Search

Intermediate-high risk acute pulmonary embolism (PE) remains associated with substantial mortality despite anticoagulation therapy.The aim of this randomised pilot study was to compare catheter-directed thrombolysis to standard anticoagulation therapy.Intermediate-high risk acute PE patients were admitted to a tertiary care centre (November 2019 to April 2021) and randomised in a 1:1 ratio to catheter-directed thrombolysis (CDT) or standard anticoagulation. Two catheters were used for the infusion of alteplase (1 mg/hr/catheter; total dose 20 mg) in the CDT group. The primary efficacy endpoint targeted improvement of right ventricular (RV) function, a decrease in pulmonary pressure, and a reduction of thrombus burden.Twenty-three patients were included (12 in the CDT group and 11 in the standard care group). The primary efficacy endpoint was achieved more frequently in the CDT group than in the standard care group (7 of 12 patients vs 1 of 11 patients, p=0.0004). An RV/left ventricular ratio reduction ≥25% (evident on computed tomography angiography) was achieved in 7 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.03). A systolic pulmonary artery pressure decrease of ≥30% or normotension at 24 hrs after randomisation was present in 10 of 12 patients in the CDT group vs 2 of 11 patients in the standard care group (p=0.001). There was no intracranial or life-threatening bleeding (type 5 or 3c bleeding, according to the Bleeding Academic Research Consortium classification).CDT for intermediate-high risk acute PE appears to be safe and effective. Further research is warranted to assess clinical endpoints.

This study aimed to analyze the influence of the hospital admitting department on adherence to the Guidelines of European Society of Cardiology for management of acute coronary syndromes in patients after out-of-hospital cardiac arrest (OHCA) of coronary etiology.We studied retrospective-prospective register of 102 consecutive patients with OHCA as a manifestation of acute coronary syndrome (ACS). Patients were admitted to the coronary care unit (CCU) 52, general intensive care unit (GICU) 21, or GICU after initial Cath lab treatment (CAG-GICU) 29. This study compared the differences in the management of ACS in patients with OHCA of coronary etiology based on the admitting department in a tertiary care institution.Twelve of the 21 (57.1%) patients admitted to the GICU were evaluated as having ACS on-site where they experienced OHCA. In the CCU group, 50 out of 52 (96.2%) and 28 of 29 (100%) patients in the CAG-GICU group (P0.001). Coronary angiography was performed in 10 of 21 patients (48%) admitted to the GICU. It was performed in 49 out of 52 (94%) CCU patients and, in the CAG-GICU group, 28 out of 29 patients. The mean time to CAG differed significantly across groups (that is, GICU 200.7 min., CCU 71.2 min., and CAG-GICU 7.5 min. (P0.001)). Aspirin was used in 48% of GICU, 96% of CCU, and 79% of CAG-GICU patients (P0.001), while in the pre-hospital phase, aspirin was used in 9.5% of GICU, 71.2% of CCU, and 50% of CAG-GICU patients (P0.001). P2Y12 inhibitor prescriptions were lower in patients admitted to the GICU (33% vs. 89% CCU and 57% CAG-GICU, P0.001). The department's choice significantly affected the time to initiation of antithrombotics, which was the longest in the GICU.The choice of admission department for patients with OHCA caused by ACS was found to affect the extent to which the recommended treatments were used. An examination of OHCA patients by a cardiologist upon admission to the hospital increased the likelihood of an early diagnosis of ACS as the cause of OHCA.

The COVID-19 pandemic presents several challenges for managing patients with acute coronary syndrome (ACS). Modified treatment algorithms have been proposed for the pandemic. We assessed new algorithms proposed by The European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Acute Cardiovascular Care Association (ACCA) on patients with ACS admitted to the hospital during the COVID-19 pandemic. The COVID-19 period group (CPG) consisted of patients admitted into a high-volume centre in Prague between 1 February 2020 and 30 May 2020 (n = 181). The reference group (RG) included patients who had been admitted between 1 October 2018 and 31 January 2020 (n = 834). The proportions of patients with different types of ACS admitted before and during the pandemic did not differ significantly: in all ACS patients, KILLIP III-IV class was present in 13.9% in RG and in 9.4% of patients in CPG (p = 0.082). In NSTE-ACS patients, the ejection fraction was lower in the CPG than in the RG (44.7% vs. 50.7%, respectively, p &lt, 0.001). The time from symptom onset to first medical contact did not differ between CPG and RG patients in the respective NSTE-ACS and STEMI groups. The time to early invasive treatment in NSTE-ACS patients and the time to reperfusion in STEMI patients were not significantly different between the RG and the CPG. In-hospital mortality did not differ between the groups in NSTE-ACS patients (odds ratio in the CPG 0.853, 95% confidence interval (CI) 0.247 to 2.951, p = 0.960) nor in STEMI patients (odds ratio in CPG 1.248, 95% CI 0.566 to 2.749, p = 0.735). Modified treatment strategies for ACS during the COVID-19 pandemic did not cause treatment delays. Hospital mortality did not differ.

