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Coronary artery disease (CAD), due to common risk factors, often accompanies aortic stenosis (AS) [1]. CAD occurs in 50–75% of patients undergoing transcatheter aortic valve implantation (TAVI) [1]. However, there are no data on the necessity and the extent of revascularization in CAD patients referred for TAVI. According to the ESC/EACTS guidelines for myocardial revascularization published in 2018, percutaneous coronary intervention (PCI) should be considered in patients with stenoses > 70% in proximal segments of coronary arteries, undergoing TAVI [2]. Optimal timing (before, simultaneously or after TAVI) and the mode of revascularization have not yet been established [2].

Background Data regarding the efficacy of percutaneous coronary intervention (PCI) with new-designed drug eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare 1-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population. Methods We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age: 69 ±8.9 years), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Results In unmatched cohort patients treated with new-DES vs. BMS had lower MACCE (28.3% vs. 21.4%, HR = 0.69, 95% CI: 0.50–0.95, p = 0.025) as well as myocardial infarctions (MI) (12.1% vs. 6.3%; HR = 0.49, 95% CI: 0.30–0.82, p = 0.005) at 1 year. After propensity score matching similar, significant reduction in MACCE and MI was sustained in new-DES vs. BMS groups (HR = 0.66, 95% CI: 0.46–0.96, p = 0.030; and HR = 0.53, 95% CI: 0.31–0.92, p = 0.020, respectively). Conclusions In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS., Background Presence of durable polymers may be associated with late/very late stent thrombosis occurrence and the need for prolonged dual antiplatelet therapy. Bioresorbable polymers may facilitate stent healing, thus enhancing clinical safety. Aim We sought to determine the 3-year clinical follow-up in patients treated with the thin strut (71 μm) bioabsorbable polymer-coated sirolimus-eluting (BP-SES) stent versus durable coating everolimus eluting stent (DP-EES) in daily clinical routine. Methods Interventional Cardiology Network Registry is a multicenter, all-comers registry of 21.400 patients treated with PCI between 2010 and 2016. All patients who underwent implantation of either ALEX (n = 287) or XIENCE (n = 1114) stents within a time frame of availability of 3-year clinical follow-up were included. We evaluated the incidence of all-cause deaths at 3-year follow-up and a composite endpoint of death or myocardial infarction. Results There was no significant differences between the groups in procedure related complications and in-hospital mortality (ALEX 1.8% vs. XIENCE 1.0%, p = 0.22). Follow-up demonstrated similar 3-year all-cause mortality (ALEX 12.0% vs. XIENCE 11.9%, p = 0.99), as well as comparable incidence of composite endpoint in ALEX group when compared to XIENCE (19.9% vs. 20.0%, p = 0.98, respectively). Conclusions In this multicenter registry, ALEX stent demonstrated comparable clinical outcomes at 3 years after implantation to the XIENCE stent. These data support the relative long-term safety and efficacy of ALEX in a broad range of patients undergoing percutaneous coronary interventions., Background Peri-strut low intensity areas (PLIA) surrounding metallic stents struts, visualized by optical coherence tomography (OCT) images, have been related to inflammation, neointimal proliferation and increased incidence of target lesion revascularization. Aim To determine the association between PLIA by OCT and the vascular healing response after bioresorbable scaffold (BRS) implantation in the setting of acute myocardial infarction (MI). Methods This is a single-centre, longitudinal study with a serial: baseline, 12- and 24-month OCT evaluation of neointimal response after percutaneous coronary intervention (PCI) with BRS implantation in patients presenting with ST-segment elevation MI (STEMI). Neointimal thickness and area were evaluated in relation to the presence of PLIA by OCT. Every analyzed cross section was scored: 0 – no PLIA; 1 – PLIA in < 1 quadrant; 2 – PLIA in 1 but < 2 quadrants; 3 – PLIA in 2 but < 3 quadrants; 4 – PLIA in ≥ 3 quadrants. A total of 18 STEMI patients treated with 20 AbsorbBRS implantation were included. Results The presence of PLIA within the scaffolds was identified in 55%. The significant positive correlation was found between PLIA score and the mean (r = 0.406; p = 0.038), maximal (r = 0.421; p = 0.032) and minimal neointimal thickness (r = 0.426; p = 0.03), but not with neointimal area (r = –0.091; p = 0.352) after 24 months. No difference was observed between the PLIA positive and negative group in terms of the neointimal thickness and area. Conclusion In STEMI patients treated with BRS implantation, presence and extent of PLIA by OCT may be associated with the pattern of neointimal formation. This surrogate parameter may serve as a tool for evaluation of in-scaffold neointimal growth after future generation BRS implantation. Figure 1 Peri-strut low intensity area (PLIA) score classification on the optical coherence tomography (OCT). The analyzed cross sections were scored: 0 – no signs of PLIA; 1 if PLIA in < 1 quadrant; 2 if PLIA in 1 but < 2 quadrants; 3 if PLIA in 2 but < 3 quadrants; and 4, if PLIA in ≥ 3 quadrants, Background The biodegradable polymer drug-eluting stents were developed to improve vascular healing. However, further data is needed to confirm the safety and efficacy of these stents in patients with acute myocardial infarction (AMI). Aim We sought to determine the 1-year clinical follow-up in patients with AMI treated with the thin strut biodegradable polymer-coated sirolimus-eluting (BP-SES) stent versus durable coating everolimus-eluting stent (DP-EES). Methods We analyzed patients with AMI (STEMI and NSTEMI) treated with either a BP-SES (ALEX™, Balton, Poland, n = 886) or DP-EES (XIENCE™, Abbott, USA, n = 1054) with available 1-year clinical follow-up using propensity-score matching. Outcomes included target vessel revascularization (TVR) as efficacy outcome and all-cause death, myocardial infarction, and definite/probable stent thrombosis as safety outcomes. Results After propensity score matching 672 patients treated with BP-SES and 672 patients treated with DP-EES were selected. Procedural and clinical characteristics were similar between both groups. In-hospital mortality was similar in both tested groups. One-year follow-up demonstrated comparable efficacy outcome TVR (BP-SES 7.1% vs. DP-EES 5.2%, p = 0.14), as well as similar safety outcomes of all-cause death, myocardial infarction, and definite/probable stent thrombosis. Conclusions The thin-strut biodegradable polymer coated sirolimus-eluting stent demonstrated comparable clinical outcomes at 1-year after implantation to the DP-EES. These data support the relative safety and efficacy of BP-SES in high-risk ACS patients undergoing PCI., Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) remains still challenging mainly due to its complex and multiple etiology. Aim To assess the relationship between gender and clinical outcomes during follow-up in patients after MINOCA and predictors of main adverse cardiac and cerebrovascular adverse events (MACCE). Methods The study consisted of 134 patients (78 females, 58.2%) at the mean age of 61.6 years who were diagnosed with MINOCA in our department of cardiology within the period from January 2015 to June 2018. The subjects were included in the average follow-up period lasting 609.5 days. The primary study endpoints were MACCE, which included death, myocardial infarction, reintervention and cerebral stroke. The evaluated secondary study endpoints were recurrent chest pains in the follow-up period and rehospitalization for reasons other than MACCE. Additionally, we assessed predictors of primary and secondary study endpoints. Results The MINOCA frequency is presented in Figure 1. Kaplan Meier