Search

Background: Data on the clinical significance of iron deficiency (ID) in patients with myocardial infarction (MI) are conflicting. This may be related to the use of various ID criteria. We aimed to compare the association of different ID criteria with all-cause mortality after MI., Methods: Consecutive patients hospitalized for their first MI at a large tertiary heart center were included. We evaluated the association of different iron metabolism parameters measured on the first day after hospital admission with all-cause mortality., Results: From the 1,156 patients included (aged 64±12 years, 25 % women), 194 (16.8 %) patients died during the median follow-up of 3.4 years. After multivariate adjustment, iron level ≤13 µmol/L (HR 1.67, 95 % CI 1.19-2.34) and the combination of iron level ≤12.8 µmol/L and soluble transferrin receptor (sTfR) ≥3 mg/L (HR 2.56, 95 % CI 1.64-3.99) termed as PragueID criteria were associated with increased mortality risk and had additional predictive value to the GRACE score. Compared to the model including iron level, the addition of sTfR improved risk stratification (net reclassification improvement 0.61, 95 % CI 0.52-0.69) by reclassifying patients into a higher-risk group. No association between ferritin level and mortality was found. 51 % of patients had low iron levels, and 58 % fulfilled the PragueID criteria., Conclusion: Iron deficiency is common among patients with the first MI. The PragueID criteria based on iron and soluble transferrin receptor levels provide the best prediction of mortality and should be evaluated in future interventional studies for the identification of patients potentially benefiting from intravenous iron therapy., Competing Interests: Declartion of competing interest Dr. Jenča has received consulting fees from Swixx Biopharma. The remaining authors have nothing to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The quality of life (QoL) is now recognised as a central indicator of the effectiveness of interventions especially in patients after myocardial infarction (MI). The QoL may be important predict poor outcomes in cardiac patients.The present work aims to increase knowledge of the level of QoL in patients after MI. Moreover, the paper analyses the QoL in relation to sociodemographic factors and the degree of functioning in chronic disease. The study was conducted among 231 patients who were hospitalized due to MI within the period of June 2021 to June 2022 in the Hospital in Racibórz in Poland. The WHO Quality of Life Questionnaire and the Chronic Disease Functioning Scale were used. The analysis showed a statistically significant correlation (coefficient value 0.5 <|r/rho|≤ 0.7) between general functioning in chronic disease and the average QoL (rho = 0.56; p < 0.001)and somatic QoL levels(rho = 0.52; p < 0.001), as well as a moderately strong positive correlation with the QoL level on the psychological domain (rho = 0.50; p < 0.001), social domain(rho = 0.48; p < 0.001) and environmental domain (rho = 0.43; p < 0.001). The results of this study suggested that healthcare workers adopts appropriate policies for the implementation of quality of life, which can reduce the number of repetitive referrals to the hospital and costs imposed on the health system., (© 2024. The Author(s).)

Background: The difference between serum sodium and chloride ion concentrations (SCD) may be considered as a surrogate of a strong ion difference and may help to identify patients with a worse prognosis. We aimed to assess SCD as an early prognostic marker among patients with myocardial infarction., Methods: Data of 594 consecutive patients with acute myocardial infarction treated with PCI (44.9% STEMI patients; 70.7% males) was analysed for SCD in relation to their 30-day mortality. A restricted cubic spline regression model was used to study the relationship between mortality and SCD. Cox regression models were used to assess the association between SCD and the mortality risk., Results: Patients with Killip class ≥3 had lower SCD values in comparison to patients with Killip class ≤2: (32.0 [30.0-34.0] vs. 33.0 [31.0-36.0], p = .006). The overall 30-day mortality was 7.7% (n = 46). There was a significant difference in SCD values between survivors and non-survivors groups of patients (median (IQR): (33.0 [31.0-36.0] vs. 31.5 [28.0-34.0] (mmol/L), p = .002). The restricted cubic splines model confirmed a non-linear association between SCD and mortality. Patients with SCD <30 mmol/L (in comparison to SCD ≥30 mmol/L) had an increased mortality risk (unadjusted HR 2.92, 95% CI 1.59-5.36, p = .001; and an adjusted HR 2.30, 95% CI 1.02-5.19, p = .04)., Conclusions: Low SCD on admission is associated with an increased risk of 30-day mortality in patients with acute myocardial infarction treated with PCI and may serve as a useful prognostic marker for these patients., (© 2024 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

This article presents an overview of existing approaches to perform vectorcardiographic (VCG) diagnostics of ischemic heart disease (IHD). Individual methodologies are divided into categories to create a comprehensive and clear overview of electrical cardiac activity measurement, signal pre-processing, features extraction and classification procedures. An emphasis is placed on methods describing the electrical heart space (EHS) by several features extraction techniques based on spatiotemporal characteristics or signal modelling and signal transformations. Performance of individual methodologies are compared depending on classification of extent of ischemia, acute forms - myocardial infarction (MI) and myocardial scars localization. Based on a comparison of imaging methods, the advantages of VCG over the standard 12-leads ECG such as providing a 3D orthogonal leads imaging, better performance, and appropriate computer processing are highlighted. The issues of electrical cardiac activity measurements on body surface, the lack of VKG databases supported by a more accurate imaging method, possibility of comparison with the physiology of individual cases are outlined as potential reserves for future research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Heart failure is a common complication after myocardial infarction (MI) and is associated with increased mortality. Whether remote heart failure symptoms assessment after MI can improve risk stratification is unknown. The authors evaluated the association of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) with all-cause mortality after MI., Methods and Results: Prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart center between June 2017 and September 2022 were used. Patients remotely completed the KCCQ 1 month after discharge. A total of 1135 (aged 64±12 years, 26.7% women) of 1721 eligible patients completed the KCCQ. Ranges of KCCQ scores revealed that 30 (2.6%), 114 (10.0%), 274 (24.1%), and 717 (63.2%) had scores <25, 25 to 49, 50 to 74, and ≥75, respectively. During a mean follow-up of 46 months (interquartile range, 29-61), 146 (12.9%) died. In a fully adjusted analysis, KCCQ scores <50 were independently associated with mortality (hazard ratio [HR], 6.05 for KCCQ <25, HR, 2.66 for KCCQ 25-49 versus KCCQ ≥50; both P <0.001). Adding the 30-day KCCQ to clinical risk factors improved risk stratification: change in area under the curve of 2.6 (95% CI, 0.3-5.0), Brier score of -0.6 (95% CI, -1.0 to -0.2), and net reclassification improvement of 0.71 (95% CI, 0.45-1.04). KCCQ items most strongly associated with mortality were walking impairment, leg swelling, and change in symptoms., Conclusions: Remote evaluation of heart failure symptoms using the KCCQ among patients recently discharged for MI identifies patients at risk for mortality. Whether closer follow-up and targeted therapy can reduce mortality in high-risk patients warrants further study.

