Search

Patients with acute coronary syndrome (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization, higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed.We aimed to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment.A total of 2638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 μmol/l) increase in the absolute value.Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referred for other treatment strategies (P0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was an independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN.Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation, and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.

In the era of potent P2Y12 inhibitors, according to current guidelines, treatment with glycoprotein IIb/IIIa inhibitors (GPIs) should be limited to bail-out and/or highly thrombotic situations. Similarly, the recommendation for aspiration thrombectomy (AT) is downgraded to very selective use. We examine the prevalence, and predictors of GPI and AT use in STEMI patients referred to primary percutaneous coronary intervention (PCI). Data on 116,873 consecutive STEMI patients referred to primary PCI in Poland between 2015 and 2020 were analyzed. GPIs were administered in 29.3%, AT was used in 11.6%, and combined treatment with both in 6.1%. There was a mild trend toward a decrease in GPI and AT usage during the analyzed years. On the contrary, there was a rapid growth of the ticagrelor/prasugrel usage rate from 6.5 to 48.1%. Occluded infarct-related artery at baseline and no-reflow during PCI were the strongest predictors of GPI administration (OR 2.3; 95% CI 2.22–2.38 and OR 3.47; 95% CI 3.13–3.84, respectively) and combined usage of GPI and AT (OR 4.4; 95% CI 4.08–4.8 and OR 3.49; 95% CI 3.08–3.95 respectively) in a multivariate logistic regression model. Similarly, the administration of ticagrelor/prasugrel was an independent predictor of both adjunctive treatment strategies. In STEMI patients in Poland, GPIs are selectively used in one in four patients during primary PCI, and the combined usage of GPI and AT is marginal. Despite the rapid growth in potent P2Y12 inhibitors usage in recent years, GPIs are selectively used at a stable rate during PCI in highly thrombotic lesions.

The impact of diabetes mellitus (DM) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was confirmed by several studies. However, it is unclear whether this effect is still present in large groups of unselected patients undergoing up-to-date treatment. Thus, we sought to assess the impact of DM on periprocedural outcomes of primary PCI in STEMI using data from the Polish National Registry of PCI. Data on 150,782 STEMI patients undergoing primary PCI were collected. Of them, 26,360 (17.5%) patients had DM. Patients with DM were higher-risk individuals who experienced longer reperfusion delays and were less likely to have closed infarct-related artery at baseline (TIMI 0 + 1 flow: 73.2% vs. 72.0%; p < 0.0001) and achieve optimal reperfusion after PCI (TIMI 3 flow: 91.8% vs. 88.5%; p < 0.0001). The periprocedural mortality (1.1% vs. 1.9%; p < 0.0001) was higher in patients with DM and DM was identified as an independent predictor of periprocedural death. In conclusion, despite continuous progress in STEMI treatment, DM remains a strong predictor of periprocedural mortality. However, this detrimental effect of DM may be partially explained by the overall higher risk profile of diabetic patients.

Introduction There are conflicting data on the clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on time of intervention. Concerns have been postulated regarding equally effective in-hospital outcomes for STEMI patients treated with PCI during normal working hours as compared to group treated off-hours. Purpose The aim of this study was to assess clinical outcomes in “real-world” patients with STEMI treated with PCI during off-hours and regular hours of work. Methods To avoid possible bias related to the non-randomized design, a propensity score was calculated to compare off- and on-hours groups. The study group consisted of 37, 469 matched pairs in STEMI treated with PCI and stent implantation between 2014 and 2018 during regular hours (weekdays 7:00 AM to 16:59 PM) and off-hours (weekdays between 17:00 PM and 06:59AM, weekends, and holidays) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry). Results No differences were reported between both groups in baseline characteristics after the propensity score match (PSM). There were no differences in time from pain to first contact (p=0.2) and door to balloon time between both groups (p=0.7). After PSM higher radiation dose was observed in off-hours group (1055.18 (±1006.52) vs. 1081.59 (±1003.25)[mGy]; p=0.001). However, there was no difference in total amount of contrast (on-hours vs. off-hours: 175.69 (±74.71) vs. 176.48 (±74.41)[ml]; p=0.1, respectively). Similar rate of periprocedural complications was observed between both groups of patients, includind stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. However, procedures performed during off-hours were associated with higher incidence of periprocedural death (1.17% (439) vs. 1.49% (559); p=0.001) and periprocedural cardiac arrest (1.76% (658) vs.1.97% (740); p=0.001) as compared to PCI conducted within normal working hours. Conclusions Percutaneous coronary intervention in STEMI performed durgin off-hours might be associated with higher rate of periprocedural mortality and higher radiation dose as compared to procedures conducted during regular working hours. Funding Acknowledgement Type of funding source: None

