Publications (141)167.31 Total impact
-
Article: The incidence and risk factors of stroke in patients with acute myocardial infarction treated invasively and concomitant impaired renal function
[show abstract] [hide abstract]
ABSTRACT: Background: Impaired renal function is a marker of poor prognosis in patients with acute myocardial infarction (AMI). The aim of the study was to assess the incidence and independent predictors of stroke in population of patients with AMI treated invasively and concomitant impaired renal function (IRF). Methods: We analyzed 2,520 consecutive AMI-patients admitted to our Center between 2003 and 2007 and treated with percutaneous coronary intervention. The whole population was divided into patients with IRF, defined as glomerular filtration rate < 60 ml/min/1.73m2 or contrast induced nephropathy (IRF-group, n = 933; 37.02%) and patients without IRF (Control-group, n = 1587; 62.98%). The IRF-group was taken into further analysis. Data on long-term follow-up were screened to identify patients who experienced stroke. Results: During median 25.5 months of follow-up 52 (2.07%) patients experienced stroke - 33 (3.54%) in IRF-group and 19 (1.2%) patients in control-group. The risk of major adverse cardiovascular events in IRF-group, including repeated AMI (68.8 vs. 14.9%, P<0.001) and death (45.5 vs. 25.1%, P<0.05) was significantly higher in patients with stroke. Previous stroke (HR 6.85), female gender (HR 3.13), as well as STEMI anterior (HR 2.55) were the independent risk factors of stroke in this population. Conclusions: Patients with AMI treated invasively and concomitant IRF were at higher risk of stroke occurance in the future. Stroke was associated with poor outcome in the studied population. Independent predictors of stroke in patients with impaired renal function and AMI treated invasively were different from commonly recognized stroke predictors.Cardiology journal 04/2013; · 1.31 Impact Factor -
Article: Outcomes of invasive treatment in very elderly Polish patients with non-ST-segment-elevation myocardial infarction from 2003-2009 (from the PL-ACS registry).
[show abstract] [hide abstract]
ABSTRACT: Elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) are rarely included in randomized trials due to concomitant diseases. As a result, invasive treatment and aggressive pharmacotherapy are used less frequently in this group. The aim of the study was to analyze the impact of invasive treatment used for elderly patients (≥ 80 years) with NSTEMI from 2003-2009 and its impact on 24-month outcomes. We performed analysis of 13,707 elderly patients, out of 78,422 total NSTEMI patients, enrolled in the prospective, nationwide, Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2003 to 2009. The percentage of elderly NSTEMI population was 17.5%. Invasive treatment received 24% of them. In-hospital complications (stroke, reinfarction and death) were significantly less frequent in the invasive group, with the exception of major bleeding, which occurred almost three times more frequently (2.9% vs. 1.1%, p < 0.0001) in the invasive group. The 24-month mortality was lower (29.4% vs. 50.4%, p < 0.0001) in the invasive group and remained so after matching patients by the propensity score method (31.1% vs. 40.9%, p < 0.0001). From 2003 to 2009 the use of thienopyridines, beta-blockers and statins rose significantly. The frequency of invasive strategy increased significantly, from 10% in to over 50% in 2009. The frequency of major bleeding increased twofold, however a significant reduction in the 24-month mortality was observed over the years. Elderly patients with NSTEMI benefit significantly from invasive strategies and modern pharmacotherapy recommended by treatment guidelines. Nevertheless, this approach is associated with an increased incidence of major bleeding.Cardiology journal 01/2013; 20(1):34-43. · 1.31 Impact Factor -
Article: Acute myocardial infarction due to left main coronary artery disease: A large multicenter national registry.
[show abstract] [hide abstract]
ABSTRACT: Optimal management of patients with acute myocardial infarction (MI) due to critical stenosis of an unprotected left main coronary artery (ULMCA) is not established. However, data from observational studies and registries encourage to perform percutaneous coronary intervention (PCI) in high risk patients. We investigated gender-related discrepancies, clinical course and prognosis in patients with acute MI and ULMCA as an infarct-related artery. A total of 643 consecutive patients (184 [28.6%] females and 459 [71.4%] males) with acute MI due to critical ULMCA stenosis were selected from the population of 121,526 patients hospitalized due to acute coronary syndromes between 2003 and 2006. The primary endpoints were in-hospital, 30-day, 6-month and 12-month mortality. Women were older than men with signifi cantly higher proportion of women older than 65 and with unfavorable risk profi le. The management in men and women was similar. There was no signifi cant gender-related differences in mortality in all follow-up periods. In multivariate analysis cardiogenic shock, pulmonary edema, ST elevation myocardial infarction (STEMI) and advanced age signifi cantly increased mortality, whereas successful PCI decreased mortality. No signifi cant differences in clinical course, treatment and prognosis between men and women were noted. Mortality remained very high in both genders. The most unfavorable prognostic factors were cardiogenic shock, pulmonary edema, STEMI and advanced age. Percutaneous coronary angioplasty is feasible and offers high success rate in this subset of patients.Cardiology journal 01/2013; 20(2):190-6. · 1.31 Impact Factor -
Article: Not All Fat Is Equal.
