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Cardiovascular disease has been the most common cause of death and disability in women. The prevelence of cardiovascular diseases in women increases dramatically with age as the population ages and women’s life expectancy inareases. Compared with men, women with coronary artery diseases are older and more likely to have hyprtension, diabetes and congestive heart failure. Principles of diagnostic and therapeutic management of women are similar to those in men. Clinical trials focusing on treatment alternatives in women have demonstrated improvements in outcomes with advances in technologies and contemporary therapies. All efforts should be focused on the proper screening, prevention and referral for treatment of women with coronary artery disease in order to impact the increasing mortality from heart failure.

According to current guidelines surgical revascularisation is a gold standard of treatment in patients with multivessel and left main coronary disease. Hybrid revascularisation, in two stages: first - minimally invasive direct coronary artery bypass grafting procedure with left internal mammary artery conduit to left anterior descending artery and second stage - percutaneus coronary intervention with drug eluting stent in non-left anterior descending vessels may be safe and effective alternative in patients with multivessel and left main coronary disease.

Despite a dramatic reduction in restenosis and target vessel revascularisation rates by drug eluting stents (DES), conflicting concerns have been raised over the risk for late DES thrombosis when compared to bare metal stents. Certainly, the heterogeneity of DES results from the introduction of a great variety of new DES types with diverse efficacy and safety parameters. Furthermore, we observe a steady increase in DES availability without parallel and robust data from randomised clinical trials. Thus, the postulated class effect of DES should be regarded as non-obligatory. This article is based on 110 randomised DES trials performed on 72 305 patients. Current status of DES and guidelines for DES implantation in various clinical scenarios were discussed.

Despite continuous progress in pharmacological management and development of myocardial revascularisation techniques, a significant number of patients with advanced ischemic heart disease and refractory angina pectoris cannot be treated successfully. For the group of patients with chronic refractory angina therapeutic options are, however, limited. Several alternative therapies, such as transmyocardial laser revascularisation, transcutaneous electrical nerve stimulation or angiogenesis by gene or cell therapy have been clinically tested. This paper presents a new promising method, non-invasive cardiac shock wave therapy with a review of available clinical information on therapeutic potential in advanced ischemic heart disease and refractory angina treatment. The method is based on percutaneous application of low frequency ultrasound, i.e. mechanical shock waves with ECG gating. Therapeutic sessions are performed under echocardiographic monitoring. In the last thirty years the shock wave therapy has become a method efficiently employed in nephrology, gastroenterology, orthopedics, rehabilitation and dermatology, as well as--pending confirmation through further research--cardiology.

A case of 74-years-old woman who was admitted to Department of Interventional Cardiology due to acute coronary syndrome is presented. The multilevel atherosclerosis was diagnosed. The patient was successfully treated with two-stage percutaneous coronary and peripheral revascularisation. During 6-months follow-up patient was in good condition.

Unlabelled: Recanalization of a chronically occluded coronary artery results in the improvement of various clinical parameters in patients with coronary artery disease. Increase of parasympathetic activity due to such procedure could be another argument for attempting recanalization. The aim of the study was to evaluate direct effects of recanalization of a chronically occluded coronary artery on the autonomic nervous system activity in patients with single-vessel coronary artery disease., Material and Methods: Forty patients aged 57 +/- 10 (36-73 years), scheduled for recanalization of a chronically occluded coronary artery were included into the study. Left ventricular ejection fraction (LVEF), mean heart period (MHP), baroreflex sensitivity (BRS) and short-term heart rate variability indices (SDNN, pNN50, RMSSD, TP, LFnu, HFnu, LF/HF) were analyzed one day before (El) and one day after (E2) the procedure., Results: Statistically significant increase of LVEF in E2 in comparison to E1 (53 +/- 7 and 50 +/- 8%, respectively; p=0.005) and borderline decrease in BRS (4.2 +/- 3.6 and 5.8 +/- 4.6 ms/mm Hg, p=0.06) were found in the studied group. Statistically significant decrease in BRS was found in a subgroup of patients with initial value of BRS > 3 ms/ mm Hg (5.8 +/- 4.3 and 9.2 +/- 4.0 ms/mm Hg, p=0.02) one day after the procedure. Of the HRV indices, only borderline decrease in pNN50 was noted (1.4 +/- 1.7 and 3.8 +/- 5.6%, p=0.09). No other differences of HRV, or MHP, were found., Conclusion: Despite the increase of LVEF recanalization of a chronically occluded coronary artery leads to the decrease of BRS and pNN50 as a result of sympathetic activation one day after the procedure in the majority of patients. These changes in BRS were more profound and reached statistical significance in patients in whom baroreflex sensitivity was initially well preserved.

