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Aim: To assess risk factors and prognosis in patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS) in Poland., Methods: Data from The Polish Registry of Acute Coronary Syndromes (PL-ACS) were analysed in 2008-2012. A total of 57400 consecutive STEMI patients included. The results of treatment and prognosis of patients with and without CS were compared. An additional analysis of the prognosis of men and women with CS was performed., Results: There were 34.2% of women and 65.8% of men. CS was diagnosed in 3589 (6.3%) patients (females 7.3% vs. males 5.7%, p<0.003). In multivariate analysis CS was the strongest factor affecting both inhospital (OR 2.51; 95%CI 2.25-2.80; p<0.0001) and 12-month (OR 2.09; 95%CI 1.96-2.24; p<0.0001) mortality. The worst prognosis was associated with pulmonary edema, advanced age, left or right bundle branch block, atrial fibrillation, and anterior MI. An early invasive strategy up to six hours from the symptom onset were the only factors reducing in-hospital and 12-month mortality. Despite of high female ratio in the group with CS and higher mortality in the female group, the female sex did not influence the in-hospital prognosis., Conclusion: In spite of enormous progress in the treatment of STEMI cardiogenic shock remains an important complication affecting the in-hospital and long-term prognosis. A symptom onset-to-treatment time is the key element in the management of patients with CS. Proper diagnosis and management including wide interventional strategy implementation increase the survival chance. An intensive study on novel treatment modalities and on effective identification methods of patients at risk and are warranted.

Background: Diabetes is a significant risk factor in patients with non ST-segment elevation myocardial infarction (NSTEMI). Sex-related differences in clinical course of NSTEMI have not been extensively studied., Material and Methods: During one year all consecutive patients presenting with NSTEMI and diabetes were enrolled. A total of 298 (158 women and 140 men) were analyzed. Clinical presentation, applied treatment and prognosis were compared between women and men., Results: Women tended to be older. More men smoked cigarettes. Pharmacological approach was similar in both groups. Men underwent revascularization more often. Despite those differences both short- and long-term mortality were comparable., Conclusion: Despite the common knowledge on negative influence of diabetes and female sex in NSTEMI patients, in multivariate analysis only age and three or four Killip class on admission were significant.

Aims: The prognosis in men and women with myocardial infarction due to left main coronary artery disease (LM) in relation to the presence of isolated LM disease or accompanying one-, two- or multivessel disease., Materials and Methods: A total of 643 consecutive patients (184 females, 459 males) with acute myocardial infarction due to LM stenosis or occlusion were enrolled. Data on clinical presentation, management and in-hospital mortality derived from the Polish Registry of Acute Coronary Syndromes PL-ACS, data on 12-month mortality derived from the Civil Registry. Patients with isolated LM disease were compared with patients in whom significant stenosis in artery another than LM was present. In-hospital, 30-day, 6- and 12-month mortality in both genders were analyzed., Results: The disease severity was similar in men and women. No difference in mortality between all subgroups was observed. A non-significant trend towards higher mortality in patients with multivessel disease accompanying to LM disease when compared to patients with isolated LM disease (34.2% vs. 25.2%; p log rank = 0.06)., Conclusions: There was no difference in in-hospital and long-term mortality between patients with isolated LM disease vs. patients with accompanying multivessel disease. No difference in mortality between genders was noticed. A longer follow-up is needed to confirm the significance of higher mortality in patients with multivessel disease.

