[Show abstract][Hide abstract] ABSTRACT: Participation in cardiac rehabilitation programs (CRPs) improves prognosis in patients with coronary artery disease (CAD). However, not much is known about the effectiveness of CRP in real life. The aim of this analysis was to identify factors related to the referral to CRP following hospitalization for CAD and estimate the effectiveness of the programs in real life.
Medical records of 1061 consecutive patients aged ≤80 years, hospitalized due to an acute coronary syndrome or for a myocardial revascularization procedure in 5 hospitals serving the city and surrounding counties, were reviewed and 611 patients were interviewed 6–18 months posthospitalization.
Of 611 patients participating in the interview, 212 (34.7%) were referred following the hospitalization to a center providing CRP. Age, hospitalization in a teaching hospital, and index diagnosis were independently related to being granted a referral. Among the referred patients, 86.3% participated in the CRP. Participation in CRP was related to the lower probability of having high total cholesterol (23% vs 32%, P < 0.05), fasting glucose (11% vs 18%, P = 0.05), HbA1c (8% vs 16%, P = 0.05), and body mass index (27% vs 37%, P < 0.05). Generally, the effect of the CRP was significant in participants with a higher education, but not in those with a low education level. Other factors were not significantly related to the effectiveness of CRP.
This study shows that CRPs are effective, but underused in Poland. The participant's education level may influence the effectiveness of CRP. Therefore, in order to increase the impact of CRP, the content of such programs should vary depending on the education level of the participants.
[Show abstract][Hide abstract] ABSTRACT: -Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients.
-We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensinconverting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-Btype natriuretic peptide and troponin) versus enalapril.
-Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255.
[Show abstract][Hide abstract] ABSTRACT: T-wave inversion (TWI) is a common ECG finding in patients with acute pulmonary embolism (APE).Objectives
To determine the prevalence of TWI in patients with APE and to describe their relationship to outcomes.Methods
Retrospective study of 437 patients with APE. TWI patterns were described in two distributions: inferior (II, III, aVF) and precordial (V1-V6).ResultsTWI was observed in 258 (59%) patients. The mortality rate was significantly higher in the group with TWI in the inferior AND precordial leads compared to the group without TWI (OR: 2.74; p = 0.024) and the group with TWI in the inferior OR precordial leads (OR: 2.43; p = 0.035). As compared those with TWI in <5 leads, patients with TWI in ≥5 leads experienced significantly higher rates of death (17.1% vs. 6.6%, OR: 2.92; p = 0.002) and complications.ConclusionsTWI and the quantitative assessment thereof can be useful to risk stratify patients with APE.
Full-text · Article · Nov 2014 · Heart and Lung The Journal of Acute and Critical Care
[Show abstract][Hide abstract] ABSTRACT: Background:
The highest priority in preventive cardiology was given to patients with estab-lished coronary artery disease (CAD). The aim of the study was to assess the implementation of guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates for patients, following their hospitalization for CAD.
Five hospitals with cardiology departments serving the city and its surround-ing districts in southern part of Poland participated in the study. Consecutive patients aged ≤ 80 years, hospitalized from January 1 2010 to April 31 2012 due to an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after hospitalization.
The medical records of 595 patients (mean age: 62.8 ± 9.0 years, 397 men and 198 women) were reviewed and included in the analyses. Proportions of medical records with available information on risk factors were high with the exception of total cholesterol levels as well as weight and height measurements, which were available in less than 80% of the hospital records. The prescription rate at discharge for antiplatelets was 99%, beta-blockers (BB) - 85%, angiotensin converting enzyme inhibitors (ACEI) or sartans - 85%, and lipid-lowering drugs - 94%. Patients scheduled for coronary artery bypass grafting were significantly less often prescribed BB, ACEI or sartans, and lipid-lowering drugs. The proportion of patients with high blood pressure (≥ 140/90 mm Hg) 6-18 months after hospitalization was 47%, with high LDL cholesterol level (≥ 1.8 mmol/L) 73%, and with a high HbA1c level (≥ 7.0%) 14%, whereas 20% of participants were smokers and 80% were overweight. The proportion of patients taking an antiplatelet agent 6-18 months after hospitalization was 90%, BB - 82%, ACEI - or sartan 78%, and lipid-lowering drug - 82%. Overall, 33.9% of the study participants declared that they had been advised to participate in a rehabilitation/secondary prevention program following their hospitalization and 30.5% participated in a rehabilitation/secondary prevention program. However, only 28.2% took part in at least half of the planned sessions. Using a multivariate analysis we showed that, in general, risk factors control and the prescription rates of cardioprotective medications were related to the patients' age, education, and participation in a rehabilitation/secondary prevention program following their hospitalization due to CAD.
