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Several mechanisms have been suggested to explain positive cardiovascular effects observed in studies with sodium-glucose co-transporter 2 (SGLT2) inhibitors. The reduction in glucose reabsorption in proximal tubuli induced by SGLT2 inhibitors increases urinary glucose and sodium excretion resulting in increased osmotic diuresis and consequently in decreased plasma volume, followed by reduced preload. In addition, the hemodynamic effects of SGLT2 inhibition were observed in both hyper and euglycemic patients. Due to the complex and multidirectional effects induced by SGLT2 inhibitors, this originally antidiabetic group of drugs has been successfully used to treat patients with heart failure as well as for subjects with chronic kidney disease. Moreover, their therapeutic potential seems to be even broader than the indications studied to date.

Background: Current guidelines recommend coronary catheterization in patients with non-ST- -segment elevation myocardial infarction (NSTEMI) within 24 hours of hospital admission. However, whether there is a stepwise relationship between the time to percutaneous coronary intervention (PCI) and long-term mortality in patients with NSTEMI treated invasively within 24 hours of admission has not been established yet., Aims: The study aimed to evaluate the association between door-to-PCI time and all-cause mortality at 12 and 36 months in NSTEMI patients presenting directly to a PCI-capable center who underwent PCI within the first 24 hours of hospitalization., Methods: We analyzed data of patients hospitalized for NSTEMI between 2007-2019, included in the nationwide registry of acute coronary syndromes. Patients were stratified into twelve groups based on 2-hour intervals of door-to-PCI time. The mortality rates of patients within those groups were adjusted for 33 confounding variables by the propensity score weighting method using overlap weights., Results: A total of 37 589 patients were included in the study. The median age of included patients was 66.7 (interquartile range [IQR], 59.0-75.8) years; 66.7% were male, and the median GRACE (Global Registry of Acute Coronary Events) score was 115 (98-133). There were increased 12-month and 36-month mortality rates in consecutive groups of patients stratified by 2-hour door-to-PCI time intervals. After adjustment for patient characteristics, there was a significant positive correlation between the time to PCI and the mortality rates (rs = 0.61; P = 0.04 and rs = 0.65; P = 0.02 for 12-month and 36-month mortality, respectively)., Conclusions: The longer the door-to-PCI time, the higher were 12-month and 36-month all-cause mortality rates in NSTEMI patients.

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments., Methods: The present research is a subanalysis of a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF)., Results: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55)., Conclusions: A greater reduction in hospital admissions in 2020 vs. 2019, higher rates of patients brought by ambulance together with lower rates of self-referrals and higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths were observed in cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones.

Atherosclerotic cardiovascular disease (ASCVD), which includes coronary artery disease (CAD), cerebrovascular disease, and peripheral arterial disease (PAD) is associated with significant morbidity, mortality, and healthcare costs. Antiplatelet therapy has long been the mainstay of antithrombotic therapy for the prevention of first-ever and recurrent ASCVD events. More recently, however, randomized trials have demonstrated the benefits and cost-effectiveness of a dual pathway inhibition (DPI) strategy in acute and chronic ASCVD. When used in combination, aspirin and low-dose rivaroxaban work synergistically to inhibit platelet activation and thrombin generation, thereby preventing thrombus formation. Among patients with recent acute coronary syndrome (ACS), those with positive cardiac biomarkers or ST-segment elevation myocardial infarction, or a history of heart failure derive the greatest absolute benefits. Among patients with chronic ASCVD, those with involvement of two or more vascular beds, heart failure, chronic kidney disease, or diabetes derive the greatest absolute benefits. Additional trials are underway to assess the impact of DPI therapy in other populations of interest, including patients with ACS at high risk of left ventricular thrombus formation, intracranial atherosclerotic disease with recent transient ischemic attack or stroke, peripheral arterial disease with limiting claudication or post lower extremity revascularization, and advanced chronic kidney disease with ASCVD or risk factors for ASCVD. Further work is required to assess the possible added benefit of combining rivaroxaban with clopidogrel or ticagrelor instead of aspirin.