Unlabelled: The benefit of immediate reperfusion in the treatment of ST-segment elevation myocardial infarction (STEMI) is indisputable. Unfortunately, no reperfusion therapy is applied to nearly 30% of patients without contraindication to such treatment. We aimed to analyze the impact of therapeutic approach on the prognosis after acute phase of STEMI., Material and Methods: The study group consisted of 26035 consecutive STEMI patients (8989 females, 34.4%) hopitalized in 456 sites during one year. Data were available from the Polish Registry of Acute Coronary Syndromes (PL-ACS) launched in Silesian Center for Heart Diseases, Zabrze., Results: Patiens treated with primary percutaneous intervention (pPCI) had the best outcome. All therapeutic strategies resulted in worse prognosis in women when compared to men. Women had greater 12-month mortality in the conservative, fibrinolytic and interventional treatment group: 33.1% vs 23.2%; p < 0.0001; 24.3% vs 16.2%; p < 0.0001 i 11.4% vs 8.2%, p < 0.0001, respectively. Differences in the surgically treated group were insignificant (men: 25%, women: 8%, p = 0.42)., Conclusions: The outcome of conservative, fibrinolytic and interventional treatment was worse in the female group. Primary coronary angioplasty was the most benefical therapeutic strategy.

Despite improvements in stent technology, including introduction of drug eluting stents, problem of neointimal hyperplasia and restenosis remains. These phenomena are associated with multiple risk factors and gene polymorphisms. Well known periprocedural risk factors of restenosis such as site of stenting, oversizing, implantation of overlapping stents along with change in vessel geometry affect blood flow conditions. Both experimental and clinical studies provide a number of arguments regarding importance of hemodynamic factors like oscillatory shear stresses in the process of restenosis. Computational fluid dynamic (CFD) enables calculation of indices describing fluid flow including tangential shear stress. This method enables the virtual representation of the physical forces in the flow system and depicting them in graphical form. Flow modeling is used in the process of designing of coronary stents, which allows for the assessment of restenosis risk in the project phase. In the nearest future CFD will be used for prediction of restenosis risk after stent implantation.

The concept of hybrid room is to combine capabilities of cardiosurgery operating room and fully equipped cathlab. Since May 2011, an ultramodern hybrid room has been working, in our center. The cases reported in this article show the possibilities of cooperation of cardiosurgeons, anaesthesiologists and invasive cardiologists in performing difficult, complex cardiovascular interventions. In near future the capabilities of hybrid room will allow to perform simultaneously a number of complex cardiovascular procedures. It should not only shorten the time of hospitalisation but also substantially improve the patients comfort.

Percutaneous epicardial catheter ablation of ventricular tachycardia (VT) is used when ablation by a conventional endocardial access has been unsuccessful. In patients after cardiac surgery operations, due to high risk, an open chest approach for ablation is usually used. We report a case of 66 year-old man after bypass surgery operation admitted to the hospital with incessant VT, which was successfully ablated from the epicardial aspect achieved by subxyphoidal approach.

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.

Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension with persistent pulmonary perfusion defects causes by unresolved thrombi. All symptomatic CTEPH patients with documented pulmonary vascular resistance > 300 dyn*sec*cm(-5) and proximal lesions should be considered for surgical treatment--pulmonary endarterectomy. The role of pharmacological treatment remains controversial and should be restricted to inoperable cases and persistent pulmonary hypertension after pulmonary endarterectomy. Every year about 30 procedures is performed in two specialised centers in Poland with 1 year mortality at 8-9%. Number of procedures done gives the frequency of pulmonary endarterectomy at 0.7/million of population/year. Current data from UK indicate the actual ratio of surgical treatment of CTPH at 2/million/year. The article discusses reasons for CTEPH is underdiagnosed and why rate of surgical therapy in Poland is too low.

The authors present the results of minimally invasive transvascular reduction of severe mitral insufficiency in the first three patients with extensive postinfarction cardiac injury treated in Poland. The positive early in-hospital outcomes in the first three patients encourage further implementation of this treatment method in patients with postinfarction cardiomyopathy and high perioperative risk.