survival curve analysis did not reveal statistically significant differences in the frequency of MACCE (p = 0.63) or mortality rate (p = 0.29) between males and females during follow-up period. There was no statistically significant impact of gender on secondary study endpoints during the follow-up. Univariate and multivariate analysis of predictors of primary and secondary study endpoints has not included gender among other confirmed predictors of clinical outcomes during follow-up in patients after MINOCA. Figure 1 MINOCA frequency stratified by sex and year of enrollment Conclusions Despite a number of clinical differences and comorbid diseases between genders in patients after MINOCA, gender was not found to be significantly associated with clinical outcomes during the follow-up., Background Frailty syndrome (FS) is an exponent of advanced biological age and an important risk factor for the development of adverse outcomes. The multi-factor cascade of the change process should be considered in the context of both biological and psychological as well as socio-environmental factors. In connection with the above, it is indicated increasingly the importance of a new phenomenon which is cognitive impairment (CI) associated with co-existing FS, so-called cognitive frailty (CF). The heterogeneity of FS and CI is one of the risk factors for cardiovascular events. This can be extremely important in elderly patients with the acute coronary syndrome (ACS) because patients with CF may not meet the therapeutic goals. Aim To describe the association between FS and CI in elderly patients with ACS. Methods This prospective observational study included one-hundred patients aged 65 or older hospitalized for ACS. Frailty was assessed using the Tilburg Frailty Indicator (TFI). The Mini-Mental State Examination (MMSE) was used for cognitive function evaluation (study results are presented in Tables I-IV). Table I Characteristics of participants Mean (SD) Median (min.-max.) P-value 76.08 (8.24) 77 (68–84) 0.004 Mean age of women = 78.43 years old, mean age of men = 73.87 years old. Table II Results of the TFI questionnaire TFI Women (n = 48) Men (n = 52) All (n = 100) P-value n % n % n % Frail 36 73.47 24 46.15 60 60.00 0.01 No frail 12 25.00 28 53.85 40 40.00 The mean total TFI score = 6.98. Table III Cognitive impairment in patients with frailty syndrome FS CI (n = 40) No CI (n = 60) P-value n % n % Frail 36 90.00 24 40.00 < 0.001 No frail 4 10.00 36 60.00 Females 50% > Males 30%. Table IV Domain of the TFI questionnaire in patients with cognitive impairment Domain CI N Mean SD Median Min. Max. Q1 Q3 P-value* Physical + 40 6.17 1.52 6 2 8 5.75 7 < 0.001 – 60 3.48 2.08 3 0 8 2 5 Psychological + 40 2 0.93 2 0 3 1 3 0.001 – 60 1.28 0.98 1 0 3 1 2 Social + 40 0.92 0.86 1 0 3 0 1 0.655 – 60 0.8 0.68 1 0 2 0 1 Conclusions Cognitive frailty occurred in the studied population of patients with ACS. There is a negative relationship between the presence of FS (especially in the physical and psychological domain of the TFI) and CI. It is worth mentioning that there is still a lack of sufficient studies on the cognitive frailty in patients with ACS. The obtained results may be helpful in optimizing the care plans and implementing interventions to improve physical and psychological functioning in patients with co-existing cognitive frailty., Background Profilin 1 (Pfn 1) is a small protein crucial in the regulation of actin cytoskeleton. Several studies show it may play a role in gene expression and intracellular communication, being released from platelets and possibly other cells (endothelium, leukocytes). An increasing amount of data suggests Pfn 1 is a key player in the pathogenesis of stable angina and acute coronary syndrome. A basic factor influencing the treatment and prognosis of patients with type 1 myocardial infarction (t1MI) is the duration of symptoms of ischemia. In everyday clinical practice, it is often difficult to determine this parameter, due to a number of patient-related factors (e.g. unclear symptom onset, stress, etc). Therefore, it is reasonable to search for a laboratory indicator of symptom duration. Methods 65 patients with t1MI (STEMI or NSTEMI) treated with pPCI were enrolled in the study. The exclusion criteria were: inability to define the time of symptom onset; symptom duration > 24 h; s/p CABG; active inflammation; any thrombosis, stroke or MI within the last 3 months; neoplasms; hypercoagulability; stage 4 or 5 chronic kidney disease. Pfn 1 concentration in peripheral blood was assessed using an enzyme-linked immunosorbent assay (ELISA) in three time points: on admission, 24 and 48 h post pPCI. Results We found a negative correlation between symptom duration and Pfn 1 concentration on admission (Spearman R = –0.42, p = 0.008), 24 h post pPCI (Spearman R = –0.30, p = 0.022) and 48 h post pPCI (Spearman R = –0.28, p = 0.033). Patients presenting with symptoms lasting less than 6 h had a significantly higher concentration of Pfn 1 than those with symptoms lasting longer than 6 h (838.54 vs. 687.12, p = 0.007). Conclusions To our knowledge, this is the first study investigating the relationship between Pfn 1 and symptom duration in both STEMI and NSTEMI patients. We have shown that Pfn 1 concentration in peripheral blood is inversely proportional to symptom duration, probably due to release from activated platelets during intracoronary thrombus formation. Pfn 1 may be an objective indicator of the symptom duration in MI, and as such could be a a valuable tool in decision-making and prognostic assessment., Background Epidemiology of valvular hearth defects has changed in recent years. Aging of the population has contributed to the increase of the percentage of both, degenerative defect and coronary heart disease. Due to the lack of current data on coronary artery disease among patients with valvular diseases in Podlaskie region this study gathers information about this group of patients. Aim The analysis of the atherosclerotic plaque burden distribution in the coronary arteries and long term prognosis among patients with valvular heart disease. Methods Retrospective analysis considered medical documentation of 12954 patients hospitalized in the Department of Invasive Cardiology of the Medical University of Bialystok. Follow-up of total morality was done after the average of 1500 days. Results Valvular heart disease was diagnosed in 1214 patients, among whom 843 subjects had coronary artery disease. Mitral regurgitation was the most common valvular defect, which, at different severity grading, occurred at 50% of the studied population (n = 607). The most common severe valvular heart defect was aortic valve stenosis, which affected 23% of patients (n = 279). Combined valvular heart disease occurred in 44.7% patients (n = 543), of which 29.5% (n = 358) had a disease of more than one valve. Significant coronary artery narrowings were diagnosed in 524 patients. Angiographicaly significant stenoses were mostly reported in LAD (25.25%, n = 303), Cx, (23.91%, n = 287) and RCA (23.66%, n = 284). There were 236 percutaneous coronary interventions (19,6%), with the prevailing PCI of Cx (n = 139) and LAD (n = 93). The operation due to valvular heart defects was performed in 47.98% patients, and 41.06% of those underwent coronary artery bypass surgery. Significant stenosis of the right coronary artery was more frequently diagnosed among patients who died (21.77% vs. 31.38%, p < 0.001). Subjects with severe mitral valve insufficiency more often presented with the diagonal artery stenosis. Conlcusions The most common defect in the analysed population was mitral regurgitation of all grading severity. Aortic valve stenosis was the most severe valvular heart defect and presented with significantly worse prognosis comparing to other heart diseases despite lower risk of death. Coronary artery disease was an additional factor worsening the prognosis of patients with heart defects. More than 50% of