Background: Mean arterial pressure (MAP) can be used to evaluate macro-circulatory perfusion while serum lactate concentration is a marker of tissue perfusion. It is important to note that the primary objective of initial medical interventions is to restore microcirculatory perfusion rather than focusing solely on macro-hemodynamics., Aims: We aimed to investigate the prognostic value of the combination of MAP and serum lactate levels measured on admission to the hospital in relation to patients' 30-day survival rate in patients with acute myocardial infarction (MI)., Methods: Data from 532 consecutive patients with acute MI treated with percutaneous coronary intervention were analyzed. The study endpoint was 30-day all-cause mortality., Results: We found that both MAP and lactate levels were relevant predictors of the 30-day mortality in multivariable Cox regression analysis (HR, 0.83; 95% CI, 0.71-0.97; P = 0.02 and HR, 1.16; 95% CI, 1.06-1.16; P = 0.01, respectively). There was a significant increase in the prognostic performance in relation to 30-day mortality for the combination of both MAP and lactate levels in comparison to MAP alone (P = 0.03 for comparison between areas under the curve). Conversely, the combination of MAP and lactates did not add a significant prognostic value in comparison to lactates alone (P = 0.53 for comparison between areas under the curve)., Conclusions: In patients with acute MI, serum lactate level seems to have a higher prognostic value in comparison to MAP. Our data suggest that on initial assessment of patients with acute myocardial infarction, we should move toward a tissue perfusion-based approach instead of focusing on a blood pressure-oriented strategy alone.

Objective: Women have a higher comorbidity burden and a lower survival rate after acute myocardial infarction (AMI) than men. This analysis aimed to investigate the impact of sex on the effect of treatment with the sodium glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin immediately after an AMI., Methods: Participants were randomized to either empagliflozin or placebo and followed for 26 weeks after initiating the treatment no later than 72 hours after a percutaneous coronary intervention following an AMI. We analyzed the impact of sex on the beneficial effects of empagliflozin observed for heart failure biomarkers as well as structural and functional cardiac parameters., Results: Women had higher NT-proBNP levels at baseline (median 2117pg/mL, IQR 1383-3267 pg/mL versus 1137 pg/mL, IQR 695-2050 pg/mL; p < 0.001) and were older than men (median 61y, IQR 56-65y versus 56y, IQR 51-64y, p = 0.005). The beneficial effects of empagliflozin on NT-proBNP levels (P interaction  = 0.984), left ventricular ejection fraction (P interaction  = 0.812), left ventricular end systolic volume (P interaction  = 0.183), or left ventricular end diastolic volume (P interaction  = 0.676) were independent of sex., Conclusions: Empagliflozin exhibited similar benefits in women and men when administered immediately after an AMI., Competing Interests: Declaration of competing interest H.S. is on the advisory board and speaker's bureau of Boehringer Ingelheim, NovoNordisk, Sanofi-Aventis, Amgen, AstraZeneca, Bayer, Eli Lilly, Kapsch, MSD, and Daiichi Sankyo. DvL is on the advisory board and speaker's bureau of Boehringer Ingelheim, Novartis, Sanova, Sanofi, Orion, AstraZeneca, Bayer Recardio, Vaxxinity, and Daiichi Sankyo. FA reports no conflict of interest related to this study., (Copyright © 2023 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.)

Background: Stress hyperglycemia and lactates have been used separately as markers of a severe clinical condition and poor outcomes in patients with myocardial infarction (MI). However, the interplay between glucose and lactate metabolism in patients with MI have not been sufficiently studied. The aim in the present study was to examine the relationship of glycemia on admission (AG) and lactate levels and their impact on the outcome in non-diabetic MI patients treated with percutaneous coronary intervention (PCI)., Methods: A total of 405 consecutive, non-diabetic, MI patients were enrolled in this retrospective, observational, single-center study. Clinical characteristic including glucose and lactate levels on admission and at 30-day mortality were assessed., Results: Patients with stress hyperglycemia (AG ≥ 7.8 mmol/L, n = 103) had higher GRACE score (median [interquartile range]: 143.4 (115.4-178.9) vs. 129.4 (105.7-154.5), p = 0.002) than normoglycemic patients (AG level < 7.8 mmol/L, n = 302). A positive correlation of AG with lactate level (R = 0.520, p < 0.001) was observed. The coexistence of both hyperglycemia and hyperlactatemia (lactate level ≥ 2.0 mmol/L) was associated with lower survival rate in the Kaplan-Meier estimates (p < 0.001). In multivariable analysis both hyperglycemia and hyperlactatemia were related to a higher risk of death at 30-day follow-up (hazard ratio [HR] 3.21, 95%, confidence interval [CI] 1.04-9.93; p = 0.043 and HR 7.08; 95% CI 1.44-34.93; p = 0.016, respectively) CONCLUSIONS: There is a relationship between hyperglycemia and hyperlactatemia in non-diabetic MI patients treated with PCI. The coexistence of both hyperglycemia and hyperlactatemia is associated with lower survival rate and are independent predictors of 30-day mortality in MI patients and these markers should be evaluated simultaneously.

Objectives: To assess dietary supplements, functional foods and nutraceuticals use among the patients after myocardial infarction (MI)., Material and Methods: The authors prospectively enrolled 100 consecutive patients hospitalized due to MI and remaining under coordinated outpatient care after MI in the authors' cardiology department., Results: The authors showed that patients within median (interquartile range) 12.30 (10.18-14.57) months after MI use dietary supplements, nutraceuticals and functional foods in their everyday diet. Vitamins (53% patients), especially vitamin D (35%), were the most frequently used dietary supplements. In contrary to common usage of dietary supplements (59%), smaller proportion of patients use functional foods (21%) and nutraceuticals (5%), especially phytosterols. The authors found that the use of over-the-counter (OTC) drugs and dietary supplements is associated with age (participants <60 years old vs. participants ≥60 years old: OTC drugs: N = 8 [20.0%] vs. N = 32 [53.3%], p < 0.001; herbals: N = 3 [7.5%] vs. N = 16 [26.7%], p = 0.019), sex of the patients following MI (females vs. males: vitamins: N = 17 [70.8%] vs. N = 36 [47,4%], p = 0.045; vitamin D: N = 13 [54.2%] vs. N = 22 [28.9%], p = 0.024; omega-3 fatty acids: N = 3 [12.5%] vs. N = 1 [1.3%], p = 0.042; herbals: N = 8 [33.3%] vs. N = 11[14.5%], p = 0.040), as well as the BMI of the participants (BMI < 24.9 vs. BMI ≥ 25.0: multivitamin/ multimineral dietary supplements: N = 3 [15.0%] vs. N = 31 [42.5%], p = 0.035; vitamin B 6 : N = 1 [5.0%] vs. N = 21 [28.8%], p = 0.035). In the study group all participants with the age above retirement age have already withdrawn from professional activity and they more often used OTC drugs (N = 14 [25.9%] before retirement age vs. N = 26 [56.5%] above retirement age, p = 0.002)., Conclusions: The patients following MI use supplements, functional foods and nutraceuticals. Their use depends on sex, age, BMI and professional activity. The authors believe that their potential beneficial effects require further evaluation in clinical longitudinal studies. Int J Occup Med Environ Health. 2023;36(6):732-43., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 332,109 patients underwent cardiac surgery in 37 centers; 4852 (1.5%) patients presented with CS. Of those 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Median follow-up was 4.6 years (max.10.0), mean age was 62 (± 15) years and 68% patients were men. Thirty-day mortality was 36% (1728 patients). The origin of CS included acute myocardial infarction (1751 patients, 36%), acute aortic dissection (1075 patients, 22%) and valvular dysfunction (610 patients, 13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06-1.34; P = 0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00-1.40; P = 0.045). Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion or more aggressive perioperative circulatory support should be addressed in the future., (© 2023. The Author(s).)

