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Background: The impact of left circumflex coronary artery (LCX) ostium atherosclerosis in left main coronary artery (LM) bifurcation disease is not well-known., Aim: The study aimed to assess whether the involvement of LCX ostium carries prognostic implications in patients undergoing unprotected LM percutaneous coronary intervention (PCI)., Methods: Consecutive 564 patients with unprotected LM (ULMCA) disease who underwent LM PCI between January 2015 and February 2021, with at least 1 year of available follow-up were included in the study. The first group was composed of 145 patients with ULMCA disease with LCX ostium stenosis, and the second group consisted of 419 patients with ULMCA disease without LCX ostium stenosis., Results: Patients in the group with ULMCA disease with LCX ostium stenosis were significantly older and had more comorbidities. The two-stent technique was used more often in the group with LCX ostium stenosis (62.8% vs. 14.6%; P <0.001). During 7-year follow-up, all-cause mortality did not differ significantly between groups with and without LCX ostium stenosis (P = 0.50). The use of one-stent or two-stent technique also did not impact mortality in patients with LCX ostial lesions (P = 0.75). Long-term mortality subanalysis for three groups of patients: (1) patients with LM plus LCX ostium stenosis; (2) LM plus left anterior descending artery (LAD) ostium stenosis; (3) LM plus LCX ostium plus LAD ostium stenosis also did not differ significantly (P = 0.63)., Conclusions: LCX ostium involvement in LM disease PCI is not associated with adverse long-term outcomes, which is highly beneficial for the Heart Team's decision-making process.

Backgrounds: The data concerning the use of bioresorbable vascular scaffolds (BVS) in coronary bifurcation lesions are limited., Aims: The objective of the study was to evaluate the early and very long-term clinical outcomes of bifurcation stenting with ABSORB BVS., Methods: One hundred consecutive patients with coronary bifurcation lesions treated with BVS were included. A total of 124 BVS were implanted. Provisional side branch stenting was performed in 66 patients, distal main stenting in 14 patients, systematic T stenting in 2, and T with minimal protrusion (TAP) in 5 patients. Side branch ostial stenting was performed in additional 12 patients., Results: The procedural success was achieved in 98% of patients. In long-term follow-up, the rate of cardiac death was 4.0%, target vessel myocardial infarction was 5.0%, and target vessel revascularization (TVR) was 11%. The cumulative incidence of definite/probable scaffold thrombosis (ST) was 2% at long-term follow-up. Comparison with the historical drug-eluting stents (DES) group revealed higher mortality and major adverse cardiac events rate in the ABSORB group., Conclusions: Stenting of coronary bifurcation lesions of low-to-moderate complexity with BVS was feasible with good acute performance and acceptable results. However, the risk of death and major adverse cardiovascular events was higher as compared with DES.

Background: Many operators are discouraged from performing left main (LM) percutaneous coronary interventions (PCI) in the absence of right coronary artery (RCA) support due to the increased procedure risk., Aims: We aimed at assessing the impact of absent functional RCA on prognostic implications in patients undergoing unprotected LM PCI., Methods: 613 patients underwent LM PCI in our department between 2015 and 2019. Consecutive 385 patients with unprotected LM and at least 1-year follow-up were included in the study. The study population comprosed 272 patients with unprotected left main coronary artery disease (ULMCAD) with dominant RCA, without any significant lesions (Group 1), and 113 ULMCAD patients and without RCA support (Group 2)., Results: In Group 2, 32.7% patients had a significant RCA stenosis, 48.7% had chronic total occlusion (CTO) of RCA, and 18.6% had recessive RCA. Patients in Group 2 were older and had higher prevalence of chronic obstructive pulmonary disease (COPD). SYNTAX Score (median [IQR] 26.0 [20.0-33.0] vs 19.0 [13.0-25.5]; P <0.001) was higher and left ventricular ejection fraction was lower (median [IQR] 50.0 [40.0-60.0]% vs 55.0 [45.0-60.0]%; P = 0.01) in this group. All periprocedural complications did not differ among the groups. Long-term all-cause mortality at a median follow-up of 1149 days did not differ significantly (23% vs 20%; P = 0.37). The long-term mortality in CTO-RCA group was also not significantly different., Conclusions: Patients with ULMCAD who have undergone LM PCI in the absence of RCA support, compared with those with ULMCAD and RCA support, differed neither in the prevalence of periprocedural complications nor in long-term all-cause mortality.