Unlabelled: Renal Angiography and IntraVascular UltraSonography (IVUS), are valuable diagnosis methods for assessment of renovascular hypertension (RVH). Endovascular techniques employing percutaneous transluminal renal angioplasty (PTRA) are effective for therapy of ischaemic nephropathy in patients with RVH. Success of PTRA is limited by a significant rate of restenosis. THE AIM OF STUDY was to compare the assessment of residual stenosis and restenosis with angiography and IVUS., Material and Methods: Residual stenosis after PTRA (combine with intravascular brachyterapy in 33 patients--group I) were assessed in 62 RVH patients with angiography and IVUS techniques. Both baseline and 9-month follow-up quantitative computerized angiography (QCA) and intravascular ultrasound (IVUS) analysis were performed to assess restenosis., Results: Residual stenosis after PTRA of atherosclerotic lesions was slightly lower with QCA than IVUS (in group I 15.49 +/- 4.69% and 18.81 +/- 4.81% and in group II 15.36 +/- 4.68% and 18.43 +/- 4.69%, respectively). The loss of lumen area in QCA assessment was slightly greater than in IVUS measurement (1.2 +/- 0.7 mm vs. 0.9 +/- 0.8 mm in group I i 1.7 +/- 0.7 mm vs. 1.5 +/- 0.8 mm in group II). The angiographic measurements of late lumen loss, diameter stenosis, and minimal lumen diameter correlated well with IVUS measurements (r = 0.81, r = 0.89 and r = 0.89 respectively)., Conclusions: Angiography and IVUS are equally effective methods for diagnosis and assessment of residual stenosis and restenosis after endovascular renal artery revascularisation.

Patients with severe symptomatic aortic stenosis, who from November 2008 to March 2009 were treated with Edwards-Sapien transcatheter aortic valve implantation (TAVI) within the POL-TAVI First Polish Registry, were included in the analysis. Nineteen patients aged 78+/-4.8 years with high operation risk and Logistic EuroSCORE 25+/-7.6% were reported (74% were females). In 15 (79%) patients the valve was implanted transapically (TA), in the other four (21%)--via the femoral arterial access (TF). The valve was successfully implanted in 16 (84%) patients, in one patient aortic valvuloplasty alone was performed. During in-hospital period two patients died (one during periprocedural period and another one--two months after the implantation). During the mean follow-up of 5+/-1.5 months (except for one patient who is still in hospital) all patients are in NYHA class I or II. Results of the initial series of 19 TAVI patients in Poland are satisfactory, and the trial will be continued with careful medical and economical analysis.

In the present report we describe a 70-year-old woman after antimitotic stent implantation who developed an allergy to clopidogrel. We monitored her platelet activity while on different drug regimes and at different time points during the allergic reaction. Tests showed incomplete platelet inhibition by acetylsalicylic acid and clopidogrel (dual antiplatelet drug resistance) during the acute allergic reaction with gradual improvement together with patient clinical status.

Background: In recent years significant progress has been made in invasive treatment of patients with acute myocardial infarction (AMI). Primary coronary stenting is currently a routine strategy which replaced primary balloon angioplasty with bailout stenting preferred in the past. Studies comparing these two strategies of stenting in AMI are scarce., Aim: To compare the immediate and long-term outcomes after primary angioplasty strategy and bailout stenting versus primary stent placement strategy in patients with AMI., Methods: We analysed data from a single-centre registry of consecutive patients with ST segment elevation myocardial infarction admitted between January 1998 and October 2003. In our centre in years 1998-2000 stenting was used only after failed or suboptimal balloon angioplasty. Starting from year 2001 we used routine primary stenting strategy. We compared these two angioplasty strategies applied in different time intervals with regard to in-hospital outcome and long-term mortality. Patients with cardiogenic shock at admission were excluded., Results: Out of a total of 1602 patients treated invasively for AMI (cardiogenic shock excluded) 479 underwent primary balloon angioplasty strategy with bailout stenting - group 1 (years 1998-2000) and 1123 were treated with primary stenting strategy - group 2 (years 2001-2003). In group 1 bailout stenting occurred in 34.4% of patients whereas in group 2 stents were implanted in 83% of patients. Patients in the balloon angioplasty group were younger, had shorter time from the onset of symptom to hospital arrival and more frequently underwent rescue coronary intervention after failed thrombolysis. In-hospital mortality was 2.9 vs. 2.4% in groups 1 and 2, respectively (p=NS). Twenty-four month mortality rate was 9.8% in group 1 and 10.06% in group 2 (p=NS)., Conclusions: 1. Effectiveness of coronary angioplasty is high and comparable in both groups. 2. In-hospital and long-term mortality and procedure-related complication rate are all low and comparable with both stenting strategies. 3. Independent factors increasing long-term mortality include: culprit vessel reocclusion, multivessel coronary disease, older age and hypertension. 4. Patients with complete patency of culprit vessel restored and with higher left ventricular ejection fraction presented lower 2-year mortality rate. 5. Bailout stenting did not increase 2-year mortality.

