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Purpose Contrast-induced acute kidney injury (CI-AKI) is a common and potentially serious complication of percutaneous coronary interventions (PCI). In this study, we tested the hypothesis whether serum and urinary hepcidin could represent early biomarkers of CI-AKI in patients with normal serum creatinine undergoing PCI. In addition, we assessed serum and urinary neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, eGFR and serum creatinine in these patients. Methods Serum and urinary hepcidin and NGAL, serum cystatin C, were evaluated before, and after 2, 4, 8, 24 and 48 h after PCI using commercially available kits. Serum creatinine was assessed before, 24 and 48 h after PCI. Results We found a significant rise in serum hepcidin as early as after 4 and 8 h when compared to the baseline values. Serum NGAL increased after 2, 4 and 8 h, and in urinary NGAL after 4, 8 and 24 h after PCI. We found a significant fall in urinary hepcidin after 8 and 24 h after PCI. Serum cystatin C increased significantly 8 h after PCI, reaching peak 24 h after PCI and then decreased after 48 h. The prevalence of CI-AKI was 8%. Urine hepcidin was significantly lower 8 and 24 h after PCI in patients with CI-AKI, while serum and urine NGAL were significantly higher in patients with CI-AKI. Conclusions Our findings suggest that serum hepcidin might be an early predictive biomarker of ruling out CI-AKI after PCI, thereby contributing to early patient risk stratification. However, our data needs to be validated in large cohorts with various stages of CKD.

Introduction The clinical courses of takotsubo syndrome (TS) and of acute coronary syndromes (ACS) seem to be very similar. However, there is limited knowledge about risk factors of poor outcomes. Low body mass index worsens the prognosis of patients with cardiovascular diseases, especially those undergoing surgical treatment. The aim of the study was to evaluate the influence of the body mass index (BMI) on the prognosis in patients diagnosed with TS. Material and methods Eighty patients aged 15-89 (mean: 67.9 years), 74 women and 6 men with TS diagnosis according to Mayo Clinic diagnostic criteria were divided into 3 groups: low body mass (BMI < 18.5 kg/m2), normal body mass (18.5 ≥ BMI < 25 kg/m2) and excessive body mass (BMI ≥ 25 kg/m2). Results Patients with low BMI were older, but with less prevalent risk factors such as hypertension, hypercholesterolemia and positive family history of coronary artery disease and more frequent risk factors such as cigarette smoking, chronic obstructive pulmonary disease (COPD), depressive and anxiety disorders as well as malignancy. They also had higher haemoglobin, lower troponin, creatine kinase, C-reactive protein and lipid fractions. The highest annual, 3-year and 5-year mortality was observed in the group with BMI < 18.5 kg/m2. None of the patients with low BMI survived the 5-year follow-up period (100% vs. 25% vs. 15.2%; p < 0.0001). In group III, mortality among overweight patients (25 ≥ BMI < 30 kg/m2) was 8.3%, and in obese people (BMI ≥ 30 kg/m2) 1 out 5 patients died during follow-up. Conclusions The majority of typical cardiovascular risk factors are less frequently observed in patients with TS and low body mass. Early prognosis for TS patients and low BMI is relatively favourable, whereas the 5-year follow-up is associated with extremely high mortality. Overweight patients have the best prognosis in the long-term follow-up.

Rapid scoring systems validated in patients with atrial fibrillation (AF) may be useful beyond their original purpose. Our aim was to assess the utility of CHA2DS2-VASc, HAS–BLED, and 2MACE scores in predicting long-term mortality in the population of the Białystok Coronary Project, including AF patients. The initial study population consisted of 7409 consecutive patients admitted for elective coronary angiography between 2007 and 2016. The study endpoint was all-cause mortality, which occurred in 1244 (16.8%) patients during the follow-up, ranging from 1283 to 3059 days (median 2029 days). We noticed substantially increased all-cause mortality in patients with higher values of all compared scores. The accuracy of the scores in predicting all-cause mortality was also assessed using the receiver operator characteristic (ROC) curves. The greatest predictive value for mortality was recorded for the CHA2DS2-VASc score in the overall study population (area under curve [AUC] = 0.665; 95% confidence interval [95%CI] 0.645–0.681). We observed that the 2MACE score (AUC = 0.656; 95%CI 0.619–0.681), but not the HAS–BLED score, had similar predictive value to the CHA2DS2-VASc score for all-cause mortality in the overall study population. In AF patients, all scores did not differ in all-cause mortality prediction. Additionally, we found that study participants with CHA2DS2-VASc score ≥3 vs.

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

Funding Acknowledgements Type of funding sources: None. Background The short-term effect of air pollution on cardiovascular mortality is well-documented but a scarce number of studies focus on cause-specific mortality in low-polluted areas. Purpose We decided to distinguish deaths due to cerebrovascular disease (CbVD) from a region widely known as the Green Lungs of Poland to assess the short-term effect of air pollution on CbVD mortality. Methods The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR) of air pollution. Results In the overall analysis of the studied region PM2.5 had an impact on increased CbVD mortality at LAG 0 (OR 1.046, 95% CI 1.013 – 1.080, P = 0.006), LAG 0-1 (1.048, 1.002-1.082, P = 0.040), and LAG 0-3 (1.052, 1.015-1.090, P = 0.006). The influence of PM10 was noted at LAG 0 (1.041, 1.002-1.082, P = 0.040). CbVD mortality in Bialystok was increased by exposure to PM10 at LAG 0 (1.05, 1.00-1.09, P = 0.048) and CO at LAG 1 (1.07, 1.00-1.14, P = 0.04). Additionally, an effect of CO was observed in cold season at LAG 1 (1.09, 1.02-1.17, P = 0.02), LAG 0-1 (1.08, 1.00-1.016, P = 0.04), and LAG 0-3 (1.09, 1.01-1.18, P = 0.04). In Suwalki, an impact of PM2.5 was also observed. Conclusions A short-term increase in air pollutants concentrations, especially in PM2.5 and CO, had an influence on CbVD mortality. Mortality rates were significantly increased in cold season. We also found heterogeneity in the influence of major contributors on mortality between analyzed cities.

Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndromes (ACS) are the leading cause of death all over the world, in the last years chronobiology of their occurrence has been changing. Purpose The aim of this study was to assess the influence of climate change on hospital admissions due to ACS. Methods Medical records of 10,529 patients hospitalized for ACS in 2008–2017 were examined. Weather conditions data were obtained from the Institute of Meteorology. Results Among the patients, 3537 (33.6%) were hospitalized for STEMI, 3947 (37.5%) for NSTEMI, and 3045 (28.9%) for UA. The highest seasonal mean for ACS was recorded in spring (N = 2782, mean = 2.52, SD = 1.7; OR 1.07; 95% CI 1.0-1.2; P = 0.049) and it was a season with the highest temperature changes day to day (Δ temp.=11.7). On the other hand, every 10ºC change in temperature was associated with an increased admission due to ACS by 13% (RR 1.13; 95% CI 1.04-1.3; P = 0.008). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (N = 1703, mean = 2.7, SD = 1.9; OR 1.16; 95% CI 1.0-1.23; P = 0.004), in STEMI subgroup it was Monday (N = 592, mean = 0.9, SD = 1.6, OR 1.2; 95% CI 1.1-1.4; P = 0.002). Sunday was associated with decreased admissions due to all types of ACS (N = 1098, mean = 1.7, SD = 1.4; OR 0.69; 95% CI 0.6-0.8, P Conclusion We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuation associated with climate change in this season. The lowest frequency of ACS took place on weekends. Atmospheric changes had a much more pronounced effect on admissions due to ACS in the second half of the analyzed period, which is in line with the dynamics of global climate change.

IntroductionAcute coronary syndromes (ACS) are the leading cause of death all over the world. In the last years, the chronobiology of their occurrence has been changing.Material and methodsMedical records of 10,529 patients hospitalized for ACS in the Medical University of Bialystok, in 2008–2017, were examined. Weather conditions data for Bialystok County were obtained from the Institute of Meteorology.Results: The highest seasonal mean for ACS was recorded in spring (OR = 1.08, 95% CI: 1.00–1.18, p = 0.049) and it was the season with the largest temperature changes from day to day (∆ temp. = 11.01). On the other hand, every 10ºC change in temperature was associated with increased admission due to ACS by 13% (RR = 1.13, 95% CI: 1.040–1.300, p = 0.008) and 12% in patients over 70 (RR = 1.118, 95% CI: 1.001–1.249, p = 0.048, lag 1). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (OR = 1.16, 95% CI: 1.05–1.28, p = 0.003), while in the STEMI subgroup it was Monday (n = 592, mean = 0.94, SD = 1.04, OR = 1.20, 95% CI: 1.07–1.36, p = 0.003). Sunday was associated with decreased admissions due to all types of ACS (OR = 0.70, 95% CI: 0.63–0.77, p < 0.001).ConclusionsWeather conditions have an impact on ACS frequency and the elderly are more susceptible. We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuations associated with climate change in this season. The lowest frequency of ACS took place on weekends.

Background The wide variation in bifurcation anatomy has generated an ongoing search for stents explicitly designed for coronary bifurcations, and to date, results have been underachieved. Methods The POLBOS I and POLBOS II were international, multicentre, randomized, open-label, controlled trials. Patients were randomly assigned to BiOSS Expert (in POLBOS I, biodegradable polymer eluting paclitaxel)/BiOSS LIM (in POLBOS II, biodegradable polymer eluting sirolimus) stent implantation or regular drug-eluting stent (rDES) deployment. A provisional T-stenting strategy was the default treatment option. The primary endpoint of this pooled data study was the cumulative rate of major adverse cardiovascular events (MACE) consisting of cardiac death, myocardial infarction (MI) and target lesion revascularization (TLR). Telephone follow-up was performed annually up to 72 months. (ClinicalTrials.gov Identifier: POLBOS I-NCT02192840, POLBOS II-NCT02198300). Results The total study population consisted of 445 patients, 222 patients in the BiOSS group and 223 patients in the rDES group. The follow-up rate was 93.7% in the BiOSS group and 91.9% in the rDES group. At 72 months, there was no significant difference between BiOSS and rDES groups regarding MACE (25.7% vs 25.1%, HR 1.06, 95% CI 0.73-1.52), cardiac death (3.1% vs 4.0%, HR 0.94, 95% CI 0.43-2.34), MI (3.6% vs 4.9%, HR 0.76, 95% CI 0.32-2.89), TLR (18.9% vs 16.1%, HR 1.17, 95% CI 0.75-1.83) and stent thrombosis rates (0.9% vs 0.5%, HR 1.21, 95CI 0.75-2.09). Conclusions At the 6-year follow-up, clinically significant clinical events did not differ between BiOSS stents and rDES.

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84, p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67, p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38, p &lt, 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24, 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

Introduction: Air pollution contributes to the premature death of approximately 428,000 citizens of Europe every year. The adverse effects of air pollution can be observed not only in respiratory, circulatory, and nervous systems but also in renal function.Aim: Our goal was to investigate the hypothesis indicating that we can observe the long-term and also short-term impact of air pollution on kidney function.Methods: We reviewed medical notes of patients hospitalized at Medical University of Bialystok, Poland between 2007-2016. We used linear, log-linear, and logistic regression models to assess the association between renal function and NO2, SO2, and PMs. Results are reported as beta (β) coefficients and odds ratios (OR) for an increase in interquartile range (IQR) concentration with 95% confidence intervals (95%CI). Results: 3,554 patients were included into the final analysis. The median age was 66 (IQR 15) and men were in the majority (53.2%, N=1891). Chronic kidney disease (CKD) was diagnosed in 21.5% (N=764). The long-term increase in annual average concertation of PM2.5 (OR for IQR increase=1.07; 95% CI 1.01 – 1.15, P=0.037) and NO2 (OR for IQR increase=1.05;95% CI 1.01 – 1.10, P=0.047) resulted in an increased number of patients with CKD. In short-term observation the IQR increase in weekly PM2.5 concentration was associated with a 2% reduction in eGFR (OR=0.98, 95%CI 0.97 – 0.99, P=0.03)Conclusions: The effects of air pollution on renal function were observed. Long- and short–term exposure to elevated air pollution levels was associated with a decrease in eGFR. The main pollutant affecting the kidneys was PM2.5.

