[Show abstract][Hide abstract] ABSTRACT: The CHA2DS2-VASc score is widely used to stratify the risk of stroke in patients with nonvalvular atrial fibrillation. The aim of the study was to assess whether the CHA2DS2-VASc score might be useful to identify patients at a high risk of ischemic stroke and death among individuals after acute myocardial infarction and with no history of atrial fibrillation.
We analysed consecutive patients with acute myocardial infarction admitted to our centre between 2003 and 2008. On the basis of the CHA2DS2-VASc score, four groups were distinguished: low-risk (1 point), intermediate-risk (2-3 points), high-risk (4-5 points) and very high-risk (>5 points). Data on long-term follow-up were screened to identify patients who experienced stroke or died during remote observation.
Out of 2980 registry participants, 333 were excluded because of atrial fibrillation and/or ongoing therapy with oral anticoagulants. Finally, 2647 individuals were included into the analysis. An ischemic stroke occurred in 71 (2.68%) patients, whereas 439 (16.58%) died during a median follow-up of 41.5 months. The risk of stroke and death increased four-fold in the high-risk group compared with the low-risk group (P < 0.001). Every point in the CHA2DS2-VASc score was independently associated with 41% increase in stroke risk and 23% increase in mortality rate (for both P < 0.001).
The mortality rate and risk of stroke were strongly associated with the CHA2DS2-VASc scores. Hence, this scoring system could be useful to identify high-risk patients with no history of atrial fibrillation, in whom additional preventive measures might be beneficial to improve the outcome.
No preview · Article · Mar 2015 · Journal of Cardiovascular Medicine
[Show abstract][Hide abstract] ABSTRACT: Glucose abnormalities are frequent comorbidities influencing prognosis in patients with cardiovascular diseases. The objective of this study was to evaluate prognostic role of HbA1c in patients with acute myocardial infarction (AMI) treated invasively, who had newly detected glucose abnormalities.
Single-centre registry encompassed 2146 survivors of AMI. In all patients without diabetes mellitus (DM), oral glucose tolerance test was performed before hospital discharge and interpreted according to the guidelines.
From the study population, two major groups with defined new glucose abnormalities and estimated HbA1c were selected: 457 patients with impaired glucose tolerance (IGT) and 306 patients with newly detected DM (newDM). In each of these groups, the median value of HbA1c was calculated and established as the cut-off point for further analysis. The median HbA1c for IGT group was 5.9% and for newDM was 7.0%.
Patients with IGT and HbA1c ≤ 5.9% had significantly lower posthospital mortality (4.5%) than those with HbA1c >5.9% (25.0%; p<0.001). Similarly, patients with newDM and HbA1c ≤7.0% had lower mortality (6.4%) than those with HbA1c >7.0% (14.3%; p<0.05). Multivariate regression analysis revealed that increase of HbA1c was one of the strongest independent risk factors of death among IGT patients (HR 2.9, 95% CI 2.7-3.1; p < 0.001) and newDM (HR 1.53, 95% CI 1.39-1.66; p<0.05).
Increase of HbA1c in patients with newly detected glucose abnormalities was associated with significantly reduced survival after AMI treated invasively. Moreover, increase of HbA1c in patients with IGT and newDM was one of the strongest independent risk factors of death in these populations.
No preview · Article · Mar 2014 · European Journal of Preventive Cardiology
[Show abstract][Hide abstract] ABSTRACT: A 76-year-old patient was admitted to hospital due to recurrent chest pain. Angiography revealed multivessel coronary artery disease with significant stenosis in medial and distal parts of the left main coronary artery (LMCA). Two drug-eluting stents (DES) were implanted from the medial part of the LMCA to the proximal part of the left anterior descending (LAD) artery. An excellent angiographic result was achieved. After 20 days the patient returned to our clinic because of acute coronary syndrome (ACS). Angiography showed 80% stenosis in the ostial LMCA. The lesion was stented with DES, obtaining a good angiographic result.
Full-text · Article · Sep 2013 · Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology
[Show abstract][Hide abstract] ABSTRACT: Purpose: The aim of the study was to assess the clinical impact of atrial fibrillation (AF) types on developing contrast induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention.
Methods: We analyzed 2, 980 consecutive AMI-patients treated invasively, who were admitted to our center between 2003 and 2008. Data on in-hospital follow up were screened to identify subjects who developed CIN during index hospitalization. Additionally data on long-term follow up were collected to assess prognosis in this population.