patients underwent coronary revascularization. Significant stenosis of diagonal artery more frequently occurred in mitral insufficiency, and significant stenosis of right coronary artery worsened the prognosis. During 8-year follow-up 19.7% of subjects died., Background Both IVUS and FFR are been used to assess the clinical importance of a borderline coronary lesion. It has been suggested that more lesions are significant when assessed using IVUS than when using FFR. Methods Consecutive pts with borderline, de novo coronary lesions (%DS ≥ 40%, but < 70%) from the ANIN IVUS & FFR registries were analyzed. Cut-off values of significance were an IVUS minimum lumen area (MLA) < 3.0 mm2 and minFFR < 0.8. Results Between 1/2009 to 12/2016 there were 1225 patients with 1547 borderline lesions (880 IVUS; 667 FFR). IVUS was almost exclusively preferred for left main (LM) lesions (p < 0.001); but other coronaries were examined with both techniques equally (Figure 1). After exclusion of 408 pts with LM lesions, those examined with FFR were significantly older, had more hypertension and hyperlipidemia, but had less previous PCI. Mean MLA was 4.2 ±1.8 mm2, and mean minFFR was 0.83 ±0.09. Overall, 31.8% of LAD lesions were significant because of an IVUS MLA < 3.0 mm2 or an minFFR < 0.8 vs. 19.5% in RCA and 21.2% in LCx (p = 0.001). More lesions were significant by FFR vs. IVUS (32.6% vs. 23.9%; p = 0.002), especially in the LAD; whereas RCA lesions were considered significant more frequently by IVUS, and LCx lesions were significant with similar frequency by both techniques (Figure 1). Figure 1 Distribution of IVUS, FFR, MLA < 3.0 mm2 and FFR < 0.8 among the coronary arteries Conclusions The saying “If you want to treat, use IVUS. If you don’t, use FFR” is clinically untrue using contemporary criteria, especially when recognizing specific vessel differences. Use of IVUS for borderline verification does not lead to more intervention as compared to FFR assessment., Background Stress perfusion CMR or SPECT are used for assessment of myocardial ischemia. Methods Consecutive pts in whom induced ischemia (expressed as a % of left ventricular (LV) mass) was established using SPECT (SYMBIA INTEVO EXCEL) or MR (1.5T scanner, Philips Gyro-Scan NT) with different methods of inducing stress were analyzed and compared. Results From 2013 to 2017, 696 patients (65.2 years; 29.0% males) were studied with CMR; from 2016 to 2017, 690 patients (66.5 years; 31.0% males) were studied with SPECT. Ischemia of any level was more frequently identified using SPECT vs. CMR (72.3% vs. 31.5%; p < 0.001). However, total ischemia burden was greater with CMR vs. SPECT (10% (9% to 15%) vs. 5% (3% to 6%); p < 0.001). Also, ≥ 10% ischemia was identified more frequently with CMR vs. SPECT (22.7% vs. 9.6%; p < 0.001) and more frequently with dipyridamole (p = 0.028, Figure 1). Comparing patients with inducible ischemia by SPECT vs. CMR, there were more patients with a history of chronic renal disease (14.9% vs. 8.2%, p = 0.004) and CABG (22.7% vs. 15.7%, p = 0.05), but less MI (43.9% vs. 53.6%, p = 0.033). There was no difference in hypertension, dyslipidemia, or diabetes. Patients with induced ischemia ≥ 10% were less often ≥ 65 years of age (51.3% vs. 61.8%, p = 0.048), but more often had diabetes (32.5% vs. 25.2%, p = 0.04) or an MI history (55.3% vs. 41.1%, p < 0.001). Figure 1 Distribution of the ischemia burden categorized with various cut-offs and assessed with different imaging modalities Conclusions SPECT is more sensitive in detecting any amount of ischemia, but CMR is more accurate in detecting pts with ≥ 10% LV involvement who have a worse prognosis. CMR identifies more often pts with ischemia involving more than 10% of LV mass while SPECT is a more sensitive technique for detecting the presence of ischemia., Background Even after all the workshop conditions of optimum angiography are fulfilled and even when working with high-resolution angiographic equipment, > 40% of borderline LM lesions have an inconclusive assessment. Methods In 2 orthogonal views (LAO vs. RAO) lumen diameters were measured among borderline LM lesions visualized at 15 f/s with the SiemensTM AXIOM (1024 × 1024 flat panel detector). Identified were the 3 frames within the narrowest region of LM lumenogram (1 back & 1 forward, counting from the one judged as the narrowest). Then, 3 independent measurements were made: minimal lumen diameter (3× MLD) and proximal & distal reference diameters (prox & dist ref diam, 3× each). Measurements were done with image enlarged by a factor of 2, using a dedicated digital caliper (plotting lines from a single pixel to a single pixel to the nearest 2 decimal places). Measurements and %DS (100% – MLD/mean ref diam) were categorized for their minimal and maximal values. Results Among the 32 consecutive patients (67 ±8 years, 53% males), 1567 diameters were measured. Absolute variations in min vs. max measured diameters as displayed on Figure 1. In a per patient analysis relative variations in measured diameters for prox ref, MLD and dist ref led to variations in min vs max %DS in LAO and RAO views of 30 ±14% vs. 49 ±14% (p < 0.001) and 32 ±17% vs. 55 ±13% (p < 0.001), respectively. Conclusions Even using contemporary coronary angiographic equipment, assessment of LM stenosis severity (as well as LM reference lumen size) is highly variable. The inherent limitations of angiography lead to inconsistency in LM stenosis severity assessment. Figure 1 Variations in measured minimal (solid) vs. maximal (transparent) diameters at the sites of: prox ref (◻), MLD (○) and dist ref (◊) (on a per frame (A) & per patient basis (B)) (p < 0.001 for all corresponding comparisons of min vs. max), Background In primary care, 10–20% of people complain of significant sleep problems, with nearly 100 identified types of sleep disorders. A number of factors lead to under-detection of sleep deprivations. Its effective diagnosis is important to receive the correct treatment. Aim To proposed original concept of the infrastructure of the home-care system for sleep identification and sleep event scoring (Figure 1). Figure 1 Block diagram summarizing the steps followed in this study, from signal recording to the biostatistical and Information Theory based analysis Methods This study includes some preliminary results toward ECG-based diagnosis of sleep disorders. Sleep deprivation detection problem is modeled as a two-group classification problem. The two subject groups are: healthy individuals and Sleep Related Breathing Disorders (SRBD) positives (12 subjects). Parameters derived from ECG and acoustic analysis were considered as input for the predictive statistical models used to find the best possible classification of sleep disorders. Moreover, as an alternative to statistical analysis Lempel-Ziv Complexity (LZC) algorithm as detection tool of sleep deprivation via ECG was applied. Results Our results show that the best events recognition is reached for over 89% (raw database) and for over 92% (up-sampled database) good predictions. It turned also out, that the SRBD patients have more regular ECGs, which are characterized by LZC around 0.32, while control group has the complexity around 0.85 and variability of patterns is much larger. Conclusions Proposed diagnostic method, which links biostatistics with Information Theory approach, is a powerful tool for the classification of sleep disorders, even in the early stage. It provides also inspiring insight into developing effective algorithms of telemedical data interpretation., Background Coarctation of the aorta (CoA) is a common cause of secondary arterial hypertension (HTA). Aim To analyze the diagnostic route and medical therapy of HTA in a series of adults undergoing endovascular stenting of CoA. Methods Twenty-four consecutive adults (median age: 36 years, 15 men) were enrolled. Clinical history was collected at baseline, wherein special attention was paid to the time period between onset