Patient: Female, 71-year-old Final Diagnosis: Acute pleuropericarditis Symptoms: Weakness Medication:— Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Pleuropericarditis after pacemaker (IPG) implantation is a rare post-cardiac injury syndrome (PCIS) condition. Pericarditis is one of the complications following insertion of a IPG; it affects 2–5% of patients within 5–21 days after IPG implementation and is associated with screw-in (active fixation) atrial lead positioning. Usually, pericarditis following IPG implantation is benign and has a self-limiting course. The mechanism of this complication remains unclear. It could involve a direct irritation of pericardium by minimally protruding electrodes, low bleeding, and autoimmune and inflammatory responses. The frequency of pleuropericarditis is not well defined. The etiopathogenesis is presumed to be the same as for pericarditis, yet there are no standardized criteria for the diagnosis, and treatment is based on the empirical anti-inflammatory therapy used in pericarditis. Case Report: A 71-year-old woman was admitted due to syncope. Sinus arrests with escape atrioventricular rhythm were observed during hospitalization; therefore, a dual-chamber pacemaker (IPG) was implanted with 2 active fixation (screw-in) electrodes. On the first day after implantation, a slight pericardial hemorrhage occurred with resorption in the following days, and an inflammatory reaction with pericardial and left pleural effusion occurred later. The first-line treatment was ineffective. However, prednisolone with colchicines with longer use than suggested by pericarditis recommendations was effective. Conclusions: Patients with even mild pericardial effusion after IPG insertion should be followed closely due to the risk of pleuropericarditis, with consideration of anti-inflammatory treatment for longer than in pericarditis.

Background Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. Methods This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). Results The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST]. Conclusions The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.

Background: Data regarding the use of percutaneous coronary intervention with drug-eluting balloons (DEB) versus thin-strut drug-eluting stents (thin-DES) for treating DES in-stent restenosis in everyday clinical practice is scarce. Our goal was to evaluate the efficacy and safety profile of DEB versus thin-DES in DES in-stent restenosis. Methods: Consecutive patients with DES in-stent restenosis who underwent percutaneous coronary intervention between 2008 and 2019 entered the multicenter DEB-DRAGON Registry with a follow-up of 3 years. Patients who received DEB at the index procedure (n=557, 49.9%) were compared with those who received thin-DES (n=560, 50.1%). Results: Analysis of the unmatched cohort revealed lower rates of target lesion revascularization (9.1% versus 13.6%; hazard ratio [HR], 0.58 [95% CI, 0.41–0.83], P =0.003), target vessel revascularization (11.8% versus 16.7%; HR, 0.62 [95% CI, 0.45–0.84], P =0.003) and device-oriented composite end point, defined as a composite of cardiac death, target lesion revascularization, and target vessel myocardial infarction (12.7% versus 16.0%; HR, 0.69 [95% CI, 0.50–0.94], P =0.018) in the thin-DES group compared with the DEB group. The incidence of cardiac death, target vessel-myocardial infarction, and myocardial infarction were similar in both groups. However, after propensity score matching, there were no significant differences in target lesion revascularization (11.2% versus 11.2%; HR, 0.91 [95% CI, 0.55–1.51], P =0.707), target vessel revascularization (13.4% versus 14.2%; HR, 0.86 [95% CI, 0.55–1.36], P =0.523), and device-oriented composite end point (14.2% versus 14.2%; HR, 0.91 [95% CI, 0.58–1.42], P =0.667) between the thin-DES and DEB group, respectively. Conclusions: This analysis of a real-life registry revealed similar long-term outcomes of thin-DES and DEB in DES in-stent restenosis regarding target lesion revascularization, myocardial infarction, cardiac death, and device-oriented composite end point. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04415216.

Background: Recent studies have reported associations between air pollution and daily mortality. The majority of them are conducted in highly polluted areas. Therefore, we aimed to assess the short-term impact of air pollution on cardiovascular (CVD)-, coronary artery-related (CAD)-, and cerebrovascular-related (CbVD) mortality in moderately polluted cities. Methods: The analysis with a time-stratified case-crossover design was performed. Findings: The interquartile range (IQR) increase in PM2.5 (OR 1×036, 95%CI 1×016–1×056, P

BACKGROUND Cardiovascular diseases (CVD) are the leading cause of death worldwide. Many studies have reported an association between serum uric acid (sUA) and CVD, and its role as a risk marker for mortality. OBJECTIVES To assess the relationship between sUA levels and the long-term prognosis of patients with non-ST-elevation myocardial infarction (NSTEMI). MATERIAL AND METHODS The study was conducted at the Clinical Hospital of Bialystok (Poland). Based on medical records, 9328 patients were hospitalized between 2011 and 2013, of which 726 had NSTEMI. The exclusion criteria were: any diagnosed neoplasms and estimated glomerular filtration rate (eGFR)

Introduction Currently, the greatest threat to the health and life of people and the leading cause of death in Poland are cardiovascular diseases (CVD). Air quality is a well-known risk factor for the development of them. Purpose The aim of this study is to assess the impact of air pollution on the frequency of hospital admissions due to acute coronary syndrome (ACS). Methods The medical records of 30,695 patients hospitalized in the Department of Invasive Cardiology were analyzed. Patients treated for ACS and living within the borders of the analyzed city met inclusion criteria. Weather conditions such as temperature, humidity, atmospheric pressure, wind speed and the following components of air pollution were analyzed: carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2), trioxygen (O3), particulate matter with a diameter of 2.5 μm or less (PM2.5) and with a diameter of 10 μm or less (PM10). Poisson regression was used for statistical analysis. Results The study included 3,325 inhabitants of analyzed city (mean age 66.2 years, SD=12.2), male in majority (60.3%). The number of patients admitted for ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA) was 1002, 1265, and 1058, respectively. An increase of CO concentration by 1 g/m3 was associated with a higher number of admissions due to NSTEMI (RR 1.74; 95% CI, 1.08–2.8; P=0.02), this effect was more noticeable in the female population (RR - 2.8; 95% CI, 1.39–5.65; P=0.004). In male subjects an increase in the concentration of PM2.5 by 10 μg/m3 was associated with a 0.5% increase in the number of admissions for NSTEMI (RR 1.05, 95% CI 1.02–1.22; P=0.02) and UA (OR 1.14, 95% CI 1.02–1.25; P=0.014). An increase in the concentration of SO2 by 1 μg/m3 affected the frequency of admissions in men due to NSTEMI (0.5% increase, RR 1.04, 95% CI 1.01–1.07; P=0.007) and UA (OR 1.17, 95% CI 1.02–1.36; P=0.031). The concentration of 03 and NO2 did not affect admissions rate due to ACS. Conclusions Air quality had an impact on the occurrence of ACS among residents of Bialystok. Increased exposure to air pollution, in particular, elevated PM2.5, SO2 and CO levels, was associated with a higher incidence of NSTEMI and UA. This effect was more noticeable in the male population. Funding Acknowledgement Type of funding source: None