Results: CIN was recognized in 719 (24.13%) patients (CIN group), whereas in 2,261 (75.87%) patients (Control Group) no significant deterioration of renal function was detected. The incidence of atrial fibrillation was significantly higher in CIN group: 14.74% vs 7.8% (p<0.001). The incidence of pre-hospital non-permanent AF (AF Group 1), new-onset AF (AF Group 2) and permanent AF (AF Group 3) in CIN group was: 3.76%, 6.54% and 4.45% respectively. Apart from glomerular filtration rate < 60ml/min/m2 (HR 3.63) and left ventricular ejection fraction <35% (HR 2.63), new-onset AF (HR 2.50) as well as permanent AF (HR 2.03) were the most powerful independent predictors of CIN in the studied population. Long-term mortality was significantly higher in AF Group 2 and 3 than in AF Group 1 and CIN population free of this arrhythmia: 61.7% and 59.4% respectively vs 29.6% and 26.6% respectively (all p<0.001).
No preview · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: The role of heart rate turbulence (HRT) related to baroreflex sensitivity in predicting mortality after myocardial infarction (MI) has been confirmed by several investigators. However, the significance of HRT in predicting major adverse cardiovascular events (MACE) following acute MI is unknown.
To analyze the prognostic value of HRT and other independent risk factors associated with autonomic regulation of MACE.
HRT was assessed based on 24-hour Holter recordings in 500 patients (pts) with acute MI treated invasively (352 M, aged 60.58 years). Turbulence onset (TO,%), slope (TS, ms/RR interval) and timing (TT) were calculated. TO ≥ 0, TS ≤ 2.5 and TT ≥ 10 were considered abnormal; classic and own categories were defined. Time domain heart rate variability (HRV) parameters were also calculated. Within 30.1 ± 15.1 months of follow-up, MACE occurred in 116 pts.
Abnormal TO, TS, and TT were significantly more frequent in patients with MACE (P < 0.05 for each parameter, classic and own categories). In long-term follow-up, the largest differences in MACE were observed in patients with own category comprising abnormal TO, TS, and TT. Combining HRT parameters with SDNN (total HRV index) augmented their predictive value. Independent risk factors for MACE were TT, SDNN and rMSSD (a parasympathetic activity index) (HR 2.44, 1.71 and 1.69 respectively; P < 0.05).
Abnormal HRT distinguishes patients at risk of MACE after MI. Own category encompassing three abnormal HRT parameters best differentiates patients at risk of MACE. Turbulence timing is a strong independent risk factor for MACE following MI.
No preview · Article · Jul 2012 · Annals of Noninvasive Electrocardiology
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Diabetes (DM) deteriorates the prognosis in patients with coronary heart disease. However, the prognostic value of different glucose abnormalities (GA) other than DM in subjects with acute myocardial infarction (AMI) treated invasively remains unclear. AIMS: To assess the incidence and impact of GA on clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI). METHODS: A single-center, prospective registry encompassed 2733 consecutive AMI subjects treated with PCI. In all in-hospital survivors (n = 2527, 92.5 %) without the history of DM diagnosed before or during index hospitalization standard oral glucose tolerance test (OGTT) was performed during stable condition before hospital discharge and interpreted according to WHO criteria. The mean follow-up period was 37.5 months. RESULTS: The incidence of GA was as follows: impaired fasting glycaemia - IFG (n = 376, 15 %); impaired glucose tolerance - IGT (n = 560, 22 %); DM (n = 425, 17 %); new onset DM (n = 384, 15 %); and normal glucose tolerance NGT (n = 782, 31 %). During the long-term follow-up, death rate events for previously known DM, new onset DM and IGT were significantly more frequent than those for IFG and NGT (12.3; 9.6 and 9.4 vs. 5.6 and 6.4 %, respectively, P < 0.05). The strongest and common independent predictors of death in GA patients were glomerular filtration rate < 60 ml/min/1,73 m^2 (HR 2.0 and 2.8) and left ventricle ejection fraction < 35 % (HR 2.5 and 1.8, all P < 0.05) respectively. CONCLUSIONS: Glucose abnormalities are very common in AMI patients. DM, new onset DM and IGT increase remote mortality. Impaired glucose tolerance bears similar long-term prognosis as diabetes.
