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INTRODUCTION An international registry of ambulatory patients with stable coronary artery disease (CLARIFY) allows a comparison of management and outcomes in real‑life setting. OBJECTIVES We aimed to compare the management strategies and 5‑year outcomes in patients from Poland and from other European countries. PATIENTS AND METHODS Stable coronary artery disease was defined as previous myocardial infarction (MI) or revascularization, coronary stenosis greater than 50%, or documented symptomatic myocardial ischemia. Patients were followed on an annual basis for 5 years. RESULTS Among the total of 32 703 patients, 1000 were enrolled in Poland, and 17 326 in other European countries. Polish patients were younger, with a higher proportion of women, smokers, and patients with previous MI, dyslipidemia, and hypertension. Patients in both cohorts received adequate medical treatment, with more Polish patients receiving β‑blockers. Blood pressure and lipid control to target was similar and remained low in both cohorts. Diabetes control and successful smoking cessation rates were lower in Poland than in other European countries. Polish patients more often underwent percutaneous coronary intervention. All‑cause (8.5% vs 7.9%; P = 0.81) and cardiovascular death rates (5.3% vs 4.9%; P = 0.82) did not differ between the groups, but fatal or nonfatal MI occurred more often in the Polish cohort (5% vs 3.1%; P = 0.006). Angina control was better in Poland than in other European countries (Canadian Cardiovascular Society class II-IV, 11.5% vs 15.8% of patients; P0.001). CONCLUSIONS Risk factor control was insufficient both in patients from Poland and in those from other European countries. The more frequent use of revascularization in Polish patients was not linked to improved outcomes, but, together with more extensive prescription of β‑blockers, might have contributed to better angina control.

INTRODUCTION Despite the progress in cardiology in recent years, cardiovascular (CV) diseases remain the main cause of death in European countries. The knowledge concerning the structure of hospital admissions for CV diseases and clinical outcomes is fragmentary. OBJECTIVES The aim of the study was to analyze the characteristics and outcome of patients with CV disease, hospitalized between 2006 and 2014 and included in the Silesian Cardiovascular Database (SILCARD) covering a population of 4.6 million patients. PATIENTS AND METHODS SILCARD is based on the data from the Regional Department of the National Health Fund in Poland. The enrollment criteria were any hospitalization at a department of cardiology, cardiac surgery, diabetology or vascular surgery and hospitalization with a cardiovascular diagnosis at a department of internal medicine or intensive care. The data come from 310 hospital departments and 1863 outpatient clinics, and contain information on 487 518 patients and 956 634 hospitalizations. RESULTS Heart failure (20%) and stable coronary artery disease (18.5%) were the most frequent primary causes of hospitalization. The number of hospitalizations due to heart failure, aortic stenosis, and pulmonary embolism significantly increased. The highest 12‑month mortality was reported in patients with heart failure and pulmonary embolism (30%). A decrease in 12‑month mortality in patients with heart failure, stable coronary artery disease, myocardial infarction, and atrial fibrillation was noted, although for some disease entities, it remained relatively high. CONCLUSIONS Between the years 2006 and 2014, in‑hospital and 12‑month mortality showed a trend for decline in many disease entities, with considerable space for prognostic improvement.

New therapies for refractory angina are needed.Assessment of transendocardial delivery of bone marrow CD133Randomized, double-blinded, placebo-controlled trial enrolled 31 patients with recurrent Canadian Cardiovascular Society II-IV angina, despite optimal medical therapy, ≥1 myocardial segment with inducible ischemia in Tc-99m SPECT who underwent bone marrow biopsy and were allocated to cells (n=16) or placebo (n=15). Primary end point was absolute change in myocardial ischemia by SPECT. Secondary end points were left ventricular function and volumes by magnetic resonance imaging and angina severity. After 4 months, there were no significant differences in extent of inducible ischemia between groups (summed difference score mean [±SD]: 2.60 [2.6] versus 3.63 [3.6],Transendocardial CD133URL: http://www.clinicaltrials.gov. Unique identifier: NCT01660581.