Introduction Air pollution is considered to be one of the main risk factors for public health, in particular its impact on the disorders of the pulmonary and cardiovascular system and the related mortality. Purpose This study was carried out to assess the influence of the atmospheric conditions and air pollutants on mortality in the population of the big city in the eastern Poland. Materials and methods Based on the data from the Central Statistical Office, the number and causes of the deaths of the city residents in the period 2008–2017 were analyzed. The study utilized the data recorded by the Provincial Inspectorate for Environmental Protection station and the Institute of Meteorology and Water Management during the analysis period. Multivariate Poisson regression was used for statistical analysis. Results A total of 34,005 deaths had been recorded, in which women accounted for 47.5%. The proportion of cardiovascular-related deaths was 48% (N=16,370). The main causes of deaths in the female population were chronic ischemic heart disease (N=1683; 10.42%) and cerebral infarction (N=1617; 10.01%), while in the male population, in addition to chronic ischemic heart disease (N=1530; 8.57%), deaths were caused mainly by malignant neoplasm of the bronchus and lung (N=1555; 8.71%). During the analysis, it was observed that the 1-day norm of sulfur dioxide (SO2) recommended by the World Health Organization (WHO) guidelines was sporadically exceeded (N=18, 0.50% of analyzed days), while the daily norm for the particulate matter with a diameter of 2.5 μm or less (PM2.5) was exceeded on 688 days (23.60% of analyzed days). In the female group, excluding the seasonal impact, an increase of SO2 concentration by 1-μg/m3 (RR 1.05, 95% confidence interval (CI) 1.01–1.10; P=0.009) and a 10°C decrease of temperature (RR 1.04, 95% CI 1.02–1.07; P=0.003) were related to an increase in the number of daily deaths. In the male group, a stronger effect of SO2concentration on mortality was noted; the RR for 1-μg/m3 increase of SO2 was 1.10 (95% CI 1.04–1.18; P=0.002). In the subgroup analysis of cardiovascular deaths, the main pollutant that was found to have an effect on daily mortality was PM2.5; the RR for 10-μg/m3 increase of PM2.5 was 1.07 (95% CI 1.02–1.12; P=0.01). Conclusions Air quality and atmospheric conditions had an impact on the mortality of Białystok residents, and this effect was more pronounced in the male population. The main air pollutants that influenced the rate of mortality were SO2and PM2.5. In the female population, an additional factor that influenced the total mortality and mortality due to cardiovascular diseases was temperature. It is worth emphasizing that the impact of SO2 on mortality was clear within “safe” range recommended by WHO. More research on that topic is necessary, but our results bring questions whether the recommended norms should be stricter, or is there a safe concentration of SO2 in the air at all. Funding Acknowledgement Type of funding source: None

Introduction Bifurcation lesions pose a therapeutic challenge during percutaneous coronary intervention (PCI). Results of regular drug-eluting stents (rDESs) in bifurcation treatment are not optimal. Purpose The aim of this study was to analyze the 6-year follow-up of BiOSS (Balton, Poland) stents in patients enrolled into two randomized clinical trials POLBOS I (NCT02192840) and POLBOS II NCT02198300). Methods The BiOSS stent is a coronary dedicated bifurcation balloon expandable stent made of 316L stainless steel and coated with a biodegradable polymer as well as the drug. The stent consists of two parts with different diameters connected with two struts of 1.9 - 2.5 mm length each. The aim of randomized POLBOS trials was to compare the BiOSS stents with regular drug eluting stents (rDES) in patients with stable CAD or NSTE-ACS (POLBOS I: paclitaxel eluting BiOSS Expert vs rDES; POLBOS II: sirolimus eluting BiOSS LIM vs rDES). Provisional T-stenting was the default strategy. Angiographic control was performed at 12 months in all patients. The primary end-point was composed MACE defined as cardiac death, myocardial infarction or target lesion revascularization (TLR). Clinical assessment was performed every year after index procedure. Results In POLBOS I trial BiOSS Expert was implanted in 120 patients (49.4%), and rDES was implanted in 123 patients. The target vessel was the left anterior descending (LAD) artery (52% vs 70%) followed by the left main stem (LMS) coronary artery (22% vs 15%). In rDES group, 38.2% of patients received paclitaxel-eluting stents. Side branch treatment with rDES was required in 10% of cases in both groups. At 12 months, the incidence of cumulative major adverse cardiovascular events (MACE) was similar in both groups: 13.3% vs 12.2% (P=0.7). The TLR rate was significantly higher in the BiOSS Expert group compared with rDES group (11.5% vs 7.3%; P=0.02). Significantly lower rates of restenosis were observed in final kissing balloon (FKB) subgroups of both the BiOSS Expert (8.1% vs 13.2%; P In POLBOS II 202 patients were randomly assigned 1:1 to treatment of the coronary bifurcation lesions either with the BiOSS LIM stent (n=102) or with rDES (n=100). The target vessel was the LAD (44% vs 43%) followed by the LMS (35.3% vs 38%). Side branch treatment was required in 8.8% (rDES) and 7% (BiOSS). At 12 months, the cumulative MACE incidence was similar in both groups (11.8% [BiOSS] vs. 15% [rDES, p=0.08]), as was the TLR rate (9.8% vs. 9% [p=0.8]). The binary restenosis rates were significantly lower in the FKBI subgroup of the BiOSS group (5.9% vs. 11.8%, p At the time of ESC Congress 2020 we will present data from 6-year follow-up from POLBOS I trial and POLBOS II trial focusing on LM stenting and patients with diabetes. Conclusions BiOSS® stents provided satisfactory 1-year results which seemed comparable with rDES. Long-term data are pending. Funding Acknowledgement Type of funding source: None

Data regarding the potential influence of gender on outcomes of rotational atherectomy (RA) percutaneous coronary intervention (PCI) are scarce and conflicting. Using the Euro4C registry, an international prospective multicentric registry of RA PCI, we evaluated the influence of gender on clinical outcomes of RA PCI. Between October 2016 and July 2018, 966 patients were included. In them, 267 (27.6%) were females. Female patients were older than males (77.7 years old ± 9.8 vs 73.3 ± 9.5 years old respectively, p < 0.001) had a poorer renal function (43,1% of females had a GFR < 60 ml/min:1.73m² vs 30.4% of males, p < 0.001) and were more frequently admitted for an acute coronary syndrome (32.2% vs 22.3% p = 0.002). During RA procedure, women were less likely to be treated by radial approach (65.0% vs 74.4%, p = 0.004). In-hospital major adverse cardiac event rate—defined as cardiovascular death, myocardial infarction, stroke/transient ischemic attack, target lesion revascularization, and coronary artery bypass grafting surgery—was higher in the female group (7.1% vs 3.7%, p = 0.043). However, coronary perforation, dissection, slow/low flow and tamponade did not significantly differ in gender, neither did cardiovascular medications at discharge. At 1 year follow-up, rate of major adverse cardiac event was 18.4% in the female group vs 11.2% in the male group (adjusted Hazard Ratio 1.82 [1.24 to 2.67], p = 0.002). No significant bleeding differences were observed in gender, neither in hospital, nor during follow-up. In conclusion women had worse clinical outcomes following RA PCI during hospitalization and at 1 year follow-up than did men