Full-text · Article · Jun 2012 · Cardiovascular Diabetology
[Show abstract][Hide abstract] ABSTRACT: To assess the incidence of atrial fibrillation (AF) and the clinical impact of AF types on outcomes in patients with acute myocardial infarction (AMI) treated invasively, we analyzed 2,980 consecutive patients with AMI admitted to our department from 2003 through 2008. Data collected by the insurer were screened to identify patients who died during the median follow-up of 41 months. AF was recognized in 282 patients (9.46%, AF group); the remaining 2,698 patients (90.54%) were free of this arrhythmia (control group). The AF group was divided into 3 subgroups: prehospital paroxysmal AF (n = 92, 3.09%), new-onset AF (n = 109, 3.66%), and permanent AF (n = 81, 2.72%). In-hospital and long-term mortalities were significantly higher (p <0.001 for the 2 comparisons) in the AF than in the control group (14.9% vs 5.3%, 37.2% vs 17.0%, respectively). Long-term mortality was significantly higher (p <0.001 for the 2 comparisons) in the new-onset AF (35.8%) and permanent AF (54.3%) groups than in the control group but did not differ significantly between the prehospital AF and control groups (21.7% vs 17.0%, p = NS). Considering types of arrhythmia separately, only permanent AF (hazard ratio 2.59) was an independent risk factor for death in the studied population. In conclusion, AF occurs in 1 of 10 patients with AMI treated invasively, with nearly equal distributions among prehospital, new-onset, and permanent forms. Although arrhythmia is a marker of worse short- and long-term outcomes, only permanent AF is an independent predictor for death in this population.
No preview · Article · Mar 2012 · The American journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: To compare the impact of the efficacy of percutaneous coronary intervention (PCI) on prognosis in ST and non-ST elevation myocardial infarction (STEMI and NSTEMI) patients with respect to infarct-related artery (IRA).
The significance of the efficacy of PCI in STEMI and NSTEMI depending on the type of IRA has yet to be clarified.
Study population consisted of 2,179 STEMI and 554 NSTEMI consecutive patients treated with urgent PCI. The efficacy of PCI (TIMI [thrombolysis in myocardial infarction] 3 vs. TIMI < 3) was assessed with regard to the type of IRA (left anterior descending artery, circumflex artery [Cx] or right coronary artery). The mean follow-up was 37.5 months.
The rate of unsuccessful PCI was similar in STEMI and NSTEMI irrespectively of IRA (14.1 vs. 17.7%; P = 0.062). In STEMI, unsuccessful PCI was associated with significantly higher early (23.1 vs. 5.6%; P < 0.001) and late (29.9 vs. 12.8%; P < 0.001) mortality regardless of IRA. In NSTEMI, the inefficacious PCI significantly increased early (19.0% vs. 0.9%; P < 0.001) and late (27.3% vs. 6.3%; P < 0.001) mortality only in patients with Cx-related infarction. Unsuccessful PCI of IRA was an independent risk factor for death in STEMI (HR 1.64; P < 0.05), but not in NSTEMI (P = 0.64). Further analysis showed that whilst unsuccessful PCI of any vessel in STEMI is an independent risk factor for death, in NSTEMI this applies to unsuccessful PCI of Cx only.
The significance of unsuccessful PCI of IRA seems to be different in STEMI and NSTEMI. Unsuccessful PCI is an independent risk factor for death in STEMI regardless of IRA and in NSTEMI with the involvement of Cx.
Full-text · Article · Oct 2011 · Catheterization and Cardiovascular Interventions
[Show abstract][Hide abstract] ABSTRACT: The significance of anemia in patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) remains controversial. The aim of the present study was to evaluate the effect of anemia on the short- and long-term prognosis of patients with AMI treated with PCI, including high-risk subgroups. The study group consisted of 1,497 consecutive patients with AMI treated in the acute phase with PCI. Anemia was defined using World Health Organization criteria (hemoglobin level <13 g/dl for men and <12 g/dl for women). The study population was divided into 2 major groups (patients with [n = 248, 16.6%] and without [n = 1,249, 83.4%] anemia) and 6 subgroups (diabetes mellitus, impaired renal function, age >70 years, left ventricular dysfunction, incomplete revascularization, and multivessel disease). A comparative analysis was performed between both groups within the whole population and within the particular subgroups. Significantly greater 30-day (13.2% vs 7.3%), 1-year (20.5% vs 11.3%), and total (24.1% vs 12.7%; all p <0.05) mortality rates were observed in the anemic group. Multivariate analysis identified anemia as an independent predictor of any-cause death in the whole population during the observation period (covariate-adjusted hazard ratio 1.46, 95% confidence interval 1.31 to 1.61, p <0.05). Anemia was significantly associated with excessive long-term mortality in the multivessel disease group (adjusted hazard ratio 1.54, 95% confidence interval 1.34 to 1.74) and in the incomplete revascularization group (hazard ratio 1.67, both p <0.05). In conclusion, anemia on admission in patients with AMI treated in the acute phase with PCI was independently associated with increasing short- and long-term mortality, especially in the subgroups with incomplete revascularization and multivessel disease.