of HTA and diagnosis of CoA. Patients were contacted by phone after 34 ±17 months to follow up medical treatment. Results The mean age at detection of HTA was 17.1 ±8.8 years (range: 1–36 years), while the mean age at diagnosis of CoA was 33.5 ±14.9 years (range: 1–77). The mean delay in diagnosis was 16.4 ±11.1 years (maximally 37). All patients underwent successful CoA stenting with excellent trans-coarctation gradient reduction (40.1 ±15.9 before the procedure vs. 1.3 ±2.2 mm Hg after the procedure; p < 0.001; 95% CI: 32.1–45.4). No early complications were observed; in 1 case redo intervention was performed due to aortic aneurysm formation. Overall, 95.8% of patients received antihypertensive treatment at baseline (79.2% with ≥ 3 drugs), compared to 65.2% at follow-up (30.4% with ≥ 3 drugs); p = 0.008, Z = –2.65. The mean number of antihypertensives dropped from 3.1 ±1.3 to 1.9 ±1.7 (p < 0.001; 95% CI: 0.67–1.94). The mean number of reduced drugs per patient was 1.3 ±1.4 (Table I). Table I Detailed characteristics of the patients enrolled Patient Sex Age at the intervention [years] Delay in the diagnosis [years] SBP/DBP [mm Hg] Number of antihypertensive drugs Invasive PG [mm Hg] Before stenting After stenting Baseline Follow-up Before stenting After stenting 1† F 77 n/a 140/90 n/a 4 n/a 39 3 2 M 46 10 130/80 130/80 5 5 58 1 3$,# F 26 < 1 140/90 130/70 3 0 25 5 4# M 18## 2 200/120 140/70 2 4 60 6 5 F 41 1 175/84 120/70 3 2 51 4 6 M 30 4 170/75 117/69 5 3 28 0 7 F 35 11 208/87 133/79 3 0 49 1 8 M 26 10 145/80 129/77 3 0 45 0 9* F 35 n/a 162/93 123/76 3 1 48 0 10 M 38 21 169/102 154/109 3 2 70 0 11$ M 41 < 1 170/80 164/96 3 2 62 4 12 M 37 19 175/77 151/91 6 4 33 3 13 F 38 29 135/70 101/73 0 0 39 0 14 M 38 36 150/84 135/70 3 2 25 0 15 M 30 17 182/82 162/84 3 4 18 0 16 M 47 12 131/75 132/75 4 0 39 3 17* F 27 n/a 117/76 101/70 1 0 30 3 18 M 60 30 173/85 120/82 3 0 26 0 19 F 35 16 148/81 122/78 3 2 14 1 20** M 31 n/a 158/68 135/72 4 5 34 1 21 F 27 14 146/84 129/86 2 0 27 0 22** M 41 n/a 144/84 105/67 4 2 24 2 23 M 29 16 144/79 148/77 1 1 67 0 24 M 45 37 149/89 135/87 4 4 57 1 M – male, F – female, SBP – systolic blood pressure, DBP – diastolic blood pressure, PG – pressure gradient, n/a – not available/not applicable † intra-hospital death $ prompt diagnosis of CoA # treated with a bare metal stent ## age at the original intervention * diagnosed in infancy, not operated, ** diagnosed and operated in infancy. Conclusions Delayed diagnosis of CoA leads to unnecessary antihypertensive medication, therefore diagnostics focused on CoA should be carried out in all children and young adults presenting with HTA. Endovascular stenting is a safe and effective treatment strategy for CoA in adults that significantly improves medical treatment.

Bakground Current recommendations indicate invasive coronary angiography (ICA) as the first-line anatomic test in stable patients with high probability of significant coronary artery disease (CAD). However, this approach effects in increased proportion of non-actionable ICAs (not followed by invasive treatment). Clinical efficacy and the safety of the strategy employing coronary computed tomography angiography (CCTA) as the first-choice imaging test in this population has been recently evaluated in the CAT-CAD randomised trial. Based on prospectively collected data we aimed to evaluate its economic outcomes. Methods One hundred and twenty consecutive stable patients with indications to invasive CAD diagnosis were randomised 1 : 1 to undergo ICA versus CCTA as the first-line anatomic test. Outcomes were evaluated during the entire diagnostic and therapeutic course. Simultaneously, we counted the number of medical resources, such as: CCTAs, ICAs, percutaneous coronary interventions (PCIs), coronary artery bypass grafts (CABGs), functional tests, stents, clinical visits, hospital days. We estimated the cumulative cost for each strategy by multiplying medical resources by its standarised costs. Clinical Trials: NCT 02591992. Results Economic analysis showed that the total cost of CAD diagnosis was significantly higher in the direct ICA group as compared to the CCTA group ($305,962 vs. $234,550), with the median per-patient cost of $2838 (2,838–2,838) vs. $409 (409–3,247), respectively (p = 0.0001). Similarly, the entire diagnostic and therapeutic course was significantly more expensive in the direct ICA group ($603,746 vs. $354,690), with the median per-patient cost of $2,838 (2,838–16,102) vs. $409 (409–9,930), respectively (p < 0.0001) (Figure 1). Figure 1 Main results and economical analysis of the CAT-CAD trial Conclusions Application of CCTA as the first-line anatomic test in patients with suspected significant CAD decreased the total costs of diagnosis. This benefit can be achieved by reducing the number of invasive tests and hospitalisations., Background Thick cap fibroatheroma (TCFA) is considered as one of the features of vulnerable plaque. However, current methodology is based on measurement in arbitrary points and ignores 3-dimensional structure of coronary arteries. Purpose The aim of our study was to compare TCFA area using 3-demensional programming between stable angina (SA) and ST-elevation myocardial infarction (STEMI) patients using optical coherence tomography. Methods We have compared non-culprit plaques in 27 SA and 27 STEMI patients undergoing percutaneous coronary intervention. The TCFA was defined as a fibrous cap thickness lower than 80 μm. Whole TCFA area, number of spots with TCFA and average area of each spot were measured. Results Patients characteristics between two groups were comparable. However, patients with STEMI were less frequently on statins (17% vs. 70%; p < 0.001) and β-blockers (4% vs. 48%; p = 0.001). STEMI patients had greater TCFA area (1.2 ±1.3 vs. 0.2 ±0.5 mm2; p < 0.001), bigger largest TCFA spot (0.5 ±0.5 vs. 0.1 ±0.2 mm2; p < 0.001), greater number of TCFA spots (10.0 ±10.1 vs. 3.2 ±4.4; p = 0.002), as well as greater mean spot area (0.18 ±0.36 vs. 0.05 ±0.04 mm2; p < 0.001) (Figure 1). Figure 1 Optical coherence tomography example of fibrous cap thickness (FCT) of stable angina (SA) and ST elevation myocardial infarction (STEMI) patient. Red colour represents FCT lower than 80 μm, green from 80–200 μm, and blue more than 200 μm Conclusions The STEMI patients have greater TCFA area in non-culprit plaques, which may explain higher rate of adverse events in this groups as compared to SA patients., Background Prevalence of coronary artery disease as well as cardiac mortality varies between Asians and White patients. However, the link between race and plaque characteristics among patients with coronary artery disease remains largely unexplored. Purpose The aim of our study was to compare the detailed culprit plaque characteristics between East Asian and White patients with coronary artery disease using optical coherence tomography. Methods We performed propensity score matching between Asian and White patients at 1 : 1 ratio based on the following variables: (1) age; (2) gender; (3) clinical presentation; (4) diabetes mellitus; (5) hyperlipidemia; (6) culprit lesion location. Overall, 101 East Asian patients were matched to 101 White patients. Results Majority of patients were male (80.2%) and average age was 60 years. Other than higher body mass index (BMI) in White patients (29.6 ±5.1 vs. 24.2 ±3.1 kg/m2; p < 0.001) baseline demographics were comparable between the two groups. In those patients presented with acute coronary syndrome (ACS) no differences in underlying pathology (rupture vs. erosion) were found between the two races (Table I). In adjusted analysis, lesion length was longer, lipid length and lipid index were greater, and mean reference area was larger in White patients compared to East Asian patients. Table I Optical coherence tomography findings Parameter White (n = 101) East Asians (n = 101) P-value Underlying pathology (ACS), n: 62 50 0.935 Rupture, n (%) 32 (50.0) 33 (51.6) Erosion, n (%) 