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Partial anomalous pulmonary venous connection

Leszek Wrotniak, Grzegorz Kopeć, Lidia Tomkiewicz‑Pająk, Leszek Drabik, Anna Kabłak‑Ziembicka, Tadeusz Przewłocki, Piotr Podolec
2017 Figshare  
We present patient with Partial Anomalous Pulmonary Venous Connection in form of Scimitar syndrome. PAPVC is a rare congenital heart defect where some of the pulmonary veins drain into the right atrium either directly or indirectly through its venous tributaries.The scimitar vein can often be visible on a plain chest X‑ray at the right side of the heart silhouette, as a structure resembling in shape a Turkish sword used in the times of the Ottoman Empire – a scimitar. Management depends in
more » ... deal on the magnitude and the effects of the left‑to‑right shunt. Patients with a significant shunt resulting with the right ventricular volume overload and the right sided heart dilation are candidates for surgical repair.
doi:10.6084/m9.figshare.5140270.v1 fatcat:rai7nv5q5vgwpdo3oxtnbrl2oa

Subarachnoid hemorrhage after carotid artery stenting

Tadeusz Przewlocki, Piotr Pieniazek, Anna Kablak-Ziembicka, Rafal Motyl, Zbigniew Moczulski, Wieslawa Tracz
2007 Journal of Vascular Surgery  
We describe subarachnoid hemorrhage (SAH) in a 66-year-old man, who underwent technically successful carotid stenting for a string-stenosis of the right internal carotid artery (ICA) in a presence of contralateral ICA occlusion with recurrent right hemisphere transient ischemic attacks. At 2 hours, the patient developed headache and vomiting, but no focal neurological deficits. Performed transcranial color-coded Doppler (TCCD) showed over 2.8-fold increase of the peak systolic velocity in the
more » ... ght middle cerebral artery. The emergent CT of the brain showed SAH with the right hemisphere edema. Patient was treated with Nimodipine in continuous infusion, diuretics i.v. and additional hypotensive therapy depending on blood pressure values. Clopidogrel was stopped for 5 days. Over next 4 weeks, a gradual cerebral velocities decrease was observed on TCCD, which was related to clinical and CT resolution. ( J Vasc Surg 2007;45: 1072-5.)
doi:10.1016/j.jvs.2007.01.041 pmid:17466804 fatcat:joxo3pg3obctbkyq4noc6gimtu

The benefit of atrial septal defect closure in elderly patients*

Monika Komar, Tadeusz Przewlocki, Maria Olszowska, Bartosz Sobien, Piotr Podolec
2014 Clinical Interventions in Aging  
Closure of an atrial septal defect in elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defects (ASDs) in elderly patients. From a total of 488 patients with ASDs who underwent transcatheter closure, 75 patients aged over 60 years (45 female, 30 male) with a mean age of 65.3±15.7 (60-75) years were analyzed. All patients had an isolated secundum ASD with a mean pulmonary blood flow:systemic blood flow of
more » ... .9 (1.5-3.9). Symptom-limited treadmill exercise tests with respiratory gas-exchange analysis and transthoracic color Doppler echocardiographic study, as well as quality of life measured using the Short Form (36) Health Survey (SF-36) were repeated in all patients before the procedure and after 12 months of follow-up. The atrial septal device was successfully implanted in all patients (procedure time 37.7±4.5 [13-59] minutes, fluoroscopy time 11.2±9.9 [6-40] minutes). There were no major complications. The defect echo diameter was 17.7±15.8 (12-30) mm. The mean balloon-stretched diameter of ASDs was 22.4±7.9 (14-34) mm. The diameter of the implanted devices ranged from 16 to 34 mm. Significant improvement of exercise capacity was noted at 6 and 12 months after the procedure. Exercise time within 6 months of ASD closure was longer (P<0.001) compared to baseline values, and also oxygen consumption increased (P<0.001). Seven quality-of-life parameters (except mental health) improved at 12-month follow-up compared to baseline data. The mean SF-36 scale increased significantly in 66 (88%) patients, with a mean of 46.2±19.1 (5-69). As early as 1 month after the procedure, a significant decrease of the right ventricular dimension and the right atrium dimension was observed (P<0.001). The right ventricular dimension decreased in 67 patients (89.3%). Closure of ASDs in elderly patients caused significant clinical and hemodynamic improvement after percutaneous treatment, which was maintained during long-term follow-up, justifying this procedure in old age.
doi:10.2147/cia.s62313 pmid:25075179 pmcid:PMC4106953 fatcat:qcznjsujifaipgwuuaocglnkbq