This study addresses the problem of vibration syndrome diagnosis by means of a cooling test verified by photoplethysmography. Measurement was taken on a small area on the fingertip plexus in which many arterio-venous anastomoses are present. In the opinion of many authors, flow disorders in this area are more typical for developing vibration syndrome than changes in the micro vessels. The study group comprised 128 subjects (58 women aged 40.9 +/- 5.4 years and 70 men aged 38.7 +/- 8.8 years) exposed to vibration. The control group consisted of 41 people (20 women aged 39.6 +/- 7.3 years and 21 men aged 39.3 +/- 6.4 years) who were not exposed to vibration. The patients were examined by a questionnaire and then a vibration perception threshold test and a cooling test were performed. The cooling test was verified both visually and using the computer method. Measurement data (S1, S2 and A) for each patient were obtained from averaging three pulse graphs. We departed from an average of 60 graphs (and more), the standard established in the literature, because of the cooling test specification, which causes huge thermodynamic parameter changeability in the plexus mass of the small finger under pulse waves coming one after another. A longer measurement time will reflect the thermal drift of the tested area in a direction to compensate for the reduced temperature. In the control group, all subjects showed an increase in planimetric indicators during the cooling test verified by computerized photoplethysmography. In the study group visual verification of the cooling test was positive in eight cases (6.2%) and the vibration perception threshold test was positive in seven cases (5.5%), but in computerized photoplethysmography the planimetric indicators decreased after cooling in 87 (67.4%) cases. Computer photoplethysmography is highly specific and shows greater sensitivity in detecting preclinical forms of vascular-type vibration syndrome when compared with palesthesiometry, the visually verified cooling test and the questionnaire. The proposed test enables the detection of vascular disorders in the prodromal period and gives time for preventive measures to be taken.

Diminished activity of 5,10 methylenetetrahydrofolate reductase (MTHFR), a regulatory enzyme of homocysteine metabolism, may predispose to coronary artery disease (CAD). In a case-control study we determined the prevalence of two common MTHFR polymorphisms, C677T and A1298C, in 161 male patients under the age of 50 years with angiographically documented CAD and compared it to that in 211 healthy controls. Genotyping was also performed in a random population sample, consisting of 149 men and 121 women at an average age of 40 years. The studied group had classic risk factors of atherosclerosis but did not differ in fasting plasma homocysteine, folic acid, and vitamin B12 levels in either the control group or population sample. The frequency of the 1298C allele was significantly higher in CAD (0.304) than in controls (0.199) or the population sample (0.235). Allele 1298C showed a significant association with early-onset CAD both in homozygotes and in heterozygous carriers. These findings were further supported by comparisons with the population sample. Homozygosity for allele 677T showed a tendency to associate with CAD. Allele 1298C of MTHFR is associated with early-onset CAD (carriers− RR = 1.71, 95% CI: 1.13–2.59; homozygotes− RR = 3.09, 95% CI: 1.36–7.02), even when blood homocysteine levels are not elevated. © 2001 Wiley-Liss, Inc.

We present a case of a 73 year-old man with, long-segment thigh stenosis in the right common and internal carotid artery with occlusion left common carotid artery. Complex angioplasty with modification proximal and distal system protection was successful performed. There were no procedure-related complications. We concluded that in very complex, multilevel lesions in carotid artery, there is a place for safe double system protection. This maneuver can increase safe of the carotid artery stenting and minimise potential complications.

We present a case of a 72 year-old male who underwent successful closure of two mitral paravalvular leaks with the Amplatzer vascular Plug II using a transapical approach.

Severe aortic stenosis (AS) with preserved systolic function may coexist with 'low flow' and a lower stroke volume (SV). As the mechanisms of this phenomenon are not fully understood, the study aim was to assess the cardiac and vascular mechanisms of 'low-flow' severe AS with a preserved left ventricular ejection fraction (LVEF).Forty-four consecutive patients (mean age 69.7 +/- 7.6 years) with severe degenerative AS [mean effective orifice area (EOA) 0.7 +/- 0.3 cm2] and preserved LVEF (50%) were enrolled into the study, and allocated to two groups depending on their stroke volume index (SVI) (35 andor = 35 ml/m2, respectively). The clinical data, N-terminal pro-brain natriuretic peptide (NT-proBNP) serum levels and ultrasound assessment of LV geometry and function [stroke work (SW), relative wall thickness (RWT)], AS severity, indices of systemic arterial hemodynamics [systemic arterial compliance (SAC), systemic vascular resistance (SVR)] and remodeling [flow-mediated dilatation (FMD), pulse wave velocity (PWV)], as well as valvuloarterial impedance (Z(va)) were analyzed for all study patients.Twenty-four patients (56%; 13 females, 11 males) had low-flow LV output, and 20 (44%; four females, 16 males) had a normal LV output. The mean NT-proBNP serum levels were comparable between the study groups. An analysis of LV remodeling and function revealed a lower LV end-diastolic volume (LVEDV; 85.5 +/- 24.1 versus 160.4 +/- 60.9 ml, p = 0.001), LV end-systolic volume (LVESV; 40.3 +/- 18.5 versus 66.8 +/- 44.2 ml, p = 0.03), LV mass index (LVMI; 150.1 +/- 53.4 versus 183.7 +/- 57.5 g/m2, p = 0.07) and SW (95.6 +/- 23.7 versus 183.2 +/- 50.6 mmHg x ml, p0.0001) in the group with SVI35 ml/m2. The average RWT was higher in the group with SVI35 ml/m2 (48.7 +/- 14.8 versus 40.0 +/- 7.5, p = 0.04). The indices of systemic arterial hemodynamics were significantly different between the groups: the SAC was lower, and the SVR and Z(va) were higher, in patients with SVI35 ml/m2 while FMD values were significantly greater in patients with SVI35 ml/m2 (11.85 +/- 6.4 versus 7.29 +/- 6.3%, p = 0.035). However, the brachial artery diameter (BAd) was smaller in the latter group, and no differences were found in the FMD x BAd index values. The PWV values were comparable in both study groups.The low-flow phenomenon in severe AS with preserved LVEF is related to smaller LV dimensions, LV concentric hypertrophy, and an increased systemic arterial afterload without differences in plasma NT-proBNP levels. 'Paradoxically' higher values of FMD observed in this population may be associated with a higher proportion of females and a smaller BAd.

