6 gene.

Tessari et al. (1) elegantly demonstrated—by a precursor-product stable isotope method—independent contributions of age, type 2 diabetes, and asymmetric dimethylarginine (ADMA) to impaired conversion of 15 N -labeled L-arginine into nitrite and nitrate (NOx), products of nitric oxide (NO) metabolism. Interestingly, the authors observed no associations of any parameter of NOx kinetics with insulin sensitivity by a hyperinsulinemic-euglycemic clamp technique (1). Our group was the first to report elevated plasma …

Purpose Identification of vulnerable plaques remains crucial for better cardiovascular risk assessment. At least 20% of inflammatory cells within unstable (vulnerable) plaques comprise T lymphocytes, which contain receptors for interleukin-2 (IL-2); those receptors can be identified by scintigraphy with radiolabelled IL-2.The aim of this study was to identify the “inflamed” (vulnerable) plaques by scintigraphy using IL-2 labelled with 99mTc in the selected, high cardiovascular risk group of end-stage renal disease (ESRD) patients. Methods A total of 28 patients (18 men, 10 women, aged 55.2 ± 9.6 years, 17 on peritoneal dialysis, 11 on haemodialysis) underwent common carotid artery (CCA) scintigraphy with the use of 99mTc-hydrazinonicotinamide (HYNIC)-IL-2. In all cases, ultrasound examination of the CCA was performed and levels of selected proinflammatory factors, atherogenic markers and calcium-phosphate balance parameters were measured. Finally, the target to non-target (T/nT) ratio of IL-2 uptake in atherosclerotic plaques with intima-media thickness (IMT), classic cardiovascular risk factors and concentrations of the measured factors were compared. Results Increased 99mTc-HYNIC-IL-2 uptake in atherosclerotic plaques in 38/41 (91%) cases was detected. The median T/nT ratio of focal 99mTc-HYNIC-IL-2 uptake in atherosclerotic plaques was 2.35 (range 1.23–3.63). The mean IMT value on the side of plaques assessed by scintigraphy was 0.79 ± 0.18 mm (median 0.8, range 0.5–1.275). Correlations between T/nT ratio and homocysteine (R = 0.22, p = 0.037), apolipoprotein B (apoB) (R = 0.31, p = 0.008), apoB to apoA-I ratio (R = 0.29, p = 0.012) and triglyceride concentration (R = 0.26, p = 0.021) were detected. A lower T/nT ratio in patients with better parameters of nutritional status (haemoglobin, albumin, adiponectin) in comparison with patients with worse nutritional parameters (3.20 ± 0.5 vs 2.16 ± 0.68, p = 0.025) was revealed as well as a difference between values of T/nT ratio in groups of patients with values of apoB, soluble CD40 ligand and asymmetric dimethylarginine above and below median (3.18 ± 0.52 vs 2.16 ± 0.68, p = 0.031). No statistically significant association was found between T/nT ratio and mean value of either IMT or classic cardiovascular risk factors. Conclusion Scintigraphy with the use of 99mTc-HYNIC-IL-2 can be a tool for inflamed atherosclerotic (vulnerable) plaque visualization within CCA in ESRD patients. Quantitative results of carotid artery scintigraphy with 99mTc-HYNIC-IL-2 correlate with serum concentration of selected cardiovascular risk markers.

This paper concerns the way in which poor inhabitants of a rapidly industrialized terrain in central Poland gather and collect different sort of waste. Such phenomena as dwelling by using gathered scrap and any industrial waste serve as a field for an anthropological study. One the one hand the gathering is a certain strategy of surviving. On the other these collected things create a kind of a narrative - the objects anchor the gatherers experience, write down their biographies and reveal their relation to the local social and economic life.

We present a case of a 47-year-old man with ST-segment-elevation myocardial infarction (STEMI), successfully treated with bare metal stent implantation. After 20 months the patient was readmitted with another episode of STEMI due to in-stent thrombosis following voluntary withdrawal of anti-platelet therapy. The implications of late stent thrombosis after bare metal stent implantation are discussed. We compare this phenomenon with thrombosis after implantation of drug-eluting stents. Various aspects and potential causes of late stent thrombosis are reviewed, especially the issues pertaining the use of anti-platelet therapy and duration of this therapy

The current article summarises more than 12 years' experience in the treatment of ST-segment elevation myocardial infarction in the Malopolska region (southern part of Poland). Data on the development phase of the STEMI treatment network, as well as the current status of interventional treatment of acute coronary syndromes in that region of Poland are provided.