Introduction: SARS‑CoV‑2 infection is associated with an increased risk of thromboembolic complications. Thromboembolism is one of the possible causes of myocardial infarction with nonobstructive coronary arteries (MINOCA)., Objectives: We aimed to compare the characteristics and 12‑month clinical outcomes of patients with MINOCA treated before and during the COVID‑19 pandemic., Patients and Methods: We retrospectively analyzed data of 51 734 patients with acute myocardial infarction registered in the nationwide Polish Registry of Acute Coronary Syndromes database in 2019 and 2020. The final study group included 3178 patients with MINOCA. We compared the baseline characteristics, management strategies, and 12‑month clinical outcomes of the MINOCA patients treated before (2019) and during the COVID‑19 pandemic (2020)., Results: The rate of MINOCA was higher in 2019 than in 2020 (6.3% vs 5.9%; P = 0.03). The only difference between the groups was a higher hypercholesterolemia rate before the pandemic (33.9% vs 28.2%; P <0.001). In‑hospital stroke was observed more frequently during the pandemic (0% vs 0.3%; P = 0.01), whereas other in‑hospital complications were similar between the groups. Most patients were discharged on aspirin (85.6%), a β‑blocker (73.1%), an angiotensin‑converting enzyme inhibitor / angiotensin receptor blocker (70.2%), and a statin (62.7%), but only 50.6% of the participants received a P2Y12 inhibitor. There was no difference in 12‑month all‑cause mortality between the patients with MINOCA treated before and during the pandemic (9.2% vs 11%; P = 0.09)., Conclusions: We observed a lower percentage of MINOCA cases and higher in‑hospital stroke rates in the MINOCA patients treated during the COVID‑19 pandemic (2020). The possible association between worse clinical outcomes of the MINOCA patients treated during the pandemic and the increased risk for thromboembolic complications of SARS‑CoV‑2 infection needs further evaluation.

Background The hypocretin/orexin system has been shown to play a role in heart failure. Whether it also influences myocardial infarction (MI) outcomes is unknown. We evaluated the effect of the rs7767652 minor allele T associated with decreased transcription of the hypocretin/orexin receptor-2 and circulating orexin A concentrations on mortality risk after MI. Methods and Results Data from a single-center, prospectively designed registry of consecutive patients hospitalized for MI at a large tertiary cardiology center were analyzed. Patients without previous history of MI or heart failure were included. A random population sample was used to compare allele frequencies in the general population. Out of 1009 patients (aged 64±12 years, 74.6% men) after MI, 6.1% were homozygotes (TT) and 39.4% heterozygotes (CT) for minor allele. Allele frequencies in the MI group did not differ from 1953 subjects from general population (χ 2 P =0.62). At index hospitalization, MI size was the same, but ventricular fibrillation and the need for cardiopulmonary resuscitation were more prevalent in the TT allele variant. Among patients with ejection fraction ≤40% at discharge, the TT variant was associated with a lower increase in left ventricular ejection fraction during follow-up ( P =0.03). During the 27-month follow-up, there was a statistically significant association of the TT variant with increased mortality risk (hazard ratio [HR], 2.83; P =0.001). Higher circulating orexin A was associated with a lower mortality risk (HR, 0.41; P <0.05). Conclusions Attenuation of hypocretin/orexin signaling is associated with increased mortality risk after MI. This effect may be partially explained by the increased arrhythmic risk and the effect on the left ventricular systolic function recovery.

Background: Preclinical data suggest that central renin-angiotensin system blockade by the brain aminopeptidase-A inhibitor firibastat can improve left ventricular ejection fraction (LVEF) after myocardial infarction (MI)., Objectives: This study aimed to compare the effect of firibastat versus ramipril on post-MI LVEF., Methods: In this phase 2, randomized, double-blind trial, patients selected within 24 h of first acute anterior MI treated by primary percutaneous coronary intervention were randomly assigned (1:1:1) to firibastat 100 mg, firibastat 500 mg or ramipril 5 mg, each twice daily for 12 weeks. The primary endpoint was change in LVEF on cardiac magnetic resonance imaging (cMRI) from baseline to day 84 in the modified intent-to-treat (mITT) population (at least one dose received and one follow-up cMRI available) for each treatment group., Results: From June 4, 2019 to April 12, 2021, 294 patients were randomized and 229 were evaluable for the mITT analysis. After 12 weeks, mean ± standard deviation (SD) percent change in LVEF was 5.6 ± 1.2 with firibastat 100 mg, 5.3 ± 1.1 with firibastat 500 mg and 5.7 ± 1.1 with ramipril. The absolute ± SE adjusted difference in LVEF change from baseline between firibastat 500 mg and ramipril was - 0.36 ± 1.32% (p = 0.79). Occurrence of treatment-related adverse events was similar in the three groups., Conclusions: Firibastat was not superior to ramipril for prevention of left ventricular dysfunction after first acute anterior MI, and their safety profiles were similar., Registration: ClinicalTrials.gov identifier NCT03715998., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Discharge after myocardial infarction (MI) reduces the risk of repeated myocardial infarction and stroke and has a positive effect on the patient’s prognosis. An important element of preparation is the assessment of the patient’s readiness for discharge from hospital. This study aimed to evaluate the associations between a patient’s readiness for hospital discharge after MI, their functioning in the chronic illness, and socio-demographic and clinical variables. Methods: This was a cross-sectional, single-center study. The study was conducted among 242 patients who were hospitalized for myocardial infarction after percutaneous coronary intervention (PCI). The Readiness for Hospital Discharge After Myocardial Infarction Scale (RHD-MIS) and the Functioning in Chronic Illness Scale (FCIS) were used. Results: No statistically significant differences were found between socio-demographic and clinical factors and the overall result of the RHD-MIS (p >0.05).There is a positive correlation between hospital discharge readiness and functioning in chronic disease in patients after MI (r = 0.20; p < 0.001). The higher the level of subjective knowledge, the better the functioning in chronic disease (rho = 0.16; p < 0.05), the greater the increase in the sense of influence on the course of the disease (rho = 0.17; p < 0.05) and the greater the decrease in the impact of the disease on the patient’s attitude (rho = 0.23, p < 0.05). Conclusions: The higher the readiness for discharge from hospital, the better the patient’s functioning in the disease and the lower the impact of the disease on the patient.