A pericardial cyst is, according to the definition, a collection of fluid or blood in the pericardial space (inside the pericardial sac) around the heart. New visualization methods can help in the non-invasive diagnosis of pericardial cysts. Based on a presented case, we conclude that multi-slice computed tomography can have a great impact on the detection of pericardium diseases such as a pericardial cyst.

In those without symptoms of coronary artery disease (CAD), the incidence of coronary events is still high. The aim of this study was to evaluate whether flow mediated dilatation (FMD) is a useful tool in identifying those with CAD in who are under 45 years of age.Seventy five men below 45 years of age, hospitalized in order to perform elective coronary angiography, were enrolled into the study. Based on coronary angiography findings, they were divided into two groups: study group (Group A, n = 55) with obstructive coronary lesions and the control group (Group B, n = 20) without significant lesions in coronary arteries. In all subjects atherosclerosis risk factors were analyzed. Endothelial dysfunction was assessed in ultrasound via FMD. FMD was significantly lower in the study group than in the control group (3.92 +/- 1.1 vs 6.51 +/- 1.1, p0.001). FMD, as well as age, diabetes and positive family history, appeared to be statistically significant CAD risk factors. AUROC for FMD was 0.957 (p0.001), meaning this model had an almost complete ability to predict the presence of CAD. AUROC for CAD diagnosis on the basis of significant clinical parameters was 0.992 (p0.001), also representing almost complete ability of this model to identify asymptomatic subjects with CAD risk.The evaluation of endothelial function by the use of FMD in the population of men below 45 years of age with diabetes and positive family history can help in identifying subjects at high risk of coronary artery disease.

Reperfusion therapy reduces mortality rate in patients with acute myocardial infarction with ST-segment elevation (STEMI).The aim of the study was to access the early outcome of patiens (pts) with STEMI admitted to Upper Silesian Cardiology Centre in 2002.957 pts with AMI were enrolled into the study. The influence of several factors on in-hospital mortality was analised.Out of 957 pts 51 died during hospitalization (5,3%). Coronary angiography was performed in 98,0% of pts. Primary PTCA was performed in 94,5% of pts. Stents were implanted in 85,9% of patients who underwent PTCA. The following factors significantly contributed to increased mortality among pts with acute myocardial infarction: female sex (p0,02), multivessel disease (p0,05), age above 65 yrs (p0,001), time from the onset of chest pain above 6 hours (p0,01) and 12 hours (p0,001). The use of GP IIB/IIIA inhibitors significantly reduced the mortality rate (p0,05). Cardiogenic shock was the only independent factor of the increased risk of mortality in multivariate regression analysis (p0,0001) with relative risk of death (RR 33,5). The mortality rate in pts with shock was 40,2%: 70,8% in case of conservative treatment, 70% in the group of failed PTCA and only 17,2% in the group of successful PTCA. Among pts who underwent primary PTCA the failure to restore coronary blood flow of the infarct related artery contributed to increased relative risk of death (RR 14,5) (p0,001). Stents improved the survival rate (p0,01). In PTCA group cardiogenic shock and failed PTCA were independent risk factors in multivariate regression analysis.The results of our study show low rate of in-hospital mortality in pts without cardiogenic shock (1,2%). PTCA is highly successful method of treatment of pts with shock with mortality rate 17,2% in pts who underwent successful procedure.

