Search

Background: The Coordinated Care Program after Myocardial Infarction (KOS-MI) implemented in Poland has shown significant improvement in patient prognosis, ended in nationwide success, and got international attention. A similar program and methodology may be an attractive option for patients with heart failure (HF)., Aims: This study aimed to analyze whether a similarly structured program would also be beneficial for HF patients after myocardial infarction., Methods: This is a multicenter retrospective study of 1972 patients hospitalized for MI. Almost half of patients (n = 963, 48.8%) participated in the KOS-MI program. In the total population, 467 patients presented with reduced ejection fraction HF (HFrEF ≤40%), and 237 (50.7%) participated in the program. Major adverse cardiovascular and cerebrovascular events were evaluated at a 3-year follow-up. Multivariate independent risk analysis was performed. We used propensity score matching for participants and non-participants in the KOS-MI program, resulting in 127 pairs., Results: A 3-year follow-up (completed by 93% of patients), there was a 57% reduction in major adverse cardiovascular and cerebrovascular events (HR, 0.43; 95% CI, 0.31-0.6; P <0.001), 67% in mortality (HR, 0.33; 95% CI, 0.22-0.5; P <0.001), and 42% in hospital admissions for HF (HR, 0.58; 95% CI, 0.4-0.9; P <0.007) in the KOS-MI patients. There was no difference in the occurrence of MI (HR, 0.71; 95% CI, 0.37-1.34; P = 0.29), stroke (HR, 0.9; 95% CI, 0.18-4.45; P = 0.89), and repeated revascularization (HR, 0.6; 95% CI, 0.34-1.05; P = 0.07). Following propensity score matching 127, well-matched pairs between groups were created. Following adjustment, there was a statistically significant reduction in the risk of death (HR, 0.02; 95% CI, 0.29-0.89; P = 0.02) while other parameters were similar., Conclusions: The KOS-MI program significantly improved HFrEF patients' prognosis up to 3 years post-treatment, even after its cessation after one year. Thus, implementing a dedicated comprehensive care program for HF patients is warranted.

Background: The evidence on performing minimally invasive coronary artery surgery early after drug-eluting stent (DES) implantation due to acute coronary syndrome (ACS) is limited., Aim: The study aimed to determine the safety and feasibility of this approach., Methods: This registry included 115 (78% male) patients treated from 2013 to 2018, who underwent non-left anterior descending (LAD) percutaneous coronary intervention (PCI) due to ACS with contemporary DES implantation (39% diagnosed with myocardial infarction at baseline), followed by endoscopic atraumatic coronary artery bypass (EACAB) surgery within 180 days, after temporary P2Y12 inhibitor discontinuation. Primary composite endpoint of MACCE (major adverse cardiac and cerebrovascular events), defined as death, myocardial infarction (MI), cerebrovascular incident, and repeat revascularization was evaluated in long-term follow-up. The follow-up was collected via a telephone survey and in line with National Registry for Cardiac Surgery Procedures., Results: The median (interquartile range [IQR]) time interval separating both procedures was 100.0 (62.0-136.0) days. Median (IQR) follow-up duration was 1338.5 (753.0-2093.0) days and was completed for all patients with regard to mortality. Eight patients (7%) died; 2 (1.7%) had a stroke; 6 (5.2%) suffered from MI, and 12 (10.4%) required repeat revascularization. Overall, the incidence of MACCE was 20 (17.4%)., Conclusions: EACAB is a safe and feasible method of LAD revascularization in patients who received DES for ACS within 180 days before surgery despite early dual antiplatelet therapy discontinuation. The adverse event rate is low and acceptable.

Background: The Coordinated Care in Myocardial Infarction Program (KOS-MI) was introduced to improve prognosis for patients after myocardial infarction (MI). The program includes complete revascularization followed by unrestricted access to rehabilitation, electrotherapy, and cardiac care., Aim: This study aimed to assess major adverse cardiac and cerebrovascular events (MACCE) of patients enrolled in the KOS-MI at 3-year follow-up., Methods: This is a retrospective, multicenter registry of patients treated for MI. The study group (KOS-MI) of 963 patients was compared to the control group (standard care) of 1009 patients. At 3-year follow-up, MACCE including death, MI, stroke, and repeated revascularization were reported. Additionally, hospitalization for heart failure (HF) was analyzed. Propensity score matching (PSM) was utilized for group baseline characteristic adjustment., Results: Patients in the KOS-MI group were younger (65 vs. 68 years; P <0.001), mostly men (70% vs. 62.9%; P <0.001), admitted with ST-segment elevation myocardial infarction (STEMI) (44.6% vs. 36.2%; P <0.001). Patients in the control group had more comorbidities and were admitted more often with non-ST-segment elevation myocardial infarction (63.8% vs. 55.4%; P <0.001) and acute HF (5.1% vs. 2.7%; P = 0.007). Following PSM, 530 well matched pairs were selected. At three years (92.3% follow-up completeness), the relative risk reduction was: 25% in MACCE (P = 0.008), 38% in mortality (P = 0.008), 29% in repeated revascularization (P = 0.04), and 28% (P = 0.0496) in hospitalization for HF in the KOS-MI group., Conclusions: The combination of contemporary invasive techniques, complete revascularization, cardiac rehabilitation, and ambulatory care included in the KOS-MI Program improves long-term prognosis of patients after MI in 3-year follow-up.

Background: The collateral damage caused by the COVID-19 pandemic affected cardiovascular disease patients, mainly acute coronary syndrome (ACS) cases. Additionally, lockdown caused treatment-related concerns and reluctance to seek medical help, factors that can delay treatment., Aim: We aimed to analyze the incidence and course of ACS after the first COVID-19 wave., Methods: The report is based on a multi-institutional registry of 10 interventional cardiology departments. ACS patient data were gathered from June to October 2020, i.e. in the period following the first lockdown in Poland (March 30-May 31, 2020) and compared with the corresponding 2019 timeframe., Results: Patients (2801 and 2620) hospitalized for ACS in 2019 and 2020 (June-October) represented 52.8% and 57.9% of coronary artery disease admissions, respectively. In 2020 vs. 2019, more cases of arterial hypertension (80.2% vs. 71.5%; P <0.001), diabetes (32.7% vs. 28.2%; P <0.001) hyperlipidemia (53.2% vs. 49.8%; P = 0.01), and smoking history (29.5% vs. 25.8%; P = 0.003) were detected. Median troponin and cholesterol values, as well as glycemia, were higher in 2020. Patients were more likely to undergo percutaneous treatment (91.2% vs. 87.5%; P <0.001) and were less often referred for surgery (3.7% vs. 4.9%; P = 0.03). No differences in deaths from repeat myocardial infarction, stroke, and/or composite endpoint (major adverse cardiac and cerebrovascular events [MACCE]) were noted. However, suffering from ACS in 2020 (June-October) was a risk factor for mortality based on multivariable analysis., Conclusions: The COVID-19 pandemic affected ACS patient profile, course of treatment, and increased risk for mortality.