A case of a patient with unstable coronary artery disease, insulin-dependent diabetes mellitus and acetylsalicylic acid hypersensitivity is presented. Acetylsalicylic acid desensitisation and coronary angioplasty with stent implantation were successfully performed. The patient continues to receive antiplatelet therapy and has stable angina. No late hypersensitivity reactions were seen after a follow-up of 16 months.

Background: Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients aged > or =80 years., Aim: To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patients > or =80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age., Methods: In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83+/-3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied., Results: Severity of coronary atherosclerosis measured by angiographic Gensini score and author's own score was similar in diabetic and non-diabetic patients (23.25+/-9.6 vs. 20.6+/-10.2; NS, and 9.1+/-6.0 vs. 8.1+/-5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosis <20%, was obtained in 92.2% of patients with DM compared to 83.7% of non-diabetics (NS). One-day mortality was 7.1 vs. 6.1% (NS), in-hospital mortality was 7.1 vs. 17.4% (NS). Successful pPCI reduced 30-day mortality threefold (OR=0.31; p <0.05). Contrast-induced nephropathy occurred in 35.7% of diabetic patients compared to 26.5% of those without diabetes (NS) Contrast-induced nephropathy increased risk for in-hospital mortality fivefold (p <0.02). No significant correlation between DM or baseline glucose level and in-hospital mortality was found. During one-year follow-up mortality rate in diabetic patients was 38.5% compared to 7.3% of those without diabetes (p <0.01). One-year mortality predictors were: age (OR=1.27; p=0.0047), metabolic syndrome (OR=4.4; p <0.04), type 2 diabetes (OR=5.25; p <0.02), insulin treatment (OR=5.7; p <0.03), baseline glucose level (OR=1.01; p <0.007), maximum CK-mass level (OR=1.006; p <0.05), noninvasive STEMI management (OR=5.0; p <0.02), and stroke (OR=7.5; p <0.006). Stroke (OR=40.0; p <0.005) and diabetes (OR=6.2; p <0.01) were identified by multivariable analysis as independent risk factors of one-year mortality., Conclusions: In patients with DM aged > or =80 years with ACS-STE, severity of coronary atherosclerosis and in-hospital prognosis after pPCI seems to be similar to subjects in the same age without DM. Diabetes mellitus is an independent risk factor of one-year mortality after successful pPCI.

Stenosis of the unprotected left main coronary artery (LMCA) is a classical indication for coronary artery bypass graft surgery (CABG). Percutaneous coronary intervention (PCI) of LMCA may be an alternative to surgical treatment if atherosclerosis of distal segments is very advanced. The periprocedural risk is high, especially if comorbidities are present. However, long-term results remain unclear. The ongoing Syntax trial will clarify whether angioplasty of LMCA with drug-eluting stents can be equivalent to CABG. We present a case of a patient with occluded right coronary artery, severe stenoses of the LMCA, left anterior descending artery and left circumflex artery, and poor left ventricular ejection fraction in whom PCI for stenosis of unprotected LMCA with standby cardiopulmonary support was performed.

We present a case of a 51-year-old male with multivessel coronary artery disease and disseminated peripheral arterial disease (PAD) who underwent coronary angioplasty, followed by angioplasty with stent implantation of the left superficial iliac artery and right femoral artery. Thirty days later the patient was admitted for elective angioplasty of the previously closed superficial right femoral artery; however, angiography showed that the artery was patent with a residual stenosis which narrowed the vessel lumen by 10%. We believe that spontaneous recanalisation of this artery was caused by multiple factors, including cessation of smoking, physical training, pharmacological therapy and previous angioplasty of the right femoral artery.