20 (31.3) 17 (26.6) Lesion length [mm] 18.0 ±6.0 14.6 ±5.4 0.002 Lipid core length [mm] 9.4 ±4.6 7.2 ±3.8 0.044 Mean lipid arc [°] 169.2 ±41.8 148.8 ±40.7 0.002 Lipid index 1635 ±987 1104 ±730 0.006 Mean reference area [mm2] 8.1 ±3.0 6.5 ±2.4 0.021 Values are mean ± standard deviation (SD) or n (%). Conclusions There are significant differences in plaque morphology between East Asian and White patients even after controlling for confounders. Our findings underscore key differences in atherosclerosis between East Asian and White populations and may have to be taken into consideration in interpreting the results of future research., Purpose The aim of the study was to define cardiac complications risk during antegrade coronary artery chronic total occlusion (CTO) recanalization. Methods From 2009 to 2013 the attempt of antegrade coronary artery CTO recanalization was performed in 217 patients. Depending on success of recanalization patients were divided into: group 1 (n = 158) – successful procedure, group 2 (n = 59) – unsuccessful attempt of CTO recanalization. Results Occurrence of cardiac complications was noted in 57 patients (26.3% of cases) – coronary artery dissection (11.5%), perforation of a coronary artery (5.5%) and coronary artery spasm (5.1%) among them. We didn’t note any cases of cardiac death, an acute myocardial infarction, and an immediate coronary artery bypass surgery. All perforation cases were induced by wire manipulation, dissections most often occurred during coronary stent implantation, coronary spasm developed at all stages of CTO recanalization. Frequency of cardiac complications was identical in both groups (25.9% in group 1 vs. 27.1 % in group 2, p = 0.8637). Unsuccessful CTO recanalization was associated with higher perforation rate (2.5% in group 1 vs. 13.6% in group 2, p = 0.0266), especially Ellis II type perforation (2.5% in group 1 vs. 10.2% in group 2, p = 0.0039). Conclusions The obtained data confirm a high safety profile of antegrade CTO recanalization emphasized by absence of “big”” cardiovascular complications and suitable outcome in coronary artery dissection and perforation cases., Purpose The aim of the study was to assess the accuracy of Pd/Pa ratio registered during submaximal hyperemia induced by contrast medium (CMR) in predicting of fractional flow reserve (FFR), quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR). Methods Resting Pd/Pa, CMR, FFR, QFR and iFR were measured in 110 intermediate coronary stenosis. CMR was obtained after intracoronary injection of contrast medium. FFR was measured after intravenous administration of adenosine. QFR was derived from fixed empiric hyperemic flow velocity based on coronary angiography. The iFR was calculated by measuring the resting pressure gradient across a coronary lesion during the portion of diastole when microvascular resistance is low and stable. Results Forty four patients with 110 intermediate coronary stenosis were enrolled. Mean baseline Pd/Pa was 0.93 ±0.05. Mean CMR value was similar to FFR value (0.83 ±0.09 vs. 0.81 ±0.09, p = 0.13) and QFR (0.81 ±0.1, p = 0.69) and iFR (0.9 ±0.07, p = 0.1). Forty-six vessels (41.8%) had FFR ≤ 0.80. Fifty (45.5%) vessels had CMR ≤ 0.83. Forty-four (40.0%) vessels had QFR ≤ 0.80. Thirty-eight (34.5%) vessels had iFR ≤ 0.89. Resting Pd/Pa, FFR, QFR and iFR correlated with CMR (r = 0.83, r = 0.98, r = 0.96, r = 0.81, respectively, p < 0.001 for all). The optimal cutoff value of CMR was 0.83 for prediction of FFR ≤ 0.80 with sensitivity, specificity, and accuracy of 96.9%, 97.8%, and 97.3% respectively. A 100% sensitivity was observed for cutoff value of 0.82 and a 100% specificity for cutoff value of 0.84; AUC = 0.998 (0.995–1.00); p < 0.001. Conclusions CMR seems to be accurate in predicting the functional significance of coronary stenosis assessed with FFR, iFR and QFR., Background Rotational atherectomy (RA) is a method of treatment of highly calcified lesions that cannot be treated with traditional percutaneous coronary intervention (PCI). Despite higher access site complication rates, transfemoral approach (TFA) may be preferred to obtain proper backup, facilitate atherectomy and achieve procedural success. In this study we compare transradial (TRA) and TFA in RA patients. Methods We retrospectively analysed data in 177 patients who underwent RA using either TFA (n = 54) or TRA (n = 123). Results Patients with TRA were more likely to be males (73% vs. 57%, p < 0.05) with no difference in age (71 ±10 years). The prevalence of risk factors and comorbidities was similar in groups, however EuroSCORE II mortality risk was higher in the TFA group (3.15% vs. 2.1%, p < 0.05). Procedural success was achieved in 93% cases with no inter-group difference. TFA was associated with higher rates of major bleeding (13% vs. 1%), more frequent usage of pacing (30% vs. 3%), higher contrast volume (280 ml vs. 250 ml), and longer hospital stay (3 vs. 2 days, all p < 0.05). There was no difference in total in-hospital or 1-year stroke, acute coronary syndrome, decompensated heart failure or mortality rates. Conclusions Rotational atherectomy is a challenging and demanding technique and TFA may seem to be optimal approach to achieve optimal effect, however our data show that TRA is associated with lower bleeding rates with the same success as compared with TFA. It is necessary to include TRA in complex coronary procedures training to achieve best results and minimize the risk of complications., Background There paucity of real-life data on left main (LM) therapy with self-expandable drug eluting stent (DES). The following Stentys Left Main registry aimed to assess clinical outcomes of LM percutaneous coronary intervention (PCI) using such self-expandable platform (Stentys). Methods A multicenter registry consists of 154 consecutive patients treated with Stentys implanted to LM. Major adverse cardiac and cerebral events (MACCE) such as composite of death, myocardial infarction (MI) and stroke were recorded at 30-days and 12-months. Results Patients’ mean age was 69 ±10.5 years. Acute coronary syndrome was diagnosed in 40 (26.5%) cases including NSTE-ACS (n = 28, 18.1%) and STEMI (n = 12, 7.8%). Median EuroSCORE II was 2.2% (IQR: 1.0–4.5). Prior CABG were performed in 40 (25.9%) patients. Mean LVEF was 46.0 ±11.9%. Distal LM bifurcation lesions were present in 152 (98.7%) patients (Medina: 1,1,1 (n = 59, 38.3%), 1-1-0 (n = 62, 40.2%), 1-0-1 (n = 16, 10.4%), 1-0-0 (n = 17, 11.1%)). There was a significant difference between proximal and distal reference diameter of the lesions (4.0 (IQR: 3.9–4.1) vs. 2.9 (IQR: 2.8–3.0), p < 0.001). Stentys DES was implanted in the sequence LM to LAD in 107 (69.4%) cases. Stentys strut disconnection for SB access were done in 94 (61.2%) patients, because of angiographically significant stenosis of SB. Final kissing balloon inflation was performed in 25 (16%) cases. Six patients required ventricular assist devices during procedure. One patient had an acute stent thrombosis (ST) and 1 patient had late ST post PCI, there were 7 (4.5%) cardiac death, 2 (1.2%) target lesion revascularization (TLR), 3 (1.9%) MI and 9 (5.8%) MACCE during 30 days follow-up. At 12-month follow-up there were 9 (5.8%) cardiac death, 9 (5.8%) TLR, 7 (4.5%) MI and 19 (12.3%) MACCE. In 2 cases, TLR was the cause of MI. Conclusions The real-life multicenter registry showed that the use of Stentys DES self-expanding coronary stent is associated with acceptable short and midterm outcomes in all-comer population of patients including ACS with significant LM stenosis., Background Acute myocardial infarction may be the first manifestation of coronary artery disease (CAD). The aim of this study was to compare demographics, past medical history and angiographic presentation of patients with myocardial infarction as a first or subsequent manifestation of CAD. Methods Patient with STEMI or NSTEMI treated with PCI were enrolled to this registry study in Poland in 