Background: Cytisine is contraindicated, and its effects have not been evaluated in patients with coronary artery disease (CAD)., Aims: The safety, feasibility, and short-term efficacy of cytisine for smoking cessation were evaluated in active smokers with CAD after percutaneous coronary interventions (PCI)., Methods: Patients with stable CAD and acute coronary syndromes (ACS), who smoked at least 10 cigarettes per day, were included 30 days post PCI and offered cytisine therapy. Adverse events, smoking activity, and drug adherence were assessed after 30 days., Results: 117 patients participated (mean standard deviation [SD] age, 60.8 [7.7] years; men, 73.6%, median and interquartile range [IQR] of the number of pack-years, 40 [30-46.5]). Overall, 79 patients consented (study group) and 38 declined (control group) to use cytisine. At the follow-up visit, the incidence of adverse events did not differ between groups (17.7% vs 21%; P = 0.67). The groups had a similar success rate of smoking cessation in the intention-to-treat analysis (41.8% vs 36.8%; P = 0.61). In the as-treated analysis, patients who completed the therapy achieved a higher success rate than those who declined (69.7% vs 36.9%; P = 0.006) or did not complete therapy (69.7% vs 34.8%; P = 0.01). In the multivariable analysis, complete cytisine therapy and ACS at admission were associated with an increased and male sex with a decreased chance of smoking cessation., Conclusions: Cytisine therapy is not associated with an increase in adverse events in patients with CAD after PCI. Cytisine is tolerable but effective in short-term follow-up only when the treatment is completed.

The risk of ischemic events gradually decreases after acute coronary syndrome (ACS), reaching a stable level after 1 month, while the risk of bleeding remains steady during the whole period of dual antiplatelet treatment (DAPT). Several de-escalation strategies of antiplatelet treatment aiming to enhance safety of DAPT without depriving it of its efficacy have been evaluated so far. We hypothesized that reduction of the ticagrelor maintenance dose 1 month after ACS and its continuation until 12 months after ACS may improve adherence to antiplatelet treatment due to better tolerability compared with the standard dose of ticagrelor. Moreover, improved safety of treatment and preserved anti-ischemic benefit may also be expected with additional acetylsalicylic acid (ASA) withdrawal. To evaluate these hypotheses, we designed the Evaluating Safety and Efficacy of Two Ticagrelor-based De-escalation Antiplatelet Strategies in Acute Coronary Syndrome - a randomized clinical trial (ELECTRA-SIRIO 2), to assess the influence of ticagrelor dose reduction with or without continuation of ASA versus DAPT with standard dose ticagrelor in reducing clinically relevant bleeding and maintaining anti-ischemic efficacy in ACS patients. The study was designed as a phase III, randomized, multicenter, double-blind, investigator-initiated clinical study with a 12-month follow-up (ClinicalTrials.gov Identifier: NCT04718025; EudraCT number: 2020-005130-15).

Background: Many patients with stable coronary artery disease (CAD) have no visual segmental wall motion abnormalities and a left ventricular (LV) ejection fraction (LVEF) ≥ 50% at rest despite significant coronary artery stenosis. Here, the aim was to determine the impact of percutaneous coronary intervention (PCI) on LV function assessed by enhanced echocardiography in patients with stable CAD with or without diabetes mellitus type 2 and a preserved LVEF., Methods: Sixty-six consecutive patients with CAD and LVEF ≥ 50%, admitted to the hospital for planned coronary angiography, were prospectively assessed. PCI was performed for coronary artery stenosis > 70%. CAD extent was assessed using SYNTAX and EXTENT scores. To assess LV function, LVEF, global longitudinal strain (GLS), and LV peak systolic myocardial velocity (S') were measured and Tei index was calculated before and 3 months after PCI., Results: Before PCI, LVEF, GLS, and Tei index were significantly worse in diabetic patients. LV functional indices improved significantly after PCI in all patients (p < 0.001). Multivariate linear regression analyses were performed to evaluate the impact of selected factors on LV function after PCI expressed as changes (D) of LVEF, GLS, S', and Tei index. LV function improvement expressed as DGLS was associated only with SYNTAX score. Higher SYNTAX scores were related to greater GLS improvement (b = 0.003, 95% confidence interval: 0.0004-0.005; p = 0.02)., Conclusions: Percutaneous coronary intervention significantly improved LV function in diabetic and non-diabetic CAD patients with preserved LVEF. Enhanced echocardiography allowed an assessment of subtle changes in LV function.