Saddle pulmonary embolism diagnosed by bedside transthoracic echocardiogram

Jakub Baran, Anna Kabłak-Ziembicka, Dorota Sobczyk, Tadeusz Przewłocki, Andrzej Gackowski
2019 Polish Archives of Internal Medicine  
doi:10.20452/pamw.4436 pmid:30733428 fatcat:zsnpow6vyvbc7jxvi46zcklhsm

Simultaneous vertebral and subclavian artery stenting

Damian R. Maciejewski, Łukasz Tekieli, Roman Machnik, Anna Kabłak-Ziembicka, Tadeusz Przewłocki, Piotr Paluszek, Mariusz Trystuła, Robert Musiał, Karolina Dzierwa, Piotr Pieniążek
2017 Advances in Interventional Cardiology  
A b s t r a c t Introduction: Vertebrobasilar territory ischemia leads to disabling neurological symptoms and may be caused both by vertebral artery (VA) and subclavian artery (SA) stenosis. The coexisting symptomatic ipsilateral VA and proximal SA stenosis should be considered as a true bifurcation lesion for percutaneous treatment. Aim: To evaluate the safety and efficacy of simultaneous angioplasty of vertebral and subclavian stenosis. Material and methods: Fifteen patients (age 69.5 years,
more » ... 6.7% men, all symptomatic from posterior circulation (history of stroke, transient ischemic attack, chronic ischemia symptoms)) were scheduled for simultaneous SA/VA angioplasty. Clinical and duplex ultrasound follow-up was conducted 1, 6 and 12 months after the procedure. Results: The technical success rate was 100%. Single balloon-mounted stent angioplasty was performed for all VAs and for 13 (86.7%) SAs. In 4 cases a simultaneous radial and femoral approach was required. The mean North American Symptomatic Carotid Endarterectomy Trial (NASCET) VA stenosis was reduced from 88.7 ±9.7% to 5.7 ±6.8% and SA stenosis from 80 ±12.2% to 11 ±12.3% (p < 0.01). No periprocedural death, stroke, myocardial infarction or transient ischemic attack occurred. During follow-up (range: 6-107 months) in 10 of 15 (66.7%) patients relief of chronic ischemic symptoms was observed. No stroke/TIA occurred. One cardiovascular and 2 non-cardiovascular deaths were recorded. There was 1 symptomatic vertebral and 1 subclavian in-stent restenosis, and 2 cases of asymptomatic VA in-stent occlusion occurred. Conclusions: Simultaneous vertebral and subclavian artery stenting is safe and effective. The restenosis rate remains at an acceptable level and it may be treated successfully with drug-eluting balloon angioplasty. In selected patients a dual radial and femoral approach may facilitate the procedure.
doi:10.5114/pwki.2017.68052 pmid:28798785 pmcid:PMC5545664 fatcat:pygv5zsua5h3bjyzhnt5ai7l4u