2014–2016 (the national ORPKI registry). Results There were 123 965 patients who fulfilled inclusion criteria. Acute myocardial infarction as first CAD presentation was diagnosed in 77% of cases (Table I). Table I Baseline characteristics Parameter First manifestation of CAD Subsequent manifestation of CAD P-value Age [years] 66 ±12 69 ±11 < 0.001 Gender – females 34% 30% < 0.001 Time from pain onset till angiography [min] – median 390 538 < 0.001 Diabetes mellitus 19% 33% < 0.001 Smoking 28% 20% < 0.001 Arterial hypertension 61% 77% < 0.001 COPD 2% 4% < 0.001 Femoral access site 27% 36% < 0.001 1-vessel disease in angiography 46% 30% < 0.001 Conclusions Patients with acute myocardial infarction as first CAD manifestation constitute ca. 75% of all cases and are characterized by lower mean age, more frequent female gender and cigarette smokers. These patients are also prone to more frequent use of radial approach and are characterized by single vessel disease in angiography. The time from pain onset to angiography was significantly (by ca. 2 h) lower in patients with first CAD manifestation., Background Secondary prevention of cardiovascular disease (CVD) aims to prevent the recurrence of cardiovascular events in patients already diagnosed with CVD. It involves the optimal pharmacotherapy and modification of the risk factors, understood as lifestyle changes in the area of physical activity, diet and addiction habits like smoking. Purpose The aim of the study was to analyze the realization of guidelines for secondary prevention of CVD in clinical practice. Methods: We included 320 consecutive patients (92 women) with a mean age of 64.8 ±9.0 years hospitalized at the 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital in Krakow. Patients had a history of acute myocardial infarction and/or had undergone percutaneous coronary interventions, coronary artery bypass grafting, or pharmacologically treated CVD. Results The mean body mass index (BMI) was 28.7 ±4.5 kg/m2 (45.6% of patients were overweight, 34.3% were obese). At the time of hospitalization, 16.3% of patients were active smokers; 43.8% smoked cigarettes for 28.2 ±12.4 years, 20.2 ±10.8 cigarettes per day. Only 15.4% of patients with acute myocardial infarction had cardiac rehabilitation after hospital discharge. In laboratory tests, mean level of total cholesterol 4.2 ±1.4 mmol/l; LDL 2.2 ±1.0 mmol/l; HDL 1.2 ±0.4 mmol/l; triglyceride 1.7 ±1.7 mmol/l. The mean fasting glucose in people without diabetes was 5.6 ±0.8 mmol/l; HbA1c in diabetics 7.1 ±1.2%. Furthermore, diet was assessed using study-dedicated questionnaire and level of physical activity was evaluated by The International Physical Activity Questionnaire. Conclusions In the studied group, there were differences from the recommendations for secondary prevention of CVD. There is a necessity to improve the care of patients with CVD. Adherence to recommendations may reduce the risk of recurrent cardiac events., Background Radial artery (RA) access for percutaneous coronary interventions (PCI) is gaining more supporters each year. It is considered safer than commonly used femoral access, however it also has its drawbacks. One of the major complications of radial access is radial artery occlusion (RAO). Purpose The aim of the study was to assess the predicting factors of RAO in patients undergoing various coronary interventions. Methods We prospectively evaluated clinical and laboratory data of 351 consecutive patients. Presence of blood flow in radial artery was evaluated in all patients by plethysmography on the next day after the procedure. Results RAO was observed in 52 (15%) patients. Differences between patients with and without RAO are presented in table below. Univariate logistic regression models showed compression time (OR = 1.6; 95% CI: 1.3–1.9; p < 0.001) female sex (OR = 2.8; 95% CI: 1.5–5.2; p < 0.001), coronary angiography as the only procedure (OR = 2.3; 95% CI: 1.2–4.6; p = 0.02), height (OR = 0.94; 95% CI: 0.91–0.98; p = 0.002), weight (OR = 0.97; 95% CI: 0.95–0.99; p = 0.02), and eGFR (OR = 0.98; 95% CI: 0.97–0, p = 0.006) to be predictors of RAO. In multivariate model time of RA compression (OR = 1.8, 95% CI: 1.4–2.2; p < 0.001) and coronary angiography as the only performed procedure (OR = 3.8; 95% CI: 1.7–8.7; p = 0.001) remained independent predicting factors of RAO (Table I). Table I Clinical and procedural characteristics Parameter RAO + RAO – All patients P-value N (%) 52 (15) 299 (85) 351 (100) Female sex, n (%) 29 (56) 92 (31) 121 (34) < 0.001 Age [years] 66 ±9 66 ±11 66 ±11 0.83 Height [cm] 165 ±9 170 ±8 169 ±9 0.001 Weight [kg] 78 ±16 82 ±14 82 ±15 0.005 Diabetes, n (%) 13 (25) 78 (26) 91 (26) 0.86 Hypertension, n (%) 49 (94) 271 (91) 320 (91) 0.39 Prior CABG, n (%) 4 (8) 27 (9) 31 (9) 0.75 Prior MI, n (%) 19 (37) 130 (43) 149 (42) 0.35 HFrEF, n (%) 10 (19) 64 (21) 74 (21) 0.72 Current smoker, n (%) 17 (33) 70 (23) 87 (25) 0.15 eGFR [ml/min/1.73 m2] 80 ±28 90 ±22 88 ±23 0.004 Compression time [h] 4.3 ±1.9 3.0 ±1.2 3.2 ±1.4 < 0.001 Coronary angiography only, n (%) 40 (77) 176 (59) 216 (62) 0.01 Coronary angiography + PCI, n (%) 11 (21) 100 (33) 111 (32) 0.08 PCI only, n (%) 1 (2) 23 (8) 24 (7) 0.12 5 Fr sheath only, n (%) 0 7 (2) 7 (2) 0.56 5 Fr catheter only, n (%) 28 (54) 146 (49) 174 (41) 0.5 GP2b3a inhibitors, n (%) 7 (13) 38 (13) 45 (13) 0.8 Urgent procedure, n (%) 25 (48) 102 (34) 127 (36) 0.05 UFH dose [× 1000 U] 4.1 ±1 5.1 ±1.6 4.9 ±1.6 0.07 Conclusions RAO is not uncommon after PCI. Its clinical significance is still unknown. Higher incidence of RAO after coronary angiography in our population may be attributed to lower doses of heparin administered during this procedure which may need to be increased. Compression times after all procedures should be limited to minimum., Purpose The aim of the study was to assess survival in CTEPH patients treated with balloon pulmonary angioplasty (BPA) in comparison to pulmonary endarterectomy (PEA) and conservative treatment (CON). Methods We enrolled 68 patients with the diagnose of inoperable or persistent CTEPH confirmed by CTEPH-team treated with BPA from 2013 to 2017. The survival of this population was compared to historical control group (n = 112) CTEPH patients which have undergone PEA (n = 46) or been treated conservatively (n = 66). Results The median survival duration observed in BPA population was 22.1 ±14.8 months. The cumulated survival index was 94.2% (95% CI: 88–100%) in the 50th month. In the historical control group the cumulated index of survival after PEA was 90.9% (95% CI: 84–97%) after 50 months (log-rank test vs. the BPA-treated group; 0.31) and in the patients receiving conservative treatment the survival rates were 70.1% (95% CI: 56–84%) after 50 months, respectively. The survival rate of patients treated with BPA was better than that of the historical CTEPH patients (Figure 1) only on pharmacotherapy (p < 0.001), and was similar to that of the patients treated with PEA (p = 0.31). Figure 1 Cumulative survival in CTEPH patients treated with different methods BPA – treated with balloon pulmonary angioplasty, PEA – treated with pulmonary endarterectomy, CON – treated conservatively. Conclusions The survival rate in patients with CTEPH treated with BPA is better than that in patients receiving pharmacotherapy and similar to that in the group of patients subjected PEA., Purpose The aim of the study was to compare long-term outcomes after PAD endovascular revascularization with two types of atherectomy with tip(tAT) (Phoenix® Philips) and side(sAT) (SilverHawk® Medtronic) based excision blades. Methods This was a single center, retrospective registry of obstructive and symptomatic PAD patients who underwent revascularization with atherectomy. The endpoints were considered as target lesion revascularization (TLR), death, amputations and bailout stenting (BS). Results In tAT group was 97 patients, whereas 85 was in sAT group. There were no significant differences between group