Even up-to-date reperfusion therapy using primary percutaneous intervention (PCI) in acute myocardial infarction does not result in improvement of the left ventricular (LV) function in all patients. Cellular myoblasty, a novel method using mononuclear bone marrow cells (BMC), can be applied in the infarcted myocardium area to stimulate regeneration and to limit the organ damage. However, the impact of intracoronary BMC administration on the effect of PCI is not clear.To assess angiographic outcomes in patients with anterior myocardial infarction and LV dysfunction, undergoing intracoronary BMC administration after a successful primary PCI.The study group consisted of 40 patients (mean age 56.2 years) with LV ejection fraction below 40%, in whom 20 ml of BMC were administered to the infarct-related artery (IRA) distally to the occlusion. The control group comprised 25 age- and sex-matched patients with similar values of LV ejection fraction undergoing bare metal stenting of IRA without BMC administration. Quantitative coronary angiography was performed 6 months later to assess IRA patency.The reference diameter of the stented artery decreased in the study group from 3.22 +/- 0.28 mm to 3.16 +/- 0.18 mm (p0.05) and in the control group from 3.22 +/- 0.31 mm to 3.15 +/- 0.28 mm (p0.082); also in the area of the implanted stent the diameter decreased from 3.57 +/- 0.21 mm to 2.96 +/- 0.79 mm in the study group vs. 3.48 +/- 0.22 mm to 3.01 +/- 0.35 mm in the control group. For lumen diameter measured 10 mm distally to the stent, the diameter loss was similar in both groups. In 6 patients from the BMC treated group and in 3 patients from the control group there was asymptomatic lumen reduction70% (NS).The results of our study show that BMC administration into IRA is safe. The degree of lumen loss in the stent area was larger in the BMC group than in the control group. There was no significant difference in the lumen change distally to the stent; the artery diameter loss in both groups was similar, and the improvement in LV ejection fraction was greater in the BMC-treated group.

Multi-slice computed tomography (MSCT) is becoming an increasingly acknowledged means of visualizing coronary arteries. The accuracy of 64-MSCT is still a subject of clinical evaluation. Our study, performed with a 64-slice scanner, was intended to assess the concordance of coronary artery lumen visualization in MSCT and invasive coronary angiography (ICA), both in post-revascularization and previously medically treated patients.We examined data from 73 patients (31 women, 42 men, mean age 59 years) referred to our hospital in 2006 and 2007 who underwent MSCT and subsequent ICA. Twenty two patients had a history of previous revascularization. Of the remaining 51 patients with intermediate coronary artery disease probability, the indication for 64-MSCT was suspicion of coronary artery disease. MSCT coronary angiography was performed with Aquilion 64 scanner (Toshiba, Japan). We evaluated 15 segments of four native coronary arteries (RCA, LM, LAD and Cx in all patients plus 11 arterial and 22 venous conduits). The cut-off value for significant stenosis was the lumen cross section area reduction exceeding 50%, regardless of segment.Regarding native arteries, MSCT and ICA findings were coherent in 80.8% of all patients, 93.8% of vessels, and 98.4% of segments. MSCT coronary stent patency evaluation was 90.9% correct. The by-pass grafts evaluation was entirely concordant in both methods. The respiratory and heart rate variability artifacts hindered the MSCT analysis in ten patients (13.7%). The artifacts occurrence in misinterpreted studies was nearly two-fold higher than in those that were coherent (21.4% vs. 11.9%).We concluded that a reliable evaluation of the coronaries by means of 64-MSCT is feasible both in patients with suspected coronary artery disease and those with definite coronary artery disease who had previous coronary intervention. Patient selection and co-operation is necessary to avoid respiratory and heart rate variability artifacts that may hinder analysis.

An increasing number of patients who undergo coronary artery bypass grafting(CABG) have a history of coronary stent implantation. This study aims to assess perioperative and medium-term follow-up outcomes in patients in whom CABG was preceded by coronary stent implantation within two years before operation.One hundred and sixty two patients undergoing CABG after previous stent placement (PCI + CABG group) were compared to 149 who had CABG without PCI in the past (CABG group). Clinical, angiographic and perioperative outcome data were compared. The three year follow-up comprised data on number of deaths and the presence of anginal symptoms.In both groups the extent of coronary artery disease was comparable, but more patients in the PCI + CABG group had a history of myocardial infarction. Perioperative outcome data did not differ between the groups except for a higher number of vessels considered infarct-related grafted in the CABG group. Patients operated on up to three months after PCI had more extensive coronary heart disease than those operated on later. They also had a significantly shorter operation time. This group also showed a trend towards less postoperative bleeding, less rethoracotomy and less low cardiac output syndrome. In a three year follow-up, 48 (30%) patients in the PCI + CABG group reported presence of angina compared to 28 (19%) in the CABG group (p = 0.04).Previous PCI does not significantly influence the CABG outcome. In mediumterm follow-up, freedom from anginal symptoms is less likely in patients in whom CABG was preceded by stent implantation.