Our data provide evidence that there is a considerable potential for further reduction of cardiovascular risk in CAD patients. Our results suggest that increasing patient participation rates in rehabilitation/secondary prevention programs may improve the imple-mentation of the secondary prevention.
No preview · Article · Oct 2014 · Cardiology journal
[Show abstract][Hide abstract] ABSTRACT: Background
European recommendations on the management of acute pulmonary embolism (APE) divide patients into 3 risk categories: high, intermediate and low. Mortality has previously been estimated at 3-15% in the intermediate group. The aim of this study was to use a new metric “ischemic ECG patterns” to more precisely estimate the risk (complications or death) of APE patients identified as “intermediate-risk” by current ESC criteria.
Study group consisted of 500 consecutive patients (290 females), with a mean age 66.3 ± 15.2 years, 245 (72.8%) patients were initially classified as intermediate-risk. Four ischemic ECG patterns were studied: (i) ST-segment ischemic pattern (STIP), (ii) global ischemic pattern (GIP), (iii) negative T wave pattern (NTW), and (iv) control group consisting of patients with no ischemic changes.
Predictors of death in univariate analysis included elevated troponin concentration (OR 6.8 [95% CI, 1.28-169; p = 0.02]) and ischemic ECG patterns: STIP (OR 6.3 [95% CI, 1.6-46.0; p = 0.007]). Patients with right ventricular dysfunction (RVD) who were STIP (+) experienced significantly higher mortality rate compared to RVD patients who were STIP(−), (11.4% vs. 1.6%, OR 7.26, [95% CI,1.82-52.8; p = 0.004]). In patients with STIP (+) as compared to STIP (−), rate of death (OR 6.35; p = 0.007) and rate of complications (OR 4.19; p = 0.002) were significantly higher. Neither presence of negative T-waves nor GIP pattern were associated with a worse prognosis.
In patients with APE, an ischemic ECG pattern on hospital admission, when identified in addition to classic risk markers, is an independent risk factor for worse in-hospital outcomes.
Full-text · Article · Oct 2014 · American Journal of Emergency Medicine
[Show abstract][Hide abstract] ABSTRACT: Cardiogenic shock (CS) is a predictor of poor prognosis in patients with acute pulmonary embolism (APE).
The aim of this study was to compare electrocardiography (ECG) parameters in patients with APE presenting with or without CS.
A 12-lead ECG was recorded on admission at a paper speed of 25 mm/s and 10 mm/mV amplification. All ECGs were examined by a single cardiologist who was blinded to all other clinical data. All ECG measurements were made manually.
Electrocardiographic data from 500 patients with APE were analyzed, including 92 patients with CS. The following ECG parameters were associated with CS: S1Q3T3 sign, (odds ratio [OR]: 2.85, P < .001), qR or QR morphology of QRS in lead V1, (OR: 3.63, P < .001), right bundle branch block (RBBB) (OR: 2.46, P = .004), QRS fragmentation in lead V1 (OR: 2.94, P = .002), low QRS voltage (OR: 3.21, P < .001), negative T waves in leads V2 to V4 (OR: 1.81, P = .011), ST-segment depression in leads V4 to V6 (OR: 3.28, P < .001), ST-segment elevation in lead III (OR: 4.2, P < .001), ST-segment elevation in lead V1 (OR: 6.78, P < .01), and ST-segment elevation in lead aVR (OR: 4.35, P < .01). The multivariate analysis showed that low QRS voltage, RBBB, and ST-segment elevation in lead V1 remained statistically significant predictors of CS.
\In patients with APE, low QRS voltage, RBBB, and ST-segment elevation in lead V1 were associated with CS.
Full-text · Article · Feb 2014 · The American journal of emergency medicine
[Show abstract][Hide abstract] ABSTRACT: Introduction: More attention is given to patients with heart failure and preserved left ventricular ejection fraction (HFPEF). There are no data on the epidemiology of HFPEF in Poland.