in baseline characteristics except for increased CLI prevalence in tAT group. The mean follow up was 282.6 ±147.4 and 255.7 ±186.1, sAT and tAT, respectively (p = 0.44). The TLR was more frequent in sAT group than in tAT (sAT: 25 (29.0%) vs. tAT: 15 (15.9%) p = 0.03). There were no significant differences in death (sAT: 1 (1.7%) vs. tAT: 5 (5.7%); p = 0.54), amputations (sAT: 2 (2.3%) vs. tAT: 5 (5.7%); p = 0.45) and bailout stenting (sAT: 2 (2.3%) vs. tAT: 3 (3.2%); p = 0.74). Kaplan-Mayer analysis showed no significant differences between groups in time to TLR, amputation and death (Figure 1). Figure 1 Results Conclusions This study is hypothesis generating that plaque modification with tip based excision blades in directional atherectomy is more efficient than with blades placed on the side of the catheter., Background Concurrent carotid and coronary disease affects an increasing number of patients eligible for surgical coronary revascularization. Assuredly, higher perioperative risk is observed in these individuals. Combined 1-day intervention may reduce the postoperative major cardiac and cerebrovascular events (MACCE) rate; however, bleeding and renal complications can be observed more frequently. Purpose The aim of the study was to asses safety and feasibility of hybrid carotid and coronary revascularization. Methods Retrospective cohort study including 57 consecutive patients (42 males, 15 females; mean age: 70.8 ±6.9 years) with median EuroSCORE II of 2.4% (1.7–3.0) who underwent hybrid one-day carotid and coronary revascularization. Results No 30-day mortality or MACCE were observed and patients were usually discharged on postoperative day 8. Postoperative chest-tube output significantly increased after receiving Clopidogrel (0.2 vs. 0.4 ml/kg/h; p < 0.001). Bleeding events, including re-exploration for bleeding, pleural hematoma, cardiac tamponade, active bleeding (> 1.5 ml/kg/h), massive blood product transfusions (≥ 5 units of PRBC or FFP), and gastrointestinal bleeding occurred in 19.3% of individuals. Platelet count ≤ 110 000 at the cessation of extracorporeal circulation increased the risk of bleeding event (OR = 5.7 (1.39–23.36); p = 0.016). Acute kidney injury was observed in 22.8% of patients and the risk increased with the duration of extracorporeal circulation (OR = 1.41 (1.06–1.88); p = 0.02 for every 10 min). At the median follow-up of 28 (12.5–61) months MACCE occurred with 21.1% rate and was predicted by EuroSCORE II in a Cox-regression model (HR 1.71 (1.11–2.64); p = 0.016). Conclusions Hybrid carotid and coronary revascularization may be performed with acceptable outcome in a specialized cardiac center., Background This prospective study investigated associations between circulating microRNAs (miRNAs) and symptomatic, asymptomatic internal carotid artery stenosis (ICAS), carotid plaque morphology and future cardiovascular events. Methods Circulating miRNAs (miR-1-3p, miR-16-5p, miR-34a-5p, miR-124-3p, miR-133a-3p, miR-133b, miR-134-5p, miR-208b-3p, miR-375 and miR-499-5p) were analyzed in 92 consecutive patients with significant ICAS referred to revascularization. Group I comprised 65 subjects (41 M, age: 69.3 ±9.7 y.o.) with recent cerebral ischemic event (CIE). Group II comprised 27 patients (15 M, age: 68.2 ±8.4 y.o.) with asymptomatic ICAS. The ICAS degree and plaque morphology was assessed by ultrasonography. The incidences of cardiovascular death (CVD), myocardial infarction (MI) and recurrent CIE (CVD/MI/CIE) were recorded prospectively (mean: 38.7 ±3.8 months). Results Group II and group I differed significantly in levels of miR-124-3p (p = 0.036), miR-133a-3p (p = 0.043) and miR-134-5p (p = 0.02). Hypoechogenic, as compared to echogenic plaques differed in levels of miR-124-3p (p = 0.038), miR-34a-5p (p = 0.006), miR-133b (p = 0.048), miR-134-5p (p = 0.045), and miR-375 (p = 0.016), while calcifiedinmiR-16-5p (p = 0.023). Ulcerated plaques showed higher levels of miR-1-3p (p = 0.04) and miR-16-5p (p = 0.003), while thrombotic lower levels of miR-1-3p (p = 0.032). CVD/MI/CIE occurred in 14 (15.5%) out of 90 follow-up patients. Multivariate Cox and ROC analysis showed associations between miR-1-3p and CVD (AUC = 0.634; HR = 4.84; 95% CI: 1.62–14.5; p = 0.005), MI (AUC = 0.743; HR = 7.8; 95% CI: 2.01–30.0; p = 0.003), CVD/MI/CIE (AUC = 0.560; HR = 4.6; 95% CI: 1.61–13.1; p = 0.004), while miR-133b with recurrent CIE (AUC = 0.581; HR = 2.25; 95% CI: 1.01–5.02; p = 0.047). Conclusions The significant difference in levels of selected miRNAs is observed in symptomatic vs. asymptomatic ICAS. Plaque morphology and structure is associated with miRNAs levels change. The expression of miR-1-3p may be potentially prognostic factor for future cardiovascular events., Background Transcatheter aortic valve implantation (TAVI) is an increasingly common treatment of symptomatic severe aortic valve stenosis (AS). Thus, it is reasonable to carefully investigate the impact of individual clinical factors on outcomes after TAVI. Purpose We aimed to investigate the impact of the previous cerebro-vascular events (CVEs) on outcomes of patients with severe AS undergoing TAVI. Methods A total of 148 consecutive patients scheduled for TAVI were included and stratified as with and without a history of CVEs (stroke or transient ischemic attack). Frailty features were also assessed. The primary endpoint was 12-month all-cause mortality. Results Seventeen (11.5%) patients had a history of CVEs (the CVE group). At 30 days and 12 months all-cause mortality was higher in the CVE group (30-day: 5 (29.4%) vs. 7 (5.3%); p = 0.005; 12-month: 9 (52.9%) vs. 13 (9.9%); p = 0.001). Similarly, at the longest available follow-up mortality was higher in the CVE group (10 (58.8%) vs. 23 (17.6%); p = 0.001). Similar rates of other complications after TAVI were noted, apart from in-hospital acute kidney injury (AKI) grade 3 (3 (17.6%) vs. 5 (3.8%); p = 0.049) and blood transfusions (9 (52.9%) vs. 35 (26.7%); p = 0.026). Results of 5MWT and Katz index assessment indicated a greater level of frailty in the CVE group. There were no differences in subsequent events including CVEs, bleeding, myocardial infarction, and new-onset of atrial fibrillation (AF) at 12 months between groups. Conclusions We showed that a history of CVEs in patients with severe AS undergoing TAVI is associated with a higher long-term mortality., Purpose The aim of the study was to characterize morphological variations in the papillary muscles and tendinous cords of the left ventricle and ventricular zones of the mitral valve leaflets. Methods A total of 100 autopsied human hearts from healthy donors with classical mitral valve type were investigated. Results In one heart, only one group of papillary muscles was found, and in the remaining 99%, we could distinguish two groups of muscles: superolateral (SLPM) and inferoseptal papillary muscle (ISPM) groups. The SLPM group had one papillary muscle (75.8%), two in 20.2%, and > three in 4.0%. In the ISPM group, the muscle percentages were 38.4%, 36.4%, and 25.2%, respectively. The apex of at least one papillary muscle was situated higher than the plane of the opened anterior leaflet (AML) in 47.5% and 50.5% for the SLPM and ISPM groups, respectively. The number of strut cords arising from the SLPM group was 0 (2.0%), 1 (50.5%), 2 (33.3%), 3 (12.1%), and 4 (2.0%), and from the ISPM group was 0 (6.1%), 1 (52.5%), 2 (35.4%), or 3 (6.1%). Cords to left ventricular outflow tract were present in 14 specimens. Muscular cords were found in eight hearts. In all hearts specimens AML had rough and clear zones. The classical zones (rough, clear, and basal) in the posterior mitral leaflet were observed in 38.4%. Conclusions There is a high variability in the papillary muscles and tendinous cords in the mitral valve complex. The ventricular surface of AML always has two zones while PML has an inconsistent zone number., Background Treatment of long coronary lesions with bioresorbable