In-stent restenosis (ISR) is one of the major limitations of percutaneous coronary intervention (PCI).To evaluate the relationship between the levels of hs-CRP, IL-6, IL-10 and intimal hyperplasia six months after coronary bare metal stent (BMS) implantation.The study population consisted of 73 consecutive patients who underwent bare metal stent implantation into narrowed coronary segments. A total of 74 stents were implanted. Angiographic study after six months, together with evaluation of serum level of IL-6 (pg/ml), IL-10 (pg/ml), hs-CRP (microg/ml), fasting insulin (microIU/ml) and glucose (mg%) was performed. Insulin sensitivity was calculated using the HOMA-IR formula. The QCA analysis of stented segments was performed at baseline, after intervention and at six-month follow-up.Restenosis at six months occurred in 10 patients (13.7%). The mean % diameter stenosis at follow-up was 27.8 +/- 19% and late loss was 0.81 +/- 0.6 mm. We found a correlation between late loss and serum hs-CRP, IL-6 and IL-10 concentration. There was no correlation between the lipid profiles, insulin levels and HOMA-IR and re-narrowing of the stented segments. Patients with restenosis were characterised by significantly higher serum concentration of CRP (2.04 +/- 3.4 vs. 10.38 +/- 6.7 microg/ml, p = 0.0036), IL-6 (14.98 +/- 8.3 vs. 5.70 +/- 5.5 pg/ml, p = 00062), and fasting glucose (184.0 +/- 50.5 vs. 107.5 +/- 40.4 mg%, p = 0.0051), as well as lower IL-10 levels (1.25 +/- 0.6 vs. 4.85 +/- 4.9 pg/ml, p = 0.0000). The ROC analysis indicated that CRP (2.86 microg/ml), IL-6 (6.24 pg/ml) and IL-10 (1.7 pg/ml) values predicted the restenosis with reasonable accuracy. A multiple logistic regression model identified CRP and IL-10 levels as independent predictors of restenosis.We demonstrated that elevated inflammatory markers 6 months after PCI are associated with late angiographic in-stent restenosis.

The aim of the study was to evaluate early and late outcomes after percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCA) and to compare bare-metal stent (BMS) and drug-eluting stent (DES) subgroups.PCI is an increasingly utilized method of revascularization in patients with ULMCA.This multicenter prospective registry included 252 patients after ULMCA stenting enrolled between March 1997 and February 2008. Non-ST-segment elevation acute coronary syndrome was diagnosed in 58% of patients; ST-segment elevation myocardial infarction cases were excluded. Drug-eluting stents were implanted in 36.2% of patients.Major adverse cardiovascular and cerebral events (MACCE) occurred in 12 (4.8%) patients during the 30-day period, which included 4 (1.5%) deaths. After 12 months there were 17 (12.1%) angiographically confirmed cases of restenosis. During long-term follow-up (1 to 11 years, mean 3.8 years) there were 64 (25.4%) MACCE and 35 (13.9%) deaths. The 5- and 10-year survival rates were 78.1% and 68.9%, respectively. Despite differences in demographical and clinical data in favor of BMS patients, unmatched analysis showed a significantly lower MACCE rate in DES patients (25.9% vs. 14.9%, p = 0.039). This difference was strengthened after propensity score matching. The DES lowered both mortality and MACCE for distal ULMCA lesions when compared with BMS. Ejection fraction50% was the only independent risk factor influencing long-term survival.Stenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease.

In prognostic terms, evaluation of an ECG recording in acute myocardial infarction (AMI) appears to be inferior to echocardiographic (ECHO) assessment of left ventricular remodelling and the activities of cardiac enzymes and certain hormones. It was our hypothesis that, in the era of interventional treatment of AMI, some ECG parameters are still valid for the purpose of risk stratification.A total of 66 consecutive patients with AMI (43 male and 23 female, with a mean age of 61 +/- 11 years) were treated with primary percutaneous coronary intervention (PCI). In each patient ECG and ECHO examinations were performed within 5-7 days of admission for the detection of left ventricular hypertrophy (LVH). In further analysis the following ECG- based LVH parameters were taken into consideration: Sokolov-Lyon voltage duration (SLVd), Cornell voltage duration CVd), 12-lead QRS voltage duration (12QRSVd), their product with QRS duration and an ECG index of left ventricular mass (LVMI(ECG)). Patients were followed for 6 months. The combined end-point included death, infarction, a need for prompt coronary intervention and hospitalization for heart failure.The combined end-point was observed in 16 patients (24.2%). Survival analysis revealed that the most important prognostic factors were associated with a prolongation of the QRS duration. Increased SLVd was found in 43% of the patients with events compared to 14% in those without them (p0.01), CVd in 43% vs. 12% (p0.05), 12QRSVd in 81% vs. 44% (p0.05) and LVMI(ECG) in 75% vs. 26%, p0.001). There was no evidence for a difference in Cornell voltage. Univariate logistic regression indicated a 4-fold to 8-fold increase in the risk of events associated with abnormal SLV, SLVd or LVMI(ECG). Multivariate Cox analysis showed that the LVH presence in the ECG, defined as an increased SLVd product or increased LVMI(ECG), was an independent predictor of cardiovascular events after AMI.In the era of interventional treatment of AMI, the ECG features of left ventricular hypertrophy carry independent significant prognostic information. (Cardiol J 2007; 14: 347-354).