Introduction The main impact of myocardial infarction is shifting from acute mortality to adverse remodeling and chronic left ventricle dysfunction. Several circulating biomarkers are explored for better risk stratification of these patients. Biomarker testing is a very attractive idea, since it is non-invasive, not operator-dependent and widely available. Aim In the present paper we analyze data from the years 2005-2020 about circulating biomarkers of remodeling after myocardial infarction. Material and methods We assessed 53 articles, which examined 160 relations between biomarkers and remodeling. We analyze inclusion criteria for individual studies, time points of serum collection and remodeling assessment as well as imaging methods. Results The main groups of assessed biomarkers included B-type natriuretic peptides, markers of cardiomyocyte injury and necrosis, markers of inflammatory response, markers of extracellular matrix turnover, microRNAs and hormones. The most common method of remodeling assessment was echocardiography and the most frequent time point for remodeling evaluation was 6 months. Conclusions The present analysis shows that although a relatively large number biomarkers were tested, selecting one ideal marker is still a challenge. A combination of biomarkers from different groups might be appropriate for predicting remodeling. Data presented in this analysis might be helpful for designing future studies, evaluating clinical use of an individual biomarker or a combination of different biomarkers.

Drawing from Danuta Markowska’s notion of “urbanisation of the steppe” (1969) I present in this article some processes of transformation of pastoral life that occurred in postsocialist and post-transitional Mongolia. I focus especially on how some new forms of sedentarization, mobility and self-organization appeared among the new generation of the Torghuts from Bulgan district (soum) in western Mongolia, sons and daughters of the herders. Nowadays, they are developing their new businesses in Bulgan, and also in Ulaanbaatar, the capital city, where they have established a Torghut business-hub called the Torguud Town. In this article I will reconstruct some essential processes in which they rearrange their space of living and their patterns of mobility, and show that these reac­tions, the new patterns of sedentarization and mobility, are related to spatial dimensions of pastoral self-organization. Moreover, these reactions are still rooted in mobility, constant swapping and a “technology of solidarity”, and thus embody very specific pastoral practices and ideas.

Background: This study is to assess differences in periprocedural outcomes among diabetic and non-diabetic patients treated with percutaneous coronary intervention (PCI) and rotational atherectomy (RA). Methods: Under assessment were 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) including all PCIs performed in Poland in 2015 and 2016. Data was extracted of 975 patients treated with RA — 336 (34.5%) diabetics and 639 (65.5%) non-diabetics. Periprocedural complications were defined as overall rate or particular complications such as deaths, no-reflows, perforations, dissections, cerebral strokes or bleedings. Multivariate analysis was performed to assess predictors of periprocedural complications. Results: The mean age was similar in diabetics and non-diabetics (70.9 ± 9.0 vs. 72.1 ± 9.9; p = 0.06). Diabetics were more often females (p < 0.01), with arterial hypertension (p < 0.01), kidney failure (p < 0.01) and prior myocardial infarction (p = 0.01). No significant differences were observed in overall or individual periprocedural complications and angiographic success was expressed as thrombolysis in myocardial infarction grade 3 flow after PCI. At baseline, de-novo lesions accounted for 96.5% in diabetics and 99% in non-diabetics (p < 0.01), while overall rate of restenosis was 3.5% and 1%, respectively (p < 0.01). Diabetes was an independent predictor of periprocedural complications in the overall group of patients treated with PCI (OR 1.11, 95% CI 1.04–1.194; p < 0.001). Conclusions: The negative impact of diabetes on the incidence of periprocedural complications and angiographic effectiveness in the group of patients treated with RA is mitigated in the comparison to the non-RA group.