Journal of the American College of Cardiology 12/2012; · 14.16 Impact Factor -
Article: Three-year survival of patients with chronic systolic heart failure due to hypertension - analysis of prognostic factors.
[show abstract] [hide abstract]
ABSTRACT: INTRODUCTION Despite advances in medicine, chronic systolic heart failure (CHF) due to hypertension still constitutes a serious clinical problem. OBJECTIVES To determine risk factors for death in 3-year follow-up in patients with CHF due to hypertension. PATIENTS AND METHODS The analysis encompassed 140 consecutive in-hospital stable patients with CHF [left ventricular end diastolic diameter (LVEDd)>57mm, left ventricular ejection fraction (LVEF)<40%], free from epicardial artery stenosis (>30% vessel lumen), significant heart defect, diabetes, neoplastic disease or chronic kidney disease, with a history of hypertension (minimum 5 years), and receiving angiotensin convertase inhibitors, β-adrenolytics, spironolactone, furosemid and digoxin for ≥3 months. The follow-up began on admission after performing laboratory tests, resting electrocardiograph and echocardiograph, six-minute walk test, coronarography and endomyocardial biopsy. Late follow-up data was obtained from six-monthly follow-up visits or by telephone. RESULTS The analysis encompassed 130 out of 140 patients aged 47.8±7.9 years old. The three-year mortality rate was 18.5%. Independent risk factors for death were: LVEF (hazard ratio (HR) 0.881, p<0.05), serum glucose (HR 1.266, p<0.01), N-terminal pro-B-type natriuretic peptide (NT pro-BNP) (HR 1.369 per each 100ng, p<0.001) and bilirubin (HR 1.057, p<0.05). CONCLUSIONS Beside left ventricular ejection fraction (LVEF) and serum NT pro-BNP, also glucose and bilirubin are independent risk factors for death in patients with CHF due to hypertension.Polskie archiwum medycyny wewnȩtrznej 10/2012; · 1.37 Impact Factor -
Article: Impact of chronic total occlusion artery on 12-month mortality in patients with non-ST-segment elevation myocardial infarction treated by percutaneous coronary intervention (From the PL-ACS Registry).
[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: Three-vessel coronary artery disease is associated with high mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The purpose of this study was to assess the impact on 12-month mortality of chronic total occlusion (CTO) in the non-infarct-related artery (non-IRA), as assessed by coronary angiography during percutaneous coronary intervention (PCI) for NSTEMI, of patients with 3-vessel disease. METHODS: The study included all of the NSTEMI patients with 3-vessel disease by coronary angiogram who were treated by PCI and who were registered in the prospective Polish Registry of Acute Coronary Syndromes (PL-ACS) from July 2007 to November 2009. The patients with prior coronary artery bypass grafting and those with significant stenosis of the left main coronary artery were excluded. The 12-month mortality was obtained from a government database. RESULTS: Of the 925 patients fulfilling the inclusion and exclusion criteria, 438 (47.4%) patients had 1 or more CTO of a major non-IRA coronary artery (+CTO), and 487 (52.6%) patients had 3-vessel disease without CTO (-CTO). The in-hospital mortality for the +CTO and -CTO patients was 5.3% and 2.1%, respectively (p=0.009), whilst the 12-month mortality was 21.1% and 11.9%, respectively (p=0.0001). After multivariate adjustment for differences in the baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk=1.42, 95%CI=1.01-2.00, p=0.047). CONCLUSIONS: The presence of CTO in non-IRA in patients with NSTEMI and 3-vessel coronary disease predicts higher 12-month mortality.International journal of cardiology 10/2012; · 7.08 Impact Factor -
Article: Calcific aortic valve damage as a risk factor for cardiovascular events.