Efficacy of carotid endarterectomy (CEA) in prevention of stroke in patients with carotid artery stenosis has been confirmed in randomised trials. Carotid artery stenting (CAS) is a routine clinical practice and recent results of CAS are not worse than CEA. Moreover, percutaneous transluminal angioplasty (PTA) techniques allow other cephalad arteries to be dilated.To assess early and long-term outcome of PTA of cephalad arteries and to determine risk factors of early and late major adverse cardiovascular and cerebral events (MACCE).The study group consisted of 223 consecutive patients (151 males, 67.7%, mean age 65.3+/-8.6) in whom 256 PTA procedures of cephalad arteries were performed. Two hundred and forty-two internal carotid, 7 common carotid and 15 vertebral arteries were dilated. Thirty-four patients underwent one-stage carotid and coronary procedures, while in 46 patients one-stage carotid and peripheral procedures were performed. Neuroprotection with a distal protection device was used in 51.5% of cases. The procedures were divided into two groups: with high (n=181) and low (n=75) risk of cardiovascular events. Early and late events were recorded and analysed subsequently.In hospital 30-day MACCE occurred in 12 (4.6%) patients, including 7 (2.7%) strokes, 3 (1.1%) myocardial infarctions and two (0.8%) deaths. Transient ischaemic attacks were observed in 8 patients, pulmonary oedema in 3 cases, as well as a single episode of retinal artery embolisation and acute renal insufficiency. The incidence of 30-day MACCE was not significantly higher in the high-risk group (6.07 vs. 1.33%; NS), but the risk of any adverse event was significantly higher (p=0.03). There was no difference in stroke incidence between procedures with or without neuroprotection (2.27 vs. 3.22%; NS). There was no difference in risk of MACCE between angioplasty of cephalad artery and one-stage cephalad and coronary artery angioplasty procedure (3.6 vs. 5.5%; NS). During 50.3+/-20 months of follow-up there were 16 (7.1%) deaths, 9 (3.5%) strokes and 6 (2.3%) re-stenoses confirmed angiographically. One-year total survival and one-year MACCE-free survival rates according to the Kaplan-Meier analysis were 94.9% and 89.0%, showing a trend towards better outcome in the low-risk group (F-Cox=2.46; p=0.19 and F-Cox=2.17; p=0.09 respectively).Percutaneous transluminal angioplasty of cephalad arteries is safe and feasible, with a low periprocedural complication rate and good late outcome. Carotid artery stenting is an alternative method to CEA.

Myocardial reperfusion following primary percutaneous coronary intervention (pPCI) is limited due to, among other things, microembolic events. Abciximab and a mechanical system of distal protection both reduce their incidence during PCI.Prospective, randomised study to compare effectiveness of abciximab and protection devices in reduction of microembolic complications during pPCI.One hundred and twenty consecutive patients with ST elevation acute myocardial infarction referred for pPCI after coronary angiography were randomly assigned to the following groups: Group A (n=63), treated with abciximab; and Group B (n=57), treated using the distal protection system. Primary endpoint was blood flow through the infarct-related artery (IRA) using TIMI grading after pPCI; secondary endpoints included myocardial perfusion assessment using myocardial blush grade (MBG), ST resolution and improvement of echocardiographic left ventricular ejection fraction (LVEF) after pPCI.TIMI grade 3 flow after pPCI was obtained in 89% of patients in both groups, TIMI grade 2 flow in 5% (NS). Myocardial perfusion after pPCI assessed with MBG scored 3 in 66% of patients in group A and 62% of patients in group B (NS). ST resolution was present in 62% (26-84) in group A and 68% (41 - 86) in group B (NS). Logistic regression analysis showed no significant influence of selected variables on the primary endpoint. Analysis performed in the distal protection group revealed significant effects on the following factors on the final TIMI flow in IRA: presence of thrombus prior to pPCI (p=0.026), presence of residual thrombus after aspiration (p0.001), and IRA diameter ofor =3.5 mm (p=0.01). Median LVEF in group A at sixth month of follow-up was 46% (44-50%), similar to group B - 46% (45-49%) (NS).Use of the PercuSurge distal protection device during pPCI allows angiographic and electrocardiographic measures of reperfusion to be improved. It has a similar effect on left ventricular systolic function as administration of abciximab. The device seems to be useful in patients with culprit artery diameter ofor =3.0 mm, and optimallyor =3.5 mm and thrombus visible on angiography. Successful initial thrombectomy prior to deployment of stent seems particularly important when using the PercuSurge system.