We present a case of a 43 year-old male with a diagnosis of non-ST-segment elevation acute coronary syndrome related to in-stent thrombosis successfully treated with intralesion administration of abciximab via a local drug delivery catheter and thrombectomy during primary percutaneous coronary intervention.

We assessed the impact of early infarct-related artery (IRA) recanalisation on the outcomes of patients in the recently conducted, large-scale, multicentre HORIZONS-AMI trial.Of the 3,602 patients enrolled in the HORIZONS-AMI trial, 3,093 patients (85.9%) were treated with percutaneous coronary intervention (PCI) to a single artery. We analysed one-year outcomes in these patients according to the presence or absence of early IRA patency, defined as Thrombolysis in Myocardial Infarction (TIMI) 2 or 3 flow in the IRA. Baseline coronary angiography showed early IRA patency in 1,121 patients (36.2%), while 1,972 patients (63.8%) had TIMI 0 or 1 flow. The presence compared with the absence of early IRA patency was associated with better angiographic results after primary PCI with more TIMI 3 flow after PCI (93.2% vs. 82.9%, p0.0001) and myocardial blush grade 2 or 3 (84.4% vs. 71.1%, p0.0001). Early IRA patency was associated with lower rates of one-year mortality (2.5% vs. 3.9%, p=0.04) and definite or probable stent thrombosis (2.0% vs. 4.0%, p=0.002). In multivariable analysis, early IRA patency at baseline angiography was an independent predictor of reduced mortality at one year (HR 0.58, 95% CI: 0.36-0.98, p=0.02).Early IRA patency in patients with STEMI undergoing primary PCI is associated with better TIMI flow and myocardial blush post PCI and is an independent predictor of lower one-year mortality. ClinicalTrials.gov identifier NCT00433966.

Background: Endothelial dysfunction, largely dependent on impaired nitric oxide bioavailability, has been reportedly associated with incident type 2 diabetes. Our aim was to test the hypothesis that asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide formation, might be linked to future deterioration in glucose tolerance in stable coronary artery disease (CAD). Methods: We studied 80 non-diabetic men (mean age 55 ± 11 years) with stable angina who underwent successful elective complex coronary angioplasty and were receiving a standard medication according to practice guidelines. Plasma ADMA and its structural isomer symmetric dimethylarginine (SDMA) were measured prior to coronary angiography. An estimate of insulin resistance by homeostasis model assessment (HOMA-IR index) was calculated from fasting insulin and glucose. Deterioration in glucose tolerance was defined as development of type 2 diabetes or progression from a normal glucose tolerance to impaired fasting glucose. Results: Over a median follow-up of 55 months 11 subjects developed type 2 diabetes and 13 progressed to impaired fasting glucose. Incident deterioration of glucose tolerance was associated with ADMA (hazard ratio [HR] per 1-SD increment 1.64 [95% CI: 1.14–2.35]; P= 0.007), log (HOMA-IR index) (HR = 1.60 [1.16–2.20]; P= 0.004) and body-mass index (HR = 1.44 [0.95–2.17]; P = 0.08) by univariate Cox regression. ADMA (HR = 1.65 [1.14–2.38]; p = 0.008) and log (HOMA-IR index) (HR = 1.55 [1.10–2.17]; P = 0.01) were multivariate predictors of a decline in glucose tolerance. ADMA and SDMA were unrelated to body-mass index, HOMA-IR index, insulin or glucose. Conclusions: ADMA predicts future deterioration of glucose tolerance independently of baseline insulin resistance in men with stable CAD. Whether this association reflects a contribution of endothelial dysfunction to accelerated decline of insulin sensitivity, or represents only an epiphenomenon accompanying pre-diabetes, remains to be elucidated. The observed relationship might contribute to the well-recognized ability of ADMA to predict cardiovascular outcome.