The prevalence of atrial fibrillation (AF) in acute coronary syndrome (ACS) patients is increasing. Data on outcomes of anticoagulation in ACS patients with AF are lacking., The aim of our study was to investigate the prevalence of stroke, myocardial infarction, bleeding complications, and all-cause mortality in this population., PL-ACS and AMI-PL registries gather an all-comer population of ACS patients in Poland, exceeding half a million records. We have selected ACS survivors with concomitant AF on admission, divided them into subgroups with regard to the administered anticoagulation, and followed up with them for a 12-month period ( n  = 13,973). Subsequently, groups were propensity score matched for age, sex, ejection fraction, diabetes, heart failure, renal impairment, and type of ACS., The study population was divided with regard to the administration of anticoagulation. Anticoagulation was prescribed in 2,466 patients (17.6%). The (D)OAC+ patients were younger; however, comorbidities were more prevalent in this group. The 12-month follow-up showed that the (D)OAC+ patients had significantly lower rates of all-cause mortality, myocardial infarction, and ischemic stroke, with no significant increase in bleeding events. After matching, the study groups consisted of 2,194 patients each and showed no differences in baseline characteristics. The outcomes of the 12-month observation were similar to the findings before matching., This all-comer national registry analysis shows that the use of guideline-recommended therapy and anticoagulation in ACS survivors with AF is associated with a lower rate of all-cause mortality, recurrent myocardial infarction, and ischemic stroke., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Despite significant advances in interventional cardiology and mechanical circulatory support (MCS) techniques, outcomes for patients with myocardial infarction (MI) complicated by cardiogenic shock (CS) remain suboptimal. This expert consensus aims to provide information on the current management of patients with MI complicated by CS in Poland and to propose solutions, including systemic ones, for all stages of care. The document uses data from the Polish PL-ACS Registry of Acute Coronary Syndromes, which includes records of more than 820 000 hospital admissions. We describe the role of medical rescue teams, highlighting the necessity to expand their range of competencies at the level of prehospital care. We emphasize the importance of treating the underlying cause of CS and direct patient transfer to centers capable of performing percutaneous coronary interventions. We present current recommendations of scientific societies on MCS use. We underline the role of the Cardiac Shock Team in the management of patients with MI complicated by CS. Such teams should comprise an interventional cardiologist, a cardiothoracic surgeon, and an intensive care physician. Patients should be transferred to highly specialized CS centers, following the example of so-called Cardiac Shock Care Centers described in some other countries. We propose criteria for the operation of such centers Other important aspects discussed in the document include the role of rehabilitation, multidisciplinary care, and long-term follow-up of treatment outcomes. The document was developed in cooperation with experts from different scientific societies in Poland, which illustrates the importance of interdisciplinary care in this patient population.

Cardiovascular diseases account for 43% of deaths in Poland. The COVID-19 pandemic increased the number of cardiovascular deaths by as much as 16.7%. Lipid metabolism disorders are observed in about 20 million Poles. Lipid disorders are usually asymptomatic, they cause a significant increase in the risk of cardiovascular diseases. Up to 20% of patients who experience an acute coronary syndrome (ACS) may experience a recurrence of a cardiovascular event within a year, and up to 40% of these patients may be re-hospitalized. Within 5 years after a myocardial infarction, 18% of patients suffer a second ACS and 13% have got a stroke. Lipid-lowering therapy is an extremely important element of comprehensive management, both in primary and secondary prevention, and its main goal is to prevent or extend the time to the onset of heart or vascular disease and reduce the risk of cardiovascular events. A patient with a history of ACS belongs to the group of a very high risk of a cardiovascular event due to atherosclerosis. In this group of patients, low-density lipoprotein cholesterol levels should be aimed below 55 mg/dl (1.4 mmol/l). Many scientific guidelines define the extreme risk group, which includes not only patients with two cardiovascular events within two years, but also patients with a history of ACS and additional clinical factors: peripheral vascular disease, multivessel disease (multilevel atherosclerosis), or multivessel coronary disease, or familial hypercholesterolemia, or diabetes with at least one additional risk factor: elevated Lp(a) >50 mg/dl or hsCRP >3 mg/l, or chronic kidney disease (eGFR <60 ml/min/1.73 m²). In this group of patients, the LDL-C level should be aimed at below 40 mg/dl (1.0 mmol/l). Achieving therapeutic goals in patients after ACS should occur as soon as possible. For this purpose, a high-dose potent statin should be added to the therapy at the time of diagnosis, and ezetimibe should be added if the goal is not achieved after 4-6 weeks. Combination therapy may be considered in selected patients from the beginning. After 4-6 weeks of combination therapy, if the goal is still not achieved, adding a proprotein convertase subtilisin/kexin type 9 protein inhibitor or inclisiran should be considered. In order to increase compliance with the recommendations, Polish Cardiac Society and Polish Lipid Society propose to attach in the patient's discharge letter a statement clearly specifying what drugs should be used and what LDL-C values should be achieved. It is necessary to cooperate between the patient and the doctor, to follow the recommendations and take medicines regularly, to achieve and maintain therapeutic goals.

Aims: Recent advances in therapy led to a significant decrease in mortality and morbidity after myocardial infarction (MI). However, little is known about quality of life (QoL) after MI. We examined heart failure (HF)-related quality-of-life (QoL) impairment, its trajectories, and determinants after MI., Methods: Data from a single-center prospectively designed registry of consecutive patients hospitalized for MI at a large tertiary cardiology center were utilized. At 1 month and 1 year after hospital discharge, patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ)., Results: In total, 850 patients (aged 65 ± 12 years, 27% female) hospitalized between June 2017 and October 2020 completed KCCQ at 1 month after discharge. Of these, 38.7% showed HF-related QoL impairment (KCCQ ≤ 75). In addition to characteristics of MI (MI size, diuretics need, heart rate), comorbidities as renal dysfunction and anemia were associated with QoL impairment. Of the 673 eligible, 500 patients (74.3%) completed KCCQ at 1 year after MI. On average, QoL improved by 5.9 ± 16.8 points during the first year after MI (p < 0.001); but, in 18% of patients QoL worsened. Diabetes control and hemoglobin level at the time of hospitalization were associated with QoL worsening., Conclusion: Two out of 5 patients after MI present with HF-related QoL impairment. In addition to guideline-directed MI management, careful attention to key non-cardiac comorbidities as chronic kidney disease, anemia and diabetes may lead to further augmentation of the benefit of modern therapies in terms of QoL., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

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.