Background: The PSP (predilatation, sizing, post-dilatation)-technique was developed to improve the prognosis of patients after bioresorbable vascular scaffold (BVS) implantation. In acute coronary syndrome (ACS) the use of BVS is particularly demanding and carries some potential risk regarding aggressive lesion preparation, proper vessel sizing due to spasm and thrombus inside the artery. The aim herein, was to determine the long-term results of BVS stenting in ACS patients depending on the scaffold implantation technique., Methods: The present study is a prospective, two-center study, which consisted of 182 patients who underwent percutaneous coronary intervention (PCI) with BVS (Absorb, Abbott Vascular, Santa Clara, California, USA) implantation for the ACS. All patients were divided into two groups. The first consisted of 52 patients treated with the PSP-technique (PSP group). The second group enrolled 130 patients treated with a non-PSP procedure (non-PSP group)., Results: The procedure was successful in all patients. The mean observation time was 28.8 ± 16.5 months (median 28.3 months, interquartile range 24.0 [17.0-41.0] months). It was found that target vessel failure (TVF) was consistently reduced in patients using the PSP-technique as compared with the non-PSP group (5.8% vs. 17.7%, p = 0.03). Moreover, PSP-technique was superior to non-PSP-technique concerning major adverse cardiac events (MACE) (3.7% vs. 22.3%, p = 0.02). Logistic regression analysis revealed that the use of PSP technique significantly decreased the risk of target vessel revascularization (odds ratio [OR] 0.11, p = 0.01), TVF (OR 0.28, p = 0.03) and MACE (OR 0.29, p = 0.02)., Conclusions: The PSP-technique for BVS implantation improves long-term results and should also be recommended for newer generations of the bioresorbable scaffold.

Background: Appropriate double (DT) and triple (TT) antithrombotic therapy in patients with atrial fibrillation and stent implantation is unclear., Aim: The aim of the study was to perform a meta‑analysis of studies comparing DT and TT in patients with atrial fibrillation and stent implantation., Methods: Of the 450 reports, 5 randomized trials were included in the meta‑analysis: WOEST, ISAR‑REACT, PIONEER AF‑PCI, RE‑DUAL PCI, and AUGUSTUS, with a total of 9931 patients., Results: Treatment efficacy, as assessed by the incidence of major adverse cardiac events, did not differ significantly between both therapeutic strategies: 8.98% for DT vs 8.71% for TT (odds ratio [OR], 1.02; 95% CI, 0.86-1.21). The incidence of hemorrhagic complications was significantly lower in patients treated with DT than TT (13.1% and 21.0%, respectively; OR, 0.57; 95% CI, 0.47-0.70). In over 90% of patients, DT included clopidogrel along with an oral anticoagulant (non-vitamin K antagonist oral anticoagulant or vitamin K antagonist)., Conclusions: The results of our meta‑analysis are clearly in line with the current trend of the fastest possible reduction in the use of TT in favor of DT. Almost half lower risk of hemorrhagic complications during DT compared with TT, with similar efficacy of the 2 strategies, provides an argument for the wider use of DT in patients with AF and stent implantation.