Background: Data on the efficacy of coronary angioplasty in patients with ST-segment elevation myocardial infarction (STEMI) treated during off-shift hours are limited, but some publications suggest a worse outcome in this group of patients., Aim: To compare the results of percutaneous coronary interventions (PCI) in STEMI patients admitted to hospital during the daytime and off-shift hours and to identify factors which influence prognosis., Methods: From January 1998 to October 2003, 1992 patients with STEMI were hospitalised and 1778 of them were treated with immediate PCI, including 482 admitted in the daytime (weekdays 8 a.m. - 3 p.m.; group I) and 1296 during off-shift hours (weekdays 3 p.m. - 8 a.m., weekends and holidays; group II). The clinical characteristics of both groups were similar, except for less frequent hypercholesterolaemia in the daytime group (52.1 vs. 59.7%; p=0.0041)., Results: There was no significant difference between the groups regarding time from admission to angiography (30 vs. 25 minutes), rates of reocclusion (5.2 vs. 4.9%), stroke (1.4 vs. 1.6%), haemorrhagic complications (8.1 vs. 6.9%), in-hospital mortality (6.8 vs. 6.2%) and long-term (24 months) mortality (13.7 vs. 13.6%) (p >0.05 for all parameters). The rate of stent implantation was significantly higher in the daytime group (71.2 vs. 66.2%; p=0.047)., Conclusions: The proper organisation of duties of the division of cardiology and the cardiac catheterisation laboratory, with focus on providing onsite staffing of the cardiac catheterisation laboratory around the clock, enables similar results of PCI in patients with ST-segment elevation myocardial infarction treated during off-shift hours as compared with patients treated during the daytime.

Objectives: The aim of the study was to evaluate the occurence of death and major adverse cardiac events (MACE) in patients with normal (group A) and elevated (group B) plasma bilirubin levels., Patients and Methods: We evaluated 124 patients (83% males, mean age 50.1 +/- 7.7 yrs) in New York Heart Association class II and III with hypertension-related chronic heart failure. We assessed the occurence of death and MACE (death, urgent heart transplantation and readmission to hospital)., Results: Groups A and B comprised 77 and 47 patients respectively. The independent predictors of death in group B were: N-terminal pro-brain natriuretic peptide (NT-proBNP) level (per 100 pg/ml difference; 95% CI: 1.29-4.76; p = 0.005) and physical component summary score (per 10 point difference; 95% CI: 0.66-0.99; p = 0.03). The independent predictors of MACE in group B were: age (per 10 yrs; 95% CI: 0.1-1.8; p = 0.04), NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.02-3.69; p = 0.04) and the symptoms of depression (95% CI: 1.02-2.5; p = 0.01). The independent predictors of MACE in group A were: NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.31-5.32; p = 0.006) and mental component summary (per 10 point difference; 95% CI: 0.85-0.98; p = 0.01). In a two-year follow-up the death rate was 5.2% in group A, and 23.4% in group B (p = 0.002) and frequency of MACE 18.2% and 42.6% in group A and B (p = 0.003), respectively., Conclusions: Elevated bilirubin levels are associated with higher incidence of death and MACE during a two-year follow-up in patients with hypertension-related chronic heart failure. Thus, it may be used as a simple prognostic factor in such of patients.