Resumen Introduccion y objetivos Existen pocos estudios que comparen los accesos por la radial izquierda (ARI) y por la radial derecha en intervenciones coronarias percutaneas (ICP) en poblacion general y practicadas por cirujanos con diferentes grados de experiencia en intervencionismo. El objetivo de nuestro estudio es comparar la seguridad y el beneficio clinico con cada acceso en pacientes no seleccionados con sindrome coronario agudo (SCA) y angina estable (AE). Metodos Para evitar los posibles sesgos de un estudio no aleatorizado, se uso la puntuacion de propension para comparar ambos accesos radiales. Se recogieron datos de 18.716 pares con AE y 46.241 con SCA sometidos a ICP con implante de stent entre 2014 y 2017, en 151 centros terciarios con cardiologia intervencionista en Polonia (registro nacional de Polonia [ORPKI]). Resultados No se encontraron diferencias en cuanto a mortalidad y complicaciones periprocedimiento en AE. El ARI se asocio con mayores dosis de radiacion independientemente de la presentacion clinica (AE, 1.067,0 ± 947,10 frente a 1.007,4 ± 983,5 mGy; p = 0,001; SCA, 1.212,7 ± 1.005,5 frente a 1.053,5 ± 1.029,7 mGy; p = 0,001). En los pacientes con SCA, el ARI se asocio con mayor cantidad de contraste (174,2 ± 75,4 frente a 167,2 ± 72,1 ml; p = 0,001). Ademas, en los pacientes con SCA y ARI, las complicaciones periprocedimiento como diseccion coronaria (el 0,16 frente al 0,09%; p = 0,008), fenomeno de no reflow (el 0,65 frente al 0,49%; p = 0,005) y hemorragia en el sitio de puncion (el 0,09 frente al 0,05%; p = 0,04) resultaron mas frecuentes. No hubo diferencias en la mortalidad entre los 2 grupos (p = 0,90). Conclusiones Los resultados que se presentan podrian estar en relacion con una menor experiencia en el ARI. Ambos accesos son seguros en los pacientes con AE, pero el ARI se asocio con una mayor frecuencia de complicaciones periprocedimiento de ICP en el SCA.

In this article, I elaborate on some ethical and methodological doubts that have emerged in the course of my ethnographic fieldwork. They relate to the process of constructing the field, moments of collective experimentation, and the process of developing long-term relationships between the ethnographer and his or her interlocutors. I show how the stage of constructing the field may be uncertain and contingent, yet at the same time crucial for understanding the studied phenomena. I then explain how some forms of closeness and friendship in the field may be also transform into common social and artistic projects. Finally, I reflect on deeper ethical tensions related to authorship and authorization during the writing-up stage of research. I argue that some forms of collaboration in the field lead both towards a form of shared authorship and to the necessity to make our interlocutors’ identity anonymous and invisible.

Patients with ST-segment-elevation myocardial infarction (STEMI) treated during the COVID-19 pandemic might experience prolonged time to reperfusion. The delayed reperfusion may potentially aggravate the risk of out-of-hospital cardiac arrest (OHCA) in those patients. Limited access to healthcare, more reluctant health-seeking behaviors, and bystander readiness to render life-saving interventions might additionally contribute to the suggested change in the risk of OHCA in STEMI. Thus, we sought to explore the effects of the COVID-19 outbreak on treatment delay and clinical outcomes of patients with STEMI with OHCA. Overall, 5,501 consecutive patients with STEMI complicated by OHCA and treated with primary percutaneous coronary intervention with stent implantation were enrolled. A propensity score matching was used to obviate the possible impact of non-randomized design. A total of 740 matched pairs of patients with STEMI and OHCA treated before and during the COVID-19 pandemic were compared. A similar mortality and prevalence of periprocedural complications were observed in both groups. However, patients treated during the COVID-19 outbreak experienced longer delays from first medical contact to angiography (88.8 (±61.5) vs. 101.4 (±109.8) [minutes]; p = 0.006). There was also a trend toward prolonged time from pain onset to angiography in patients admitted to the hospital in the pandemic era (207.3 (±192.8) vs. 227.9 (±231.4) [minutes]; p = 0.06). In conclusion, the periprocedural outcomes in STEMI complicated by OHCA were comparable before and during the COVID-19 era. However, treatment in the COVID-19 outbreak was associated with a longer time from first medical contact to reperfusion.