Background: Multivessel coronary artery disease (CAD) not suitable for revascularisation remains a challenge for present cardiology. Due to high mortality and difficulties in pharmacological therapy patients with this particular disease constitute a group of great interest., Aim: To define the main unfavourable prognostic factors in patients with clinically stable multivessel CAD who do not qualify for percutaneous or surgical revascularisation., Methods: The analysed group consisted of 106 patients (79 men, 66+/-8 years) with multi-vessel CAD, confirmed in coronary angiography, who were primarily disqualified from interventional treatment. Thirty-eight (36%) of them had diabetes and 5 (5%) had a previous stroke. The left ventricular ejection fraction was 37+/-15%, and mean Gensini score - 72+/-34., Results: During 7.4+/-4 years of follow-up, 19 (18%) patients died. Predicting factors of mortality included older age (p=0.014), higher heart rate (p=0.02), diabetes (0.003), renal failure (p=0.0003), heart failure (p=0.013), past stroke (p=0.006) and lower left ventricular ejection fraction (p=0.0012). In multivariate logistic analysis the only significant parameter related to prognosis was decreased level of haemoglobin (p=0.007) and elevated leucocytosis (p=0.002). The ROC curves analysis showed that decreased Hgb (<12.3 g/dl) and increased leucocytosis (>11.3 t/mm3) were significantly associated with higher mortality (HR 6.3)., Conclusions: In patients with multi-vessel CAD not amendable revascularization the haemoglobin level and leucocytosis seem to be at least as important as well known risk factors. More intensive complex pharmacotherapy and innovative cell and gene therapeutic methods may improve the prognosis in this group of patients.

A case a of a life-saving angioplasty of left main coronary artery (LMCA) is presented. A 75 year old patient with a history of diabetes, previous CABG and carotid surgery was admitted to our hospital with symptoms of early post-infarct angina. Coronary angiography revealed significant stenosis of LMCA, in addition to previously known multi-vessel diffuse CAD. Taking into consideration a very high risk of repeat CABG surgery a decision was made to perform an angioplasty. The intervention was carried out with good angiographic effect and the patient was discharged home few days later, free from angina. In 9 month follow-up angiography there was no restenosis in LMCA. In patients to whom cardiac surgery presents very high risk, an angioplasty of LMCA can be life-saving, with good long term effects.

Melatonin--sleep-inducing remedy was reported to be implicated in "biological clock" of circulatory system. The deficits of this pineal hormone were observed in patients with coronary artery disease (CAD) and those with abnormal circadian pattern of blood pressure (BP). We hypothesize that melatonin supplementation could be beneficial for this group of patients thanks to return from "non-dippers" to physiological "dippers" group, which is characterized by lower rate of left ventricle hypertrophy and/or number of ischemic episodes, in comparison with "non-dippers". The aim of this study was to assess safety and the effects of melatonin treatment in patients with CAD and impaired circadian pattern of BP., Investigated Group and Methods: Thirty-nine ambulatory patients (69% males, mean age 61+/-5,0), with CAD confirmed by coronary angiography and with circadian pattern of BP classified in 24 hour ambulatory blood pressure monitoring (ABPM) as "non-dippers" were included into the study. All study participants, apart of previous treatment, started to use 5 mg melatonin before sleep. Control 24h ABPM was performed after 30 days of such cure. The results of both ABPMs were compared using statistical methods., Results: Melatonin supplementation improved circadian pattern of BP in one third (30,8%) of study group - they were classified in the second ABPM as "dippers". Despite a tendency to increase a day/night difference of average BP for 5,9%--a percentage of patients who remained in the group of "non-dippers" was 46,2%. Unfavourable effect of melatonin treatment was observed in 23% of patients: 15,4%--"extreme-dippers", 7,6% --"reverse-dippers"., Conclusion: Twenty-four hour noninvasive blood pressure monitoring performed before and during melatonin cure is crucial by considering benefits and dangers of this treatment begun in purpose to modify impaired pattern of blood pressure in patients with coronary artery disease.