Every patient after heart valve replacement belongs to the risk group of infective endocarditis (IE). Some of the laryngological procedures are related to the transient bacteriaemia and consequently IE. Patients after heart valve replacement need a proper care before some laryngological procedures. The proper cooperation of cardiologist, cardiac surgeon, and laryngologist can decrease the risk of IE. In the paper the laryngological procedures for which prophylaxis against infective endocarditis is recommended have been identified. The standarts therapy for prophylaxis have been presented. The specificity of prophylaxis in the case of some other laryngological procedures have been shown. The other cardiac conditions predisposing to endocarditis demanding prophylaxis before laryngological procedures have been mentioned. Every patient after heart valve replacement in Silesian Center of Heart Disease in Zabrze obtains Identity Card of the Patient with Artificial Heart Valve. It contains a list of procedures, including laryngological ones, for which prophylaxis against IE is recommended.

Background: In a large group of patients with myocardial infarction, lack of tissue reperfusion following successful recanalisation of the infarct-related epicardial artery is seen. Blood flow in the microcirculation depends not only on structural changes in the microvasculature but also on rheological features of the blood itself., Aim: To investigate the association between baseline fibrinogen concentration and myocardial reperfusion following successful coronary angioplasty., Methodology: In 105 patients with acute ST-segment elevation myocardial infarction, baseline fibrinogen concentration was compared between patients with successful tissue reperfusion (n=79) and with no myocardial reperfusion (n=26) measured as the degree of ST-segment normalisation after successful recanalisation of the infarct-related artery., Results: Baseline fibrinogen concentration was significantly higher in the no-reperfusion group than in the reperfusion group (523+/-198.02 mg/dl vs 395.56+/-144.98 mg/dl, p=0.0004). In the overall study population, fibrinogen level correlated positively with maximum creatine kinase MB fraction concentration (r=0.25, p=0.012) and duration of chest pain (r=0.31, p=0.002). Mean fibrinogen concentration was higher in patients with anterior myocardial infarction than in patients with the infarct-related artery other than the left anterior descending artery. The risk of no-reflow phenomenon assessed in multivariate analysis was higher if duration of chest pain was longer (OR=1.46, CI 95% 1.06-2.16, p=0.001) and baseline fibrinogen concentration higher (OR=1.51, CI 95% 1.011-4.58, p=0.021)., Conclusions: Baseline fibrinogen concentration following successful mechanical recanalisation of the infarct-related coronary artery is an independent risk factor of a lack of myocardial reperfusion and it positively correlates with maximum creatine kinase MB fraction concentration and duration of chest pain. High fibrinogen concentration may affect rheological parameters of the blood and play an important role in the pathomechanism of myocardial no-reperfusion phenomenon following successful mechanical recanalisation of the infarct-related coronary artery.

Pulmonary arterial hypertension is a serious and severe complication of liver cirrhosis and portal hypertension. We present a case of a 47 year old female who developed pulmonary hypertension and right ventricular heart failure symptoms 6 years from the diagnosis of liver biliary cirrhosis and portal hypertension.

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.

Introduction: Femoral artery pseudoaneurysms (PSA) develop in 0.2-8% patients undergoing procedures that require femoral artery cannulation. Ultrasound guided thrombin injection has been described as successful and safe alternative to ultrasound guided compression and surgical treatment., Aim of the Study: Assessment of efficacy and safety of PSA treatment with USGTI., Methods: 28 patients (pts) (18 female, mean age 64.6 +/- 11.4) with femoral pseudoaneurysms developed due to coronary angiogram or percutaneous coronary angioplasty were treated with ultrasound guided thrombin injection. 24 PSAs arose from right common femoral artery, 3 from right superficial femoral artery, and 1 from left common femoral artery. 24 patients were receiving antiplatelet and 4 anticoagulation therapy at the time of the procedure. With ultrasound guidance, a 21Gx11/2 needle was placed into pseudoaneurysm lumen followed by thrombin injection (1074 +/- 473 U). No complications of the procedure were observed. In 24-hour observation USGTI was successful in 28 (100%) patients. However, in 7-day follow-up resolution of 1 PSA was found, which reduced efficacy rate to 96.3%., Conclusions: Ultrasound guided thrombin injection is a successful, safe and well tolerated method of pseudoaneurysms treatment. Neither antiplatelet nor anticoagulation therapy affects success rate of the method.