Elevated level of plasma endothelin-1 in patients with atrial septal defect

Monika Komar, Jakub Podolec, Wojciech Płazak, Jakub Stępniewski, Bartosz Sobień, Lidia Tomkiewicz-Pająk, Tadeusz Przewłocki, Piotr Podolec
2014 Cardiovascular Ultrasound  
The study aimed to assess the level of plasma Endothelin-1 (ET-1) in patients before and after transcatheter closure of atrial septal defect (ASD) and to evaluate the usefulness of measuring ET-1 levels for the diagnosis and selection of candidates for ASD closure. Methods: 80 patients (55 F, 25 M), mean age 42,2 ± 11,5 years were enrolled for an attempt at ASD closure. A group of 19 healthy volunteers, (12 F, 7 M) mean age 39.2 ± 9.15 served as controls. All ASD patients underwent: clinical
more » ... echocardiographic study and cardiopulmonary exercise test. ET-1 levels were measured before and after closure. Whole blood was collected from femoral artery and vein and from pulmonary artery during cardiac catheterization. Results: ET-1 levels at peripheral artery and vein in ASD patients were significantly higher than in the volunteers (p < 0.0001). The ASD subjects with highest ET-1 level presented the larger area of right ventricle and right atrium and higher pulmonary artery systolic pressure(p < 0.05). The ASD subjects with lower ET-1 level demonstrated longer time of exercise and higher peak oxygen consumption (p < 0.05). There was a decrease of ET-1 at peripheral artery (5.128 ± 8.8 vs. 2.22 ± 6.2; p < 0.001) and at peripheral vein (4.401 ± 3.33 vs. 2.05 ± 1.35; p < 0.001) within 48 hours after ASD closure, as compared to the baseline data. After 6 and 12 months farther drop in ET-1 level was observed. Conclusions: 1. The level of ET-1 in ASD patients is elevated in compare to healthy subject. 2. The significant reduction of ET-1 level is observed after percutaneous closure of ASD. 3. Elevated level of ET-1 in patients with ASD is associated with right heart enlargement. 4. Measurements of ET-1 may be a supplemental diagnostic tool and may be helpful in establishing indications for defect closure. Figure 6 Meta-analysis of selected parameters influencing elevated ET-1 levels using the Peto method. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI).
doi:10.1186/1476-7120-12-31 pmid:25099217 pmcid:PMC4128543 fatcat:a2vvkevpnva5fczuaufb7la7sm

Partial anomalous pulmonary venous connection (RCD code: II-3C.0)

Leszek Wrotniak, Grzegorz Kopeć, Lidia Tomkiewicz-Pająk, Leszek Drabik, Anna Kabłak-Ziembicka, Tadeusz Przewłocki, Piotr Podolec
2013 Journal of Rare Cardiovascular Diseases  
A 48-year-old woman was admitted to our institution with a year's history of uncharacteristic chest pain episodes and decrease in exercise tolerance. A CT lung scan performed nine months earlier revealed an anomalous vein arising from the right lower pulmonary lobe and draining into the inferior vena cava. A chest radiogram performed 2 months prior to the admission showed a curved shape adjacent to the right heart border. Right heart catheterization revealed: normal systolic, diastolic and mean
more » ... pulmonary artery pressures, normal pulmonary resistance and insignificant shunt volume. Pulmonary artery angiography demonstrated an anastomotic vessel between the aberrant pulmonary vein and the right upper pulmonary vein. The patient was diagnosed with Partial Anomalous Pulmonary Venous Connection in form of Scimitar syndrome. Given a mild character of symptoms, no signs of the right-sided heart volume overload, insignificant shunt fraction and normal pulmonary circulation parameters, the patient was qualified to a conservative treatment with a close medical observation. JRCD 2013; 1 (2): 75-77
doi:10.20418/jrcd.vol1no2.81 fatcat:bcpib7er5bcarhdtfcudmq3pqa

Is it worth closing the atrial septal defect in patients with insignificant shunt?

Monika Komar, Tadeusz Przewłocki, Maria Olszowska, Bartosz Sobień, Lidia Tomkiewicz-Pająk, Piotr Podolec
2014 Advances in Interventional Cardiology  
Closure of the atrial septal defect in patients with insignificant shunt is controversial. To evaluate the outcomes of transcatheter closure of atrial septal defect (ASD) in symptomatic patients with borderline shunt. One hundred and sixty patients (120 female, 40 male) with a mean age of 30.1 ±16.2 (20-52) years with a small ASD who underwent transcatheter closure were analyzed. All patients had a small ASD with Qp: Qs ratio ≤ 1.5, mean 1.2 ±0.9 (1.1-1.5) in echo examination. Cardiopulmonary
more » ... ercise tests, clinical study, transthoracic echocardiographic study as well as quality of life (QoL) (measured using the SF36 questionnaire (SF36q)) were repeated in all patients before and after the procedure. The devices were successfully implanted in all patients. After 12 months of ASD closure, all the patients showed a significant improvement of exercise capacity (oxygen consumption - 21.9 ±3.1 vs. 30.4 ±7.7, p > 0.001). The QoL improved in 7 parameters at 12-month follow-up. The mean SF36q scale increased significantly in 141 (88.1%) patients of mean 43.2 ±20.1 (7-69). A significant decrease of the right ventricular area (20.3 ±1.3 cm(2) vs. 18.3 ±1.2 cm(2), p < 0.001) and the right atrial area (15.2 ±1.9 cm(2) vs. 12.0 ±1.6 cm(2), p < 0.001) was observed at 12-month follow-up. Closure of ASD in the patients with insignificant shunt resulted in significant durable clinical and hemodynamic improvement after percutaneous treatment.
doi:10.5114/pwki.2014.43510 pmid:25061452 pmcid:PMC4108730 fatcat:nlxm4us4xrabvav4344nvhakaa