Background: Coronary stenting is associated with acute inflammation within the arterial wall followed by neointimal growth. Acute inflammatory response is expressed by a marked systemic elevation of the inflammatory biomarker C-reactive protein (CRP). It has been shown that the degree and extent of CRP increase may be related to clinical presentation or periprocedural treatment., Aim: To investigate whether an increase in CRP level is associated with the extent of arterial injury during stent deployment., Methods: CRP levels were measured with a high-sensitivity CRP (hsCRP) assay. Seventy-three patients (51 males) with normal baseline plasma CRP (<3 mg/L) underwent percutaneous coronary intervention (PCI) with stent implantation for stable coronary disease. Blood samples for hsCRP were drawn before the intervention, and 6, 12 and 24 hours after the procedure. Both quantitative (single vs multivessel coronary intervention) and qualitative analyses (including lesion classification according to the ACC/AHA grading system) were performed in all patients. The examined angiographic parameters and procedural data obtained included reference diameter, lesion location, lesion length, total stented segment length, diameter of stent after deployment, maximal deployment pressure, total inflation number and duration., Results: The mean hsCRP level increased in all patients between baseline and 24 hours (1.36+/-0.93 mg/L and 4.34+/-3.3 mg/L, p <0.0001). Single vessel procedure was performed in 51 patients and multivessel coronary intervention in 22 patients. Mean hsCRP was similar at baseline and after 6 hours in both groups and the increase after 12 and 24 hours was higher among patients with multivessel coronary intervention compared to patients with single vessel procedure (2.69+/-2.48 vs 4.15+/-3.17; p=0.039 and 3.76+/-3.13 vs 5.69+/-3.38; p=0.021, respectively). There was no correlation between hsCRP and the degree of lesion complexity. Multiple regression analysis showed that the total stented segment length (p=0.01) contributed to the hsCRP increase after 24 hours., Conclusions: The inflammatory response expressed by hsCRP levels is higher in patients with multivessel coronary intervention with longer total segment stented.

Patients with end-stage renal disease (ESRD) and coronary heart disease have a very high risk of cardiovascular mortality. We describe results of recent studies on prevention and treatment strategies. Although the outcomes of revascularization methods, i.e. coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), in ESRD patients are worse than in the general population, CABG and PCI significantly improve survival of the ESRD population. The studies suggest more favorable results with CABG compared with PCI. Patients with a kidney transplant and coronary artery disease (CAD) have better prognosis. In this population, the long-term results of revascularization (CABG and PCI) are comparable. Studies should be focused on optimizing and individualizing revascularization methods, preventing restenosis after PCI, and improving invasive cardiology techniques and anti-aggregation treatments.

Unlabelled: We aimed at assessing the frequency of death, myocardial infarction, unstable angina, repeat revascularization, cardiovascular hospitalisation during 12 months in patients assigned to early invasive strategy., Material and Method: We analysed 658 consecutive patients with acute coronary syndrome (ACS) without ST-segment elevation hospitalized between January 2000 and February 2003. Patients had to fulfill the following criteria: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0,05 mV), transient (< 20 min) ST-segment elevation (> or = 0,05 mV), T-wave inversion (> or = 1 mV) in at least 2 contiguous leads, positive serum cardiac markers., Results: All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 71.8% of patients. 18.2% were assigned to CABG (coronary artery bypass graft) and 8.7% of patients were treated conservatively. 1.3% of patients underwent PCI followed by an elective CABG surgery. In-hospital mortality rate was.,3%. 3.3% patients died after hospital discharge. The frequency of myocardial infarction, unstable angina and repeat PCI at 12 months was 2.1%, 16.8% and 11.5% respectively. The rate of cardiovascular hospitalisation was 15.6%. Multivariate analysis identified two independent predictors ofdeath: diabetes mellitus (OR: 7.02, 95% CI: 1.5-13.8, p = 0.03) and heart failure (OR: 12.6, 95% CI: 2.86-16.6 p = 0.005)., Conclusions: Early invasive strategy in analysed group yields good long-term outcomes with low rate of adverse ischemic events. Independent predictors of deaths were diabetes mellitus and heart failure.