Background and Aim:  The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI)., Methods:  This is a systematic review and meta-analysis. Randomized controlled trials and non-randomized studies were included. Outcomes evaluated were combined major adverse cardiovascular events (MACEs), myocardial infarction (MI), target vessel revascularization, death and bleeding complications. Summary estimates of the relative risks with therapy were calculated., Results:  Twenty-three studies met the selection criteria and included 60,907 patients. Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction (RRR) of MACE (95% confidence interval [CI] = 0.68-0.89; p  < 0.001). Early clopidogrel loading was associated with a 25% RRR of MACE (95% CI = 0.65-0.85; p  < 0.001), a 30% RRR of MI (95% CI = 0.6-0.82; p  < 0.0001) and 25% RRR of death (95% CI = 0.64-0.87; p  = 0.0002), without an impact on major bleedings. In ST-elevation myocardial infarction as well as non-ST elevation acute coronary syndrome (NSTE-ACS), early clopidogrel loading resulted in 35 and 22% RRR in 30 days MACE ( p  < 0.001), respectively, with no impact in elective PCI. Whereas early loading with prasugrel and ticagrelor did not improve ischaemic outcomes, prasugrel administered early increased bleeding risks in NSTE-ACS., Conclusion:  Early clopidogrel loading is associated with a better efficacy and similar safety, whereas timing of ticagrelor or prasugrel loading had no effects on ischaemic events., Competing Interests: None declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Bioresorbable vascular scaffolds (BVS) have emerged as a new treatment option in cardiovascular medicine. Nonetheless, there is still limited data on the use of these novel devices in patients with acute coronary syndromes (ACS). The purpose of this study was to evaluate the feasibility and efficacy of BVS implantation in patients with ACS., Methods: The present report is a prospective, two-center registry that involved 165 consecutive patients hospitalized with the diagnosis of ACS and treated with the Absorb BVS (Abbot Vascular, Santa Clara, USA). During 1-year, all patients were monitored for the following endpoints: death, myocardial infarction (MI), scaffold thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR) and target vessel failure (TVF), defined as cardiac death, target vessel MI, and TVR., Results: A total of 165 patients underwent 179 BVS implantations. 94 patients were diagnosed with unstable angina (UA; 57.6%), 45 with non-ST-segment elevation myocardial infarction (NSTEMI; 27.3%) and 26 with ST-segment elevation myocardial infarction (STEMI; 15.7%). Procedural success was achieved in all patients with thrombolysis in myocardial infarction flow 3. During a follow-up of 14.1 ± 8.5 months (median 12.4 months, IQR 8.7 [8.4 to 12.1] months) death occurred in 4 (2.4%) patients, including 2 (1.3%) cardiac deaths. There was only 1 case of subacute ST (0.66%), without late ST. The incidence of MI, TLR, TVR and TVF were: 2.65%, 2.65%, 7.95%, 9.3%, respectively., Conclusions: The present results suggest that BVS implantation in ACS patients is feasible and safe in highly experienced centers. One-year clinical results are encouraging with a low rate of stent thrombosis.

Background: Multivessel disease (MVD) is a significant risk factor in patients with acute ST-segment elevation myocardial infarction (STEMI). Whether the presence of chronic total occlusion (CTO) poses an additional hazard is still unknown. The objective of this study was to evaluate the impact of CTO on survival in STEMI patients., Methods: The study group consisted of 836 STEMI patients treated with primary percutaneous coro-nary intervention (PCI). MVD was diagnosed in 52.3%, and CTO in 17.5% of patients., Results: In MVD patients, 30-day mortality was 4.8% (6.8% in the CTO and 3.8% in the non-CTO group, p = 0.167). After 6 years, of the 437 patients with MVD, 56 (38.6%) died in the CTO group, and 74 (25.4%) in the non-CTO group (p = 0.0055). CTO was an independent predictor of long-term mortality (OR 2.07, 95% CI 1.30-3.28, p = 0.002), whereas triple vessel disease was not (OR 1.27, 95% CI 0.78-1.97, p = 0.358). The other independent predictors of mortality were: age, anterior myocardial infarction, and PCI failure., Conclusions: The presence of CTO is an independent predictor of the long-term mortality in STEMI patients treated with primary PCI. (Cardiol J 2017; 24, 2: 117-124).

Introduction: Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion in ST-segment elevation myocardial infarction patients. Adjunctive pharmacotherapy is, however, still under investigation., Objective: To assess the effect of combined pharmacologic therapy on myocardial perfusion and infarct size in relation to time delays., Materials and Methods: We studied 309 consecutive ST-segment elevation myocardial infarction patients admitted within 12 h from symptom onset with (a) chest pain persisting for more than 30 min, (b) ST-segment elevation more than 1 mm in at least two contiguous leads, and (c) pretreatment with 600 mg of clopidogrel, 300 mg of aspirin, and 5000 U of intravenous heparin. Group I (n=90) included patients transferred directly to cathlab (immediate transfer) and group II (n=219) included patients transferred by referring hospitals (staged transfer). The results of thrombolysis in myocardial infarction (TIMI) flow before and after PCI, ST-segment resolution (STSR), troponin T level, and myocardial blush grade were analyzed in relation to delay to intervention., Results: The delay between pharmacologic pretreatment and angiography was two times longer in cases of staged transfer (80 vs. 47.5 min; P<0.0001). Despite the longer delay, higher rates of preangiography total STSR (26.4 vs. 15.5%; P=0.039) and initial TIMI flow 3 (20.1 vs. 11.1%; P=0.059) were observed in those patients. Differences in the rate of total STSR (70.3 vs. 66.7%; P=0.52), TIMI flow 3 (91.3 vs. 88.9%; P=0.33), and myocardial blush grade (60.7 vs. 63.3%; P=0.66) were no longer observed after PCI. Similarly, the peak troponin T level was also comparable (3.6 vs. 3.9 ng/ml; P=0.74)., Conclusion: Pretreatment with a combination of antiplatelet and antithrombotic agents may improve myocardial perfusion and compromise longer delay to a mechanical intervention.