Introduction: Peripheral venous blood sample may be used to obtain acid‑ base balance parameters (PVA‑BP) measured in rapid point‑of‑care test (POCT) analyzers on admission to an emergency department (ED). Thus, lactates, anion gap (AG), and base excess (BE) may be early prognostic markers in patients with myocardial infarction (MI)., Objectives: We aimed to confirm the relationship between PVA‑BP on admission and the outcome in patients with MI treated with percutaneous coronary intervention (PCI)., Patients and Methods: This was a retrospective, observational analysis of MI patients admitted primarily to an ED and secondly transferred to PCI department., Results: A total of 336 patients (41.1% ST‑elevated MI, 58.9% non-ST‑elevated MI) were divided according to their lactate level, that is, G1 group with lactate below or equal to 2.0 mmol/l (n = 207) and G2 group with lactate above >2.0 mmol/l (n = 129). G2 patients had higher values of AG (mean, [SD], 9.6 [4.3] vs 6.8 [3.2] mEq/l; P <0.001) and lower BE (median [interquartile range], -0.7 [-3.9 to 0.8] vs 1.0 [-0.2 to 2.4] mEq/l; P <0.001). In‑hospital nonsurvivors had higher values of lactates (4.0 [2.0-8.7] vs 1.7 [1.3-2.4] mmol/l; P <0.001), AG (10.5 [4.6] vs 7.7 [3.8] mEq/l; P <0.001), and lower BE (-4.8 [-10.6 to -1.8] vs 1.5 [-0.8 to 2.3] mEq/l; P <0.001) than the survivors. Lactates, AG, and BE correlated with Global Registry of Acute Coronary Events score (r = 0.361, P <0.001; r = 0.158, P = 0.004; r = -0.383, P <0.001, respectively). Only BE independently predicted both 30- and 365‑day mortality in the whole group (hazard ratio [HR], 0.79; 95% CI, 0.65-0.95; P = 0.01 and HR, 0.89; 95% CI, 0.76-0.99; P = 0.04, respectively) as well as in‑hospital mortality among patients without infarct‑related out‑of‑hospital cardiac arrest (odds ratio, 0.74; 95% CI, 0.57-0.97; P = 0.03)., Conclusions: In the patients admitted to the ED with MI treated with PCI the evaluation of PVA‑BP in POCT analyzers may be a reliable tool for early risk stratification.

Introduction: Reperfusion therapy by primary percutaneous coronary intervention (PPCI) is generally indicated in patients suffering from acute myocardial infarction (MI) with ST-segment elevation (STEMI). Prior to hospital admission, full ST-segment resolution (fSTR) may occur. Optimal management of such patients with transient STEMI (TSTEMI) is potentially challenging. Our aim was to evaluate the hypothesis that in TSTEMI patients, patency of infarct related artery (IRA) is achieved before PPCI, and to compare the outcome of TSTEMI and STEMI patients during a prolonged follow-up., Material and Methods: Three hundred consecutive adult STEMI patients were referred to catheterization laboratory. In all patients, standard 12 lead ECGs were obtained both at the time of the first medical contact, and on catheterization laboratory admission., Results: TSTEMI occurred in 20 patients (6.7%). Despite fSTR (isoelectric ST segment), occluded IRA was found in 5 of these patients (25%). Pre-PPCI TIMI flow grade 2 was found in 6 TSTEMI patients (30%). Troponin T value at 24 h after symptom onset was lower in the TSTEMI group (1.8±2.5 mg/L vs. 3.6±3.5 mg/L, P=0.008). These patients also had a lower value of brain natriuretic peptide (156.3±119.5 ng/L vs. 438.5±429.0 ng/L, P<0.001) and higher left ventricular ejection fraction (59.9±6.3% vs. 51.6±10.2%, P<0.001). All patients were followed for a median of 5.6 years during which the overall survival did not differ between the TSTEMI and STEMI groups., Conclusion: Primary PCI is strongly recommended in TSTEMI patients because of a relatively high incidence of occluded infarct related arteries. The rate of patients with TSTEMI is relatively low., Competing Interests: The authors report no conflicts of interest in this work.

Objective: Vectorcardiography (VCG) as an alternative form of ECG provides important spatial information about the electrical activity of the heart. It achieves higher sensitivity in the detection of some pathologies such as myocardial infarction, ischemia and hypertrophy. However, vectorcardiography is not commonly measured in clinical practice, and for this reason mathematical transformations have been developed to obtain derived VCG leads, which in application in current systems and subsequent analysis can contribute to early diagnosis and obtaining other useful information about the electrical activity of the heart. Methods and procedures: The most frequently used transformation methods are compared, namely the Kors regression method, the Inverse Dower transformation, QLSV and the Quasi-orthogonal transformation. These transformation methods were used on 30 randomly selected records with a diagnosis of myocardial infarction from the Physikalisch-Technische Bundesanstalt (PTB) database and their accuracy was evaluated based on the calculation of the mean square error (MSE). MSE was subjected to statistical evaluation at a significance level of 0.05. Results: Based on statistical testing using the nonparametric multiselective Kruskall-Wallis test and subsequent post-hoc analysis using the Dunn method, the Kors regression as a whole method achieved the most accurate transformation. Conclusion: The results of statistical analysis provide an evaluation of the accuracy of several transformation methods for deriving orthogonal leads, for possible application in measuring and evaluation systems, which may contribute to the correct choice of method for subsequent analysis of electrical activity of the heart at orthogonal leads to predict various diseases.