Background: Thrombus containing lesions (TCL) are often associated with unfavourable immediate results of invasive procedures thus influencing long-term outcome. Early invasive treatment strategy employed in patients (pts) with acute coronary syndromes without sustained ST segment elevation (ACS) may be crucial for improvement of immediate and in-hospital results., Objective: The aim of this study was to find out whether the presence of thrombi in lesions related to instability may negatively affect the results of early invasive treatment strategy and long-term outcome of patients with acute coronary syndromes., Materials and Methods: We analyzed coronary angiograms of 364 consecutive pts with ACS who were assigned to early invasive treatment strategy. Pts with angiographically recognizable thrombus containing lesions (group A) were compared with remaining ones (group B) with regard to immediate results of percutaneous intervention (PCI), in-hospital outcome and 12-month follow up., Results: The study group consisted of 84 patients with TCL and 280 without thrombus. Pts with TCL were younger (58 +/- 9,9 vs 61 +/- 10,8; p<0,03) and less frequently had impaired LV function (EF<35%; 5% vs 13% p<0,04). Cardiac enzymes at admission were positive in 49% and 35% of pts in group A and B respectively (p<0,04). Baseline TIMI flow was 2,7 +/- 0,8 in group A and 2,5 +/- 0,9 in group B (NS) and TIMI 3 flow before PCI was observed in 54,8% and 69,3% of pts respectively (p<0,01). Type B and C lesions were observed in 100% and 91% culprit lesions respectively (p<0.05). TIMI flow after PCI was 2,9 +/- 0,4 in group A and 2,9+/-0,5 in group B and TIMI 3 flow after PCI was observed in 95,2% and 95,9% respectively (NS). GP IIB/IIIA antagonists were used in 4,8% pts of group A and 6,4% patients of group B. Frequency of stent implantation was 96,5% and 96,7% respectively (NS). One (1,2%) in-hospital death occurred in group A and 4 (1,4%) in group B (NS). Myocardial infarction was observed in 4 (4,8%) pts in group A and 12 (4,3%) in group B (NS). In 12-month follow up 2 (2,4%) deaths in group A and 10 (3,6%) in group B were observed (NS). No difference between groups was noted in myocardial infarction rate: 7,14% (group A) vs 2.84% (group B), NS. More pts in group B had episodes of unstable angina during follow up (19,5% vs 9,5%; p<0,04)., Conclusions: Thrombus containing lesions in patients with ACS assigned to early invasive strategy do not negatively influence the immediate, in-hospital and 1-year results of percutaneous intervention.

Background: Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation., Hypothesis: The aim of the study was analysis of clinical characteristics, in-hospital outcome and factors of in-hospital mortality., Methods: The study group comprised 853 patients who were defined as high-risk, based on resting pain episodes within previous 24 hours, changes of ST-T segment in ECG, and elevated serum cardiac markers. All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 73.1% of patients. 16.7% were assigned to CABG (coronary artery bypass graft), 1.6% of patients underwent PCI and CABG and 8.6% of patients were treated conservatively., Results: Overall in-hospital mortality was 3%; 1.4% in the PCI group, 8.4% in the CABG group and 6.8% in conservatively treated patients. The independent risk factors of in-hospital deaths were: Braunwald's IIIC class angina (OR 7.8; 95%CI 3.6-12.37 p=0.004), recurrent angina after revascularization (OR 13.04; 95%CI 7.62-29.23 p=0.002), congestive heart failure (OR 11.45; 95%CI 8.01-18,38 p=0.00001) and evolving myocardial infarction with ST-segment elevation (OR 12.77; 95%CI 8.35-27.35 p=0.0001). Stent implantation was associated with decreased risk of in-hospital death (OR 0.12; 95%CI 0.07-0.41; p=0.003)., Conclusions: Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.

Unlabelled: Early invasive strategy is one of two methods of treatment of acute coronary syndromes without ST-segment elevation (NSTEACS). We aimed at assessing 12-month outcomes and quality of life in patients with NSTEACS and multivessel coronary artery disease (CAD) who underwent percutaneous or surgical revascularization. Analyzed group comprised 412 patients (92%) who were qualified for invasive treatment based on coronary angiography performed 24 hours after admission and in whom long-term follow up data was available. The inclusion criteria were: rest angina within 24 hours prior to admission and at least one of the following: ST segment depression (> or = 0.5 mm), transient (< 20 min) ST-segment elevation, negative T-waves (> or = 1 mm)in at least 2 contiguous leads, positive serum cardiac markers. Patients with single-vessel CAD or qualified for conservative treatment were excluded from the study. We analysed the rate of adverse cardiac events (death, non-fatal myocardial infarction, unstable angina, repeated revascularization, cardiovascular hospitalization) at one year. The quality of life was assessed using Short-Form-36 (SF-36) questionnaire. The rate of death was 5.3% vs 9.3% (NS), myocardial infarction 3.4% vs 0% (p = 0.054), unstable angina 20.9% vs 2.8% (p = 0.0000), repeated revascularization 12.6% vs 0% (p = 0.0001) and cardiovascular hospitalization 36% vs 22.7% (p = 0.001) in the PCI and CABG group respectively. Physical Component Summary scores were 38.7 +/- 11.6 vs 43.08 +/- 9.5, p = 0.001 in the PCI and CABG group respectively. Mental Component Summary Scores were similar in both groups (46.34 +/- 13.05 vs 45.97 +/- 11.9, NS)., Conclusions: Overall mortality rate was similar in both groups. PCI patients had more frequent rate of unstable angina, rate of hospitalization and repeat revascularization. This study has shown that there is a significant difference in health-related quality of life 12 months after PCI and CABG. This difference arises from better physical function (Physical Component) for CABG surgery patients compared with PCI patients. Despite impairment of the physical health status, the mental health status (Mental Component) remained similar in both groups.