Aims: Data concerning the use of bioresorbable vascular scaffolds (BVS) for chronic total occlusion (CTO) lesions are limited. The aim of this study was to evaluate the early and midterm clinical outcomes of CTO stenting with BVS., Methods and Results: Forty consecutive patients (male 78%, mean age 59.9±8.3 years, diabetics 30%) with CTO treated with BVS were enrolled. Patients with a reference vessel diameter >4 mm, metallic stents, excessive calcium and tortuosity were excluded. Mean J-CTO score was 1.6. A total of 63 BVS were implanted with an average number of 1.6 per patient, and an average scaffold length of 42.4±21.5 mm. Procedural success was achieved in all patients with no device-related complications. At follow-up (median time 556 days), there were no deaths, one patient experienced subacute and late scaffold thrombosis (ST), and another one developed symptomatic in-scaffold focal restenosis treated with repeat PCI. At control angiography, performed at a median time of 329 days in 27 patients (68%), no more restenosis or vessel reocclusion was found., Conclusions: CTO stenting with BVS is feasible with good acute performance, and good early and midterm clinical outcomes.

Objectives: To assess performance of new, bioresorbable polymer sirolimus-eluting stent (BP-SES), in patients with long coronary lesions (LL) and to compare it to permanent polymer everolimus-eluting stent (PP-EES)., Background: LL have been associated with worse clinical outcomes in percutaneous coronary interventions (PCI). The impact of lesion length on the outcomes of drug eluting stent (DES) implantations is not as clear., Methods: In the frame of a randomized, multicentre CENTURY II study, out of 1119 patients enrolled, 182 patients had LL (defined as ≥25 mm), and were assigned randomly to treatment with BP-SES (101) or PP-EES (81). Primary endpoint was target lesion failure (TLF, composite of cardiac death, target vessel related myocardial infarction [MI], and target lesion revascularization [TLR]) at 9 months. All data were 100% monitored and adverse events were adjudicated by an independent clinical event committee., Results: The baseline patient and lesion characteristics were similar in the 2 study arms. At 9-months, the rates of cardiac death (2.0% vs 1.2%; P = 0.70), MI (3.0% vs 4.9%; P = 0.49) and clinically driven TLR (2.0% vs 3.7%; P = 0.48) and TLF (6.9% vs 8.6%; P = 0.67) were similar for BP-SES and PP-EES, respectively. There was no stent thrombosis (ST) in BP-SES group up to 9 months, while 1 case (1.2%) of ST was recorded in PP-EES group (P = 0.44)., Conclusions: Patients with LL showed similar clinical outcomes when treated with Ultimaster BP-SES and Xience PP-EES., (© 2015, Wiley Periodicals, Inc.)

Background: Studies on the treatment of patients with an acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI) have shown a high rate of aborted MI despite a relatively long delay from the onset of symptoms to reperfusion., Aim: To assess predictors of aborted MI in patients undergoing primary PCI., Methods: 310 STEMI patients referred for primary PCI within 12 h of symptom onset were included into a prospective study. Relationships between incidence of aborted MI, clinical, electrocardiographic and angiographic factors were analysed., Results: Aborted MI was diagnosed in 29 (9.8%) patients. Patients with aborted MI did not differ with respect to age(59.4 ± 10.1 vs. 60.5 ± 11.2 years; p = 0.88), male sex (75.9% vs. 76.0%; p = 0.83), hypertension (51.7% vs. 48.3%;p = 0.87) or total ischaemic time (215.9 ± 104.6 vs. 241.9 ± 134.3 min; p = 0.44) except for the frequency of diabetes mellitus (34.5% vs. 16.1%; p = 0.02) when compared to a group with true MI. TIMI flow ≥ 2 prior to PCI (86.2% vs. 27.7%; p < 0.001), total ST-segment resolution (STSR), both pre-angiography (65.5% vs. 19.5%; p < 0.001) and post-PCI (89.7%vs. 69.2%; p = 0.018) and myocardial blush grade 3 (89.7% vs. 60.0%; p = 0.001) were significantly more frequent in patients with aborted MI. A logistic regression model confirmed TIMI flow ≥ 2 prior to PCI (OR 10.7; CI 3.1-37.8; p = 0.0002), pre-angiography total STSR (OR 3.6; CI 1.2-10.5; p = 0.02) and a history of previous diabetes mellitus (OR 8.6; CI 2.6-27.6; p = 0.0003) as predictors of aborted MI., Conclusions: 1. Aborted MI was observed in 9.8% of STEMI patients undergoing PCI. 2. TIMI flow ≥ 2 and total STSR priorto PCI were identified as major angiographic and electrocardiographic predictors of aborted MI.