The increased risk of non-cardiovascular death in patients receiving clopidogrel or prasugrel in comparison with the placebo group in the Dual Antiplatelet Therapy (DAPT) trial in contrast to the decreased risk of cardiovascular death and all-cause death seen in patients treated with low-dose ticagrelor in the EU label population of the PEGASUS-TIMI 54 trial, resulted in inclusion in the 2020 ESC NSTE-ACS guidelines the recommendation for use of clopidogrel or prasugrel only if the patient is not eligible for treatment with ticagrelor. The prevalence of the primary outcome composed of cardiovascular death, stroke, or myocardial infarction was lower in the low-dose rivaroxaban and acetylsalicylic acid (ASA) group than in the ASA-alone group in the COMPASS trial. Moreover, all-cause mortality and cardiovascular mortality rates were lower in the rivaroxaban-plus-ASA group. Comparison of the PEGASUS-TIMI 54 and COMPASS trial patient characteristics clearly shows that each of these treatment strategies should be addressed at different groups of patients. A greater benefit in post-acute coronary syndrome (ACS) patients with a high risk of ischemic events and without high bleeding risk may be expected with ASA and ticagrelor 60 mg b.i.d. when the therapy is continued without interruption or with short interruption only after ACS. On the other hand, ASA and rivaroxaban 2.5 mg b.i.d. seems to be a better option when indications for dual antithrombotic therapy (DATT) appear after a longer time from ACS (more than 2 years) and/or from cessation of DAPT (more than 1 year) and in patients with multiple vascular bed atherosclerosis. Thus, both options of DATTs complement each other rather than compete, as can be presumed from the recommendations. However, a direct comparison between these strategies should be tested in future clinical trials.

Background: Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA)., Aim: To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA., Methods: An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY)., Results: Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon, results indicated that ticagrelor was the more cost-effective option compared to generic clopidogrel, with an incremental cost per LYG estimated at 21,566 PLN and an incremental costper QALY estimated at 24,965 PLN., Conclusions: In a lifetime horizon, which should be used when comparing technologies with different impacts on mortality, cost-effectiveness evaluation resulted in more favourable economic outcomes for ticagrelor than for generic clopidogrel, with the cost per QALY well below the recommended willingness to pay threshold in Poland (24,965 PLN vs. 111,381 PLN).

Background: In patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS), the long-term risk of deathand myocardial infarction (MI) is estimated by scores based on noninvasively derived variables. Much less is known about the relation between the degree of atherosclerotic burden in the coronary tree and the long-term risk of patients with NSTE-ACS., Aim: To evaluate the accuracy of a wide spectrum of coronary angiographic and clinical data in predicting outcomes ina long-term follow-up of patients successfully treated invasively for NSTE-ACS., Methods: The study group consisted of 112 consecutive patients (age 62 ± 10 years; 76 men) treated invasively for NSTE-ACS.27 (24%) patients had a history of diabetes mellitus (DM) and 37 (33%) patients a history of MI. The coronary angiograms priorto intervention were evaluated blindly for the four angiographic scores: (1) Stenosis score derived from the assessment of thedegree of stenosis in 15 segments of the coronary tree; (2) Vessel score showing the number of main vessels stenosed > 70%; (3) Extensity score assessing the proportion of lumen length irregularity in 15 segments; and (4) Complexity score describingthe number of complex plaques. The angiographic analysis also focused on the flow, presence of thrombus and collateralsupply prior to intervention (according to TIMI) and the size of the culprit lesion vessel. The intervention was successful in 95% of cases. All patients were followed-up for 6-24 months for the occurrence of death or MI., Results: In the follow-up period, the composite end point of death or MI occurred in 20 (17%) patients. In order to indicate therisk predictors from the group of clinical and angiographic variables (age, sex, history of DM, history of MI, four angiographicscores and culprit lesion vessel characterisation), logistic regression analysis was performed. The independent angiographic predictors of composite end point (selected by forward conditional selection) were stenosis score (OR 1.13; 95% CI 1.05-1.2;p < 0.001) and size of the vessel (OR 0.08; 95% CI 0.01-0.6; p = 0.02)., Conclusions: Our preliminary data shows that attempting to add angiographic variables into the risk assessment scoring systems in order to strengthen their predictive accuracy is justified.