No preview · Article · Mar 2010 · The American journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: The transradial approach for percutaneous coronary intervention (PCI) seems to be superior to transfemoral. The safety and efficacy of transradial approach for PCI in acute myocardial infarction is not well-established.
Hundred patients with acute myocardial infarction qualified to PCI were randomly assigned to transradial (group I; n = 50) and transfemoral (group II; n = 50) approaches.
PCI was successful for almost all patients, except one from group II. There were no significant differences between groups in X-ray exposition, volume of contrast and total procedure duration. Small but significant elongation of door to stent time in group I was caused mostly by a longer time between beginning of procedure and arterial sheath introduction. Major bleeding complications occurred in three patients from group I and seven from group II. There were no significant differences observed between the two groups. Time to ambulation in group I was significantly shorter then in group II (22.6 +/- 10.3 h vs. 34.7 +/- 34.6 h; p = 0.003).
The transradial approach for PCI in acute myocardial infarction has the same efficacy as transfemoral. There are no differences in total procedure duration, X-ray exposition or volume of contrast between the two approaches. A longer time from the patient's admission to the individual stages of the PCI procedure in group I was mostly due to the longer times of the initial stages of the procedure. The use of transradial approach reduces the time to ambulation and allows rehabilitation to begin sooner. In both groups, bleeding complications occurred rarely.
No preview · Article · Feb 2009 · Cardiology journal
[Show abstract][Hide abstract] ABSTRACT: It has been shown that successful reperfusion improves in-hospital and long-term outcome of patients with acute myocardial infarction (AMI). Nevertheless, some patients are still at high risk due to AMI despite achievement of reperfusion. Impaired renal function (IRF) is one of the recently recognised risk factors in this population. However, the prognostic value of different types of IRF in patients with AMI treated with percutaneous coronary intervention (PCI) has not been well characterised.
To evaluate the prognostic value of different types of IRF in AMI patients treated with PCI.
The single centre AMI registry encompassed 1486 consecutive AMI patients treated with PCI, who were followed for a mean of 29.7 months. Subjects with at least 1 measurement of serum creatinine >133 micromol/l (>1.5 mg/dl) during hospitalisation were selected (n=194; 13.1%) and incorporated into the IRF group. The control group consisted of 1292 (86.9%) subjects with normal renal function. The IRF patients were divided into subgroups: contrast-induced nephropathy--CIN (n=90; 6.1%); and chronic kidney disease--CKD (n=66; 4.4%). Thirty-eight patients from the IRF group (2.6%) had normal value of serum creatinine on admission and did not match criteria of CIN. Patients with creatinine value >133 micromol/l on admission were incorporated into the CKD group. CIN was defined as a serum creatinine level <134 micromol/l on admission and a 25% increase of that parameter, with a value >133 micromol/l within 48 hours after PCI. Among CIN patients 2 subgroups were identified with respect to coexisting diabetes mellitus: CIN-DM and CIN-nDM (both n=45; 3.05%).
Remote mortality rate was significantly higher in the IRF group (38.7%) and in particular subgroups--CKD (51.5%), CIN-DM (46.7%), CIN-nDM (28.9%)--than in controls (10.3%, p <0.001 for all study groups vs. controls). Multivariate analysis identified IRF as an independent predictor of any-cause death in the whole population [hazard ratio (HR) 2.23; 95% CI 1.99-2.47, p <0.001]. All defined types of IRF had a significant and independent influence on remote survival in the study population (CIN-DM - HR 3.52; 95% CI 3.23-3.81; CIN-nDM--HR 2.60; 95% CI 2.29-2.91; CKD--HR 1.98; 95% CI 1.68-2.28).
Impaired renal function and all defined types of renal impairment have been shown to worsen the long-term prognosis of AMI patients treated with PCI. The most important risk factor of mortality is CIN in diabetic patients, which is associated with an over 3.5-fold increase of death hazard in this study population.
No preview · Article · Jul 2007 · Kardiologia polska