Conduction Abnormality and Arrhythmia After Transcatheter Closure of Atrial Septal Defect

Monika Komar, Tadeusz Przewłocki, Maria Olszowska, Bartosz Sobień, Jakub Stępniewski, Jakub Podolec, Szymon Mleczko, Lidia Tomkiewicz-Pająk, Krzysztof Żmudka, Piotr Podolec
2014 Circulation Journal  
doi:10.1253/circj.cj-14-0456 pmid:25253507 fatcat:ahkr2obny5bjlbnzs7oi6wdlsy

Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening?

Monika Komar, Maria Olszowska, Tadeusz Przewłocki, Jakub Podolec, Jakub Stępniewski, Bartosz Sobień, Rafał Badacz, Anna Kabłak-Ziembicka, Lidia Tomkiewicz-Pająk, Piotr Podolec
2014 Cardiovascular Ultrasound  
Persistent foramen ovale (PFO) is considered a cause of cryptogenic stroke and a risk factor for neurological events in young patients. The reference standard for identifying a PFO is contrast-enhanced transesophageal echocardiography (TEE). The goal of this study was to evaluate the feasibility of transcranial color Doppler (TCD) and its diagnostic sensitivity compared with TEE. Methods: We investigated 420 patients admitted to our department with cryptogenic stroke, transient ischemic attacks
more » ... or other neurological symptoms. All patients underwent TCD and TEE evaluation. TCD and TEE examinations were performed according to a standardized procedure: air-mixed saline was injected into the right antecubital vein three times, while the Doppler signal was recorded during the Valsalva maneuver. During TCD the passage of contrast into the right-middle cerebral artery was recorded 25 seconds following the Valsalva maneuver. Results: We detected a right-to-left shunt in 220 patients (52.3%) and no-shunts in 159 patients (37.9%) with both TCD and TEE. In 20 (4.8%) patients TEE did not reveal contrast passage which was then detected by TCD. In 21 (5.0%) patients only TEE revealed a PFO. The feasibility of both methods was 100%. TCD had a sensitivity of 95% and a specificity of 92% in the diagnosis of PFO. Conclusions: TCD has a relatively good sensitivity and specificity. TCD and TEE are complementary diagnostic tests for PFO, but TCD should be recommended as the first choice for screening because of its simplicity, non-invasive character, low cost and high feasibility.
doi:10.1186/1476-7120-12-16 pmid:24884981 pmcid:PMC4046065 fatcat:3hw6pjxg4zg73pi2fggn5jy2cq

Improvement of physical capacity in patients undergoing transcatheter closure of atrial septal defects

Paweł Prochownik, Tadeusz Przewłocki, Piotr Podolec, Piotr Wilkołek, Bartosz Sobień, Urszula Gancarczyk, Natalia Podolec, Monika Komar
2018 Advances in Interventional Cardiology  
A b s t r a c t Introduction: Atrial septal defect (ASD) is the most common congenital cardiac anomaly diagnosed in adults. It often remains asymptomatic until the fourth or fifth decade of life. Significant left-to-right interatrial shunting is associated with the risk of heart failure, pulmonary hypertension and atrial fibrillation. Percutaneous ASD closure is a recognized method of treatment. Aim: To evaluate the clinical outcomes and physical capacity in patients undergoing transcatheter
more » ... sure of ostium secundum ASD. Material and methods: One hundred and twenty adult patients (75 females and 45 males) with a mean age of 43.1 ±13.3 (17-78) years who underwent transcatheter device closure of ostium secundum ASD were analyzed. Clinical evaluation and transthoracic color Doppler echocardiographic study were repeated in all patients before as well as 1 and 24 months after the procedure. To assess the physical capacity symptom-limited treadmill exercise tests with respiratory gas-exchange analysis were performed in all patients before the procedure and after 24 months of follow-up. Results: The devices were successfully implanted in all patients. During 24 months of follow-up all patients showed significant clinical and spiroergometric improvement of exercise capacity, and a significant decrease of right heart chamber overload features on echocardiography. Conclusions: Transcatheter closure of ASD in patients with significant shunt resulted in significant clinical and hemodynamic improvement regardless of the baseline functional class.
doi:10.5114/aic.2018.74360 pmid:29743909 pmcid:PMC5939550 fatcat:cqnrshiw5nhy7pgqvkj7g66p7i