Background: Management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) depends on risk evaluation. The recommended approach involves the use of risk stratification tools such as TIMI and GRACE risk scores. However, these clinical scores do not include variables derived from coronary angiography which is currently performed in most patients., Aim: To evaluate the prognostic value of adding selected coronary angiographic parameters to the established TIMI and GRACE risk scores., Methods: We studied consecutive patients with NSTEMI who underwent coronary angiography. We evaluated selected vascular variables (vessel score, lesion location, percent stenosis, presence of thrombus, lesion length, vessel size, TIMI flow, lesion type according to the ACA/AHA classification, and extent score) and estimated risk using the TIMI and GRACE scores. We assessed total mortality at 30 days, 180 days, and 3 years. To determine the prognostic value of vascular variables and risk scores, we used a logit model and the Hosmer-Lemeshow test. Diagnostic utility of the models was measured by the area under receiver operating characteristic (ROC) curves. To determine usefulness of selected vascular variables as outcome predictors in addition to the GRACE and TIMI scores, we used Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) indices., Results: The study included 237 patients (mean age 65.5 years, 62% men). The TIMI and GRACE risk scores were good predictors of mortality in the evaluated periods. Among vascular variables, independent prognostic factors included the extent score which predicted mortality at 30 days (odds ratio [OR] 12.7, 95% confidence interval [CI] 1.6-99, p = 0.016), 180 days (OR 8.8, 95% CI 2.3-33.7, p = 0.002), and 3 years (OR 3.5, 95% CI 1.6-8.0, p = 0.003), and distal lesion location which predicted mortality at 180 days (OR 3.1, 95% CI 1.0-9.4). Addition of the extent score to the TIMI risk score improved the prognostic value of the latter at all time points, as confirmed by NRI and IDI indices. The GRACE risk score itself had good prognostic value which was not significantly improved by any of the evaluated vascular variables., Conclusions: The extent score added to the TIMI risk score improves the prognostic value of the latter in patients with NSTEMI. Angiographic variables should be more widely used in risk stratification models in patients with acute coronary syndromes.

Background: Shortening the time delay at the beginning of treatment in ST-segment elevation myocardial infarction (STEMI) has proven to be clinically essential. Invasive vs. thrombolytic treatment strategy is currently under investigation, particularly in terms of the time from the onset of symptoms to treatment initiation. It is likely that enrolment to trials in STEMI may paradoxically prolong the time delay to treatment if randomisation procedures are too complex., Aim: To evaluate time to the onset of reperfusion therapy (door-to-thrombolysis time - DtT) in patients randomised to trials (TT) or treated routinely with thrombolytics (Thrx)., Methods: We evaluated DtT in a group of 189 consecutive STEMI patients (TT: n = 96; Thrx: n = 93). The inclusion criteria for the analysis were identical in both groups: 1. STEMI diagnosis was given on admission. 2. Patients had no signs of heart failure. 3. Patients did not require any additional therapy prior to thrombolysis (no need for electrical cardioversion or blood pressure lowering). 4. There were no contraindications for immediate reperfusion therapy. The comparison of DtT between evaluated groups was performed. To find out the independent predictors of DtT prolongation, the impact of patients' age, gender, admission time, pre-hospital delay and trial participation has been evaluated in multivariate analysis., Results: Highly statistically longer mean value of DtT was measured in the entire TT group than in Thrx (41 ± 18 vs. 22 ± 8 min; p 〈 0.001). The difference was also significant for patients who constituted the subgroup of TT who were proposed and refused to participate in trials (37 ± 13 vs. 22 ± 8 min; p 〈 0.01). No differences in DtT were found between groups of patients enrolled to various trials. The participation in TT was found to be the strongest predictor of DtT prolongation over 30 min (OR 13.2; 95% CI 6.1-28.5; p 〈 0.001). The risk of over 30 min DtT prolongation was five times higher if patients were admitted in an early phase of the trial., Conclusions: 1. Participating in trials delays the beginning of reperfusion therapy. 2. This delay may be clinically important, particularly in patients hospitalised in a very early phase of STEMI. 3. The call for reappraisal of informed consent issues and randomisation procedures in the context of simplicity seems to be justified.

Background: Right ventricular (RV) involvement increases mortality and morbidity in inferior myocardial infarction (MI). There are sparse data on the usefulness of pulsed tissue Doppler imaging (TDI) in the diagnosis of RV dysfunction in ST segment elevation MI (STEMI) treated by primary percutaneous coronary intervention (pPCI)., Aim: To evaluate the diagnostic and prognostic significance of RV myocardial velocities compared to classical electrocardiographic RVMI diagnostic criteria in this group of patients., Methods: Consecutive patients with first, acute, inferior STEMI treated with pPCI were prospectively assessed. The RVMI was defined as an ST-segment elevation ≥ 0.1 mV in lead V4R. Echocardiography with TDI was performed after pPCI within 24 h of the onset of symptoms. Follow up including in-hospital events was performed., Results: Out of 101 patients (58 males, mean age 63.7 ± 11.1 years), RVMI was found in 37 (37%). In multivariate analysis, peak systolic RV velocity (SmRV) (OR 5.12), peak early diastolic RV velocity (EmRV) (OR 5.03) and RV wall motion abnormalities (OR 4.94) were independent parameters for RVMI diagnosis. Receiver operating characteristics revealed high diagnostic significance of SmRV (C statistics = 0.90) and EmRV (C statistics = 0.89). The SmRV < 12 cm/s as a cut-off for a diagnosis of RVMI had a 89% sensitivity and a 83% specificity, whereas EmRV < 10 cm/s - 81% and 80%, respectively. Multivariate analysis showed that two variables - SmRV and ST-segment elevation ≥ 0.1 mV in lead V4R, were independent predictors of in-hospital prognosis., Conclusions: Right ventricular myocardial velocities derived from TDI predict ECG diagnosis of RVMI with relatively high sensitivity and specificity. Their high negative predictive value may be of practical importance when ECG tracings are equivocal. More importantly, decreased RV systolic myocardial Doppler velocity predicts unfavourable clinical outcomes in patients with inferior STEMI independently of ECG changes.