In-stent restenosis still remains a serious clinical problem. Local intramural drug delivery (LDD -- Local Drug Delivery) seems to be an interesting alternative to drug-eluting stents (DES).The aim of the study was to assess the safety and effectiveness of local intramural paclitaxel administration in the treatment of recurrent in-stent restenosis (ISR).Five patients were enrolled in the study (3 men, mean age 50+/-7 years) with at least a second episode of ISR within the same stent. Percutaneous coronary angioplasty was performed on a total of 11 vessel segments. Remedy delivery catheters (Boston Scientific) were used for balloon angioplasty. Inflation pressure was calibrated to obtain a balloon/vessel lumen ratio of 1.1:1. Then the pressure was lowered to 3 atmospheres and 100 microg of paclitaxel diluted in 2 ml of 0.9% NaCl was given over 60 seconds under the pressure of 2-3 atmospheres. This dose was used for each 10 mm of lesions. Control coronary angiography was performed six months after the procedure.In all patients effective target vessel revascularisation was achieved. No adverse events were observed in the periprocedural period or during the 6-month follow-up period. Control angiography revealed ISR in three segments (27.2%) and in-stent late lumen loss of 0.21+/-0.93 mm.Local intramural paclitaxel delivery is a safe and effective method of ISR treatment. The optimal paclitaxel dose should be established in further studies.

Stent implantation for the unprotected left main coronary artery (ULMCA) is regarded as controversial and coronary heart disease with LMCA stenosis still remains a basic indication for bypass surgery. Although there is no doubt that the risk of stent implantation for LMCA lesions is low, there are still limited data on long-term outcomes. There have been no reports so far answering the question whether ULMCA stenting ensures adequate coronary blood flow in the vessel.Assessment of the effect of LMCA flow restoration with stenting on the coronary flow reserve assessed by an exercise test, as well as on left ventricular function and angina in patients followed for 12 months after the procedure.The study population included 62 patients (17 women and 45 men) aged 61.4+/-11.1 (35-84 years) who underwent coronary angioplasty with elective ULMCA stenting. In all patients, serial echocardiography (before and 1, 3, 6, and 12 months after the procedure) and the exercise test according to the Bruce protocol (1, 3, 6, 12 months after the procedure) were carried out. Routine coronary angiography was performed 3 to 6 months after the procedure. Fifty-nine patients (95.2%) survived a 12-month period. In 24 (38.7%) patients major adverse cardiac events (MACE) occurred. In-stent restenosis was observed in 13 patients; in 11 of them repeated PCI was performed and 2 of them underwent CABG. One patient after repeated PCI required CABG.Severity of angina, evaluated according to the CCS scale, decreased significantly in the 12-month follow-up period as compared with the preprocedural period (p0.00001). The mean baseline left ventricular ejection fraction was 51.6+/-12.5%. It increased to 53.8+/-12.8% (p0.02) at 6 months and remained at this level at 12 months. The mean exercise test time was 7.0+/-3.4 minutes in the first month after ULMCA stenting, and in the sixth and the twelfth month of follow-up it increased to 7.6+/-3.4 minutes (p0.002) and 7.8+/-3.2 minutes (p0.05), respectively. The metabolic equivalent task (MET) value did not change significantly during the observation period.Restoration of the physiological blood flow in the unprotected left main coronary artery with stent implantation is associated with a significant reduction of angina, significant improvement of the left ventricular systolic function and preservation of exercise capacity in long-term follow-up.

Acute coronary syndromes (ACS) include unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Acute coronary syndromes lead to important epidemiological and economical problems. In polish population an estimated incidence of ACS is 250 000 cases per year. 30-day mortality in UA/NSTEMI is approximately 3.5%, and 8.4% in STEMI. The atherosclerotic plaque instability with subsequent rupture and thrombus formation is a primary mechanism of ACS. Plaque destabilization is evoked by local and systemic inflammation. The primary risk factors in ACS are: age65 years, diabetes, peripheral artery disease, stroke, previous myocardial infarction and elevated levels of cardiac troponins. The guidelines for treatment of ACS are based on the results of large randomized clinical trials assessing the reduction of relevant clinical end-points (death, AMI, recurrent ischaemia). The goal of treatment of UA/NSTEMI is the stabilization of the plaque, prevention and reduction of myocardial ischaemia and AMI. Inefficient medical treatment and sustained symptoms are the indication for coronary angiography and percutaneous coronary intervention (PCI). The main goal of treatment in STEMI is quick regaining of the culprit vessel patency and maintaining of sufficient myocardial perfusion. It can be done by thrombolytic therapy or primary coronary angioplasty. In comparison to fibrynolysis PCI confers the lower risk of death and recurrent AMI. New regimens of pharmacological treatment (facilitated PCI) including the half-dose of fibrynolytic and GPIIbIIIa inhibitor prior to PCI are assessed to improve the efficiency of PCI.