Objective: To compare the clinical characteristics and prognosis of the patients with heart failure with preserved and reduced left ventricle ejection fraction (HFREF)
Methods: The analysis included 786 Polish patients enrolled in the EURObservational Research Programme: The Heart Failure Pilot Survey, for which baseline left ventricular ejection fraction (88% of patients) was available. Patients were divided into groups according to left ventricular function: with preserved (EF> 40%) and decreased (EF ≤ 40%) ejection fraction.
Results: 322 (41%) patients had preserved left ventricular ejection fraction. Average EF in HFREF group was 28.9±7.7% (from 10 to 40%) and 52.8±7.2% (41 to 76%) in the HFPEF group. Compared with patients with low EF, the HFPEF patients are older (69.4±11.9 vs 63.9±13.5 years, p<0.0001), more often female (46% vs 25%, p <0,0001). In this group, there was less heart failure of ischemic origin (47.5% vs 61.4%, p<0.0001) and chronic kidney disease (16.5% vs 21.8%, p=0.03), more hypertension (75.5% vs 55.2%, p<0.0001) and atrial fibrillation (43.8% vs 37.3%, p=0.04). Both groups had a similar incidence of diabetes (34% vs 33%). Patients with HFPEF had a higher BMI (29.2±5.3 vs 27.9±5.1, p<0.0001), lower baseline NYHA class (2.6±0.8 vs 2.9±0, 8, p <0.0001), lower baseline heart rate (81±18.9 vs 86.1±23.3) and higher baseline systolic (140.2±27.5 vs. 127.2±24.4, p<0.0001) and diastolic blood pressure (81.7±15.1 vs 77.7±13.9, p<0.0001) blood pressure. After 12 months of follow-up patients with preserved ejection fraction had lower NYHA class (2.0±0.7 vs 2.2±0.7, p<0.001), lower re-hospitalization rate (43% vs 51%, p=0.01) and better survival (93% vs. 88%, p=0.015).
Conclusions: Patients with heart failure with preserved left ventricular ejection fraction are significantly different from patients with reduced ejection fraction, and have better prognosis in the one-year follow-up.
Preview · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Background: In the Heart Failure Pilot Survey (ESC-HF Pilot) clinical and epidemiological data of 5118 subjects was collected. Gender-related differences in heart failure patients are still unclear.
Aim of study: The aim of study was to evaluated sex-related differences and similarities in the clinical presentation, pharmacotherapy and their relationship with clinical outcomes in the one-year follow-up in the Polish Population of Heart Failure Pilot Survey.
Methods: ESC-HF Pilot, a multi-center prospective observational study, in 136 cardiac centers in 12 European countries, including Poland in the years 2009-2011 was conducted.
In this study the following data demographics, presence of cardiovascular risk factors, etiology of heart failure, biochemical, echocardiographic and electrocardiographic parameters, pharmacological treatment and outcomes in patients enrolled in Poland to the Heart Failure Pilot Survey (892 patients) were analysed.
Results: The study population consist of 33.6% women. Women compared to men with HF characterized by: older age 70.8±12.4 vs. 63.8±13.1 (p<0.05), lower BMI index 27.8±6.8 vs. 28.8±6.0 (p=0.06), higher systolic blood pressure 136.3mmHg ±30.8 vs. 130.6mmHg ±23.2 (p<0.05), higher left ventricul ejection fraction 47.4% ±13.2 vs. 39.0% ±13.6 (p<0.05), longer QTc 401.9ms ±38.7 vs. 389.7ms ±45.8 (p<0.05), higher NYHA functional class 2.9 vs. 2.7 (p<0.05), higher incidence of hypertension (p<0.05), thyroid dysfunction (p<0.05) and depression (p<0.05), frequenter proteinuria (p<0.05), higher level of BNP 1826.9 pg/ml, vs. 1183.2 pg/ml (p<0.05), lower level of bilirubin 4.7 md/dl vs. 7.2 mg/dl (p<0.05). Women were longer hospitalized in ICCU 4.1days vs. 2.8 days (p<0.05). Women compared to men were more often treated by ARB and CCB, but less frequently by ACEI, BB and Eplerenone. There were no significant differences in the rate of deaths in the in the one-year follow-up between men and women: 99 (11%) subjects died.