[show abstract] [hide abstract]
ABSTRACT: Aortic valve calcification (AVC) is a common disease of the elderly. It is a progressive disease ranging from mild valve thickening to severe calcification with aortic valve stenosis. Risk factors for AVC are similar to those for atherosclerosis: age, gender, hypercholesterolemia, diabetes, hypertension, smoking and renal failure. AVC shares many similarities to atherosclerosis, including inflammatory cells and calcium deposits, and correlates with coronary plaque burden. Presence of AVC is associated with increased risk of adverse cardiovascular events. The objective for this review is to discuss the clinical features, natural history and prognostic significance of aortic valve calcifications, including mechanical and hemodynamic factors of flow distribution.Polish Journal of Radiology 10/2012; 77(4):30-4. -
Article: Differences in presentation, treatment, and prognosis in elderly patients with non‑ST‑segment elevation myocardial infarction.
[show abstract] [hide abstract]
ABSTRACT: Advanced age is a significant risk factor for acute coronary syndrome (ACS). Because women live longer than men, they constitute the majority of elderly patients with ACS. The aim of the study was to assess differences in clinical presentation, treatment, and prognosis in elderly women with non‑ST‑segment elevation myocardial infarction (NSTEMI). A total of 1219 consecutive patients with NSTEMI (women, 43%) hospitalized during 1 year in a district of 1,300,000 inhabitants were analyzed. Data concerning in‑hospital course were obtained from the Polish Registry of Acute Coronary Syndromes (PL‑ACS), data on rehospitalization from the local branch of the National Health Fund, and data on mortality from the local register office. There were 387 patients aged under 65 years (women, 27%) and 832 aged over 65 years (women, 50.1%). In both groups, women had more risk factors than men. Coronary angiography and percutaneous transluminal coronary angioplasty were performed less frequently in the age group over 65 years, both in men and women, compared with the younger age group (23.8% vs. 41.9%, P <0.001 and 11.8% vs. 25.6%, P <0.01, respectively). Treatment outcomes were comparable between men and women in both age groups. In elderly patients with NSTEMI, the percentage of women is higher than that of men compared with the younger age group. Despite the fact that invasive approach was less frequently used in women, long‑term prognosis was similar in both sexes.Polskie archiwum medycyny wewnȩtrznej 05/2012; 122(6):253-61. · 1.37 Impact Factor -
Article: Effect of glycemic control on response to antiplatelet therapy in patients with diabetes mellitus and ST-segment elevation myocardial infarction.
[show abstract] [hide abstract]
ABSTRACT: Impaired glycemic control (GC) is a troubling clinical condition with an unclear prognostic value that is frequent in diabetics, especially in the setting of acute coronary syndrome. Residual platelet reactivity can be also affected by GC. We evaluated the relation between response to dual antiplatelet therapy and GC in diabetics with STEMI treated with primary coronary angioplasty (PCI). Sixty diabetic patients were prospectively enrolled in the study. All patients were treated with clopidogrel and aspirin. Platelet reactivity (whole blood aggregation and phosphorylation of vasodilator-stimulated phosphoprotein, VASP) were assessed serially before and 24 hours, 7 days, and 30 days after the PCI. Blood glucose >8.5 mmol/L on admission was an independent predictor of a impaired clopidogrel response measured with platelet reactivity index (PRI) >50% on admission (OR 7.8, 95% CI 1.4-17.7, p<0.02) and 24 hours after PCI (OR 13.1, 95% CI 3.4-28.1, p<0.01). In conclusion, diabetic patients with STEMI and glycemia >8.5 mmol/L on admission is related to a poorer response to clopidogrel. There were no interaction between glycated hemoglobin level or glycemia on admission and platelet reactivity measured with collagen, arachidonic acid or thrombin receptor agonist peptide-induced aggregation. Further clinical studies of the role of GC in the efficacy of antiplatelet agents are warranted.The American journal of cardiology 04/2012; 110(3):331-6. · 3.58 Impact Factor -
Article: Acute Coronary Syndromes in Patients with Chronic Kidney Disease.
[show abstract] [hide abstract]
ABSTRACT: Chronic kidney disease (CKD) is associated with high cardiovascular morbidity and mortality. The available data suggest that efforts to reduce mortality in the CKD population should be focused on treatment and prevention of, among others, coronary artery disease and congestive heart failure. Accelerated atherosclerosis present in CKD patients also leads to a decline in renal function. Definite data concerning the treatment of heart failure in CKD patients are lacking, because patients with significant renal impairment have mostly been excluded from randomized studies. Nevertheless, it seems that CKD patients should receive similar cardiovascular treatment to that used in patients with normal kidney function, but the doses of drugs ought to be titrated to achieve an optimal effect while avoiding adverse events. Several studies have also shown that despite the high risk, in patients with acute coronary syndrome (ACS), revascularization procedures in patients with CKD appear to be advantageous in the long run and are therefore justified. However, large clinical trials are needed to confirm the benefits and to identify possible disadvantages associated with various methods of treatment.Current Vascular Pharmacology 01/2012; · 2.90 Impact Factor -
Article: Personalized Medicine for cardiovascular disease - genomics
Kardiol.Dypl. 01/2012; 11(9):9-16. -
Article: [Comment to article Pierwotna angioplastyka w zawale serca: czy zawsze dokonujemy optymalnego wyboru?].