Objectives: Postconditioning has been reported to reduce infarct size in ST-segment myocardial infarction (STEMI). However, recently, few other studies did not show any effect of postconditioning and suggested that it may be even harmful. We sought to assess whether postconditioning could reduce infarct size and improve myocardial reperfusion in early presenters with STEMI., Methods: 72 STEMI patients treated with primary percutaneous coronary intervention (PCI) were randomly assigned to either the postconditioning (n = 35) or the standard PCI group (control group; n = 37). Blood samples were obtained for creatine kinase (CK) and its MB isoform (CK-MB) within 36 h. The angiographic (myocardial blush grade, MBG) and electrocardiographic (ST-segment resolution, STR) data were evaluated and compared between groups., Results: The areas under the curve of CK and CK-MB release were significantly reduced in the postconditioning group compared with the control group (38,612.91 ± 25,028.42 vs. 60,547.30 ± 25,264.63 for CK and 5,498.23 ± 3,787.91 vs. 7,443.12 ± 3,561.13 for CK-MB, p < 0.0001). MBG was significantly better in the postconditioning group than in the control group (MBG 3: 82.3 vs. 47.1%, p = 0.0023). In the postconditioning group, STR >70% was more often observed (97.1 vs. 64.1%, p = 0.0007)., Conclusions: In patients with STEMI, postconditioning could significantly reduce enzymatic infarct size and improve myocardial reperfusion.

Objectives: The aim of this single-center, randomized placebo-controlled trial in 70 consecutive patients (64 ± 14 years) with acute myocardial infarction was to examine the role of a new protocol of adenosine administration during primary angioplasty on immediate electrocardiographic and angiographic results, clinical outcome and 1-year follow-up., Methods: Group A (n = 35) twice received intracoronary adenosine through the guiding catheter: immediately after crossing the lesion of the infarct-related artery with guidewire and then after first balloon inflation. Group B (n = 35) received placebo., Results: Resolution of ST segment elevation was more frequently observed in the adenosine than in the placebo group (p < 0.01). Percutaneous coronary intervention (PCI) resulted in borderline better TIMI 3 flow after the procedure in the adenosine group than in the placebo group. Myocardial blush grade 3 at the end of the procedure was significantly improved in the adenosine compared to the placebo group (p < 0.05). At 1-year the composite end-point of death, recurrent myocardial infarction, heart failure and clinically driven target vessel revascularization was present in 8 patients in the adenosine group and 16 patients in placebo group (p < 0.05)., Conclusions: Intracoronary adenosine improved electrocardiographic and angiographic results in patients undergoing primary PCI and seemed to be associated with more favorable clinical course., (Copyright © 2013 S. Karger AG, Basel.)