BACKGROUND The main impact of myocardial infarction (MI) is shifting from acute mortality to adverse remodeling, chronic left ventricle (LV) dysfunction and heart failure. OBJECTIVES The aim of this study was to assess relationships between levels of circulating biomarkers and function of LV after MI. PATIENTS AND METHODS Prospective study of 80 patients with MI treated with percutaneous coronary interventions (PCI). Novel biomarkers including mid-regional pro-adrenomedullin (MR-proADM), Notch-1, syndecan-4, myeloperoxidase, S-100 protein, soluble ST-2, as well as markers of inflammatory response and tissue injury: galectin-3, C-reactive protein (CRP), lactate dihydrogenase (LDH) and interleukin-6 (IL-6) were assessed in the acute phase of MI. Echocardiography was performed at baseline and 6 months. RESULTS Adverse remodeling, defined as >20% increase in LV end-diastolic volume occurred in 26% of patients. Reverse remodeling (>10% reduction in LV end-systolic volume) was observed in 52% of patients. In a univariable analysis higher levels of MR-proADM and LDH were predictors of adverse remodeling and higher levels of MR-proADM, LDH, CRP and Il-6 were negative predictors of reverse remodeling. In a multivariable model LDH remained an independent predictor of adverse remodeling (OR: 3.13; 95%CI: 1.42-8.18; P=0.003) and negative predictor of reverse remodeling (OR: 0.37; 95%CI: 0.17-0.8; P=0.005). CONCLUSIONS LDH and MR-proADM seem to be promising biomarkers of adverse remodeling. On the other hand, higher levels of these biomarkers were associated with reduced chance of occurrence of favorable reverse remodeling in MI patients. However, further studies on larger groups of patients are necessary to confirm this data.

Background The COVID-19 pandemic negatively affected access to health-care system and timeline of treatment. The fear of contamination might potentially forbear from accessing the emergency system.mFurthermore, pandemic-specific protocols require additional time to prepare medical stuff and catheterization laboratory before procedure. Thus, patients with ST-segment elevation myocardial infarction (STEMI) might be exposed to a longer delay for revascularization and higher risk of mortality. Purpose The aim of this study was to evaluate treatment delay and clinical outcomes in COVID-19 positive and negative patients with STEMI treated with percutaneous coronary intervention (PCI) during on- and off hours. Methods All consecutive patients with STEMI treated with PCI and stent implantation between 1st March 2020 and 31st December 2020 were enrolled into analysis. To overcome potential bias related to the non-randomized design a propensity score match (PSM) was used to compare COVID-19 positive and negative patients for both working frames hours. The study group consisted of 877 matched pairs treated during regular hours (everyday 7:00AM-16:59PM) and 418 matched pairs with PCI performed during off-hours (everyday 17:00PM and 06:59AM) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry). Results After PSM there were no differences between COVID-19 positive and negative patients in baseline characteristics during both on- and off-hours. However, patients diagnosed with COVID-19 were admitted with cardiac arrest more frequently as compared to COVID-19 negative patients during regular working hours (180 (20.5%) vs. 64 (7.30%); p=0.001). There were no differences in radiation doses and total amount of contrast between both groups. Similarly, no differences in rate of periprocedural complications were observed despite of time of intervention, including stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. Furthermore, there were no differences in periprocedural mortality between both groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%),p=0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%),p=0.5). However, COVID-19 positive patients were exposed to longer time from first medical contact to angiography during both on-hours (133.76 (±137.10) vs. 117.14 (±135.83) [min]; p=0.001) and off-hours (148.08 (±201.56) vs. 112.19 (±138.72) [min]; p=0.003). Time from pain to first medical contact remained similar during both working frame hours (On-hours and off-hours, respectively: p=0.7 and p=0.9). Conclusions Patients diagnosed with COVID-19 might experience a longer time from first medical contact to revascularization. There was no impact of COVID-19 diagnosis on rate of periprocedural mortality or periprocedural complication, irrespective of time of intervention. System-level changes might be crucial to improve health-care during COVID-19 pandemic. Funding Acknowledgement Type of funding sources: None.

Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). With a growing number of PCIs in complex lesions, the problem of CAP becomes even more important nowadays. Data on CAP rates in Poland are lacking. Presented study is an analysis of 344,517 consecutive patients treated with PCI between 2014 and 2017. Data were gathered from the Polish National PCI Registry (ORPKI). During 4 years of data collection CAP was observed in 595 (0.17%) cases. Patients diagnosed with CAP were older (69 years Q1:63; Q3:78 vs 66 years Q1:60; Q3:75; p0.001), more often female (44% vs 32%; p0.001), with arterial hypertension (77% vs 71%; p = 0.002), and chronic kidney disease (8.9% vs 5.4%; p0.001). In the CAP group, a higher rate of PCIs within chronic total occlusions (8.7% vs 2.3%; p0.001) and saphenous vein graft lesions (2.7% vs 1.3%; p = 0.002), as well as rotational atherectomy procedures (2.2% vs 0.4%; p0.001) was observed. Patients with CAP had higher rate of no-reflow phenomenon (5.5% vs 0.5%; p0.001) and greater periprocedural mortality (4.2% vs 0.5%; p0.001). In conclusion, our study confirms that CAP is more common during complex PCI procedures in high-risk patients. CAP occurrence is associated with worse immediate outcomes including increased periprocedural mortality.

Introduction Patients with peripheral artery disease (PAD) are considered as a high-risk group for hemorrhagic events. Aim To assess the safety of bivalirudin vs. unfractionated heparin (UFH) in percutaneous peripheral interventions (PPI) in short- and long-term follow-up. Material and methods The retrospective single-center, observational study included 160 patients, undergoing PPI. Patients were divided into 2 groups based on the use of anticoagulation - unfractionated heparin (UFH group) or bivalirudin (Biv. group) - and observed up to 5 years. Results The UFH group consisted of 101 patients and the Biv. group consisted of 59. We registered the following end points during in-hospital observation: 1 death (0.63% Biv, p = 0.18), 12 hematomas at puncture site (0.63% Biv. vs. 7.05% UFH, p = 0.04), 2 pseudoaneurysms (1.27% UFH, p = 0.29), thrombosis (0.63% UFH, p = 0.45), 1 bleeding from puncture site (0.63% UFH, p = 0.45). The total number of hemorrhagic complications was 1.24% in the Biv. group and 8.07% in the UFH group (p = 0.04). During long-term follow-up of 65.7 ±36.4 months the all-cause mortality rate was higher in the Biv. group (8.59% Biv vs. 0% in UFH group, p = 0.009). Regression analysis showed that bivalirudin administration is a risk factor for increased mortality risk (p = 0.003, OR = 15, 95% CI: 3.3-107.8). Conclusions Usage of UFH was associated with a higher number of hemorrhagic complications, especially hematomas at the puncture site in comparison to patients receiving bivalirudin.

The beneficial outcome of the radial (RA) over femoral approach (FA) in ST-segment elevation myocardial infarction (STEMI) has been widely demonstrated. However, most of the studies excluded patients with STEMI and cardiogenic shock (CS).We sought to evaluate periprocedural outcomes of percutaneous coronary intervention (PCI) with RA and FA in patients with STEMI complicated by CS using data from the Polish National PCI Registry (ORPKI).A total of 3,565 consecutive patients with STEMI and CS treated with emergent PCI and stent implantation were included. Data was collected prospectively between 2014 and 2018 from 151 tertiary primary-PCI centers in Poland. To avoid possible selection bias, a propensity score matching (PSM) was used to create 945 matched pairs treated via RA or FA.No differences were reported in baseline characteristics, clinical presentation and delays in treatment between RA and FA after the PSM. Similar radiation doses and the total amount of contrast were used in both groups. A similar rate of periprocedural complications was observed in both RA and FA. However, RA was associated with reduced periprocedural mortality (9.4% (89) vs. 18.6% (176); P=0.001) and lower incidence of cardiac arrest (9.7% (92) vs. 16.1% (152); P=0.001). In multivariable analysis, FA was the strongest independent predictor for increased periprocedural mortality (OR 2.087, 95% CI 1.629-2.674; P=0.001).The radial approach was associated with lower periprocedural mortality compared with FA in patients with STEMI complicated by CS. RA seems to be a valuable option in technically feasible situations.