Background: Although mortality in patients with acute myocardial infarction (MI) has decreased substantially over the last few decades in many countries, MI remains a major threat to public health., Aims: To assess the number and outcomes of patients hospitalized for acute MI in Poland in 2018 as well as proportions of patients participating in cardiac rehabilitation and undergoing invasive cardiac procedures following discharge., Methods: We used public databases. We included all patients hospitalized for acute MI in Poland in 2018 and assessed event-free survival along with uptake of invasive cardiac procedures, cardiac rehabilitation, and consultations with cardiologists., Results: A total of 75868 patients (mean age, 68.8 years) were hospitalized for acute MI in Poland in 2018 (the admission rate, 197.0 per 100000 inhabitants). In-hospital mortality was 8.4%, while one-year mortality was 17.3% (one-year post-discharge mortality was 9.8%). Approximately 75% and 96% of discharged patients consulted a general practitioner, whereas 12% and 62% consulted a cardiologist, 5% and 19% underwent percutaneous coronary intervention, 0.6% and 2.9% un-derwent coronary artery bypass grafting, while 0.04% and 1.9% had an implantable cardioverter defibrillator implanted within 30 days and 365 days following discharge. The participation rate in cardiac rehabilitation within the first 14 days following discharge was 11%, within the first 30 days was 19%, and within 365 days was 35%., Conclusions: In-hospital and post-discharge mortality is still high in Poland. The access to cardiac consultations and cardiac rehabilitation following MI is insufficient. There is considerable potential for a further decrease in mortality in patients suffering from MI in Poland.

Background: Diabetes mellitus (DM) is known to contribute to unfavorable short- and long-term outcomes in patients with myocardial infarction (MI). Particularly poor outcomes are associated with left ventricular systolic dysfunction after an MI. Our study aimed to compare the short- and long-term outcomes of MI in patients with DM and varying degrees of left ventricular systolic dysfunction with the corresponding outcomes in a non-diabetic control group., Methods: This analysis focused on patients with MI registered in the Polish National Registry of Acute Coronary Syndrome between 2009 and 2011. For this analysis, diabetic patients were additionally stratified into three subgroups depending on the degree of left ventricular systolic dysfunction, as assessed during their hospitalization for MI. Subsequently, the 30-day, 12-month, and 36-month outcomes in the diabetic study subgroups were compared with those in the corresponding non- -diabetic subgroups., Results: This analysis encompassed a nationwide cohort of 58 123 patients. Twelve- and 36-months mortality was greater in diabetic patients than in non-diabetic patients. The highest 36-months mortality (46.64%) was in the group of patients with DM and reduced ejection fraction (EF) <40%. Multivariate analysis showed diabetes and low EF to be independent risk factors for 36-month mortality, increasing the risk of death by 35% for diabetes and by 30% for each 5-percentage point EF decrease. Higher mortality was observed in older patients, smokers, and patients with ischemic heart disease before the index hospitalization., Conclusions: Both diabetes and reduced EF proved to be independent risk factors for increased mortality over a long-term follow-up after MI.

Introduction: The prevalence of diabetes mellitus (DM) in patients with myocardial infarction (MI) is estimated at about 25%. Short- and long-term prognosis is worse in patients with DM and hyperglycemia compared with nondiabetics., Objectives: Our aim was to analyze the impact of DM and transient hyperglycemia on in-hospital complications and long-term outcomes in patients with MI., Patients and Methods: We evaluated a prospective cohort of 58 394 patients with MI in the Polish Registry of Acute Coronary Syndromes (PL-ACS) in terms of in-hospital complications and 30-day, 12-month, and 36-month outcomes between 2009 and 2012., Results: Patients with type 1 DM (T1DM) and type 2 DM (T2DM) underwent invasive diagnostic and therapeutic procedures less frequently than those without diabetes, transient hyperglycemia, and new-onset DM (P <⁠0.001). T2DM was associated with a significantly higher risk of MI complicated by cardiogenic shock. The rates of pulmonary edema in the transient hyperglycemia group and the DM group were 2-fold higher than in the nondiabetic group (P <⁠0.001). T1DM and T2DM were associated with a significantly higher risk of death. Unadjusted 3-year all-cause death rates in patients with T1DM, T2DM, transient hyperglycemia, new-onset diabetes and those without diabetes were 26.8%, 25.6%, 18.5%, 17.9%, and 16.2%, respectively. Hazard ratios (95% CI) adjusted for age, sex, clinical characteristics, and revascularization were 1.49 (1.12–2.00), 1.20 (1.14–1.27), 0.94 (0.67–1.31), and 0.66 (0.34–1.28), respectively., Conclusions: T1DM and T2DM are associated with elevated in-hospital and long-term mortality rates after MI. Diabetics and patients with transient hyperglycemia are more likely to develop significant in-hospital complications compared with nondiabetics. No significant differences regarding acute mechanical complications were noted between populations.

Introduction: Optimal medical therapy (OMT) is the cornerstone of treatment for stable coronary disease with the ISCHEMIA trial showing similar outcomes using OMT with or without an initial invasive approach. Objectives: To describe OMT goal attainment in Polish ISCHEMIA participants compared with other countries. Patients and methods: Among 5179 trial participants, 333 were randomized in Poland. The median follow-up was 3.2 years. OMT targets were: not smoking, high-intensity statin therapy, low-density lipoprotein cholesterol (LDL-C) of less than 70 mg/dl, systolic blood pressure of less than 140 mm Hg, aspirin therapy, and ACEI / ARB, and β-blocker therapy if indicated. Results: Compared with 36 other countries, at randomization, patients in Poland were older (67 [62–75] y vs 65 [58–71] y); P <⁠0.001), more often female (30% vs 22%; P = 0.002), with a longer history of angina (3 [1–9] y vs 1 [0–3] y; P <⁠0.001), and there were more cases of prior myocardial infarction (32% vs 18%; P <⁠0.01) and revascularization (PCI, 40% vs 19%; CABG, 11% vs 3%; P <⁠0.001 for both). The number of OMT goals attained increased from baseline to follow-up visits (5 [4–5] vs 6 [5–6]; P <⁠0.001) in Poland and other countries alike (P = 0.89 vs P = 0.14). In Poland, significant improvements were achieved regarding high-intensity statin therapy (27% vs 50%), LDL-C <⁠70 mg/dl (29% vs 65%), and systolic blood pressure of less than 140 mm Hg (63% vs 81%) (P <⁠0.001 for all), whereas not-smoking (89% vs 89%), aspirin (90% vs 88%), ACEI / ARB (93% vs 95%), and β-blocker therapy (94% vs 90%) remained high. Conclusions: With regular surveillance and contemporary medical therapy, high OMT goal attainment was achievable among the participants of the ISCHEMIA trial in Poland relative to other countries. There is still room for improvement in LDL-C and blood pressure management.