Triple anticoagulation therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention – real life assessment

Paweł Bogacki, Anna Kabłak-Ziembicka, Krzysztof Bryniarski, Leszek Wrotniak, Elżbieta Ostrowska-Kaim, Krzysztof Żmudka, Tadeusz Przewłocki
2016 Advances in Interventional Cardiology  
A b s t r a c t Introduction: Triple anticoagulation therapy (TT), comprising dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC), is essential in atrial fibrillation (AF) patients after percutaneous coronary intervention (PCI), but it increases the bleeding risk. Aim: To assess TT models, in-and out-hospital bleeding and thromboembolic complications, and TT alterations. Material and methods: During 12 months, consecutive AF post-PCI patients were scheduled for TT. Alterations in TT
more » ... and thromboembolic events (death, myocardial infarction, ischemic stroke, in-stent thrombosis, peripheral embolization) were recorded. Major, non-major and minor bleeding episodes were assessed. Results: One hundred and thirty-six out of 3171 patients, aged 73.0 ±8.4 years (90 male), were included. Intra-hospitally, thrombotic events occurred in 9 (6.6%), while bleeding events occurred in 71 (52.2%) patients. Access-site hematoma and blood transfusions during in-hospital stay predisposed physicians to heparin administration as part of TT on discharge (p = 0.018 and p = 0.033 respectively). Eventually, DAPT plus warfarin or plus novel oral anticoagulant (NOAC) or plus low molecular weight heparin was prescribed in 72 (52.9%), 53 (39%), and 11 (8.1%) patients, respectively. HAS-BLED and CHA2DS2-VASc scores were similar between subgroups (p = 0.63 and p = 0.64 respectively). During 10.2 ±4.2 months of follow-up, 11 (8.1%) deaths, and 9 (6.6%) non-fatal thromboembolic events occurred. Bleeding events occurred in 45 (34.6%) patients, including 14 (10.3%) major. TT was the only factor associated with increased risk of major bleeding (18.6% vs. 4.2%, p = 0.008). Early termination of any TT component, which concerned 59 (45.4%) patients, did not increase the risk of thromboembolic events (p = 0.89). Conclusions: Our study indicates that TT is associated with high mortality and bleeding rates in a relatively short period of time. Discontinuation of any TT drug did not increase the thromboembolic event rate, while it was associated with reduced risk of major bleeding.
doi:10.5114/aic.2016.63629 pmid:27980543 pmcid:PMC5133318 fatcat:rukzcdyp7fg4rkf5dhr5lueacu

Expression of miR-1-3p, miR-16-5p and miR-122-5p as Possible Risk Factors of Secondary Cardiovascular Events