Conclusions: 1.The results of ESC-HF Pilot Survey from Polish Centers showed significant gender-related differences in clinical presentation and pharmacological treatment of heart failure.
2. In spite of differences in clinical characteristics and pharmacotherapy, clinical outcomes were similar in men and women with heart failure in the one-year follow-up.
Preview · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Background: Cardiogenic shock (CS) is associated with poorer pulmonary embolism (PE) prognosis and increased total mortality. ECG plays an important role in the differential diagnosis and helps with the decision making process in the emergency. The aim of the study was to compare ECG parameters in patients with PE presenting with or without CS.
Methods: We analyzed ECG and clinical data from 470 patients (pts) with acute PE, mean age 65.9 years ± 15.2 old, female 274 pts. Patients were divide into 2 groups: with CS (n=98 pts) or without CS (n=372 pts). Chi square and T student were used to compare dichotomic and continuous variables. A p value =/- than 0.05 was considered significant.
Results: ECG parameters of both groups can be seen in the table. A new ECG index called STE-aVR (ST-segment elevation in lead aVR) was observed in 96 (20.8%) pts. There were 50 (10.6%) cardiac deaths; 35/98 (35.7%) in the CS (+) group, and 15 (4%) deaths in the CS (–) group. Use of fibrynolytic therapy in 50 (10.6%) of the cases.
Results: See Table 1.
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Full-text · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Kidneys are one of the most crucial organs in heart failure, which provides a basis for understanding the nature of the disease and helps to implement appropriate treatment. A reduction in glomerular filtration rate (GFR) allows for early diagnosis of subclinical renal disease. Data from the Heart Failure Pilot Registry, conducted in 29 cardiology centres in Poland in the years 2010-2011, allow to identify this population.
Purpose: The aim of the study is to analyze a series of clinical data of patients with heart failure and GFR below 60 ml/min/1,73m2.
Material: Data of 780 patients included in the Heart Failure Pilot Registry in which GFR could be calculated from the MDRD formula. Value of serum creatinine necessary for calculation of GFR came from a stable period of the disease.
Results: GFR in the study population ranged from 10 to 384 ml/min/1,73m2. Median GFR was 74 ml/min/1,73m2. In 253 people (23% of population) GFR values didn't exceed 60 ml/min/1,73m2. The largest group of patients with GFR below 60 ml/min/1,73m2 were elderly (76±8 years vs. 62±12 years, p<0.001) women (41% vs. 29%, p<0,005), with ischemic etiology of heart failure (64% vs. 53%, p=0,001), higher NYHA class (3.0±0.7 vs. 2.7±0.8, p<0.001), with more frequent incidence of hypertension (74% vs. 59%, p<0.001) and chronic obstructive pulmonary disease (15% vs. 10%, p<0.05). In laboratory studies, beyond the elevated levels of creatinine (median – 1,4mg/dl) and urea, emphasized lower hemoglobin in blood serum (12.8±2.1 g/dl vs. 13.6±2.3 g/dl, p=0.03), frequent proteinuria (27% vs. 14%, p<0.01) and slightly higher serum potassium (4.5±0.7 mmol/l vs. 4.4±0.5 mmol/l, p=0.001). Smaller dimension of the left ventricle in diastole (56±11 mm vs. 59±10 mm, p=0.04) was accompanied by a similar left ventricular ejection fraction (42±14% vs. 41±14%, p=0.34) on echocardiography. The clinical picture often showed symptoms of pulmonary congestion at the time of hospital admission (64% vs. 50%, p<0.001), and during outpatient treatment (38% vs. 21% (p<0.01) at almost the same heart rate and blood pressure values. Jugular vein congestion was also observed more frequently (16% vs. 10%, p<0.05). In the 12-month follow-up death occurred in 44 patients (17%) with GFR not exceeding 60 ml/min/1,73m2 and 37 patients (7%) with a higher GFR (p<0,001).
Conclusions: A significant decrease in GFR accompanied by heart failure in every third patient and is observed even in the stable phase of the disease. Identification of these patients is essential to optimize treatment given the significantly higher 12-months mortality.