Background: Utilization of early invasive strategy for patients with acute coronary syndromes (ACS) without persistent ST-segment elevation remains controversial. In this study we characterized a group of high-risk patients who underwent early invasive assessment and treatment., Methods: We analysed 458 consecutive pts who fulfilled following criteria: (1) rest angina within 24 hours prior to admission, (2) at least one of the following: ST-segment depression (> or = 0.05 mV), transient (> or =20 min) ST-segment elevation (> or = 0.05 mV), T-wave inversion (> or =1 mV) in at least 2 contiguous leads, positive serum cardiac markers. All patients were diagnosed invasively with subsequent revascularization if appropriate. Analysis of long-term survival and occurrence of major adverse cardiovascular events requiring hospitalization (MACE) was performed., Results: Baseline characteristics of the pts: Age: 61.5 +/- 10 years, males: 67.3%, diabetes: 19.6%, hypertension: 72.9%, smokers: 39.5%, hyperlipidemia: 78.6%, previous myocardial infarction: 50.4%, previous CABG 6.5%, previous PCI 14.4%. PCI was performed in 71.8% of pts, 18.2% underwent CABG, 1.3% had combined PCI and elective CABG and 8.7% of pts were treated conservatively. In-hospital and overall mortality was 3.3% and 4.8% respectively. MACE were observed in 20.3% of pts. Multivariate analysis identified two independent predictors of death: diabetes mellitus (OR: 6.01, 95% CI: 1.1-13.2, p = 0.04) and heart failure (OR: 11.6, 95% CI: 2.56-15.6, p = 0.005) and three predictors of combined endpoint (death, non-fatal myocardial infarction, repeat revascularization): male sex (OR: 3.33, 95% CI: 1.30-8.55, p = 0.01), previous MI (OR: 2.32, 95% CI: 1.07-5.03, p = 0.03) and PCI treatment of acute coronary syndrome (OR: 3.11, 95% CI: 1.39-6.98, p = 0.006)., Conclusions: Early invasive strategy in high-risk ACS patients yields good long-term results with low mortality rate, especially during in-hospital observation. Diabetes mellitus and heart failure were independently associated with increased mortality rate, whereas male sex, previous MI and PCI during index hospitalization predicted major adverse cardiovascular events in 6-month follow-up.

A case of a 58-year-old male with acute aortic dissection is presented. A few months earlier the patient underwent transmyocardial laser revascularisation and implantation of venous graft to the left anterior descending coronary artery due to three-vessel disease. Acute aortic dissection was successfully treated by surgery. Therapeutic options in patients with acute aortic dissection and advanced coronary artery disease are discussed.

Introduction: Epidemiological studies show that diabetes mellitus is a serious medical, economic and public health problem. 21-30% of patients with acute coronary syndromes (ACS) have diabetes. We aimed at assessing the in-hospital and 12-month outcomes of diabetic and non-diabetic patients with ACS without ST-segment elevation., Methods: 329 consecutive patients with ACS without ST-segment elevation were entered into the study, of whom 63 patients (19.1%) had diabetes mellitus. The inclusion criteria were: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0.05 mV), transient (< 20 min) ST-segment elevation (> or = 0.05 mV), T-wave inversion (> or = 0.1 mV) in at least 2 continuous leads, positive serum cardiac markers. All patients underwent coronary angiography and percutaneous coronary intervention (PCI) within the first 24 hours of admission., Results: Baseline profiles were similar in both groups. More non-diabetic patients had initial TIMI 3 flow (76% vs 65%, p = 0.05), whereas the rate of successful PCI (final TIMI 3 flow) was similar in both groups (97.7% vs 96.8%, NS). The rate of GP IIb/IIIa inhibitors treatment was similar in both groups. Overall mortality in the diabetic group and in the non-diabetic group was 7.9% and 3.4% respectively (NS). In-hospital mortality rate was 3.2% and 1.1% respectively (NS). After discharge, 9 patients died, of whom 3 patients were in the diabetic group and 6 patients in the non-diabetic group (5.0% vs 2.28% NS). The rate of MI during follow-up was similar in both groups. More diabetic patients had episodes of unstable angina during follow-up (30% vs 17.9%, p = 0.034). Primary endpoint (death, myocardial infarction, repeat revascularization) was more frequent in the diabetic patients (28.57% vs 17.67%, p = 0.05), whereas the rate of combined endpoint (death, myocardial infarction, repeat revascularization, cardiovascular hospitalization) was similar in both groups (40% vs 26.23%, NS). More diabetic patients received beta-blockers, diuretics and digoxin during follow-up., Conclusions: Early invasive treatment and intensive medical therapy improves in-hospital prognosis for diabetic patients, whereas diabetes mellitus affects long-term outcomes with more episodes of unstable angina and a more frequent rate of repeat revascularization.