There are many patients aged over 80 years among those hospitalised for coronary artery disease (CAD). The unanswered question is whether invasive treatment of such patients is effective and safe.To assess and compare one-year clinical outcomes after percutaneous coronary angioplasty (PTCA) and surgical coronary artery bypass grafting (CABG) in patients aged over 80 years and in younger patients.There were 63 patients aged over 80 years suffering from CAD who underwent either PTCA or CABG. The control group consisted of 40 patients aged 60-65 years treated in the same way. Data on medical history, cardiovascular risk factors, and angiographic findings were analysed. The potential risks of the procedures, post-procedural complications as well as the clinical status at the end of one-year follow-up were evaluated.There were 24 surgical revascularisation procedures and 39 PCIs performed in the very old patients. Stable angina was found in 29 cases, unstable angina in 19 and acute myocardial infarction in 15 patients. There were three in-hospital deaths and 18 periprocedural complications were noted. During the one-year follow-up period six deaths occurred, persistent or recurrent angina was found in 11 patients after PCI and two after CABG. There were no deaths in the control group and the incidence of minor complications was similar to the senile group. In younger patients who underwent CABG, CCS class at one year was lower than in the very old ones.The invasive treatment of coronary artery disease in octogenarians is feasible with satisfactory results and acceptable procedural risks.

Left ventricular remodelling is a process of change in size, shape, wall thickness and heart function, initiated by a noxious stimulus such as ischaemia. Methods of pharmacological and surgical inhibition or reversal of remodelling are being sought.To assess the influence of coronary artery bypass grafting on echocardiographic measures of left ventricular size and shape in medium-term follow-up.In a group of 30 patients three echocardiographic examinations were performed: before CABG operation, 3 months after and 20 months after the operation. Left ventricular area and volumes as well as indices of sphericity, thinning and expansion were calculated.After the operation, left ventricular areas measured in short axis and in apical four-chamber view increased among patients with a history of myocardial infarction. Improvement in the sphericity index occurred after the operation in patients with a history of myocardial infarction in whom the ejection fraction before the operation was less than 50%.The left ventricular remodelling process progresses after coronary artery bypass grafting in patients with a history of myocardial infarction. Inhibition of remodelling may be expected in patients without myocardial infarction, with preserved left ventricular systolic function.

Results of many studies indicate that cardiovascular diseases develop more often in subjects with blood pressure higher than optimal, but lower than the level, at which the diagnosis of arterial hypertension and implementation of therapy is justifiable. The aims of this study were the assessment of prevalence of risk factors for atherosclerosis among people with normal blood pressure in a population of Southern Poland (Southern Poland Epidemiological Survey--SPES), the quantitative evaluation of global risk for coronary events in relation to normal blood pressure classes, as well as the estimation of the size of subpopulation of subjects eligible for lipid-lowering treatment. A subpopulation of 15,484 subjects without known hypertension and coronary heart disease with normal blood pressure measurements were chosen from a total of 50,111 participants of the SPES study. There were 5,304 men and 10,180 women, aged from 18 to 87 years. Optimal blood pressure (120/80) was observed in 24%, normal (120-129/80-84) in 40% and high normal (130-139/85-89) in 35% subjects. In both sexes, irrespective of blood pressure classes, the most prevalent risk factors were hypercholesterolemia, overweight/obesity and smoking. The prevalence of hypercholesterolemia (200 mg/dl) increased along with blood pressure classes, and the proportion of subjects with cholesterol levelor = 240 was 1.5 times greater in those with high normal (21%), compared to those with optimal blood pressure (13%). The proportion of overweight/obesity was 1.5 times greater in subjects with high normal (50.5%) when compared to those with the optimal blood pressure (32.5%). The global risk for coronary events10% was more frequent in subjects with high normal blood pressure. Increase of the proportion of subjects eligible for lipid-lowering therapy from near 0% in women with optimal to approximately 10% in men and 8% in women with high normal blood pressure. A rise of the normal blood pressure class is associated with a clear increase in the prevalence of atherosclerotic risk factors and the global coronary risk. An extended medical care should be considered to all subjects with high normal blood pressure and global risk greater than 10%, including lipid-lowering therapy in approximately 10% of this subpopulation.

Kinins play an important role in numerous of pathophysiological processes in organism. This paper encompasses mechanisms of kinins action and their role in the circulatory system. Individual components of the kallikrein-kinin system as well as their origin, structure and biodegeneration were described. Bradykinin B1 and B2 receptors along with their functions were discussed. Enzymes taking part in biodegradation of kinins were characterised. The role of the bradykinin as an inflammatory mediator as well as links between the kallikrein-kinin and renin-angiotensin systems, together with their contribution to myocardial ischaemia, were described.