scaffolds is currently limited to overlapping implantations only due to the lack of long devices. Additionally, vascular response to long versus regular scaffolds is unknown. Therefore, we compare long vs. regular scaffolds with 100 μm struts (MeRes100) in the porcine coronary restenosis model. Methods and results In total 35 scaffolds, including 23 regular (3.0 × 16 mm) and 12 long (3.0 × 33 mm) were implanted with 120% overstretch with optical coherence tomography (OCT) guidance in 12 domestic animals for 1, 7, 28, 90 and 180 days. At terminal follow-up, terminal imaging with OCT was performed and long scaffolds evaluated in pathology. Stent areas and the neointimal hyperplasia as expressed as % Area Stenosis were comparable at all time points between long and regular scaffolds (Figure 1). Healing and endothelialisation were already complete at 28 days in the long scaffold group. Figure 1 Stent area and % areas stenosis for long and regular scaffolds Conclusions Implantation of long bioresorbable scaffolds was feasible. At mid-term their integrity remained intact and neointimal response comparable to regular size scaffolds, which is contrary to historical data with metallic stents., Background The reduction of heart damage and improvement of patient outcome are the main goals in the treatment of myocardial infarction. For both crucial are the shortening of time to reperfusion and use of appropriate pharmacological treatment. Restrain of myocardial metabolic activity seems to be possible third way, which may have an impact on myocardial damage especially during the critical ischemia. Methods The study is conducted using an animal model. We compare 20 domestic swine (Polish Landrace Pig’s), 10 in the study group (SG) and 10 in the control group (CG). The animals in both groups were randomly paired by age, sex and body mass. Animals in the CG are sequentially given analgesia, sedation and respiratory therapy. After that an arterial access (femoral artery) is obtained, then coronary angiography and POBA LAD (by using balloon catheters (BC) inflation in proximal part of LAD (POBA) (target prox /mid LAD with a diameter of 2.5–4.0 mm behind ostium DG1)) is performed. After 45 min the BC is removed from the LAD. The animal is observed, monitored (if necessary appropriate medication is given). Past 48-hours since POBA the EF assessment (ejection fraction) of LV is performed. Then the subject is euthanized and staining of heart tissue is perforemd with quantitative assessment (computed planimetric assesment) of infarct area (IA) and area at risk (AAR). Similarly in SG the coronary angiography is performed with POBA LAD. After removal of BC from the LAD, a dry puncture of pericardium (pericardial catheter inserted to the pericardial sac) is performed, with subsequent, a 12 h procedure of direct hypothermia of heart (saline 30°C). Forty-eight hours since POBA, the evaluation of EF is made, subject is euthanized, then same staining procedures as in control group performed with quantitative assessment od IA and AAR (Figure 1). Figure 1 Preliminary results in four animals Conclusions Direct heart hypothermia (DHH) method by METcooler in acute experimental heart ischemia is a viable and safe method in an animal model. Dry pericardial puncture and lowering the temperature in the pericardial sac by applying a closed refrigerant circuit are relatively simple procedures that can be performed if necessary in a regular cathlab/cardiology department. Preliminary results demonstrate that the DHH may be considered in the future as an additional method to reduce cardiac damage in the course of myocardial infarction., Relevant history and physical exam 66-year-old Caucasian male patient with congestive heart failure following acute myocardial infarction was hospitalized to undergo cardiac resynchronization therapy (CRT). Past medical history was notable for hypertension, hypercholesterolemia and atrial fibrillation. Relevant test results prior to catheterization Transthoracic echocardiogram demonstrated left ventricle ejection fraction of 29%. Magnetic resonance revealed end-diastolic and end-systolic volume of 272 ml and 197 ml, respectively. An initial 12-lead ECG revealed left ventricle branch block (QRS duration 140 ms) and persistent ST elevation in V3 (3 mm). Relevant catheterization findings PCI of (1) left circumflex artery (LCx) with drug eluting stent implantation (DES), Feb 2016; and (2) left anterior descending artery (LAD) chronic total occlusion (CTO) with DES, Oct 2016. Interventional management Percutaneous catheter-based NOGA (Biosense Webster) electro-mechanical assessment of the left ventricle was performed prior to (Oct 2016) and 10 months after (Aug 2017) LAD CTO intervention. Procedure was performed through right femoral approach with 8 Fr sheath. Reference points were obtained to create a full 3D map. Unipolar (UnP) and bipolar (BiP) potentials as well as regional wall motion (local linear shortening, LLS) data analysis was performed postprocedurally (Figure 1). The periprocedural and hospitalization course was uneventful. Figure 1 Standard NOGA three-dimensional and Bullseye view of the left ventricle – unipolar (UnP), bipolar (BiP) and local linear shortening (LLS). UnP: Purple areas indicate highly viable areas (> 15 mV), red indicates scar tissue (< 5 mV). PiP: purple areas indicate highly viable areas (> 8 mV), red indicates scar tissue (< 1 mV) Case description LAD CTO procedure has improved left ventricle anterior and later wall viability mirrored by increased UnP and BiP segmental voltage values. Presented case illustrates clinical application of the electro-mechanical mapping system as a tool for analysis of myocardial viability and electrical properties in patients undergoing percutaneous coronary artery interventions., Purpose The aim of the study was to establish the clinical utility of urinary biomarkers and peri-procedural variables for the prediction of major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing coronary angiography (CA). Methods In this prospective study 95 consecutive patients with stable and unstable coronary artery disease (69.5% men; median age: 65 (59; 71)) were referred for coronary angiography and followed up for 12 month in order to disclose MACCE defined as onset of cardiovascular death, myocardial infarction, myocardial revascularization or stroke. Urine samples were collected 24-hours before and 6 h following CA and assayed for kidney injury molecule type 1 (KIM-1) interleukin 18 (IL-18), renalase and liver fatty acid-binding protein (L-FABP) using ELISA method and adjusted to urinary creatinine concentration. Results MACCE occurred in 10 (10.5%) patients. Patients with MACCE had higher rate of post-procedural CI-AKI (30.0% vs. 7.1%, p = 0.019), higher median SYNTAX score (25.5 vs. 11.5 points, p = 0.04) and higher post-procedural KIM-1 concentration (0.45 vs. 0.21 ng/mg, p = 0.028), as well as absolute (Δ; 0.41 vs. 0.10 ng/mg, p = 0.013) increase of urinary KIM-1 level. Pre-procedural KIM-1 values and other biomarker values were comparable in both groups. The Kaplan-Meier curve revealed that patients with absolute increase of KIM-1 above 75-percentile (Figure 1; log-rank p = 0.00042) and patients with contrast nephropathy after CA (log-rank p = 0.023) had significantly worse 12-month prognosis. Cox proportional hazards model revealed that absolute ΔKIM-1 was an independent predictor of 12-month MACCE (p = 0.001), while ROC curve analysis revealed that MACCE was accurately predicted by absolute increase of ΔKIM-1 > 0.093 ng/mg (AUC = 0.752, p = 0.0001). Figure 1 Kaplan-Meier survival curve of MACCE occurrence in 12-month observation depending on the increase of post-procedural urinary KIM-1 concentration: ≥ and < 75 percentile MACCE – major adverse cerebral and cardiovascular events, KIM-1 – kidney injury molecule type 1. Conclusions Excessive increase of urinary KIM-1 after CA may help identify patients with impaired 12-month prognosis.