Background Catheter-based thrombectomy (CBT) is the most effective treatment for acute ischemic stroke. Endovascular treatment program - Prague 16 was established in tertiary university hospital in 2012 as result of close cooperation among cardiologists, neurologists and radiologists. The aim of this substudy is to analyze relationship between stroke localization and its etiology. Methods Single center, prospective registry of consecutive patients (pts) treated by CBT for acute ischemic stroke. Total of 214 pts (median 70 ys, range 21–92 ys, men 53.3%) were enrolled between 2012 and 2018. During hospitalization and subsequent 3-months follow-up, all pts were carefully examined (at least 48 hours ECG monitoring, CT angiography, carotid arteries sonography, transthoracal/ transoesofageal echocardiography) to determine the most likely stroke etiology. Results Relative frequency of strokes based on occlusion site and their etiology is shown in table below. In half of all strokes (50.9%), stroke etiology was assumed to be cardioembolic, mostly due to atrial fibrillation (89.0%). Isolated middle cerebral artery (MCA) occlusion and T-type strokes were mostly caused by cardioembolism (66.3% and 58.9%), unlike vertebrobasilar (VB) strokes, isolated internal carotid artery (ICA) occlusion/tight stenosis and tandem occlusion strokes were mostly atherotrombogenic (53.8%, 44.8% and 55.6%). Conclusions The majority of strokes with MCA and T-type occlusion was caused by cardioembolization, mostly due to atrial fibrillation. ICA occlusion, tandem occlusion and VB occlusion strokes were mostly caused by atherotrombosis. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Charles University Research Project Progress Q35

Uvod: Mechanicka trombektomie (MT) se ukazala být ucinnou lecebnou metodou u pacientů s akutni ischemickou cevni mozkovou přihodou (iCMP) vzniklou uzavěrem proximalniho useku velkých mozkových tepen. Cilem teto studie bylo porovnat zavažnost neurologickeho deficitu pacientů, kteři podstoupili MT v zavislosti na jejich zakladnich klinických charakteristikach.Metody: Prospektivni observacni monocentrický registr pacientů lecených mechanickou trombektomii pro akutni iCMP. Stupeň neurologickeho deficitu byl kvantifikovan pomoci modifikovane Rankinovy skaly (mRS 0-6) s odstupem tři měsiců od vzniku iCMP. Dle zavažnosti neurologickeho postiženi byli pacienti rozděleni do dvou skupin - mRS 0-2 vs. mRS 3-6.Výsledky: Celkem bylo do registru zařazeno 111 pacientů (průměrný věk 65,9 roku, muži 55 %). Klinicky přizniveho výsledku (mRS ≤ 2 za tři měsice) bylo dosaženo v 39,8 % (44 pacientů). Tito pacienti (mRS ≤ 2) byli v porovnani s druhou, klinicky horsi skupinou (mRS 3-6) mladsi (61 let vs. 70 let, p < 0,01), měli větsi zastoupeni aktivnich kuřaků (45,5 % vs. 25,4 %, p < 0,002) a mensi prevalenci fibrilace sini (25 % vs. 53,7 %, p < 0,001). Mezi skupinami nebyly výrazne rozdily v zastoupeni jednotlivých pohlavi (muži 50 % vs. 58 %, p = 0,27), v hodnotě indexu tělesne hmotnosti (27,8 vs. 29,2, p = 0,21), v prevalenci arterialni hypertenze (70,5 % vs. 77,6 %, p = 0,26), diabetes mellitus (15,9 % vs. 25,4 %, p = 0,15), chronicke renalni insuficience (11,4 % vs. 22,4 %, p = 0,08) a ani v hodnotě NIHSS (National Institute of Health Stroke Scale) při přijmu (15 vs. 18, p = 0,69).Zavěr: Mechanicka trombektomie dosahuje lepsich klinických výsledků u mladsich pacientů, u kuřaků a u pacientů s iCMP, ktera nebyla způsobena embolizaci při fibrilaci sini.