Aim: To evaluate psychological factors influencing the effectiveness of smoking cessation using bupropion and psychological intervention in patients with cardiovascular diseases., Method: A group of 59 patients (26 M, 33 F; mean age 44.2 +/- 10.2 years) identified among smokers admitted to the 1st Cardiac Department between 2000 and 2001 with hypertension (n = 46) and coronary artery disease (n = 13). Entry criteria to participate in a 7-week programme included nicotine dependence and no contraindications to bupropion. Pharmacotherapy was used in parallel with psychological interventions based upon cognitive and behavioural methods. The type and degree of nicotine dependence was measured using Fragerstrom tolerance questionnaire whereas motivation was scored according to the Schneider questionnaire. The severity of depression symptoms was measured by the Beck Depression Inventory., Results: At 2 months and at one year after discontinuation of treatment 74.6% and 40% of the patients respectively maintained abstinence from smoking. Among patients with good therapeutic effects the level of motivation to quit smoking was higher (p < 0.001 vs. p < 0.007). The level of motivation was correlated with the severity of depression symptoms (p < 0.005) but not with nicotine dependence, age and sex. Motivation to stop smoking is related to the depression symptoms (beta = -0.32; p = -.01)., Conclusion: Patients with initially higher motivation benefit more from treatment of nicotine dependence. The level of motivation is adversely affected by the depressive mode of functioning (negative cognitive patterns, learned helplessness). It appears necessary to take into account the assessment of depressive disorders when planning treatment of nicotine dependence in patients with cardiovascular diseases.

In the article the role of immunologic cells and hemostatic factors in the formation of atherosclerosis was described. Attention was paid to restenosis in patients undergoing percutaneous transluminal coronary angioplasty (PTCA), a phenomenon that occurs in 20-50% of these patients. Among many factors that contribute to restenosis more attention is paid lately to the role of chemokines. The physiology role of chemokines was described and the contribution of monocyte chemoattractant protein-1 to restenosis after PTCA.

Background: Gene therapy is a new, experimental method of treatment in patients with coronary artery disease (CAD)., Aim: To determine the safety and efficacy of gene encoding vascular endothelial growth factor (VEGF165) administered directly into the myocardium as the single treatment or combined with coronary artery by-pass grafting (CABG)., Methods: VEGF gene transfer was performed in 22 patients (20 male, 2 female, ages from 48 to 73 years old). A 200 micro g of the plasmid encoding VEGF165 was injected into the ischaemic myocardium which could not be surgically revascularised in patients undergoing CABG (n=14), and 400 micro g - in patients without CABG (n=8). The value of ejection fraction (EF), myocardial perfusion, angiogram, ventriculography, and nitroglycerine consumption as well as quality of life were evaluated pre- and postoperatively., Results: The majority of patients had no complications and no fatal outcome was observed. Two patients developed acute myocardial infarction. Left ventricular function values improved and the majority of patients were free from angina 6 months after surgery. Patients reported improved quality of life and a reduction in nitroglycerine usage. A reduction in the ischaemic defects detected by SPECT was also observed. In some patients angiography revealed improved collateral filling., Conclusions: Direct myocardial administration of genes encoding VEGF165 can be an effective method of treatment in patients with chronic and advanced CAD either as a supplementary treatment or as a single therapy.