Kardiologia polska 01/2012; 70(1):6. · 0.51 Impact Factor -
Article: [The role of haemodynamic factors in the development of in-stent restenosis.]
[show abstract] [hide abstract]
ABSTRACT: Despite improvements in stent technology, including introduction of drug eluting stents, problem of neointimal hyperplasia and restenosis remains. These phenomena are associated with multiple risk factors and gene polymorphisms. Well known periprocedural risk factors of restenosis such as site of stenting, oversizing, implantation of overlapping stents along with change in vessel geometry affect blood flow conditions. Both experimental and clinical studies provide a number of arguments regarding importance of hemodynamic factors like oscillatory shear stresses in the process of restenosis. Computational fluid dynamic (CFD) enables calculation of indices describing fluid flow including tangential shear stress. This method enables the virtual representation of the physical forces in the flow system and depicting them in graphical form. Flow modeling is used in the process of designing of coronary stents, which allows for the assessment of restenosis risk in the project phase. In the nearest future CFD will be used for prediction of restenosis risk after stent implantation.Kardiologia polska 01/2012; 70(11):1194-1198. · 0.51 Impact Factor -
Article: [Plasma phosphorus as cardiovascular risk factor in persons with preserved kidney function.]
Kardiologia polska 01/2012; 70(9):938-942. · 0.51 Impact Factor -
Article: The influence of diabetes on in-hospital and long-term mortality in patients with myocardial infarction complicated by cardiogenic shock: results from the PL-ACS registry.
[show abstract] [hide abstract]
ABSTRACT: Backgroud: Cardiogenic shock (CS) affects the prognosis in patients with myocardial infarction (MI). An additional factor affecting the prognosis is diabetes mellitus (DM). Aim: To evaluate the impact of DM on in-hospital and long-term mortality in patients with MI complicated by CS, who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). We also sought to demonstrate a relationship between treatment method and mortality in this group. Methods: 71,290 consecutive patients with non-ST elevation MI (NSTEMI; 33,392) and ST elevation MI (STEMI; 37,898) were included in the PL-ACS register. CS was diagnosed on admission in 4,144 patients. This group included 1,159 patients with DM. Results: The patients with DM were older, more frequently female and more frequently presented with hypertension, hypercholesterolaemia, obesity, suffered from multivessel coronary disease significantly more frequently (76.4% vs. 64.6%; p = 0.00003) and had lower coronary angioplasty efficacy (TIMI 3 flow) (67% vs. 75.8%; p = 0.001) compared to patients without DM. The mortality rate comparisons for patients with DM vs. those without DM, respectively, were as follows: inhospital mortality, 61.4% vs. 55.9%; p = 0.001 (revascularisation treatment: 45.7% vs. 39.5%; p = 0.03, conservative treatment: 69.3% vs. 64.6%; p = 0.02) and 3-year mortality 78.6% vs. 70.7%; p 〈 0.0001 (revascularisation treatment: 64.7% vs. 55.0%; p = 0.001, conservative treatment: 85.5% vs. 79.2%; p = 0.0001). In the multivariate analysis, DM was, with borderline statistical significance, an independent predictor of higher in-hospital mortality (OR = 1.16; 95% CI 1.00-1.35; p = 0.054] and 3-year mortality (HR = 1.11; 95% CI 1.02-1.20; p = 0.01). Interestingly, after excluding patients who died in the hospital, DM was still associated with significantly higher 3-year mortality (50.1% vs. 40.0%; p 〈 0.0001). Multivariate analysis revealed that DM was still an independent risk factor for higher 3-year mortality (HR = 1.21; 95% CI 1.04-1.41; p = 0.02). Conclusions: Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients.Kardiologia polska 01/2012; 70(12):1215-24. · 0.51 Impact Factor -
Article: [Hybrid room - the new standard for cooperation of cardiosurgeon, anaesthesiologist and invasive cardiologist in treating difficult, complex cardiovascular patients].