INTRODUCTION The beneficial outcome of the radial (RA) over femoral approach (FA) in ST-segment elevation myocardial infarction (STEMI) has been widely demonstrated. However, most of the studies excluded patients with STEMI and cardiogenic shock (CS). OBJECTIVES We sought to evaluate periprocedural outcomes of percutaneous coronary intervention (PCI) with RA and FA in patients with STEMI complicated by CS using data from the Polish National PCI Registry (ORPKI). PATIENTS AND METHODS A total of 3,565 consecutive patients with STEMI and CS treated with emergent PCI and stent implantation were included. Data was collected prospectively between 2014 and 2018 from 151 tertiary primary-PCI centers in Poland. To avoid possible selection bias, a propensity score matching (PSM) was used to create 945 matched pairs treated via RA or FA. RESULTS No differences were reported in baseline characteristics, clinical presentation and delays in treatment between RA and FA after the PSM. Similar radiation doses and the total amount of contrast were used in both groups. A similar rate of periprocedural complications was observed in both RA and FA. However, RA was associated with reduced periprocedural mortality (9.4% (89) vs. 18.6% (176); P=0.001) and lower incidence of cardiac arrest (9.7% (92) vs. 16.1% (152); P=0.001). In multivariable analysis, FA was the strongest independent predictor for increased periprocedural mortality (OR 2.087, 95% CI 1.629-2.674; P=0.001). CONCLUSIONS The radial approach was associated with lower periprocedural mortality compared with FA in patients with STEMI complicated by CS. RA seems to be a valuable option in technically feasible situations.

IntroductionIn this study, we aimed to distinguish differences in the procedural complication rate in a group of patients undergoing percutaneous coronary interventions (PCI) of the left main coronary artery (LMCA) between patients with isolated LMCA disease and multi-vessel disease (MVD) with LMCA involvement and to identify their predictors.Material and methodsWe assessed 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) regarding all PCI procedures performed in Poland in 2015 and 2016. We extracted data of 1,819 patients with isolated LMCA disease and 3,718 patients with MVD and LMCA involvement. We compared those two groups in terms of procedural complications and their predictors.ResultsThe overall rate of procedural complications was significantly higher in patients treated with LMCA PCI both in the group of patients with isolated LMCA (6.5%) and the group with MVD with LMCA involvement (7.3%) compared to the non-LMCA PCI group (1.9%, p = 0.002). Multivariate analysis confirmed that MVD with LMCA involvement is an independent predictor of decreased risk of procedural death in the overall group of patients undergoing PCI of the LMCA (odds ratio: 0.583; 95% confidence interval: 0.4–0.848; p = 0.005).ConclusionsThe MVD involvement in patients treated with PCI of the LMCA may play a protective role. Patients with isolated LMCA involvement undergoing PCI should be subjected to special care and protected by various methods, such as devices to support left ventricle function.

Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%), p = 0.3, off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%), p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min), p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min), p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention.

IntroductionThe long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses.Material and methodsWe enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG) and death. The mean follow-up was 964 ±799.1 days and was completed among 156 patients. Multivariate analysis was used to assess determinants of study endpoints during follow-up. Moreover, we compared survival curves according to the type of PCI and presence of anti-embolic protection.ResultsThe primary endpoint of the study occurred in 59.7% of patients after the mean time of 669.6 ±598.7 days. The TVR occurred in 37.9% of individuals, TLR in 24.2%, MI in 26.3%, stroke in 4.2%, CABG in 2.1% and death in 30.5% of patients. In Cox multivariate analysis, PCI of two or more bypasses (p < 0.01), post-dilatation (p < 0.05) and no-reflow (p < 0.05) were the independent determinants of the primary study endpoint. No significant impact of anti-embolic protection devices on long-term outcomes was observed.ConclusionsPercutaneous coronary interventions of two or more bypasses, post-dilatation and no-reflow are predictors of worse outcome in patients undergoing PCI within coronary artery bypass grafts.