Full-text · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Background: ST-segment elevation in lead aVR (STE-aVR) plus ST-segment depression in the lateral leads (STD-lat) is associated with a poor prognosis in acute coronary syndromes. The aim of the study was to determine the value of STE-aVR plus STD-lat in patients with acute pulmonary embolism (APE).
Methods: We analyzed ECG and clinical data of 470 patients (pts) with APE, mean age 65.9±15.2 years old, female 274 pts. The new ECG index STE-aVR plus STD-lat was detected in 96 (20.8%) pts. ECG on admission was compared for STE-aVR plus STD-lat (+) (n= 96 pts) or (-) (n= 374 pts). Chi square and T student were used to compare dichotomic and continuous variables. A p value =/- than 0.05 was considered significant.
Results: Comparison of both groups can be seen in the table. There were 50 (10.6%) cardiac deaths in the whole population.
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Full-text · Article · Jul 2013 · Journal of Electrocardiology
[Show abstract][Hide abstract] ABSTRACT: Heart failure (HF) is currently one of the main causes of cardiovascular mortality. In order to collect current epidemiological data on patients with HF, the Heart Failure Pilot Survey (ESC-HF Pilot) registry was initiated.
Primary objective of the study was to compare clinical epidemiology of outpatients and inpatients with HF and investigate currently used diagnostic and therapeutic modalities in Poland and 11 other European countries.
The ESC-HF Pilot Survey study was a prospective multicentre observational registry conducted in 2009-2011 in 136 cardiology centres in 12 European countries selected to represent different health systems and care attitudes across Europe. All outpatients with HF and patients admitted due to acute decompensated HF were included into the registry during the enrolment period (1 day per week for 8 consecutive months). Researchers completed detailed medical data questionnaires for all HF patients recruited to the study.
In all participating centres across Europe, 6108 patients were recruited, including 1159 patients from Poland (19% of the survey population). The majority of Polish participants were admitted due to acute HF (73%), while ambulatory chronic HF patients predominated in the remaining European centres (69%). Polish patients develop HF at a younger age compared to other European countries (proportion of patients above 65 years: 54 vs. 65%, respectively) and they are more severely ill (NYHA class III: 44 vs. 34%, respectively; NYHA class IV: 18 vs. 11%; mean BNP level 910 vs. 773 pg/mL). Angiographically documented coronary artery disease was the major aetiology of HF in Poland (39 vs. 33%) which explains a higher rate of invasive revascularisation procedures in the Polish population (13 vs. 7%). In Poland, therapy with implantable cardioverter- -defibrillators was used more frequently during the initial hospitalisation (7 vs. 4%), but the rate of cardiac resynchronisation therapy device implantation was smaller than in other European countries (4 vs. 7%). Drug therapy used in our country was comparable to the rest of Europe, except for more frequent use of aldosterone antagonists. Despite significant differences in the clinical characteristics seen between Polish and other European patients participating in the ESC-HF Pilot study, mortality at 3 months did not differ between Polish and other European centres (2.5 vs. 3%).
The ESC-HF Pilot Survey findings indicate a very high standard of inpatient HF treatment but at the same time unsatisfactory current ambulatory HF therapy in Poland.
Full-text · Article · Apr 2013 · Kardiologia polska
[Show abstract][Hide abstract] ABSTRACT: AIMS: Although the focus of therapeutic intervention has been on neurohormonal pathways thought to be harmful in heart failure (HF), such as the renin-angiotensin-aldosterone system (RAAS), potentially beneficial counter-regulatory systems are also active in HF. These promote vasodilatation and natriuresis, inhibit abnormal growth, suppress the RAAS and sympathetic nervous system, and augment parasympathetic activity. The best understood of these mediators are the natriuretic peptides which are metabolized by the enzyme neprilysin. LCZ696 belongs to a new class of drugs, the angiotensin receptor neprilysin inhibitors (ARNIs), which both block the RAAS and augment natriuretic peptides.Methods
Patients with chronic HF, NYHA class II-IV symptoms, an elevated plasma BNP or NT-proBNP level, and an LVEF of ≤40% were enrolled in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortailty and morbidity in Heart Failure trial (PARADIGM-HF). Patients entered a single-blind enalapril run-in period (titrated to 10 mg b.i.d.), followed by an LCZ696 run-in period (100 mg titrated to 200 mg b.i.d.). A total of 8436 patients tolerating both periods were randomized 1:1 to either enalapril 10 mg b.i.d. or LCZ696 200 mg b.i.d. The primary outcome is the composite of cardiovascular death or HF hospitalization, although the trial is powered to detect a 15% relative risk reduction in cardiovascular death.PerspectivesPARADIGM-HF will determine the place of the ARNI LCZ696 as an alternative to enalapril in patients with systolic HF. PARADIGM-HF may change our approach to neurohormonal modulation in HF.Trial registrationNCT01035255.