Rafał Badacz, Paweł Kleczyński, Jacek Legutko, Krzysztof Żmudka, Jacek Gacoń, Tadeusz Przewłocki, Anna Kabłak-Ziembicka
2021 Biomedicines  
Ischemic event in one arterial territory increases the risk of a subsequent ischemic event. Circulating microRNAs (miRs) emerge as a potential clinical tool to assess risk of subsequent atherothrombotic events such as cardiovascular death (CVD), myocardial infarction (MI) and ischemic stroke (IS). In this prospective study, we searched for athero-specific miRs related to cardiovascular event risk in patients with symptomatic coronary, carotid lesion, or both territories involvements. The choice
more » ... of particular miRs was based on database research (Pub-Med, Bethesda, MD, USA) taking into consideration the relationship with development of atherosclerosis and potential prognostic value. Levels of circulating miRs (miR-1-3p, miR-16-5p, miR-34a-5p, mir-122-5p, miR-124-3p, miR-133a-3p, miR-133b, miR-134-5p, miR-208b-3p, miR-375 and miR-499-5p) were compared in 142 patients with an acute ischemic event resulting from carotid and/or coronary artery stenosis, who underwent revascularization for symptomatic lesion. A 6-year prospective evaluation of CVD/MI/IS risk was performed. Patients with two-territory as compared to single-territory involvement differed in levels of miR-1-3p (p = 0.016), miR-16-5p (p < 0.001), miR-34a-5p (p = 0.018), miR-122-5p (p = 0.007), miR-124-3p (p < 0.001) and miR-499-5p (p < 0.001). During follow-up, 62 (43.7%) episodes of CVD/MI/IS occurred. In multivariate Cox analysis, miR-122-5p (HR = 1.0006, 95%CI = 1.0001–1.0011) and peripheral artery disease (PAD) (HR = 2.16, 95%CI = 1.26–3.70) were associated with CVD/MI/IS risk; miR-1-3p (HR = 2.73, 95%CI = 1.22–6.12) and PAD (HR = 3.47, 95%CI = 1.88–6.41) with CVD; miR-122-5p (HR = 1.0001, 95%CI = 1.000–1.0002) and creatinine level (HR = 1.02, 95%CI = 1.01–1.04) with IS, and miR-16-5p (HR = 1.0004, 95%CI = 1.0001–1.0008) with MI. Expression of miR-1-3p, miR-16-5p and miR-122-5p during incident ischemia may be possible risk factors of secondary cardiovascular event(s).
doi:10.3390/biomedicines9081055 fatcat:j2vkcdwfyfcetksxhebdlynuoq

Comparison of drug-eluting and bare metal stents for extracranial vertebral artery stenting

Damian Maciejewski, Piotr Pieniazek, Lukasz Tekieli, Piotr Paluszek, Tadeusz Przewlocki, Tomasz Tomaszewski, Roman Machnik, Mariusz Trystula, Jacek Legutko, Anna Kablak-Ziembicka
2019 Advances in Interventional Cardiology  
Drug-eluting stents of the first (DES I) and second generation (DES II) proved superior to bare metal stents (BMS) in the coronary territory. However, there are limited data on whether they have any advantage over BMS in vertebral artery stenosis (VAS). To compare outcomes of DES (DES I, DES II) and BMS in the treatment of symptomatic extracranial VAS. During 13-year study period (2003-2016), 392 consecutive patients underwent VAS angioplasty in 428 arteries, including implantation of 148 DES
more » ... ES I: 21; DES II: 127 lesions), and 280 BMS. The technical success rates for DES and BMS groups were 96.7% and 94.6% (p = 0.103), with similar periprocedural complication rates (1.4% vs. 2.2%; p = 0.565). VAS degree was reduced from 86 ±9.7 to 2.7 ±5.0% in DES (p < 0.001) and from 84.1 ±9.4 to 4.3 ±6.9% in BMS (p < 0.001). Angiography confirmed in-stent restenosis/occlusion (ISR/ISO) 50-99% in 53 (14.2%) and 21 (5.6%) out of 373 patients (409 arteries) with at least 6-month follow-up. ISR/ISO rates were similar in DES vs. BMS (22.8% vs. 19.4%; p = 0.635), as well as in DES I vs. DES II (6/19; 31.6% vs. 25/92; 27.2%, p = 0.325). Stainless steel (24/135; 17.8%) and cobalt-chromium (23/121;19%) BMS had significantly lower incidence of ISR/ISO, as compared to platinum-chromium (7/18; 38.9%), p = 0.034. ISR/ISO was associated with age (p = 0.01) and CRP level > 5 mg/l (p = 0.043), while greater stent length was associated with ISR only in the DES group (p = 0.024). Our results do not support significant differences in ISR/ISO rates between DES and BMS, although differences between particular stent types and ISR rates require further investigation.
doi:10.5114/aic.2019.87887 pmid:31592257 pmcid:PMC6777189 fatcat:65jjlyp4s5evvfzljlpz3f5v2q