Purpose Identification of clinical and laboratory predictors related to Infectious Complications (ICs) in patients after Out-of-Hospital Cardiac Arrest (OHCA). Methods Patients, aged > 18, after an OHCA between 9/2013 and 11/2015, surviving > 24 h, were studied. Results Study group consisted of 42 patients (mean age 63.4 years, 88.1% men). Forty percent of patients had IC; lower respiratory tract infections were most common (87.5% of cases). ICs were more common in patients receiving Targeted Temperature Management (50% vs. 10%; p = 0.032). Antibiotics were used in 85.7% of patients. The mean time to therapy initiation was 9.6 (SD 7.1) hours after admission. The mean course of treatment was 9.0 (SD 6.2) days. Fifty-three percent of patients receiving early antibiotic treatment didn't have IC. Initial antibiotic therapy was changed more often in patients with IC (75% vs. 38.9%; p = 0.045). C-Reactive Protein, Procalcitonin, Troponin and White Blood Cell count values were higher in patients with IC. Conclusion Early initiated antibiotic treatment is overused in patients after OHCA. This practice is associated with necessitating antibiotic change in the majority of patients with IC. Assessment of clinical and laboratory parameters in the first days after OHCA increases the likelihood of appropriate ATB therapy.

Introduction Tako-tsubo syndrome (TTS) might be caused by two different trigger mechanisms. There is very little data available on patient characteristics and prognosis regarding the trigger mechanisms. Purpose Comparison of patients with TTS in terms of different trigger factor – emotional stress vs. psychical stress caused by severe non-cardiac condition. Method Data were obtained from the Tako-tsubo registry of patients hospitalized in Cardiocenter University Hospital from 2013 to 2018, in total 86 patients were diagnosed with TTS. The patients were divided into 2 groups according to the triggering cause, that we thoroughly examined in each case. In the first group, there were patients with TTS triggered by emotional stress (such as death in the family or anxiety disorders) and in the second group there were patients whose TTS was caused primarily by non-cardiac conditions of various etiology, such as neurological, infectious or postoperative issues. Results Out of 86 patients, there were 20 (23,3%) patients excluded, for we weren't able to establish the triggering cause. In 26 (30,2%) patients, the trigger was psychological and 40 (46,5%) patients suffered from non-cardiac condition. According to the collected data there were no significant differences amongst basic demographic facts. Women represented the majority in both groups – 92% vs 95%, age of 70,6±0,8 vs 71,9±0,7 years (p=0,650). There were no significant differences in the hs-TnT 624ng/l ± 49,9 vs 610,2±17,3ng/l (p=0,959). There were significant differences discovered in the average NT-proBNP level – 2691±220,5pg/ml vs 10610±599pg/ml (p Conclusion Physical stress in patients with severe non-cardiac conditions is a more frequent trigger for TTS than emotional stress. Patients with TTS induced by physical stress have a significantly worse prognosis.

Survivors after cardiac arrest (CA) due to AMI undergo PCI and then receive dual antiplatelet therapy. Mild therapeutic hypothermia (MTH) is recommended for unconscious patients after CA to improve neurological outcomes. MTH can attenuate the effectiveness of P2Y12 inhibitors by reducing gastrointestinal absorption and metabolic activation. The combined effect of these conditions on the efficacy of P2Y12 inhibitors is unknown. We compared the antiplatelet efficacies of new P2Y12 inhibitors in AMI patients after CA treated with MTH. Forty patients after CA for AMI treated with MTH and received one P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) were enrolled in a prospective observational single-center study. Platelet inhibition was measured by VASP (PRI) on days 1, 2, and 3 after drug administration. In-hospital clinical data and 1-year survival data were obtained. The proportion of patients with ineffective platelet inhibition (PRI > 50 %, high on-treatment platelet reactivity) for clopidogrel, prasugrel, and ticagrelor was 77 vs. 19 vs. 1 % on day 1; 77 vs. 17 vs. 0 % on day 2; and 85 vs. 6 vs. 0 % on day 3 (P < 0.001). The platelet inhibition was significantly worse in clopidogrel group than in prasugrel or ticagrelor group. Prasugrel and ticagrelor are very effective for platelet inhibition in patients treated with MTH after CA due to AMI, but clopidogrel is not. Using prasugrel or ticagrelor seems to be a more suitable option in this high-risk group of acute patients.