Full-text · Article · Apr 2013 · European Journal of Heart Failure
[Show abstract][Hide abstract] ABSTRACT: Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1.
We randomly assigned 26,449 patients who had a history of myocardial infarction, ischemic stroke, or peripheral arterial disease to receive vorapaxar (2.5 mg daily) or matching placebo and followed them for a median of 30 months. The primary efficacy end point was the composite of death from cardiovascular causes, myocardial infarction, or stroke. After 2 years, the data and safety monitoring board recommended discontinuation of the study treatment in patients with a history of stroke owing to the risk of intracranial hemorrhage.
At 3 years, the primary end point had occurred in 1028 patients (9.3%) in the vorapaxar group and in 1176 patients (10.5%) in the placebo group (hazard ratio for the vorapaxar group, 0.87; 95% confidence interval [CI], 0.80 to 0.94; P<0.001). Cardiovascular death, myocardial infarction, stroke, or recurrent ischemia leading to revascularization occurred in 1259 patients (11.2%) in the vorapaxar group and 1417 patients (12.4%) in the placebo group (hazard ratio, 0.88; 95% CI, 0.82 to 0.95; P=0.001). Moderate or severe bleeding occurred in 4.2% of patients who received vorapaxar and 2.5% of those who received placebo (hazard ratio, 1.66; 95% CI, 1.43 to 1.93; P<0.001). There was an increase in the rate of intracranial hemorrhage in the vorapaxar group (1.0%, vs. 0.5% in the placebo group; P<0.001).
Inhibition of PAR-1 with vorapaxar reduced the risk of cardiovascular death or ischemic events in patients with stable atherosclerosis who were receiving standard therapy. However, it increased the risk of moderate or severe bleeding, including intracranial hemorrhage. (Funded by Merck; TRA 2P-TIMI 50 ClinicalTrials.gov number, NCT00526474.).
Full-text · Article · Mar 2012 · New England Journal of Medicine
[Show abstract][Hide abstract] ABSTRACT: To assess the influence of electrocardiographic (ECG) pattern on prognosis and complications of patients hospitalized with acute pulmonary embolism (APE).
We performed a retrospective analysis of 292 patients who had confirmed APE. There were 183 females and 109 males, the age range was 17 to 89 years, and the mean age was 65.4 ± 15.5 years.
In our study group, there were 33 deaths (mortality rate, 11.3%), and 73 (25%) patients developed complications during hospitalization. Based on European Society of Cardiology risk stratification, we classified 75 (25.7%) patients as high risk, 163 (55.8%) patients as intermediate risk, and 54 (18.5%) patients as low risk. A comparison between patients with complicated APE and those with no complications during hospitalization indicated that the following ECG parameters were more common in patients who had complications: atrial fibrillation, S1Q3T3 sign, negative T waves in leads V2-V4, ST segment depression in leads V4-V6, ST segment elevation in leads III, V1 and aVR, qR in lead V1, complete right bundle branch block (RBBB), greater number of leads with negative T waves, and greater sum of the amplitude of negative T waves. In multivariate analysis, the sum of negative T waves (OR 0.88; p = 0.22), number of leads with negative T waves (OR 1.46; p = 0.001), RBBB (OR 2.87; p = 0.02) and ST segment elevation in leads V1 (OR 3.99; p = 0.00017) and aVR (OR 2.49; p = 0.011) were independent predictors of complications during hospitalization. In turn, in multivariate analysis, only the sum of negative T waves (OR 0.81; p = 0.0098), number of leads with negative T waves [OR 1.68; p = 0.00068] and ST segment elevation in lead V1 (OR 4.47; p = 0.0003) were independent predictors of death during hospitalization.