Conservative strategy in patients with ST-segment elevation myocardial infarction
Strategia zachowawcza w leczeniu ostrego zawału mięśnia sercowego z uniesieniem odcinka ST

Jarosław Zalewski, Krzysztof Nycz, Tadeusz Przewłocki, Monika Durak, Marek Andres, Piotr Lech, Piotr Pieniążek, Krzysztof Żmudka
2010 Advances in Interventional Cardiology  
A b s t r a c t Background: Clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) disqualified from an invasive strategy (InvS) are poorly understood. Aim: To investigate the short-term result of a conservative strategy (ConS) in a real-life population of patients with STEMI. Material and methods: 1031 patients with STEMI were retrospectively analyzed. Of these, 194 (18.8%) patients were initially qualified to the ConS. For the remaining 837 (81.2%) patients the
more » ... nvS was applied. Results: The most frequent reasons for disqualification from an InvS in STEMI patients were the duration of ischemia > 12 h (81.4%), aborted STEMI (9.8%) and anticipated transportation time > 2 h (3.1%). On admission, in the group of InvS, cardiogenic shock was noted in 45 (5.4%) patients. Death within 30 days was more frequently observed in STEMI patients who underwent ConS vs. InvS (13.9% vs. 9.0%, p = 0.037). During initial hospitalization 22 (11.3%) patients who underwent ConS and 34 (4.1%, p < 0.001) with InvS developed symptoms of heart failure (Killip class 2-4). Age (OR 1.07 per year, 95% CI 1.04-1.11, p < 0.0001) and conservative strategy (OR 1.55, 95% CI 0.73-4.86, p = 0.035) were the independent predictors of death within 30 days. Moreover, in patients with InvS cardiogenic shock on admission (OR 52.4, 95% CI 18.7-134.1, p < 0.0001) and in patients with ConS heart failure during hospitalization (OR 10.8, 95% CI 3.2-36.7, p = 0.0002) independently influenced the 30-day mortality (c-statistics 0.83). Conclusions: Duration of ischemia of more than 12 h was the main reason for disqualification from InvS. Applied ConS was associated with higher 30-day mortality when compared to InvS. The symptoms of heart failure were an independent predictor of death within 30 days in patients with ConS. Key words: ST-segment elevation myocardial infarction, conservative strategy, percutaneous coronary intervention S t r e s z c z e n i e Wstęp: Wyniki leczenia pacjentów z zawałem serca z uniesieniem odcinka ST (STEMI) niezakwalifikowanych do strategii inwazyjnej (invasive strategy, InvS) są słabo poznane. Cel: Ocena bezpośredniego wyniku klinicznego strategii zachowawczej (conservative strategy, ConS) zastosowanej w grupie kolejnych pacjentów ze STEMI niezakwalifikowanych do leczenia inwazyjnego. Materiał i metody: Retrospektywnie przeanalizowano dane 1031 pacjentów ze STEMI leczonych zgodnie z obowiązującymi wytycznymi. Spośród tej grupy 194 (18,8%) chorych zostało pierwotnie zakwalifikowanych do ConS, pozostałych 837 (81,2%) poddano InvS. Wyniki: Głównymi czynnikami wykluczającymi z InvS w grupie STEMI były: czas niedokrwienia > 12 godz. (81,4%), ustąpienie bólu i zmian w EKG (9,8%) i przewidywany czas transportu > 2 godz. (3,1%). Przy przyjęciu 45 (5,4%) pacjentów poddanych InvS miało objawy wstrząsu kardiogennego. Śmiertelność 30-dniowa wśród pacjentów STEMI w grupach InvS i ConS wyniosła odpowiednio 9,0% i 13,9% (p = 0,037). Podczas pierwotnej hospitalizacji u 22 (11,3%) pacjentów poddanych ConS i 34 (4,1%, p < 0,001) poddanych InvS pojawiły się objawy niewydolności serca (klasa 2.-4. wg Killipa). Wiek (OR 1,07 na rok, 95% CI 1,04-1,11, p < 0,0001) i strategia zachowawcza (OR 1,55, 95% CI 0,73-4,86, p = 0,035) były niezależnymi czynnikami wystąpienia zgonu do 30. dnia w całej
doi:10.5114/pwki.2010.16349 fatcat:ub246qku3bflvircfzrlhpa7jm
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