Introduction and objectives There is a paucity of data comparing the left radial approach (LRA) and right radial approach (RRA) for percutaneous coronary intervention (PCI) in all-comers populations and performed by operators with different experience levels. Thus, we sought to compare the safety and clinical outcomes of the RRA and LRA during PCI in “real-world” patients with either stable angina or acute coronary syndrome (ACS). Methods To overcome the possible impact of the nonrandomized design, a propensity score was calculated to compare the 2 radial approaches. The study group comprised 18 716 matched pairs with stable angina and 46 241 with ACS treated with PCI and stent implantation between 2014 and 2017 in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry). Results The rates of death and periprocedural complications were similar for the RRA and LRA in stable angina patients. A higher radiation dose was observed with PCI via the LRA in both clinical presentations (stable angina: 1067.0 ± 947.1 mGy vs 1007.4 ± 983.5 mGy, P = .001; ACS: 1212.7 ± 1005.5 mGy vs 1053.5 ± 1029.7 mGy, P = .001). More contrast was used in LRA procedures but only in ACS patients (174.2 ± 75.4 mL vs 167.2 ± 72.1 mL, P = .001). Furthermore, periprocedural complications such as coronary artery dissection (0.16% vs 0.09%, P = .008), no-reflow phenomenon (0.65% vs 0.49%, P = .005), and puncture site bleeding (0.09% vs 0.05%, P = .04) were more frequently observed with the LRA in ACS patients. There was no difference in mortality between the 2 groups (P = .90). Conclusions Our finding of poorer outcomes with the LRA may be related to lower operator experience with this approach. While both the LRA and RRA are safe in the setting of stable angina, the LRA was associated with a higher rate of periprocedural complications during PCI in ACS patients.

Background: During the first decade following the coronary bypass grafting, at least ten percent of the patients require percutaneous coronary interventions (PCI) due to graft failure. Saphenous vein grafts (SVG) are innately at a higher risk of periprocedural complications. The present study aimed to investigate predictors of periprocedural complications of PCI within coronary artery bypass grafts. Methods: This study analyzed data gathered in the Polish National Registry (ORPKI) between January 2015 and December 2016. Of the 221,195 patients undergoing PCI, data on 2,616 patients after PCI of SVG and 442 patients after internal mammary artery (IMA) were extracted. The dissimilarities in periprocedural complications between the SVG, IMA and non-IMA/SVG groups and their predictors were investigated. Results: Patients in the SVG group were older (p < 0.001), with a higher burden of concomitant disease and differing clinical presentation. The rate of de-novo lesions was lower, while restenosis was higher at baseline in the SVG (p < 0.001). The rate of no-reflows (p < 0.001), perforations (p = 0.01) and all periprocedural complications (p < 0.01) was higher in the SVG group, while deaths were lower (p < 0.001). Among the predictors of no-reflows, it was found that acute coronary syndromes (ACS), thrombectomy and past cerebral stroke, while the complications included arterial hypertension, Thrombolysis in Myocardial Infarction (TIMI) flow before PCI and thrombectomy. Conclusions: Percutaneous coronary interventions of SVG is associated with increased risk of specific periprocedural complications. The ACS, slower TIMI flow before PCI and thrombectomy significantly increase the periprocedural complication rate in patients undergoing PCI of SVG.

Background: Rapid ventricular pacing is mandatory for optimal balloon positioning during aortic valvuloplasty (BAV) in patients with severe aortic stenosis. We aimed to assess the safety and efficacy of direct left ventricular (LV) guidewire pacing in comparison with regular pacing induced by temporary pacemaker (PM) placement in the right ventricle. Methods: Direct rapid LV pacing was provided with a 0.035&Prime, guidewire. Baseline clinical characteristics, echocardiographic and procedural data, as well as complication rates, were compared between the two groups. Results: A total of 202 patients undergoing BAV were enrolled (49.5% with direct LV guidewire pacing). The pacing success rate was 100%. In the direct LV guidewire pacing group, we found a lower radiation dose, shorter fluoroscopy and overall procedural time (0.16 vs. 0.28 Gy, p = 0.02, 5.4 vs. 10.3 min, p = 0.01, 17 vs. 25 min, p = 0.01, respectively). In addition, the complication rate was lower in that group (cardiac tamponades, vascular access site complications, blood transfusions rate, and in-hospital mortality: 0% vs. 3.9%, 4.0% vs. 15.7%, 2.0% vs. 12.7%, 2.0% vs. 9.8%, p = 0.01 for all, respectively). Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle.