[show abstract] [hide abstract]
ABSTRACT: The concept of hybrid room is to combine capabilities of cardiosurgery operating room and fully equipped cathlab. Since May 2011, an ultramodern hybrid room has been working, in our center. The cases reported in this article show the possibilities of cooperation of cardiosurgeons, anaesthesiologists and invasive cardiologists in performing difficult, complex cardiovascular interventions. In near future the capabilities of hybrid room will allow to perform simultaneously a number of complex cardiovascular procedures. It should not only shorten the time of hospitalisation but also substantially improve the patients comfort.Kardiologia polska 01/2012; 70(1):104-8. · 0.51 Impact Factor -
Article: [Epicardial approach during ablation of ventricular tachycardia in patients with ischaemic cardiomyopathy - utility and safety of the method].
Kardiologia polska 01/2012; 70(3):277-81. · 0.51 Impact Factor -
Article: [Shear-activated nanotherapeutics. Are we witnessing a breakthrough in the treatment of thrombosis and atherosclerosis?].
Kardiologia polska 01/2012; 70(8):876. · 0.51 Impact Factor -
Article: Temporal trends in the treatment and outcomes of patients With non-ST-segment elevation myocardial infarction in Poland from 2004-2010 (from the Polish Registry of Acute Coronary Syndromes).
[show abstract] [hide abstract]
ABSTRACT: The aim of this work was to analyze temporal trends in clinical presentation, treatment methods, and outcomes of patients in Poland with non-ST-segment elevation myocardial infarction (NSTEMI) from 2004 to 2010. A total of 90,153 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS) from 2004 to 2010 were analyzed. The main outcome measure was all-cause mortality after 12 months, identified from official mortality records. The percentage of admissions for NSTEMI among all acute coronary syndromes increased from 24% in 2004 to 38% in 2010 (p < 0.0001). From 2004 to 2010, the percentage of invasive treatment for NSTEMI increased significantly, almost threefold, to 83% (p < 0.0001). The frequency of recurrent myocardial infarction and stroke during hospitalization decreased significantly over the years, while the frequency of major bleeding increased. Twelve-month mortality decreased significantly throughout the time period, from 19.1% to 14.5%, but was stable in patients treated invasively and slightly higher in the last years in patients treated noninvasively. The invasive treatment of NSTEMI (relative risk 0.62, 95% confidence interval 0.57 to 0.67, p < 0.0001), together with the pharmacotherapy recommended by the guidelines, had a significant impact on reducing 12-month mortality in a multifactor analysis. In conclusion, the distinct improvement in the short- and long-term prognoses of patients with NSTEMI may be in part the result of the popularization of invasive treatment and the optimization of pharmacotherapy.The American journal of cardiology 12/2011; 109(6):779-86. · 3.58 Impact Factor -
Article: Optimal timing for surgical revascularization in survivors of acute coronary syndromes eligible for elective coronary artery bypass graft surgery.
[show abstract] [hide abstract]
ABSTRACT: Several patients with acute coronary syndrome (ACS) are discharged home after the acute phase of ACS and are suitable for elective coronary artery bypass graft (CABG) surgery. The aim of the study was to assess the optimal timing for surgical revascularization and its effect on 12-month outcome in patients discharged from hospital after ACS and referred for elective CABG surgery. The analysis involved 2028 patients enrolled into the ongoing Polish Registry of Acute Coronary Syndromes (PL-ACS) who were discharged from hospital with the intention to undergo elective CABG surgery. Among 2028 patients 1216 (60.0%) underwent surgery during 12months of follow-up. Patients who underwent surgical revascularization had a lower prevalence of mortality (5.7% vs 11.5%, p<0.0001). Patients who underwent surgery within the first month had a significantly higher prevalence of mortality than those who did not undergo surgery (5.7% vs 1.6%, p<0.0001). By the third month, the two cumulative mortalities were similar (4.2% vs 4.6%, p=0.65). From the beginning of the fourth month, the cumulative mortality was significantly higher among patients who did not undergo surgery.International journal of cardiology 12/2011; 153(2):173-8. · 7.08 Impact Factor
Top co-authors
Top Journals
Institutions
-
2008–2013
-
Swietokrzyskie Hospital of Kielce
Kielce, Swietokrzyskie, Poland
-
-
2002–2012
-
Medical University of Silesia in Katowice
- Department of Cardiology
Katowice, Silesian Voivodeship, Poland
-
-
2011
-
Instytut Gruzlicy i Chorób Pluc w Warszawie
Warsaw, Masovian Voivodeship, Poland -
University of Leipzig
Leipzig, Saxony, Germany
-
-
2007–2011
-
Politechnika Śląska
Gliwice, Silesian Voivodeship, Poland
-
-
2003–2011
-
Śląskie Centrum Chorób Serca
Zabrze, Silesian Voivodeship, Poland
-
-
2009
-
Pomorski Uniwersytet Medyczny
Wodzisław Śląski, Silesian Voivodeship, Poland
-