INTRODUCTION Atrial fibrillation (AF) and chronic coronary syndrome (CCS) share common risk factors and frequently coexist. Additionally, AF symptoms may mimic CCS. OBJECTIVES The aim of the study was to investigate the hypothesis indicating absence of significant coronary lesions in patients with AF as compared with those with sinus rhythm. PATIENTS AND METHODS We conducted a single-center retrospective study including consecutive patients referred for elective coronary angiography between 2007 and 2016. RESULTS The study population included 8288 patients out of whom 1674 had AF. There were substantial differences between groups with and without AF. Patients with AF were significantly older, more often were men and had diabetes, and more frequently were diagnosed with both chronic kidney disease and heart failure. On the other hand, they had history of hyperlipidemia less often. CCS was less frequently detected in patients with AF as compared with those with sinus rhythm (37.5% vs 41.1%; P

The detrimental influence of air pollution on mortality has been established in a series of studies. The majority of them were conducted in large, highly polluted cities&mdash, there is a lack of studies from small, relatively clean regions. The aim was to analyze the short-term impact of particulate matters (PMs) on mortality in north-eastern Poland. Time-stratified case-crossover design was performed for mortality in years 2008&ndash, 2017. Daily concentrations of PM2.5 (28.4 &micro, g/m3, interquartile range (IQR) = 25.2) vs. (12.6 &micro, g/m3, IQR = 9.0) and PM10 (29.0 &micro, g/m3, IQR = 18.0) vs. (21.7 &micro, g/m3, IQR = 14.5) were higher in Łomża than Suwałki (p &lt, 0.001). Impact of PM2.5 on mortality was recorded in Łomża (odds ratio (OR) for IQR increase 1.061, 1.017&ndash, 1.105, p = 0.06, lag 0) and Suwałki (OR for IQR increase 1.044, 1.001&ndash, 1.089, p = 0.004, lag 0). PM10 had an impact on mortality in Łomża (OR for IQR increase 1.028, 1.000&ndash, 1.058, p = 0.049, lag 1). Cardiovascular mortality was affected by increase of PM2.5 in Łomża (1.086, 1.020&ndash, 1.156, p = 0.01) and Suwałki (1.085, 1.005&ndash, 1.171, p = 0.04). PM2.5 had an influence on respiratory mortality in Łomża (1.163, 1.021&ndash, 1.380, p = 0.03, lag 1). In the whole studied region, despite differences in the air quality, the influence of PMs on mortality was observed.

IntroductionAcute coronary syndrome (ACS) could be triggered by emotions that are often associated with watching sport events. The aim of this study was to assess the influence of soccer matches on the frequency of admissions for ACS.Material and methodsThe study was based on the medical records of patients treated at the Clinical Hospital of Medical University of Bialystok from 2007 to 2018. All the official matches of the local team that took place during the study period were included in the analysis. A Poisson regression with a time effect of 0 and +1 day was used to assess the effect of matches.ResultsA total of 10 529 patients admitted due to ACS from Bialystok city and county were included in the analysis. The mean age of the patients was 66.6 ±12 years, and the majority were male (62%). The mean daily number of ACS admissions was 2.4 ±1.7. Since 2007, Jagiellonia Białystok has played 451 matches in total. The comparative analysis of exciting matches showed a higher frequency of admissions due to unstable angina (UA) (1.50 ±1.55 vs. 0.71 ±0.90, p < 0.01). The lost matches played at home were associated with a 27% increase in the number of male admissions for ACS (RR = 1.27, 95% CI: 1.02–1.58, p = 0.03).ConclusionsThe results achieved by the local professional soccer team are related to the incidence of ACS in the male population. Emotions caused by lost games play an important role as a triggering factor for ACS in this group.

Introduction Valvular heart diseases (VHD) are a significant problem in the Polish population. Coexistence of coronary artery disease (CAD) in patients with VHD increases the risk of death and affects the further therapeutic strategy. Aim Analysis of atherosclerotic plaque burden distribution in coronary arteries and long-term prognosis among patients with VHD. Material and methods Inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ±1454 days. Results Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CAD with severe angiographic stenoses was noted in 42.3% (n = 434). Among patients with severe MVI, CAD was noted in 47.1% of cases, and prior acute coronary syndromes (ACS) in 27.1% of patients (n = 58). In severe AVS patients, significant angiographic atherosclerotic changes were observed in 29.6% (n = 86), and prior ACS in 7.6% (n = 22) of patients. During the observation 52.7% of patients died, including 62.9% of patients with severe MVI and 51.6% of those with severe AVS. Age (OR = 1.038; 95% CI: 1.005-1.072; p = 0.022) and coexisting aortic valve insufficiency (AVI) (OR = 2.39, 95% CI: 5.370-11.065, p = 0.035) increased the mortality rate. Conclusions Severe AVS is starting to be the most prevalent VHD. CAD is one of the most significant factors deteriorating prognosis of patients with VHD. AVI and age were significant risk factors for mortality. The worst prognosis was observed in severe MVI, which may result from more frequent occurrence of CAD in this group. A lesser burden of CAD and ACS in the group of patients with severe AVS did not affect survival.

Background. The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy. Methods. 101 patients with TTS hospitalized in four centers of invasive cardiology in Podlaskie Voivodeship during the period 2008–2012 were included in the study. The patients were divided into two groups: I—52 patients (GRACE ≤ 140 points) and II—49 patients (GRACE > 140 points). Results. The mean GRACE score in the study group was 138.66. The in-hospital stay of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36.7% vs 7.69%, p=0.0004), rhythm abnormalities (17.3% vs 3.85%, p=0.026), and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30.6% vs 5.77%, p=0.001). The mean observation period was 7.2 years. A significantly higher risk of 6-month (18.37% vs 3.85%, p=0.019), 1-year (22.45 vs 3.85%, p=0.005), 3-year (40.82 vs 3.85%, p<0.0001), 5-year (42.86% vs 3.85%, p<0.0001), and 7-year mortalities (53.06% vs 9.62%, p<0.0001) was observed in the group of patients with a GRACE score ≥140. At multivariate analysis including low BMI, low eGFR, and a higher GRACE score, all these factors were independent predictor of death (p=0.042; p=0.010; p=0.041). The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognostication. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI: 0.718–0.892, p<0.0001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS. Conclusion. The GRACE scale is highly valuable for the prognostication of death risk in patients with TTS in the early and long-term observation.