Background: Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary interventions (PCIs) due to the risk of cardiac tamponade. Strikingly, in contrast to numerous analyses of CAP predictors, only few studies were focused on the predictors of tamponade after PCI, once iatrogenic CAP has occurred. Our aim was to search for clinical and periprocedural characteristics, including the coronary artery involved, associated with the development of acute cardiac tamponade among patients experiencing CAP. Methods: From the medical records of nine centers of invasive cardiology in southern Poland, we retrospectively selected 81 patients (80% with acute myocardial infarction) who had iatrogenic CAP with a visible extravasation jet during angiography (corresponding to type III CAP by the Ellis classification, CAPIII) over a 15-year period (2005&ndash, 2019). Clinical, angiographic and periprocedural characteristics were compared between the patients who developed acute cardiac tamponade requiring urgent pericardiocentesis in the cathlab (n = 21) and those with CAPIII and without tamponade (n = 60). Results: CAPIII were situated in the left anterior descending artery (LAD) or its diagonal branches (51%, n = 41), right coronary artery (RCA) (24%, n = 19), left circumflex coronary artery (LCx) (16%, n = 13), its obtuse marginal branches (7%, n = 6) and left main coronary artery (2%, n = 2). Acute cardiac tamponade occurred in 24% (10 of 41), 21% (4 of 19) and 37% (7 of 19) patients who experienced CAPIII in the territory of LAD, RCA and LCx, respectively. There were no significant differences in the need for urgent pericardiocentesis (37%) in patients with CAPIII in LCx territory (i.e., the LCx or its obtuse marginal branches) compared to CAPIII in the remaining coronary arteries (23%) (p = 0.24). However, when CAPIII in the LCx were separated from CAPIII in obtuse marginal branches, urgent pericardiocentesis was more frequently performed in patients with CAPIII in the LCx (54%, 7 of 13) compared to subjects with CAPIII in an artery other than the LCx (21%, 14 of 68) (p = 0.03). The direction of this tendency remained consistent regardless of CAP management: prolonged balloon inflation only (n = 26, 67% vs. 13%, p = 0.08) or balloon inflation with subsequent stent implantation (n = 55, 50% vs. 24%, p = 0.13). Besides LCx involvement, no significant differences in other characteristics were observed between patients according to the need of urgent pericardiocentesis. Conclusions: CAPIII in the LCx appears to lead to a higher risk of acute cardiac tamponade compared to perforations involving other coronary arteries. This association may possibly be linked to distinct features of LCx anatomy and/or well-recognized delays in diagnosis and management of LCx-related acute coronary syndromes.

Conflicting data exist regarding the associations between on-site surgical backup and outcomes after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Thus, we sought to assess the impact of such a backup on periprocedural outcomes of primary PCI using data from the Polish National Registry of PCI. From 2014 to 2016 data on 66,707 patients presenting with STEMI undergoing primary PCI from 154 centers were collected. Patients were divided into 2 groups based on the presence of on-site surgical backup. Of 66,707 patients, 15,040 (22.6%) patients were treated in 28 centers with on-site surgical backup. On-site surgical backup was associated with a higher center PCI annual volume (662.4 ± 301.8 vs 1098.7 ± 483.5; p0.001), but a lower operator PCI annual volume (226.7 ± 126.0 vs 207.8 ± 96.6; p0.001). The periprocedural mortality (1.60% vs 1.09%; p0.001) was lower in patients from centers with on-site cardiac surgery and both on-site surgical backup (odds ratio [95% confidence interval], 0.618 [0.517; 0.738]; p0.001) and the mean number of PCIs by operator per year (odds ratio per 10 [95% confidence interval], 0.990 [0.984; 0.996]; p = 0.001] were independent predictors of periprocedural death. In conclusion, results of our study suggest that periprocedural mortality in patients undergoing primary PCI for STEMI is lower in centers than without on-site cardiac surgical backup. Whether this effect on mortality is attributable to such backup itself and/or whether surgical backup is a marker of overall better medical care and adherence to professional guidelines, this needs clarification in further studies.