AIMS The aim of this study was to evaluate the role of direct catheter-based thrombectomy (d-CBT, without thrombolysis) and the feasibility and safety of d-CBT performed in an interventional cardiology centre. METHODS AND RESULTS This single-centre, prospective observational registry based on the pre-specified protocol included three months of follow-up. The decision to perform acute stroke intervention was made by a neurologist based on the clinical and imaging findings. Inclusion criteria were moderate-to-severe acute ischaemic stroke (NIHSS ≥6)

Background Survival rates and outcomes after out-of-hospital cardiac arrest (OHCA) remain low despite investments of time and money. The goal of this analysis was to identify variables related to survival of patients transferred to our coronary care unit (CCU) after an OHCA. Methods 102 consecutive OHCA patients, mean age 64.6 (SD 13.3), 70.6% men, between January, 2011 and December, 2013, who were transferred to our tertiary care CCU, were studied. Results Cardiac-cause OHCA was present in 84 patients (82.4%). Of these 60.7% had an acute coronary syndrome (ACS) – STEMI 35.7%; NSTEMI 23.8%. Coronary angiography was performed in 73 (71.6%) patients – 81% with cardiac- and 31.3% (5/16) with a non-cardiac cause. Percutaneous coronary intervention (PCI) was performed in 50 patients (68.5%), 49 with cardiac-cause, and succeeded in 92%. In-hospital mortality was 38.2%, one-year mortality was 51.5%. In-hospital and one-year mortality were related to age (p = 0.002 resp. p = 0.001), first ECG rhythm (p = 0.001, resp. p = 0.005), history of coronary artery disease (RR 2.1; p = 0.026 resp. RR 1.71; p = 0.029), and history of arrhythmia (supraventricular tachyarrhythmia, bradyarrhythmia) (RR 2.74; p = 0.003 resp. RR 2.3; p = 0.001). One-year mortality was also related to a history of diabetes mellitus (RR 1.89; p = 0.006). Conclusion Cardiac-cause was the most common cause of OHCA. Acute coronary syndrome was present in more than half of the cases. Availability of interventional facilities was a crucial factor in OHCA management. A history of coronary artery disease, diabetes mellitus, and arrhythmia were associated with worse survival.

Background: Therapeutic hypothermia (TH) is currently recommended in comatose patients after out-of-hospital cardiac arrest (OHCA). Acute myocardial infarction (AMI) is the most common cause of OHCA and survivors receive dual antiplatelet therapy (DAPT) after PCI. TH can attenuate the effectiveness od P2Y12 inhibitors due to reduction of gastrointestinal absorption, reduction of metabolic activation of prodrugs and due to increased platelet aggregation. The combined effect of these conditions on platelet inhibition efficacy of P2Y12 inhibitors is unknown. The aim of this study was to compare platelet inhibitory effect of clopidogrel and prasugrel in patients after OHCA for AMI treated with therapeutic hypothermia. Methods: In single center, prospective study were enrolled 51 patients after OHCA for AMI. The subgroup of 22 pts. who underwent PCI, receive DAPT, underwent TH (32-34oC for 24 h) and survived more than 3 days was analyzed. Group A (n=11 pts.) receive clopidogrel (LD 600mg + MD 150mg daily) and group B (n=11 pts.) receive prasugrel (LD 60mg + MD 5/10mg daily) via nosogastric tube. Platelet reactivity index (PRI-VASP) was measured on day 1, 2 and 3 after administration. A PRI-VASP under 50% is defined as effective platelet inhibition. Results: In the group A was median values PRI-VASP significant higher compared to the group B in all monitored days (79,3% vs. 25,9% on day 1; 81,8% vs. 18,2% on day 2; 76,0% vs. 19,5% on day 3; p< 0,001). The number of patients with effective platelet inhibition (PRI-VASP under 50%) was in group A vs. B 18% (2/11) vs. 91% (10/11) on day 1, 18% (2/11) vs. 91% (10/11) on day 2, 9% (1/11) vs. 100% (11/11) on day 3. Conclusion: New antiplatelet inhibitor prasugrel is very effective in terms of therapeutic hypothermia in patients after cardiac arrest for AMI. Clopidogrel is not effective in platelet inhibition even at an increased dose. Futher studies are needed to confirm the clinical context of these laboratory measurements.