Left main (LM) percutaneous coronary interventions (PCI) are challenging and highly invasive procedures. Periprocedural myocardial injury (Troponin (Tn) elevation > 99th percentile) is frequently detected after LM PCI, being identified even in up to 67% of patients. However, the prognostic implications of periprocedural Tn elevation after LM PCI remain controversial. We aim to assess the impact and prognostic significance of the periprocedural troponin elevation on long-term outcomes in patients undergoing LM PCI in a real-world setting. Consecutive 673 patients who underwent LM PCI in our department between January 2015 to February 2021 were included in a prospective registry. The first group consisted of 323 patients with major cardiac Troponin I elevation defined as an elevation of Tn values > 5× the 99th percentile in patients with normal baseline values or post-procedure Tn rise by >20% in patients with elevated pre-procedure Tn in whom the Tn level was stable or falling (based on the fourth universal definition of myocardial infarction). The second group consisted of patients without major cardiac Troponin I elevation. Seven-year long-term all-cause mortality was not higher in the group with major Tn elevation (36.9% vs. 40.6%; p = 0.818). Naturally, periprocedural myocardial infarction was diagnosed only in patients from groups with major Tn elevation (4.9% of all patients). In-hospital death and other periprocedural complications did not differ significantly between the two study groups. The adjusted HRs for mortality post-PCI in patients with a periprocedural myocardial infarction were not significant. Long-term mortality subanalysis for the group with criteria for cardiac procedural myocardial injury showed no significant differences (39.5% vs. 38.8%; p = 0.997). The occurrence of Tn elevation (>1×; >5×; >35× and >70× URL) after LM PCI was not associated with adverse long-term outcomes. The results of the study suggest that the isolated periprocedural troponin elevation is not clinically significant. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the short- and long-term outcomes of left main percutaneous coronary interventions (LM PCI) in patients disqualified from coronary artery bypass graft surgery (CABG). We included 459 patients (mean age: 68.4 ± 9.4 years, 24.4% females), with at least 1-year follow-up; 396 patients in whom PCI was offered as an alternative to CABG (Group 1); and 63 patients who were disqualified from CABG by the Heart Team (Group 2). The SYNTAX score (29.1 ± 9.5 vs. 23.2 ± 9.7; p < 0.001) and Euroscore II value (2.72 ± 2.01 vs. 2.15 ± 2.16; p = 0.007) were significantly higher and ejection fraction was significantly lower (46% vs. 51.4%; p < 0.001) in Group 2. Patients in Group 2 more often required complex stenting techniques (33.3% vs. 16.2%; p = 0.001). The procedure success rates were very high and did not differ between groups (100% vs. 99.2%; p = 0.882). We observed no difference in periprocedural complication rates (12.7% vs. 7.8%; p = 0.198), but the long-term all-cause mortality rate was higher in Group 2 (26% vs. 21%; p = 0.031). LM PCI in patients disqualified from CABG is an effective and safe procedure with a low in-hospital complication rate. Long-term results are satisfactory. [ABSTRACT FROM AUTHOR]

Background. The outcome of patients with ST-elevation myocardial infarction (STEMI) strongly depends on a successful reperfusion. In some patients receiving an effective treatment myocardial infarction can be aborted. Aim. The aim of the study was to estimate the incidence, clinical outcome, prognosis and inflammatory response in patients with aborted MI. Material and methods. 119 consecutive patients with STEMI treated with a primary percutaneous coronary intervention (pPCI) were enrolled in the study. Aborted MI was diagnosed when the maximal increase in cardiac enzymes (CK-MB) was up to twice the upper limit of normal (CK-MB ≤ 50 U/I) and at least 50% reduction of ST-segment deviation was observed within 90 min of pPCI. Results. Aborted MI was diagnosed in 16 subjects (13.4%). Patients with the aborted MI had lower serum troponin I levels (p < 0.0001). The time to treatment was significantly shorter in the aborted MI group (101 min vs. 220 min, p < 0.00001). Patients with aborted MI had a lower corrected TIMI frame count (p < 0.05) and a lower wall motion score index (p < 0.005), less pronounced inflammatory response (lower serum levels of IL-6, p < 0.01, and MCP-1, p < 0.05), higher ejection fraction six months after MI (72% vs. 64%, p < 0.05). None of the aborted MI patients died during the 3-year follow-up, while there were 13 deaths among patients with non-aborted MI. Conclusions. The abortion of myocardial infarction results in a better outcome and more favorable prognosis. An inflammatory response is less pronounced in the aborted MI. [ABSTRACT FROM AUTHOR]