Background: Inconclusive data exist on risk associated with Lp(a) in patients after myocardial infarction (MI). Aims of the present study were to evaluate the association of Lp(a) level with total mortality and recurrent cardiovascular events., Design and Methods: Single center prospective registry of consecutive patients hospitalized for acute myocardial infarction between June 2017 and June 2020 at a large tertiary cardiac center with available blood samples drawn <24h of admission., Results: Data from 851 consecutive patients hospitalized for MI were evaluated. During the median follow-up of 19 months (interquartile range 10-27), 58 (6.8%) patients died. Nonlinear modelling revealed a U-shaped association between Lp(a) and total mortality risk. Compared to patients with Lp(a) ranging between 10-30 nmol/L and after multivariate adjustment, total mortality risk was increased both in patients with Lp(a)<7 nmol/L (hazard ratio (HR) 4.08, 95% confidence interval (CI) 1.72-9.68) and Lp(a) ≥125 nmol/L (HR 2.92, 95% CI 1.16-7.37), respectively. Similarly, the risk of combined endpoint of acute coronary syndrome recurrence or cardiovascular mortality was increased both in patients with low (sub-HR 2.60, 95% CI 1.33-5.08) and high (sub-HR 2.10, 95% CI 1.00-4.39) Lp(a). Adjustment for heart failure signs at the time of hospitalization weakened the association with total mortality and recurrent cardiovascular events., Conclusions: In the present analysis, both high and low concentrations of Lp(a) were associated with an increased risk of total mortality and recurrent cardiovascular events after MI. The excess of mortality associated with Lp(a) was partially attributable to more prevalent heart failure., (Copyright © 2021. Published by Elsevier B.V.)

According to the World Health Organization (WHO) forecasts, in 2030, the number of people suffering from dementia will reach 82 million people worldwide, representing a huge burden on health and social care systems. Epidemiological data indicates a relationship between coronary heart disease (CHD) and the occurrence of cognitive impairment (CI) and dementia. It is known that both diseases have common risk factors. However, the impact of myocardial infarction (MI) on cognitive function remains controversial and largely unknown. The main goal of this study is to attempt to summarize and discuss selected scientific reports on the causes, mechanisms and effects of CI in patients after acute coronary syndrome (ACS), especially after MI. The risk of CI can increase in patients after ACS, and can therefore also adversely affect the further course of treatment. A late diagnosis of CI can lead to serious clinical implications, such as an increase in the number of hospitalizations and mortality., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2021 The Author(s).)

Background: Mortality following discharge in myocardial infarction survivors remains high. Therefore, we compared outcomes in myocardial infarction survivors participating and not participating in a novel, nationwide managed care program for myocardial infarction survivors in Poland., Methods: We used public databases. We included all patients hospitalized due to acute myocardial infarction in Poland between October 1, 2017 and December 31, 2018. We excluded from the analysis all patients aged <18 years as well as those who died during hospitalization or within 10 days following discharge from hospital. All patients were prospectively followed. The primary end point was defined as death from any cause., Results: The mean follow-up was 324.8±140.5 days (78 034.1 patient-years; 340.0±131.7 days in those who did not die during the observation). Participation in the managed care program was related to higher odds ratio of participating in cardiac rehabilitation (4.67 [95% CI, 4.44-4.88]), consultation with a cardiologist (7.32 [6.83-7.84]), implantable cardioverter-defibrillator (1.40 [1.22-1.61]), and cardiac resynchronization therapy with cardioverter-defibrillator implantation (1.57 [1.22-2.03]) but lower odds of emergency (0.88 [0.79-0.98]) and nonemergency percutaneous coronary intervention (0.88 [0.83-0.93]) and coronary artery bypass grafting (0.82 [0.71-0.94]) during the follow-up. One-year all-cause mortality was 4.4% among the program participants and 6.0% in matched nonparticipants. The end point consisting of all-cause death, myocardial infarction, or stroke occurred in 10.6% and 12.0% ( P <0.01) of participants and nonparticipants respectively, whereas all-cause death or hospitalization for cardiovascular reasons in 42.2% and 47.9% ( P <0.001) among participants and nonparticipants, respectively. The difference in outcomes between patients participating and not participating in the managed care program could be explained by improved access to cardiac rehabilitation, cardiac care, and cardiac procedures., Conclusions: Managed care following myocardial infarction may be related to improved prognosis as it may facilitate access to cardiac rehabilitation and may provide a higher standard of outpatient cardiac care.

Aims: Present society is constantly ageing and elderly frequently suffer from conditions that are difficult and/or costly to treat if detected late. Effective screening of the elderly is therefore needed so that those requiring detailed clinical work-up are identified early. We present a prospective validation of a screening strategy based on a Polyscore of seven predominantly autonomic, non-invasive risk markers., Methods and Results: Within a population-based survey in Germany (INVADE study), participants aged ≥60 years were enrolled between August 2013 and February 2015. Seven prospectively defined Polyscore components were obtained during 30-min continuous recordings of electrocardiogram, blood pressure, and respiration. Out of 1956 subjects, 168 were excluded due to atrial fibrillation, implanted pacemaker, or unsuitable recordings. All-cause mortality over a median 4-year follow-up was prospectively defined as the primary endpoint. The Polyscore divided the investigated population (n = 1788, median age: 72 years, females: 58%) into three predefined groups with low (n = 1405, 78.6%), intermediate (n = 326, 18.2%), and high risk (n = 57, 3.2%). During the follow-up, 82 (4.6%) participants died. Mortality in the Polyscore-defined risk groups was 3.4%, 7.4%, and 17.5%, respectively (P < 0.0001). The Polyscore-based mortality prediction was independent of Framingham score, diabetes, chronic kidney disease, and major stroke and/or myocardial infarction history. It was particularly effective in those aged <75 years (n = 1145)., Conclusion: The Polyscore-based mortality risk assessment from short-term non-invasive recordings is effective in the elderly general population, especially those aged 60-74 years. Implementation of a comprehensive Polyscore screening of this age group is proposed to advance preventive medical care., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Aborted myocardial infarction (abMI) is a type of acute coronary syndrome in which patients treated with reperfusion avoid the great burden of necrosis. Yet, no definition of abMI in patients undergoing primary percutaneous coronary intervention (pPCI) has been proposed so far., Aims: This study aimed to identify patients with abMI and compare them with the remaining patients with ST‑segment elevation myocardial infarction (STEMI)., Methods: It was a retrospective study of 1693 consecutive patients with STEMI treated with pPCI. The median (IQR) follow‑up was 3.45 (1.45-5.09) years. Aborted MI was diagnosed if ST‑segment elevation was reduced by more than 50%, no new abnormal Q waves were observed, the maximal level of creatine kinase MB did not reach a value 5‑fold higher than the upper limit of normal (below 125 U/l), and there was successful reperfusion defined as the Thrombolysis in Myocardial Infarction score of 3 after PCI., Results: Using our definition, abMI was diagnosed in 176 cases (10.4%). Compared with the remaining patients with STEMI, those with abMI were younger (mean [SD] age, 61.8 [11.5] vs 64.4 [11.6] years; P = 0.005) and were more frequent smokers (48.9% vs 36.7%; P = 0.002). They had greater left ventricular ejection fraction (median [interquartile range (IQR)], 49% [40%-55%] vs 55% [51%-60.5%]; P <0.001), were discharged earlier from the hospital (hospitalization time, median [IQR], 73 [60-90.5] hours vs 87 [69-98] hours; P <0.001), and had a lower mortality rate at 1 month and long‑term follow‑up (2.27% vs 8%; P = 0.006 and 10.8% vs 23.9%; P <0.001, respectively)., Conclusion: Patients with abMI had better short‑ and long‑term outcomes than other patients with STEMI. Some negative cardiovascular factors such as smoking were more often observed in the abMI group.