Background: Thrombin injection is a widely accepted treatment of an iatrogenic arterial pseudoaneurysm. However, the optimal mode of injection and type of pseudoaneurysm amenable to this therapy have yet been established., Aim: To compare efficacy and safety of two approaches to ultrasound-guided thrombin injections into a femoral artery pseudoaneurysm with or without long neck that developed as an iatrogenic complication of cardiac catheterisation., Methods: Patients were randomised to thrombin administration in a bolus or slow injection. The length and width of aneurysm neck and blood flow velocity in the neck were measured with color Doppler ultrasonography before the closure procedure. Thrombin dose, time to thrombotic occlusion, blood oxygen saturation in a toe of the extremity with the pseudoaneurysm (a marker of silent microembolisation), and clinical signs of distal embolisation were recorded. Between 2006 and 2009, 73 consecutive patients (33 males; mean age 67.8 ± 11.9 years) with femoral pseudoaneurysms complicating cardiac catheterisation were randomised into two groups that were treated with thrombin bolus (n = 40) or slow injection (n = 33)., Results: The efficacy of aneurysm closure with either method was similarly high (100% vs 96.8%, NS, respectively) and did not depend on the length and width of the aneurysm neck. Independent risk factors for distal embolisation were: thrombin dose (OR 4.2; 95% CI 0.92-19.3), the length of aneurysm neck (OR 4.66; 95% CI 1.1-19.9), age above 80 years (OR 10.9; 95% CI 1.0-116.8), and bolus treatment (OR 7.6; 95% CI 1.3-44.9). We observed silent microembolisation phenomenon that was common (occurring in 38% of patients in the bolus group vs 33% of patients in the slow injection group) but in most cases asymptomatic., Conclusions: Femoral pseudoaneurysm closure with a low dose of thrombin is a valid and beneficial treatment. Either method (bolus or slow injection) was similarly efficacious and safe even in the subgroup of patients with neckless aneurysms. We observed and confirmed silent microembolisation phenomenon during thrombin injections.

Background: Increase of troponin (cTn) is a marker of myocardial injury caused by different mechanisms. Exercise testing (ExT) is a useful clinical tool in predicting the risk of myocardial ischemia, especially in patients with multivessel coronary artery disease (CAD), who are more often endangered by medical complications. The test is however limited by its low sensitivity and specificity., Aim: To evaluate the reasons for troponin I (cTnI) release after ExT, and to determine its clinical and prognostic implications in patients with stable CAD, referred for elective coronary angiography (ANG)., Methods: 118 patients without signs of systolic heart failure, referred for planned coronary ANG were included in the analysis. After baseline measurements of NT-proBNP, hsCRP, cTnI, CK-MB levels, maximal ExT was performed, followed by the consecutive measurements of cTnI and CK-MB 12 and 24 hours after examination. All patients underwent coronary ANG and ECHO within 7 days of taking blood samples. All patients were followed up on average for 35.5 months., Results: The cTnI elevation > or = 0.14 ng/mL (> or = 99th percentile value of the reference group) after 24 hours of the ExT was observed in 11 (9%) patients. Predictors of cTnI release in patients after ExT were as follows: ejection fraction < or = 50%, lack or insufficient physical activity, max systolic blood pressure > 160 mm Hg at peak of ExT (OR 6.6, 95% CI 1.2-35.4, p = 0.027; OR 5.5, 95% CI 1.1-28.8, p = 0.04; OR 6.3, 95% CI 1.3-31.6, p = 0.025, respectively). Increase of cTnI after ExT did not correlate with multivessel CAD nor with future adverse clinical events., Conclusions: The cTnI release post ExT is more frequently observed in patients with stable CAD with ejection fraction < or = 50%, low physical activity, and max systolic blood pressure > 160 mm Hg at peak ExT. Post ExT cTnI increase in patients with stable CAD did not correlate with the number of atherosclerotic coronary vessels, and had no prognostic implications. Increase of cTnI after ExT did not have any predictive value in respect to acute coronary syndrome and/or death during long-term follow up.