Introduction: Hyperkalemia is a common electrolyte disturbance that occurs within many patients. The more often prevalence of cardiovascular or renal diseases is, the more frequent medical issue hyperkalemia will be. An increasing quantity of entities requires taking medications that affect electrolyte hemostasis. Therefore, reasons for hyperkalemia should be deeply reflected. One of them is pseudohyperkalemia. Purpose: In this study diagnostics and treatment of hypokalemia were presented based on the case report of a 56-year-old man. Case presentation: A 56-year-old man was admitted to the Department of Invasive Cardiology of Medical Hospital of Białystok for complaints of strong chest pain associated with palpitations, cold sweats, feelings of general weakness and anxiety. The patient had no medical history of chronic diseases and neglected to take any medications at length. The laboratory tests performed at admission showed an increased serum concentration of potassium. Through the whole hospitalization, many medications were implicated to overcome hyperkalemia (diuretics, calcium resonium, inhalation with beta2-adrenergic agonists, intravenous infusion of glucose with insulin) with no effect. Hormone test was performed, the results excluded Addison’s or pituitary disease. Differential diagnosis with arterial blood draw showed normal potassium serum concentration. Conclusions: Hyperkalemia is encountered in a broad spectrum of patients. The severely elevated level of potassium could lead to life-threating conditions. Therefore, proper diagnosis making process is a matter of great importance. As clinicians, we need to base not only on laboratory but also examine the whole picture of the patient. Misdiagnosing pseudohyperkalemia might result in unnecessary medical management.

Introduction: Glycoprotein (Gp) IIb/IIIa is a platelet receptor participating in platelet aggregation. According to ESC guidelines, glycoprotein IIb/IIIa inhibitors might be considered during percutaneous coronary interventions in patients with the acute coronary syndrome. Purpose: A case study of profound thrombocytopenia in 80-year-old man with the acute coronary syndrome. Case presentation: An 80-year-old, medicationnaive man with acute coronary syndrome was admitted to the Department of Invasive Cardiology. Due to the unsuccessful invasive strategy, an intracoronary bolus of Gp IIb/IIIa inhibitor – eptifibatide - was administered. During the following intravenous infusion, large subcutaneous hematomas were observed. Eptifibatide infusion was discontinued. Drop in platelet count to 1 thou/μL without significant anemia was registered. A control sample in sodium citrate showed similarly low platelet count - 2 thou/uL. Acetylsalicylic acid and clopidogrel were discontinued, steroids were introduced. Neither PLT nor FFP transfusion were necessary. Consecutive lab tests showed the gradual increase of PLT up to 35 thou/μL at discharge. A week later, the patient did not complain of any cardiovascular or bleeding symptoms; hematomas resented significant involution. Laboratory findings were normal. During follow-up visit 30 days after the discharge, the patient presented no cardiovascular symptoms. Conclusions: There are patients at risk of druginduced thrombocytopenia, especially those with impaired kidney function and the elderly. In such cases, decisions concerning anti-platelet and antithrombotic therapy should be taken cautiously. Because of its rare occurrence, every case of severe thrombocytopenia in ACS patients should be reported. Moreover, such patients should be followed-up to minimalize risk of similar adverse events in the future.

Background/Aims: Several studies have implicated atrial fibrillation (AF) as a contributing factor in chronic kidney disease (CKD) and cardiovascular events. The prevalence of coronary artery disease (CAD) in patients with AF varies substantially from 17% to 46.5%. There are only few studies concerning renal function in population with AF undergoing coronary angiography. The aim of the present study was to assess which type of AF is dominant in CKD population scheduled for coronary angiography and if it can influence patients’ outcome, the association between renal impairment and the type of coronary procedures in AF patients and the influence of renal function on in-hospital mortality. Methods: We retrospectively studied 867 patients with AF hospitalized due to coronary angiography in two year time. The cut off value of CKD was eGFR ≤ 60 ml/min./1.73m2 evaluated by CKD-EPI formula. Results: A total of 867 patients with AF (44% women; mean age 72±10 years) were included in the analysis. The mean eGFR was 44±11ml/min./1.73m2 in patients with CKD and 89±18 ml/min./1.73m2 in patients with preserved renal function. Patients with CKD and AF were older (p< 0.001), had more often diabetes (p=0.009), heart failure (p< 0.001) and anaemia (p< 0.001). Patients with CKD and AF had more often permanent type of AF (p< 0.001). In CKD patients CHA2DS2VASc score was 4.3±1.5 and HAS-BLED score was 2.0±1.2 and it was significantly higher as compared to population with preserved renal function (p< 0.001, p=0.02, respectively). The use of oral anticoagulation was less frequent in CKD group (p< 0.001) although these patients had higher CHA2DS2VASc score. Patients with AF and CKD were more often admitted due to myocardial infarction (STEMI or NSTEMI) (p=0.02, p< 0.001, respectively) and more often underwent percutaneous coronary intervention (PCI) (p=0.01). Among coronary arteries the percutaneous coronary intervention (PCI) of left main artery was done more frequently in CKD patients (p=0.01). Among CKD population in-hospital mortality was significantly higher in patients with eGFR < 30 ml/min (p< 0.001). Conclusion: Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients’ prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.

Data on the clinical outcomes comparing synthetic fluorocarbon polymer polytetrafluoroethylene- (PTFE, GraftMaster) and polyurethane- (Papyrus) covered stents (CSs) to seal coronary artery perforations (CAPs) are limited. We aimed to evaluate 30-day and 1-year clinical outcomes after PCI complicated by CAP and treated with CS. We assessed 106 consecutive patients with successful CAP sealing (122 CSs): GraftMaster (51 patients, 57 CSs) or Papyrus CS (55 patients, 65 CSs). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, target lesion revascularisation (TLR), and myocardial infarction (MI). The mean age of subjects was 69 ± 9.6 years (53.8% males). No significant differences were identified between the GraftMaster and Papyrus groups at the 30-day follow-up for MACE, cardiac death, MI and stent thrombosis (ST), while significantly lower rate of TLR and TVR (p = 0.02) were confirmed in the Papyrus group. At one year, differences remained similar between stents for MACE, a trend towards a lower rate of TLR (p = 0.07), MI (p = 0.08), and ST (p = 0.08), and higher for cardiac death (p = 0.07) was observed in the Papyrus group. This real-life registry of CAP illustrated that the use of Papyrus CS is associated with lower rates of TLR and TVR at 30-day follow-up in comparison to the GraftMaster CSs and no significant differences between both assessed CS at one year of follow-up.