In our population of APE patients, the sum of negative T waves, the number of leads with negative T waves and the ST segment elevation in lead V1 were independent predictors of death during hospitalization. In turn, the sum of negative T waves, the number of leads with negative T waves, and RBBB and ST segment elevation in leads V1 and aVR were independent predictors of complications during hospitalization. We conclude that ECG analysis may be a useful noninvasive method for risk stratification of patients with APE.
Full-text · Article · Nov 2011 · Cardiology journal
[Show abstract][Hide abstract] ABSTRACT: Antiplatelet drugs currently constitute the basic treatment of coronary artery disease (acute coronary syndrome [ACS], stable angina and patients treated with percutaneous coronary interventions [PCI]). The number of patients with indication for dual antiplatelet therapy with comorbidities with high thrombo-embolic risk (such as atrial fibrillation [AF], venous thrombotic disease, valvular diseases) is increasing. That is why the need for simultaneous administration of dual antiplatelet and oral anticoagulant therapy (triple therapy) has become more common recently. The AF is the most common indication for chronic anticoagulation. Because of the lack of large randomised trials regarding triple therapy, characteristics of this group has not been well established.
To assess the presence of cardiovascular (CV) risk factors and concomitant diseases in patients with ACS requiring triple therapy.
Retrospective analysis included 2279 patients diagnosed with ACS who were admitted to the Departments of Cardiology in Cracow in 2008. In this group, 365 (16%) patients had indications for chronic anticoagulation. Demographic and clinical characteristics of these patients were compared with those of patients included in other published registries.
Patients requiring triple therapy were aged 73.2 ± 9.5 years. Hypertension was diagnosed in 80%, hyperlipidaemia in 63%, smoking in 36%, prior myocardial infarction in 33%, prior stroke in 15%, previous treatment with PCI in 13%, coronary artery bypass grafting in 7%, diabetes in 36%, heart failure in 46%, anaemia in 33% and chronic ulcer disease or gastroesophageal reflux disease in 9%. The mean left ventricular ejection fraction was 46 ± 15%. Compared with other registries of patients without indications for triple therapy, our patients had significantly more frequently hypertension, diabetes and were older.
Patients after an ACS requiring triple therapy have more often a history of comorbidities and CV risk factors when compared with the group of patients with ACS without indication for triple therapy.
No preview · Article · Sep 2011 · Kardiologia polska
[Show abstract][Hide abstract] ABSTRACT: The electrocardiogram (ECG) is characterised by little sensitivity and specificity in the diagnostic evaluation of acute pulmonary embolism (APE).
To assess the significance of ECG changes in predicting myocardial injury and prognosis in patients with APE.
The study group consisted of 225 patients (137 women and 88 men), mean age: 66.0 ± 15.2 years, in whom the diagnosis of APE was made, mostly based on computed tomography (n = 206, 92%).
We observed 26 in-hospital deaths (mortality rate: 11.5%) and complications occurred in 58 (25.7%) patients. Elevated levels of troponin were observed in 103 (46%) patients. Logistic regression analysis showed that in-hospital mortality was associated with: coronary chest pain (0.06-0.53, OR 0.18), systolic blood pressure below 100 mm Hg (2.3-13.64, OR 5.61), heart rate above 100 bpm (1.17-15.11, OR 4.21), the S1Q3T3 sign (1.31-6.99, OR 3.02), QR in V(1) (1.60-12.32, OR 4.45), ST-segment depression in V(4)-V(6) (0.99-5.40, OR 2.31), ST-segment elevation in III (0.99-6.96, OR 2.64), ST-segment elevation in V(1) (1.74-9.49, OR 4.07); borderline (1.51-16.07, OR 4.93), moderate (1.42-17.74, OR 5.01) and severe troponin elevation (2.88-36.38, OR 10.24). In patients with cTnT(+), compared to patients with normal troponin levels, the following ECG changes were significantly more common: the S1Q3T3 sign (43 vs 21%, p = 0.003), negative T waves in V(2)-V(4) (57 vs 27%, p = 0.0001), ST-segment depression in V(4)-V(6) (40 vs 14%, p = 0.001), ST-segment elevation in III (22 vs 7%, p = 0.0006), V(1) and V(2) (43 vs 10%, p = 0.0001) and QR in V(1) (16 vs 5%, p = 0.007).
ECG parameters are useful in predicting myocardial injury and assessing prognosis in patients with APE.
Full-text · Article · Sep 2011 · Kardiologia polska