Not required for Clinical Vignette.

Background: Long‑term follow‑up data from a large Polish acute myocardial infarction (AMI‑PL) database are still unavailable., Aims: This study aimed to assess the 5‑year outcomes of patients discharged after hospitalization for AMI in Poland in relation to age., Methods: The studywas based on the nationwide AMI‑PL registry including data on the management and long‑term outcomes of all patients admitted to hospitals with AMI (codes I21-I22 according to the International Classification of Diseases and Related Health Problems, 10th Revision [ICD ‑10]), derived from the database of the obligatory healthcare payer in Poland.The current analysis included all patients after AMI who were discharged alive between the years 2009 and 2010 (n = 134 602)., Results: The median age of the study patients was 66.8 years, 62.8% of them were male, and 57.1% had ST‑segment elevation myocardial infarction. Older patients, especially those at age ≥80 years, were less likely to receive invasive treatment during the index hospitalization and follow‑up. There were 37 437 deaths during the follow‑up, and the observed 5‑year survival ranged from 0.921 in women at the age below 55 years to 0.383 in men older than 80 years. Relative survival, however, ranged from 0.94 to 0.68 in these age‑sex groups. The mortality risk increased with age, was higher in men, in patients treated noninvasively, hospitalized for non-ST‑segment elevation myocardial infarction, and discharged from non‑cardiology wards. Patients were rehospitalized due to cardiovascular reasons in 63% of cases, heart failure in 17.9%, and AMI in 12.8%., Conclusions: More than 1 in 4 patients discharged after hospitalization for AMI died within 5 years. Age strongly affects the treatment and long‑term outcomes of AMI patients. Our findings indicate the need for improvement in secondary prevention after AMI.

The aim of the study was to evaluate diurnal changes of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) concentrations in relation to on-treatment platelet reactivity. The study group included 51 patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention and dual antiplatelet therapy. TF and TFPI concentrations were assessed using enzyme-linked immunosorbent assay kits. We found a significant increase of TF concentration in clopidogrel-resistant, but not clopidogrel-sensitive, patients at 10.00 a.m. (410.66 pg/mL) in comparison with 6.00 a.m. (250.99 pg/mL), 14.00 p.m. (255.12 pg/mL) and 19.00 p.m. (267.58 pg/mL). Moreover, TF concentration at 10.00 a.m. was 30% higher in clopidogrel-resistant than clopidogrel-sensitive patients ( p = .043). We failed to demonstrate diurnal variation in TFPI concentration in clopidogrel-resistant patients. However, TFPI concentration in clopidogrel-sensitive patients was significantly higher at 10.00 a.m. as compared with other sampling points ( p < .05). We observed a marked elevation in TF concentration at 10.00 a.m. only in aspirin-resistant patients and a significant increase in TFPI concentration at 10 a.m. only in aspirin-sensitive patients. Our findings suggest the presence of diurnal variations in TF and TFPI concentrations in AMI patients, with the highest thrombotic risk in patients with high on-treatment platelet reactivity in the midmorning.

Introduction: Grip strength and blood pressure are strongly interrelated. Blood pressure is an essential component of arterial load, which modulates cardiac output., Objectives: We aimed to asses the correlation between grip strength and both steady and pulsatile components of arterial load in patients with acute myocardial infarction., Patients and Methods: We included 295 participants (mean age, 63 years) with acute myocardial infarction. The following data were assessed: grip strength, echocardiography, local arterial stiffness, arterial tonometry, continuous arterial pulse, and beat‑to‑beat wave., Results: In univariable analyses, grip strength correlated with arterial stiffness (pulse wave velocity), ventricular-arterial coupling, and measures of pulsatile arterial load: aortic characteristic impedance (Zao), total arterial compliance (TAC), and central fractional arterial pulse pressure (cFPP). In a multivariable model including age, grip strength, body mass index, systolic blood pressure, sex, and descriptors of pulsatile load, the following remained associated with grip strength: Zao (R2 for the model = 0.58; P <0.001), TAC (R2 = 0.23 for the model; P <0.001), and cFPP (R2 for the model = 0.2; P <0.001). In the second model that included sex, only Zao remained associated with grip strength (R2 for the model = 0.67). Comparisons between men and women of the adjusted mean value demonstrated that Zao and cFPP were considerably higher (P <0.001 and P = 0.02, respectively) and TAC was lower in women (P <0.001)., Conclusions: In a cohort of patients with acute myocardial infarction, grip strength correlated independently and significantly with descriptors of the pulsatile arterial load. The role of sex in these interrelations needs further study.

Objectives: Adipose tissue produces a number of adipokines that have metabolic effect. Visfatin is a recently discovered adipokine whose concentration in plasma increases in obesity. It is also a proinflammatory mediator that promotes atherosclerosis and plays a role in plaque destabilization. The aim of this study was to evaluate an assay for the determination of visfatin in human plasma and to investigate its clinical relevance as a marker of acute coronary syndrome (ACS) in a young population (Men under 45 y, Women under 55 y)., Design and Methods: We clinically tested a sandwich ELISA assay in young individuals with acute myocardial infarction (n=36) vs. a control group (n=21). The control sample was a healthy proband without inflammation, hepatic or renal injury and under 55 years of age., Results: Visfatin in plasma was able to differentiate the control group from young patients with acute myocardial infarction (5 vs. 27 ng/L). Visfatin in the plasma of acute myocardial infarction (AMI) probands, correlated in individuals with acute coronary syndrome was related to plasma glucose (r=0.47; P=0.01), type 2 diabetes mellitus (r=0.65; P=0.01), plasma creatinine concentration (r=0.3, P=0.02), hsCRP (r=0.29; P=0.03), BMI values (r=0.18; P=0.04), triglycerides (r=0.5; P=0.01) and NT-proBNP (r=0.21; P=0.04). In healthy subjects, these relations were not found. ROC analysis: visfatin cut-off concentration was 20 ng/L with a sensitivity of 84% and a specificity of 90%. The area under the curve (AUC) of cTNI was 0.96, the AUC of visfatin was 0.96. Thus, there was no difference., Conclusion: We conclude that visfatin in serum may be a new independent potential marker of AMI.