Thrombocytopenia (TP) following transcatheter aortic valve implantation (TAVI) procedure is a common phenomenon but the underlying mechanisms are neither well known nor described. Postinterventional severe TP is related to worse early and late outcome. Moreover, the statement of enhanced platelet and coagulation activation might justify even stronger antiplatelet and anticoagulation therapy following TAVI procedure. Thus, the examination of the pathomechanisms responsible for TP post TAVI seems to be crucial. Several hypotheses have been raised. TP can be caused by insufficient production or impaired platelet renewal. On the other hand, increased platelet activation, consumption and destruction might also be responsible for TP. These findings, mostly related to the procedure alone, need further investigation. Here, we summarize the potential multifactorial causes of post TAVI thrombocytopenia.

Aim. The marked variation in bifurcation anatomy has brought about an ongoing search for stents specifically constructed for coronary bifurcations. This study aimed to analyze the angiographic restenosis prevalence and patterns and predictors of different patterns in dedicated bifurcation BiOSS® vs. current generation drug-eluting stents implanted in coronary bifurcation lesions based on data from two clinical trials POLBOS I and II. Methods. Dedicated bifurcation BiOSS® stents were compared with drug-eluting stents (DES) in patients with stable coronary artery disease (CAD) or nonST elevation acute coronary syndrome (NSTE-ACS) (POLBOS I: paclitaxel eluting BiOSS® Expert vs. DES; POLBOS II: sirolimus eluting BiOSS® LIM vs. DES). Provisional T-stenting was the default treatment. Morphological pattern of in-stent restenosis according to the modified Mehran classification adopted for bifurcation lesions was assessed with bifurcation dedicated quantitative coronary angiographic software (CAAS 5.11, Pie Medical Imaging BV, the Netherlands). Results. In total, 445 patients (222 patients in BiOSS group and 223 patients in DES group) were included into the analysis. In BiOSS group 24 cases of angiographic restenosis (10.8%) were recorded, and in DES group—17 cases (7.6%) at 12 months follow-up (angiographic control rate at follow-up—90.3%). In the BiOSS group most frequent medina classification in restenotic cases was 0.0.1 (25%), whereas in DES—0.0.1 and 0.1.1 (23.5% each). In multivariate regression analysis proximal optimization technique was associated with the lowest chance for restenosis (OR 0.15, 95% CI 0.06–0.33), whereas diabetes on insulin was associated with the highest risk of restenosis (OR 4.21, 95% CI 1.48–11.44). Conclusions. The angiographic restenosis pattern and rate was similar between BiOSS stents and DES in coronary bifurcation lesions.

Background: The association between periprocedural complications and the type of vascular access in patients treated with percutaneous coronary intervention (PCI) and rotational atherectomy (RA) has not been investigated as frequently as in an overall group of patients treated with PCI. Aims: The aim of this study was to assess the associations between the type of vascular access and selected periprocedural complications in a group of patients treated with PCI and RA. Methods: ased on a nationwide Polish registry (National Registry of Percutaneous Coronary Interventions [ORPKI]), we analyzed 536 826 patients treated with PCI between the years 2014 and 2018. The study included 2713 patients (0.5% of the overall group of patients treated with PCI [n = 536 826]) treated with PCI and RA. Among them, 1018 (37.5%) were treated via femoral access, and 1653 (60.9%) via radial access. Subsequently, these patients were subject to comparison, which was proceeded by propensity score matching. Results: Following propensity score matching, multiple regression analysis revealed that patients undergoing PCI via femoral access experienced coronary artery perforation significantly less frequently than those managed via radial access (odds ratio, 0.29; 95% CI, 0.08–0.92; P = 0.04). We did not observe any significant associations between the type of vascular access and the periprocedural mortality rate (P = 0.99), cardiac arrest (P = 0.41), puncture‑site bleeding (P = 0.99), allergic reaction (P = 0.32), myocardial infarction (P = 0.48), no‑reflow phenomenon (P = 0.82), or the overall complication rate (P = 0.31). Conclusion: In patients treated with PCI and RA, femoral access is associated with a lower rate of coronary artery perforations as compared with radial access.

Objectives This study aimed to assess the effect of air pollution and weather conditions on the frequency of hospital admissions due to acute coronary syndrome (ACS) in the population of Bialystok, known as the capital of the Green Lungs of Poland. Materials and methods The study analyzed the medical records of 2,645 patients living within the borders of Bialystok who were treated for ACS between 2009 and 2017 and the data on air pollutants—nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter with a diameter of 2.5 μm or less (PM2.5) and 10 μm or less (PM10)—and the basic meteorological factors (temperature, humidity, and atmospheric pressure). A time-stratified case-crossover study design was applied to assess the effects of particulate matter, the concentration of gases, and weather conditions on ACS. Results The number of patients admitted for ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA) was 791, 999, and 855, respectively. The daily concentration norm for PM2.5 recommended by the World Health Organization (WHO) was exceeded in 692 days (i.e., 24.58% of the observation period). The significant increase in the number of ACS hospitalizations was associated with an interquartile-range increase in NO2 concentration, with an odds ratio of 1.08 (95% confidence interval (CI): 1.02–1.15, P = 0.01), 1.09 (95% CI: 1.01–1.18, P = 0.03), and 1.11 (95% CI: 1.00–1.22, P = 0.048) for patients with ACS, NSTEMI, and UA, respectively. Conclusion The study showed that the effects of air pollution and weather conditions on the number of ACS hospitalizations are also observed in cities with moderately polluted or good air quality. NO2 was identified as the main air pollutant affecting the incidence of ACS.

Air pollution is a documented risk factor for cardiovascular diseases.The aim of the study was to assess the effect of air pollution on the number of hospital admissions for acute coronary syndrome (ACS) in elderly patients.The medical records of 26 695 patients hospitalized for ACS between 2008 and 2017 were examined. Weather conditions and the following components of air pollution were analyzed: sulfur dioxide, nitrogen dioxide, and particulate matter with a diameter of 2.5 μm or less (PM2.5) and a diameter of 10 μm or less (PM10).The study included 1618 inhabitants of Białystok in Poland (mean [SD] age, 75 [6.4] years; men, 52.6%). The norm for PM2.5 was exceeded on 23.5% of days, while for PM10, on 5.3% of days. Elevated PM10 levels were associated with a higher number of hospitalizations for ACS on the day of exposure (mean [SD], 0.61 [0.78] vs 0.44 [0.69]; P0.001), and this effect persisted in the subsequent days (mean [SD], 1.07 [1.07] vs 0.88 [1.00]; P = 0.02). An increase of PM10 concentrations by 10 μg/m3 was associated with an increase in the number of hospitalizations due to unstable angina, and significant effects were observed even after 6 days (rate ratio, 1.16; 95% CI, 1.03-1.32; P = 0.02).Increased exposure to air pollution, in particular, elevated PM10 levels, is associated with a higher incidence of ACS both on the day of exposure and over the following days.