The study aimed to assess the risk of myocardial infarction (MI) and major adverse cardiac events during non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin therapy in patients with atrial fibrillation (AF), both treated and not treated with percutaneous coronary interventions (PCI). In a systematic search, we selected eight randomized clinical trials with a total of 81,943 patients. Dabigatran, compared to warfarin, significantly increased the risk of MI (relative risk [RR] 1.38, 95% CI 1.14–1.67), while the FXa inhibitors' effect did not differ significantly from warfarin (RR 0.96, 95% CI 0.86–1.09). The RR comparison between analyzed subgroups (dabigatran vs. FXa inhibitors) showed a significant difference (Chi2 = 9.51, df = 1, p = 0.002). In a network meta-analysis, dabigatran 110 mg b.i.d. increased the risk of MI compared to warfarin, apixaban, edoxaban, and rivaroxaban. Also, dabigatran 150 mg b.i.d. increased the risk of MI compared to warfarin, apixaban, and rivaroxaban. Moreover, we tried to estimate the treatment ranking of the best therapy for MI prevention in patients with AF treated with PCI. Rivaroxaban had a 90% probability of being ranked the best therapy for MI prevention, whereas dabigatran 110 mg had an 8.2% probability. Dabigatran 150 mg was the most effective in stroke prevention (94% probability). Each NOAC is associated with a different risk of MI. Furthermore, we should consider FXa inhibitors as the first line NOACs in AF and coronary artery disease patients. PROSPERO ID CRD42020179808. [ABSTRACT FROM AUTHOR]

There is still controversy whether the female gender is associated with worse outcomes after the percutaneous coronary intervention within the left main (LM PCI). This study aimed to examine gender-based differences in real-life LM PCI patients and present a gender-personalized LM PCI approach. Consecutively, 613 patients underwent LM PCI in our department from January 2015 to June 2019. Five hundred and thirty-three patients, with at least a one-year follow-up, were included in the study. There were 130 (24.4%) women and 403 (75.6%) men. Compared with men, women were older (70.0 ± 9.4 vs. 67.7 ± 9.2; p = 0.006) and had higher diabetes, hypertension, and chronic kidney disease rates. Left ventricle ejection fraction was higher in women (53.5 ± 9.4 vs. 49.5 ± 11.2; p = 0.001). Euroscore II and SYNTAX scores did not differ between the genders. However, we observed a trend towards more frequent use of complex PCI techniques in women (26.2% vs. 19.4%; p = 0.098). The overall periprocedural complication rates (10.0% vs. 7.7%; p = 0.406) and the periprocedural myocardial infarction rates did not differ. Contrast-induced nephropathy was more frequent in women (6.9% vs. 3.0%; p = 0.044). Long-term all-cause mortality did not differ (20% vs. 22.5%; p = 0.069). Both genders presented similar rates of periprocedural complications, and no significant differences in long-term all-cause mortality were revealed. Our results suggest that the female gender in LM PCI is not a predictor of adverse outcomes. Further studies are required to determine the optimal revascularization strategy in women. [ABSTRACT FROM AUTHOR]

Background While the cutoffs of predictive value for ST-segment elevations resolution (STSR) following thrombolysis and/or primary PCI were well documented, the impact of pre-angiography STSR has not been established yet. Objectives The aim of this study is to assess prognostic utility of pre-angiography STSR to predict pre-procedural TIMI flow in the infarct-related artery (IRA) and infarct size in STEMI patients undergoing primary PCI. Methods A prospective study was performed, including 310 patients, admitted within 12 h of symptom onset and who underwent primary PCI. ST-segment elevations were measured in: (1) qualifying ECG, (2) ECG before angiography, and (3) ECG post PCI. STSR was defined as: total (≥ 70%), partial (between 70% and 30%) and none (< 30%). Relationships between pre-angiography STSR, initial TIMI flow and troponin T level (TnT) were analyzed. Results Pre-angiography STSR correlated with initial TIMI flow in the IRA ( r S = 0.619; p < 0.001). Pre-angiography total STSR was observed in 23.2% patients. It was noted in 79.2% of patients with pre-procedural TIMI flow ≥ 2 and in 20.8% with TIMI flow ≤ 1 ( p < 0.001). Although the sensitivity of pre-angiography total STSR to detect pre-procedural TIMI flow ≥ 2 was 93%, its specificity was only 56% and the likelihood ratio was 2.1. Pre-angiography total STSR was associated with lower peak TnT level (2.2 ± 2.5 ng/ml vs. 6.4 ± 5.0 ng/ml, p < 0.0001) when compared to the remaining patients. Conclusions 1. Pre-angiography STSR correlates with preprocedural TIMI flow. 2. The sensitivity of pre-angiography total STSR in detection of pre-procedural TIMI flow ≥ 2 is high, but low specificity of only 56% makes it an unreliable predictor of an open IRA. [ABSTRACT FROM AUTHOR]