INTRODUCTION Air pollution is a documented risk factor for cardiovascular diseases. OBJECTIVES The aim of the study was to assess the effect of air pollution on the number of hospital admissions for acute coronary syndrome (ACS) in elderly patients. PATIENTS AND METHODS The medical records of 26 695 patients hospitalized for ACS between 2008 and 2017 were examined. Weather conditions and the following components of air pollution were analyzed: sulfur dioxide, nitrogen dioxide, and particulate matter with a diameter of 2.5 μm or less (PM2.5) and a diameter of 10 μm or less (PM10). RESULTS The study included 1618 inhabitants of Bialystok in Poland (mean [SD] age, 75 [6.4] years; men, 52.6%). The norm for PM2.5 was exceeded on 23.5% of days, while for PM10, on 5.3% of days. Elevated PM10 levels were associated with a higher number of hospitalizations for ACS on the day of exposure (mean [SD], 0.61 [0.78] vs 0.44 [0.69]; P

Objective: The study aimed at assessing the effect of thrombocytopenia and platelet function abnormalities on the occurrence of variceal bleeding in patients with cirrhosis.Methods: The results of ...

Background: There is a lack of data on the effect of air pollution on acute coronary syndrome (ACS) in industrial and non-industrial areas. Objectives: A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas. Materials and Methods: The study covered 6,000,000 person-years of follow-up and five types of air pollution between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS. Results: The daily concentrations of PM2.5, PM10, NO2, SO2, CO were higher in industrial than in non-industrial area(P

Patient: Female, 62-year-old Final Diagnosis: Takotsubo syndrome Symptoms: Chest pain Medication: — Clinical Procedure: Coronarography Specialty: Cardiology • Oncology Objective: Unknown ethiology Background: The main causes for takotsubo syndrome (TS) in oncological patients are stress related to cancer diagnosis and treatment, pain in the course of the disease, treatment complications, and paraneoplastic syndromes. Case Report: An obese 62-year-old female patient, with a 3-day history of chest pain, was admitted to the hospital with a suspected acute coronary event. She had been diagnosed with high-grade bladder cancer 6 months before. After the transurethral electroresection of the tumor 5 months before and subsequent chemotherapy (gemcitabine and cisplatin), the patient was qualified for the next cancer surgery. On admission, the patient remained without chest pain. The ECG record demonstrated inverted T waves in the leads from above the anterior and lateral wall. The coronarography demonstrated minor atherosclerotic changes in the coronary arteries. The left ventriculography presented akinesis of the apex and the apical and mid-segment of the anterior wall, and the ejection fraction (EF) was 38%. Takotsubo syndrome was diagnosed. Laboratory testing revealed elevated concentration of troponin and N-terminal pro-B-type natriuretic peptide. The subsequent ECG records demonstrated deeply inverted T waves and numerous ventricular premature beats and increased QTc (528 ms). A control echocardiography showed improved left ventricular contractive function (EF – 47%). On the 4th day of hospitalization, the patient was discharged and referred for further oncological treatment. Conclusions: The diagnosis of TS in oncology patients is difficult, especially in the presence of atherosclerotic lesions in coronary arteries. Takotsubo syndrome in cancer patients delays the next stages of oncological treatment, which worsens the prognosis of these patients.

AIMS The aim of the POLBOS II randomised trial was to compare any regular drug-eluting stents (rDES) with the dedicated bifurcation sirolimus-eluting stent BiOSS LIM for the treatment of coronary bifurcation lesions. The secondary aim was to study the effect of final kissing balloon inflation (FKBI) on clinical outcomes. METHODS AND RESULTS Between December 2012 and December 2013, 202 patients with stable coronary artery disease or non-ST-segment elevation acute coronary syndrome were randomly assigned 1:1 to treatment of the coronary bifurcation lesions either with the BiOSS LIM stent (n=102) or with an rDES (n=100). Coronary re-angiography was performed at 12 months. The primary endpoint was the composite of cardiac death, myocardial infarction (MI), and target lesion revascularisation (TLR) at 12 months. The target vessel was located in the left main in one third of the cases (35.3% in BiOSS and 38% in rDES). Side branch treatment was required in 8.8% (rDES) and 7% (BiOSS). At 12 months, the cumulative MACE incidence was similar in both groups (11.8% [BiOSS] vs. 15% [rDES, p=0.08]), as was the TLR rate (9.8% vs. 9% [p=0.8]). The binary restenosis rates were significantly lower in the FKBI subgroup of the BiOSS group (5.9% vs. 11.8%, p

Background: There is not much data on matrix metalloproteinase neutrophil gelatinase-associated lipocalin (MMP-NGAL) complex in patients with atrial fibrillation (AF). Aim: The aim of the study was to assess the value of MMP-NGAL complex in predicting AF recurrence after electrical cardioversion. Methods: The serum levels of NGAL, cystatin C, interleukin-6, high-sensitivity C-reactive protein, copeptin, MMP-NGAL complex, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase 1, Von Willebrand factor, B-type natriuretic peptide and the urinary level of NGAL were evaluated before cardioversion. Results: A total of 83 patients with persistent AF were enrolled in the study. Left atrial diameter (LA) ≥4.5 cm was significantly associated with AF recurrence at follow-up (p = 0.009). In selected 39 obese patients, MMP-NGAL complex was associated with AF recurrence (p = 0.03). If the concentration of MMP-NGAL complex increased by 1 ng/ml, the odds of AF recurrence increased by 4% (OR 1.04; CI: 1.00-1.08; p = 0.03). MMP-NGAL complex did not correlate with AF recurrence in patients with a first episode of AF, in patients ≥65 years of age and in patients with a LA ≥4.5 cm or with chronic kidney disease. Conclusions: It is known that the greater the BMI at baseline, the higher the likelihood of progression from paroxysmal to permanent AF. However, European Society of Cardiology (ESC) guidelines do not consider obese patients a population with a low likelihood of success of cardioversion. That is why we need a sensitive marker to predict sinus rhythm maintenance in such a population. We found that MMP-NGAL complex may predict AF recurrence after successful cardioversion in obese patients.